Eye Complaints Flashcards
Objectives
1
Q
cornea
A
- Clear part of the eye
- Avascular
2
Q
Meibomian Glands
A
- Secrete oil
- Keeps tears from evaporating quickly
3
Q
Circulation of Aqueous Humor
A
ciliary body–> posterior chamber–> through pupil–> anterior chamber–> canal of schlemm–> circulation
4
Q
Internal Eye Anatomy
A
5
Q
General Considerations for eye complaints
A
- The eye stops growing by age three
- The eye moves thru 100° of motion
- The cornea is avascular
- The lens continues to add volume throughout life, doubling its volume by age 70
- The ciliary body produces fluid for the anterior chamber and its muscles accommodate the lens. This fluid must be continually exchanged.
- The retina converts light energy into electrical energy
6
Q
PANCE Eye Disorders
A
- Conjunctival Disorders
- Corneal Disorders
- Lacrimal Disorders
- Lid Disorders
- Neuro-Ophthalmologic Disorders
- Orbital Disorders
- Retinal Disorders
- Traumatic Disorders
- Vascular Disorders
- Vision Abnormalities
7
Q
Conjunctivitis
A
- Diffuse dilatation of conjunctival vessels with redness extending to the periphery
- Watery, mucoid, mucopurulent watery discharge can be noted
- Etiology can be bacterial, viral, allergic, or environmental irritation
- Possibly highly contagious
8
Q
Cataracts
A
- Opacity of lens
- Degenerative eye disease
- Gradual onset
- Yellowing of lens
- “Mistiness” of vision
- Like looking through a dirty window
- Occurs w/aging or UV light
- Most common cause of blindness
9
Q
Corneal Abrasion
A
- Corneal abrasions are commonly seen when foreign material comes in contact with the anterior eye. Prolonged wearing of contact lenses can also lead to corneal abrasions.
- Careful visualization of the eye along with fluorescence stain and the use of a Wood’s Lamp will elicited most superficial abrasions.
10
Q
Corneal Ulcer
A
- A single open sore of the cornea
- Caused by bacterial, viral, or fungal infections, physical or chemical trauma, prolonged wear of contact lenses, corneal drying (Bell’s Palsy)
11
Q
Corneal Ulceration
A
- Example of herpes infection after staining of the eye
12
Q
Keratitis
A
- Inflammation of the cornea
- Caused by bacterial, viral, fungal, or parasitic infections, minor trauma or injury, excessive contact lens wear
13
Q
Pterygium
A
- A triangular, pinkish, tissue growing from the canthus toward the pupil
- Will cross over the corneal margin
- Unknown etiology (Surfer’s eye)
- Once large enough, the patient’s vision will be effected
- Treated with surgical excision
** A Pinguecula does not cross the corneal margin
14
Q
Dacryocystitis
A
- An infection of the lacrimal sac, secondary to obstruction of the nasolacrimial duct at the junction of the lacrimal sac
- Causes pain, redness, excessive tearing, and swelling over the inner aspect of the lower eyelid
15
Q
Blepharitis
A
- Inflammation of the eyelids; usually seen at the area where the eyelashes grow
- Crusting is typically noted with redness and swelling
- Commonly caused by clogged Meibomian gland pores
- Treated with anti-inflammatory and antibiotic medications, warm compresses
16
Q
Hordeolum (Sty)
A
- A painful local infection of the glands of Zeis (external hordeolum) or meibomian gland (internal hordeolum); usually of Staph origin
- Usually localizes to the lid margin and therefore can be treated by removing a single eyelash
- Warm compresses, antibiotics, possible I&D are treatments
17
Q
Chalazion
A
- Redness and swelling of the eyelid away from the eyelash margin
- Usually not painful
- Usually caused by a clogged oil gland
- Usually does not make the entire eyelid swell
- Treated with warm compresses, sometimes antibiotics/cortisone; possible I&D
18
Q
Ectropion
A
- Chronic condition where the eyelid turns out; usually the lower lid; seen in older patients
- With the condition, the eyelid dries out and becomes irritated
- Treated with artificial tears and lubricating ointments; surgery maybe required
- Secondary causes: age/muscle weakness, facial paralysis (Bell’s palsy, tumors), previous scaring or surgery, eyelid growths, genetic disorders (Down Syndrome)
19
Q
Entropion
A
- Chronic condition where the eyelid turns inward so that the eyelashes contact the conjunctiva
- Usually seen in older patients; lower eyelid only
- Treated with artificial tears and lubricating ointments; surgery maybe required
- Similar causes to ectropion but may also be due to a trachoma infection or congenital conditions
20
Q
Nystagmus
A
- Repetitive, uncontrolled movements of the eye (rhythmic beating)
- Types
- Congenital
- Spontaneous
- Acquired persistent spontaneous
- Gaze-evoked nystagmus
- Rebound nystagmus
- Positional nystagmus
21
Q
Congenital Nystagmus
A
- usually has a high frequency, usually horizontal; a lifelong history without other symptoms makes the diagnosis
- More frequent than acquired
- Accompanies other disorders
- micro-ophthalmic anomalies
- Down syndrome
- Is usually mild and non-progressive
- Affected persons not normally aware of spontaneous eye movements
- Vision impairment depends on severity of movements
22
Q
Spontaneous Nystagmus
A
- results from a peripheral vestibular lesion in the labyrinth or vestibular nerve (CN 8), usually horizontal and torsional
23
Q
Acquired persistent spontaneous Nystagmus
A
- results from a lesion in the brain stem or cerebellum, usually vertical, horizontal or torsional
24
Q
Gaze-evoked nystagmus
A
- usually results from drugs, i.e., phenobarbital, phenytoin, alcohol and diazepam; is always in the direction of the gaze and may present with and without fixation
25
Q
Rebound nystagmus
A
- a type of gaze evoked nystagmus that either reverses or reverses direction as the eccentric gaze position is held; result of cerebellar atrophy or lesions of the cerebellum
26
Q
Positional nystagmus
A
- turning the head causing the nystagmus) usually results from otolith debris in the semicircular canals, i.e., vertical torsional for the vertical canals and horizontal torsional for the horizontal canal
27
Q
Physiologic Nystagmus
A
- Direction of nystagmus is defined by the direction of its quick phase
- a right-beating nystagmus is characterized by a rightward-moving quick phase
- Oscillations may be vertical, horizontal or torsional or any combination
- 2-3 beats of nystagmus is considered normal
- Nystagmus is often named as a gross description of the movement
- Downbeat, upbeat, or lateral nystagmus
28
Q
Dz(s) that can cause Pathological Nystagmus
A
- Benign Paroxysmal Positional Vertigo
- Cerebral vascular accident
- Meniere’s disease
- Multiple sclerosis
- Brain tumors
- Wernicke-Korsakoff Syndrome (encephalopathy)
- Lateral medullary syndrome
- Aniridia (absence of the iris)
- Optic nerve hypoplasia
- Albinism (absence of skin pigmentation)
- Horner’s syndrome
29
Q
Toxic or Metabolic Causes of Nystagmus
A
- Alcoholic intoxication
- Lithium
- Barbiturates
- Phenytoin (Dilantin)
- Salicylates
- Benzodiazepines
- LSD or PCP
- Ketamine
- Certain anticonvulsants or sedatives
- Methamphetamine
- Thiamine deficiency
30
Q
CNS Disorders associated with Nystagmus
A
- Cerebellum disorders such as:
- CVA
- Thalamic hemorrhage
- Tumor
- Trauma
- Multiple sclerosis
- Cerebellar ataxia
- Purely vertical nystagmus (usually central origin)
31
Q
Optic Neuritis
A
- Inflammation of the optic nerve where eye pain and temporary vision loss is noted (usually in one eye)
- Patient can also suffer loss of color vision, visual fields, see flashing lights
- Changes can become permanent
- Can be due to multiple sclerosis or unknown causes
- Treatment with steroids
32
Q
Papilledema
A
- A condition where pressure in or around the brain causes swelling of the optic nerve and the nerve is pushed into the center of the eye
- May be caused by brain tumor, abscess/infection, head injury, bleeding in the brain, intracranial hypertension, inflammation of the brain or tissue coverings, uncontrolled hypertension
- May present with vision changes, headache, nausea, vomiting, but not eye pain
33
Q
Orbital Cellulitis
A
- A major infection of the anterior tissues of the face and orbits
- Staph or Strep bacterium are the usual principal etiologic agents
- Commonly noted to be a spread of an acute sinusitis
- Presents with periorbital redness and swelling, the eye is painful to touch (11% of patients suffer loss of vision)
- Suspicion of diagnosis is confirmed by CT
- Ophthalmologic Emergency—Patient admission is recommended, ophthalmologic consultation, and treatment with IV antibiotics
34
Q
Macular Degeneration
A
- One of four major causes of vision loss in the U.S.
- 2.44 million cases 2010, affecting 2.5% of whites 50yrs and older vs. 0.9% of other races
- Rates sharply rise after age 80 with whites 13.8% and 11% overall rate
- Effects the central vision, usually begins with dry/nonexudative degeneration which can progress to wet/exudative/neovascular degeneration
- May present with drusen bodies (yellow deposits under the retina made up of lipids)
- Vitamin supplements and intraocular injections with vascular endothelial growth factor inhibitors are used to slow the progression of the disease
- Neither treatment prevents the degeneration
35
Q
Retinal Detachment
A
- Sudden loss of vision, ↓ or cloudy vision; PAINLESS, preceded by flashing lights and floaters
- “Curtain” over visual field
- Floating folds observed
- Separation of retina from its blood supply
- ↑ risk in patients with ↑ age, myopia & post-op ocular surgery
- Can occur with blunt trauma to the eye/head
- Immediate referral for laser or cryotherapy
36
Q
Retinopathy
A
- Disease of the retinal layer of the eye; usually thought of either being due to uncontrolled hypertension or diabetes
- Either condition can lead to visual changes and possible loss of vision
- Both conditions cause changes to the circulation of the retina and can be visualized by fundoscopic examination
- Cotton wool spots, copper/silver wire changes, flame hemorrhages, neovascular changes, etc.
37
Q
Orbital Blowout Fracture
A
- Facial blunt trauma can cause fractures in the floor or wall of the ocular orbit which can permit the ocular globe of “fall” into the defect.
- Patients present with a history of facial trauma, bruising, swelling, redness, and pain around the face. Diplopia, facial numbness, and epistaxis are also frequently noted.
- A hallmark of the condition is asymmetric extraocular movement or entrapment of the eye with a “frozen” gaze.
38
Q
Globe Rupture
A
- Rupture of the eyeball occurs with either blunt but more commonly penetrating trauma. Any full-thickness injury to the cornea or sclera is considered an open globe.
- Globe rupture is an ophthalmologic emergency and is associated with a high frequency of visual loss.
39
Q
Hyphema
A
- A collection of blood in the anterior chamber of the eye (between the iris and cornea—not to be confused with a subconjunctival hemorrhage)
- Hyphema is usually secondary to trauma and is therefore painful
- Ophthalmology consult is most often required
40
Q
Retinal Vascular Occlusion
A
- Two main types
- retinal artery occlusion
- retinal vein occlusion
- Retinal arterial occlusion is the more critical/time sensitive to diagnose, an Ocular Emergency
- Patients typically in their 60’s, males > females
- May obviously cause severe visual loss if circulation is not restored (<6hrs)
- Usually caused by either embolus or thrombus (CAD, AF, sickle cell, valvular heart disease, diabetes, oral contraceptives)
- Diagnosed by fluorescein angiography or optical coherence tomography
- Treated by: hyperventilation with 95% O2, 5% CO2, ocular massage, Diamox (acetazolamide 500mg IV stat), sublingual nitroglycerine, Methylprednisolone 1g IV stat, paracentesis of eye
- Of note tPA treatment has not showed improvement of visual acuity
41
Q
Retinal Vein Occlusion Hallmarks
A
- Flame type redness
- So called “blood and thunder”
42
Q
Amaurosis Fugax
A
- Transient loss of vision in one or both eyes( therefore visual exam is usually normal at the time of presentation)
- Etiology: Internal carotid artery occlusion or stenosis
- Thromboembolism, vasospasm, cerebrovascular disease, elevated plasma viscosity conditions (leukemia, multiple myeloma)
- A “rule-out” diagnostic evaluation is required, i.e. careful physical exam, labs, head CT, vascular U/S, EKG
43
Q
Glaucoma
A
- Increased interocular pressure of the eye (measured > 22 mmHg) which in turn ultimately damages the optic nerve
- Due to the aqueous humor failing to drain properly from the anterior chamber of the eye
- Two Types
- Open angle glaucoma
- Closed angle glaucoma
44
Q
Open angle glaucoma
A
- most common type, slow onset, typically painless in the early stages, typical fundoscopic changes on exam
45
Q
Closed angle glaucoma
A
- a shift in the lens of the eye with a sudden build up of inner ocular pressure AN OCULAR EMERGENCY
- Typically painful
- Sudden onset
- Presenting headache, nausea, vomiting, halos or rings around lights
46
Q
Glaucoma Tx
A
- Historic treatment of slow onset-open angle glaucoma is medication to slow aqueous humor production, newer meds now effect the release system (trabecular system) at the “angle”
- Lasers treatment has been used to put a new hole in the iris to increase drainage
- Stents are now being placed in the eye to facilitate drainage
- Lasers are being used on the trabecular meshwork and associated structures
** “Angle” refers to the reference points between the iris and cornea; where the interocular fluid drains into the venous system
47
Q
Typical fundoscopic changes in glaucoma
A
- increased disc to cup ratio
- > 6:10 ratio is suspicious for glaucoma
48
Q
Scleritis
A
- Severe, destructive, inflammation involving the sclera and episclera of the eye
- Most commonly seen in women aged 30-50; most often noted in patients with connective tissue disease (RA, lupus, polyarteritis nodosa); may be seen with infection; 50% have unknown etiology
- Presents with a deep boring pain of the eye with decreased visual acuity; 14% of patients loose significant visual acuity within 1yr
- Treated initially with a 10 day course of steroids; systemic immunosuppressive medication may be needed; consultation with ophthalmology and rheumatology after initial treatment failure
49
Q
Amblyopia
A
- Commonly called “lazy eye”; is the most common cause of visual impairment in children
- Caused by
- strabismus—improper alignment of the eyes (muscle function)
- refractive error of one eye—irregular eye shape
- cataract—congenital clouding of the lens
50
Q
Amblyopia Tx
A
- Treatment depends on the cause
- Often putting a patch on the normal eye will improve the patient’s vision because the problem eye is forced to become “stronger”
- Treatment usually only effective till age 12
- Surgery may be necessary
51
Q
Strabismus
A
- Involves a lack of coordination between extraocular muscles
- prevents bringing the gaze of each eye to the same point in space
- prevents proper binocular vision → adversely affects depth perception
- 2 main causes:
- Disorder of the brain coordinating the eyes
- Disorder of one or more muscles
- Deviated or crossed eye
- Constant or intermittent
- Also known as:
- tropia- Always deviated (concomitant/constant)
- phoria- Sometimes deviated (in-concomitant/intermittent)
- ~30% of strabismus patients have a family member with strabismus
- Risk factors: premature birth, cerebral palsy, history of seizures, vision loss
52
Q
Strabismus: types of ocular misalignment
A
- Esotropia—inward eye deviation
- Exotropia—outward eye deviation
- Hypertropia—upward eye deviation
- Hypotropia—downward eye deviation
- Esophoria—inward eye deviation (when other eye is covered)
- Exophoria—outward eye deviation (when other eye is covered)
