Eye Flashcards
3 important vital signs of ophthalmology, should include in all red eye complaints
- Vision
- Pupils (+ pattern of redness and systemic conditions)
- Pressure
What is Blepharitis ?
Chronic condition/inflammation of the eyelids, typically w intermittent exacerbations
Anterior blepharitis - may be infectious (S aureus) or seborrheic component.
Posterior blepharitis- meibomian gland dysfunction
Tx is the same
Describe clinical presentation of Blepharitis
red eyes gritty or FB sensation burning sensation excessive tearing crustiness in lashes light sensitivity \+/- blurry vision
PE of blepharitis
diffuse conjunctival injection eyelid margins inflamed/red crusting or matting eyelashes plugged glands w magnification Collarettes
Tx Blepharitis
warm compress lid massage lid hygiene (baby shampoo) topical Abx oral Abx if severe omega 3 supps for prevention
Possible complication of Blepharitis is a stye ..
Differentiate a Chalazion from Hordeolum
History!
Chalazion- is Chronic, usually painless, rubbery, nodular
Hordeolum- acute, painful, infected, purulent
Describe Periorbital Cellulitis and possible etiologies
infection of soft tissues around eye but does not extend into the orbit
external sources (blepharitis, insect bites, FB), sometimes sinusitis
Describe Orbital cellulitis and possible etiologies
medical emergency
infection of fat and muscle tissue surrounding globe/deep in eye socket
most often caused by extension of infection from the paranasal sinuses (ethmoid sinuses)
Periorbital cellulitis presentation
+eye pain
+eyelid swelling and erythema
No vision change No fever (usu) No pain w eye movement No proptosis (bulging out) No opthalmoplegia
Orbital cellulitis presentation
\+eye pain \+eyelid swelling and erythema \+vision changes \+fever \+pain w eye movement
Proptosis
Opthalmoplegia
Conjunctivitis
+/- Discharge
Tx considerations for periobital and orbital cellulitis
Periorbital
- if under 1yo hospitalize, if >1yo can manage as outpatient
- empirical Abx therapy (S aureus, S pneumoniae, MRSA)
Orbital
- hospitalization and consult Ophtho
- immediate IV broad spectrum Abx until cultures returned (vancomycin plus ceftriaxone)
- surgical drainage if abscess formation
Viral conjunctivitis
viral is most common cause of conjunctivitis - adenovirus most common agent
usu associated URI like s/sxs
Cold compress for discomfort
Bacterial conjunctivitis
S. pneumoniae, H. influenzae, Pseudomonas are the most common organisms
Copious discharge common m “eyes matted shut”
Tx Abx eye drops or ointment
Allergic conjunctivitis
usually bilateral, seasonal
itchiness, conjunctival injection, swelling (chemosis)
Tx cold compresses, topical and oral antihistamines
What is the purpose of administering
erythromycin ointment on new born?
Prevent Gonococcal conjunctivitis
What is Dacryocystitis?
infection in the lacrimal sac, usu secondary to nasolacrimal duct obstruction
more common in children- lacrimal gland a lot smaller
tx aggressive Abx (clindaycin, IV vancomycin), may require surgery
consider Dx if pt presenting w discharge but no injection, may start off looking like a pimple
What is Entropion?
eNtropion
iNward turning of eyelids (esp lower lid)
may occur w age, damage may occur w rubbing lashes on eye surface, Tx is lubrication
What is Ectropion?
Outward turning of eyelid (esp lower lid)
may occur w age, surgery may be required if excessive tearing or exposure keratitis
What endocrine anomaly should be suspected in pt w bitemporal hemianopsia?
Pituitary tumor (sitting on optic chiasm – resulting in distorted vision in both eyes)
Pingueculum vs Pteryium
Pingueculum:
- yellow, elevated nodule commonly on nasal side of conjunctiva
- common persons >35yp
- rarely grow, no Tx required
Pterygium :
- fleshy growth typically spreads over cornea
- associated w wind, sun, and dust exposure
- artificial tears, anti inflammatories may be helpful
- excision warranted if endangering vision
Which chemical exposure requires more irrigation, acidic or alkaline?
Alkaline! Much more toxic and requires more irrigation
Subconjunctival hemorrhage vs Hyphema
SCH - can result from trauma or trivial events (sneeze, valsalva). Asymptomatic. Vision unaffected, diffuse flat red patch that stops at limbus. resolves in 2-4wks
Hyphema- results from injury to anterior chamber usu blunt trauma. Acute onset pain, photophobia, tearing, n/v indicates rise in IOP. Optho referral same day. Tx includes control of IOP and pain control (topical and oral diuretics, +/- steroids)
What is hypopyon?
pus in the anterior chamber
Describe signs of possible corneal ulcer (keratitis)
- conjunctival injection, esp by limbus
- cloudy, hazy opacity overlying conrea
- +/- hypopyon (pus in anterior chamber)
- dendritic pattern on flurescein staining (HSV)
What should you suspect if see dendritic pattern on fluoresciein staining of the cornea?
HSV
herpes
Describe management of corneal abrasions
topical antibiotic drops
topical lubricants
Cornea heals quickly - f/u 1-2 days
Never send home w anesthetic - inhibits healing and places at risk for anesthetic keratitis (would req corneal transplant)
Signs of Uveitis/Iritis
- decreased vision
- ciliary flush/circumlimbal injection
- constricted pupils
- cells and flares on slit lamp examination
- IOP is low or normal
if n/v are presenting sxs what two eye Ddx should you be considering?
n/v may be indicative of a rise in IOP
- Glaucoma (acute angle closure glaucoma)
- Hyphema
