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Clin Med: PA 581 Exam 4: HEENT > Eye Complaints > Flashcards

Eye Complaints Flashcards

Objectives

1
Q

cornea

A
  • Clear part of the eye
  • Avascular
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2
Q

Meibomian Glands

A
  • Secrete oil
  • Keeps tears from evaporating quickly
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3
Q

Circulation of Aqueous Humor

A

ciliary body–> posterior chamber–> through pupil–> anterior chamber–> canal of schlemm–> circulation

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4
Q

Internal Eye Anatomy

A
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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
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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
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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
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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
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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.
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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)
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11
Q

Corneal Ulceration

A
  • Example of herpes infection after staining of the eye
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12
Q

Keratitis

A
  • Inflammation of the cornea
  • Caused by bacterial, viral, fungal, or parasitic infections, minor trauma or injury, excessive contact lens wear
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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

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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
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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
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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
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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
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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)
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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
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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
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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)

Clin Med: PA 581 Exam 4: HEENT (2 decks)

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