Eye

Question 1

3 important vital signs of ophthalmology, should include in all red eye complaints

Answer 1

• Vision
• Pupils (+ pattern of redness and systemic conditions)
• Pressure

Question 2

What is Blepharitis ?

Answer 2

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

Question 3

Describe clinical presentation of Blepharitis

Answer 3

red eyes
gritty or FB sensation 
burning sensation 
excessive tearing 
crustiness in lashes 
light sensitivity 
\+/- blurry vision

Question 4

PE of blepharitis

Answer 4

diffuse conjunctival injection 
eyelid margins inflamed/red 
crusting or matting eyelashes
plugged glands w magnification 
Collarettes

Question 5

Tx Blepharitis

Answer 5

warm compress 
lid massage 
lid hygiene (baby shampoo)
topical Abx 
oral Abx if severe 
omega 3 supps for prevention

Question 6

Possible complication of Blepharitis is a stye ..

Differentiate a Chalazion from Hordeolum

Answer 6

History!

Chalazion- is Chronic, usually painless, rubbery, nodular

Hordeolum- acute, painful, infected, purulent

Question 7

Describe Periorbital Cellulitis and possible etiologies

Answer 7

infection of soft tissues around eye but does not extend into the orbit

external sources (blepharitis, insect bites, FB), sometimes sinusitis

Question 8

Describe Orbital cellulitis and possible etiologies

Answer 8

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)

Question 9

Periorbital cellulitis presentation

Answer 9

+eye pain
+eyelid swelling and erythema

No vision change 
No fever (usu)
No pain w eye movement 
No proptosis (bulging out) 
No opthalmoplegia

Question 10

Orbital cellulitis presentation

Answer 10

\+eye pain
\+eyelid swelling and erythema 
\+vision changes 
\+fever
\+pain w eye movement  

Proptosis
Opthalmoplegia
Conjunctivitis
+/- Discharge

Question 11

Tx considerations for periobital and orbital cellulitis

Answer 11

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

Question 12

Viral conjunctivitis

Answer 12

viral is most common cause of conjunctivitis - adenovirus most common agent

usu associated URI like s/sxs

Cold compress for discomfort

Question 13

Bacterial conjunctivitis

Answer 13

S. pneumoniae, H. influenzae, Pseudomonas are the most common organisms

Copious discharge common m “eyes matted shut”

Tx Abx eye drops or ointment

Question 14

Allergic conjunctivitis

Answer 14

usually bilateral, seasonal
itchiness, conjunctival injection, swelling (chemosis)

Tx cold compresses, topical and oral antihistamines

Question 15

What is the purpose of administering

erythromycin ointment on new born?

Answer 15

Prevent Gonococcal conjunctivitis

Question 16

What is Dacryocystitis?

Answer 16

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

Question 17

What is Entropion?

Answer 17

eNtropion

iNward turning of eyelids (esp lower lid)

may occur w age, damage may occur w rubbing lashes on eye surface, Tx is lubrication

Question 18

What is Ectropion?

Answer 18

Outward turning of eyelid (esp lower lid)

may occur w age, surgery may be required if excessive tearing or exposure keratitis

Question 19

What endocrine anomaly should be suspected in pt w bitemporal hemianopsia?

Answer 19

Pituitary tumor (sitting on optic chiasm – resulting in distorted vision in both eyes)

Question 20

Pingueculum vs Pteryium

Answer 20

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

Question 21

Which chemical exposure requires more irrigation, acidic or alkaline?

Answer 21

Alkaline! Much more toxic and requires more irrigation

Question 22

Subconjunctival hemorrhage vs Hyphema

Answer 22

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)

Question 23

What is hypopyon?

Answer 23

pus in the anterior chamber

Question 24

Describe signs of possible corneal ulcer (keratitis)

Answer 24

• conjunctival injection, esp by limbus
• cloudy, hazy opacity overlying conrea
• +/- hypopyon (pus in anterior chamber)
• dendritic pattern on flurescein staining (HSV)

Question 25

What should you suspect if see dendritic pattern on fluoresciein staining of the cornea?

Answer 25

HSV

herpes

Question 26

Describe management of corneal abrasions

Answer 26

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)

Question 27

Signs of Uveitis/Iritis

Answer 27

• decreased vision
• ciliary flush/circumlimbal injection
• constricted pupils
• cells and flares on slit lamp examination
• IOP is low or normal

Question 28

if n/v are presenting sxs what two eye Ddx should you be considering?

Answer 28

n/v may be indicative of a rise in IOP

• Glaucoma (acute angle closure glaucoma)
• Hyphema