EYE BALLZ Flashcards
Slit lamp used for
Corneal involvement (pinguecula and pterygium)
CT scan use
R/o orbital cellulitis in Dx of dacroadenitis
Tied for MC eye dz in US
Cataracts and macular degeneration
MC eye dz worldwide resulting in blindness
Cataracts
Tx for macular degeneration
- Ranibizumab (Lucentis): prevents neovascularization by inhibiting VEGF aka only indicated w/ neovascular-associated MD
- may preserve vision
- monthly injections
- ADR: traumatic cataract, increase IOP, detached retina
- Also supplementation: vit e, ascorbic acid, beta carotene, zinc and cupric oxide
MC eye dz in US and worldwide (rank 1-4)
US: 1 & 2– tied w/ cataracts and macular degeneration
3– retinopathy
4– glaucoma
W: 1- cataracts
2- glaucoma
3- macular degeneration
4- retinopathy
Drusen spots:
Macular degeneration
This dz can lead to optic neuritis if left un-tx
Open Glaucoma
Cotton wool patches and neovascularization are seen w/
Diabetic retinopathy
AV nicking, papilledema, and retinal hemorrhage are seen w/ this dz
Hypertensive retinopathy
Narrowing of eye arteries w/ indentations where veins cross
AV nicking in hypertensive retinopathy
These are caused by infarcted nerve fibers
Cotton wool patches in diabetic retinopathy
These are caused by chronic hypoxia in the retinal tissue; stimulated by VEGF
Neovascularization w/ diabetic retinopathy
High pressure to BV resulting in vessel rupture
Retinal hemorrhage in hypertensive retinopathy
NSAID eye drops: Brand/generic Indication: MOA: SE:
Ketorolac (acular) Diclofenac (voltaren) MOA: inhibit prostaglandin e2 in aqueous humor Use: primary use--> post-op w/ catarct surgery; inflammation w/ seasonal allergic conjunctivitis; weird eye webs (pinguecula, pterygium) SE: minor ocular irritation But also.. - iritis - superficial keratitis - superficial ocular infx - ocular and corneal edema
Opth. Corticosteroids: Generic/brand Use MOA SE
Prednisolone (pred-forte) Tobramycin-dexamethazone (tobradex) Triamcinoclone (Triesence) Use: inflammation of eye - anterior uveitis - burns - superficial bacterial infx - weird web things (pingueculum, pterygium) MOA: inhibit prostaglandins and leukotrienes- aka inflammatory mediators SE: glaucoma
Difference between pterygium and pinguecula
Pterygium w. Corneal involvement; may require surgical excision
Pingueculum w/o
Difference between hordeolum and chalazion
Chalazion- internal surface of eyelid - blocked meibomian gland - non-tender - no real tx; warm compress/watch and wait 2-4 wks--> refer to Opth. Hordeolum: external surface of eyelid MC w. Staph A - tender and painful - oral abx -warm compress/watch and wait 2-4 wks--> refer to Opth.
Describe blepharitis s/s and tx
S/s: inflammation of the eyelid that is pruritic and “crusty”
- pt visibly uncomfortable and may feel foreign object
Tx: wash w/ baby shampoo; warm compress; if severe, may Rq. Erythromycin or bacitracin ointment
Xanthelasma etiology, presentation, & tx
- likely related to unregulated lipid levels–> chronic hyperlipidemia
- yellow plaque on eyelid
- tx: control chronic dz; potentially cosmetic surgery
C/i of corticosteroid drops
- glaucoma
- herpetic keratitis–> blindness
Lubricant eye drops:
2 kinds
Indications
MOA
Syntane
Lacri-lube
- relief for dry or itchy eyes
- buffers to adjust pH; maintains ocular Tonicity; increases viscosity of eye fluids to increase hydration and comfort (via petrolatum, carboxymethylcellulose, & polysorbate)
Tx for open angle glaucoma (first, second, and third)
1: prostaglandin inhibitors & beta blockers
2: selective alpha-2 receptor agonists & cholinergic agents
3: topical carbonic anhydrase inhibitors
Flow of tears in general:
Lacrimal gland–> canaliculi–> sac–> duct–> nasal cavity & beyond to swallow
Main difference between dacroadenitis and dacrocystitis
Lacrimal gland vs. lacrimal duct: i.e. Location of pain or discomfort
Dacroadenitis/dacrocystitis tx
R/o orbital cellulitis
Mild: keflex or augmentin w/ 24h f/u
Severe: IV abs & admit to hospital
B-blocker tx for open angle glaucoma: drugs and MOA
1st line tx
1- selective: Betaxolol (betopic)
2- non selective: timolol (timoptic) & levobunolol (betagan)
MOA: decrease production of aqueous humor
Systemic SE: respiratory arrest, bradycardia, masks hypoglycemia
C: COPD, asthma, pulmonary edema, type 2 or 3 heart blocks
Prostaglandin inhibitor: tx for open angle glaucoma–> drugs and MOA
1st line tx Bimatoprost (lumigan) Latanoprost (xalatan) MOA: increase aqueous outflow Results w. 25%; qd dosing AE: hypertrichosis & drake eyelashes (latisse); increase iris pigmentation
Selective alpha2-receptor agonist tx for open angle glaucoma: drugs and MOA
2nd line tx - brimonidine (alphagan) - increases aqueous outflow & decreases aqueous production AE: blepharo-conjunctivitis Systemic: ha, fatigue, dry mouth
Cholinergic tx for open angle glaucoma: drugs and MOA
2nd line tx
- pilocarpine soln (isopto carpine)
- increase aqueous outflow; physically pulls open trabecular meshwork
- miotic agent; only applied w/ decreased IOP
AE: brow ache, vision probs, accommodation/myopia probs
Systemic: n/v/d, bradycardia
C: sulfa allergy, COPD, hepatic insufficiency, Renal failure, hypo- kalemia and natremia
Topical carbonic anhydrase inhibitors: tx for open angle glaucoma: drugs and MOA
3rd line tx
Topical: brinzolamide(azopt)
Systemic: acetazolamide(diamox)
- decrease aqueous production
Cease secretion of na and bicarbonate from ciliary body to aqueous humor
SE: systemic–> parasthesis and kidney stones; acidosis
CI: same as cholinergic agents- except hypernatremia
Never repair an eye lid laceration w/
Tarsal plate or medial canthus involvement
- or if potential globe penetration
Never do this with an eyebrow laceration
Shave the eyebrow
Make sure to do this with an eyelid foreign body sensation
Invert and avert the upper and lower eyelids
