Eye Diseases Lecture 3 Flashcards
Essentials of diagnosis for Blepharitis- Anterior
CHRONIC bilateral inflammatory conditions of the lid margins
Epidemiology of Blepharitis- Anterior
staph aureus or seborrheic
S&S of Blepharitis- Anterior
burning, itching, “red-rimmed” eyes with scales or granulation clinging to lashes “scruff” or collarette scales
Complications of Blepharitis- Anterior
Recurrent conjunctivitis, hordeolum, chalazion, abnormal lid or lash position
F/U for Blepharitis- Anterior
your nurse will call in 24hrs, F/U 1-3 weeks if improving, sooner w/ PCP if increased symptoms or no improvement after 3 days.
Pharm Tx for Blepharitis- Anterior
1st line: Erythromycin Ophthalmic 0.5% Ointment -or- bacitracin ophthalmic ointment applied daily to lid margins
2nd line:
Ophthalmic Fluoroquinolones solution (Levofloxacin 0.5% , or Moxifloxacin 0.5%, Gatifloxacin 0.3%)
Non-pharm Tx for Blepharitis- Anterior
warm compresses daily to soften encrustations, removal of scales daily with a warm washcloth, diluted baby shampoo twice daily
Pt Ed for Blepharitis- Anterior
clean eyes daily,
wash hands before instilling Rx, chronic condition not cured but controlled. no contacts
Essential of diagnosis for Blepharitis- Posterior
chronic bilateral inflammatory condition of the lid margins meibomian glands
Epidemiology of Blepharitis- Posterior
may have staphylococcus aureus
S&S of Blepharitis- Posterior
lid margins are hyperemic with telangiectasias, meibomian glands, are inflamed, lid margins- entropion, tears may be frothy or greasy
Complications of Blepharitis- Posterior
recurrent conjunctivitis, hordeolum, chalazion, abnormal lid or lash position
Tx for MILD Blepharitis- Posterior
Erythromycin Ophthalmic 0.5% ointment or Bacitracin ophthalmic ointment
F/U and referral for MILD Blepharitis- Posterior
routine to ophthalmologist
F/U: you/nurse call within 24 hours, F/U 1 week if Rx is improving condition; sooner with PCP if increased symptoms or no improvement in 3 days
Non- pharm tx for Blepharitis- Posterior
regular meibomian gland expression
warm compresses
referral and Tx for SEVERE Blepharitis- Posterior
urgent ophthalmologist referral
Tx 1st line:
long-term, low-dose abx:
Tetracycline 250 mg, one capsule PO BID (renal dosing)
OR
Doxycycline 100 mg, one capsule/tablet PO daily (renal dosing)
OR
Erythromycin 250 mg, one capsule/tablet PO TID
Pt Ed for Blepharitis- Posterior
prevent complications by regular meibomian expression, if female, no tetracycline during pregnancy, chronic condition cannot be cured, no contacts
Essentials of diagnosis for Chalazion
CHRONIC granulomatous inflammation of a meibomian gland, firm, hard non-tender swelling on the upper or lower eyelid with/without redness
Epidemiology of Chalazion
common, blockage of Zeis or meibomian gland
Tx and referral for Chalazion
routine consult to an ophthalmologist for inclusion and curettage
Pt ed for Chalazion
treat hordeolum quickly, resolved with surgery, but may re-occur, annual eye exam
Essential of diagnosis for Ectropion
advanced age, outward turning of the lower lid, dry eyes
Tx and referral for Ectropion
routine consult to ophthalmologist for surgery
Pt Ed for Ectropion
use artificial tears in the morning, no contacts, wear sunglasses
Essentials of diagnosis for Entropian
Advanced age, FB sensation, inward turning of the lower eyelid
complications of Entropian
conjunctivitis
Tx and referral for Entropian
routine ophthalmology consult for surgery
Essentials of diagnosis for Hordeolum
acute, painful, redness
Risk factors for Hordeolum
Blepharitis, previous hordeolum, contact wearer, make-up, smoke, and dust exposure
Epidemiology of Hordeolum
staphylococcus aureus
S&S of Hordeolum
acute, painful, redness, pustule
F/U for Hordeolum
72 hours if not resolved- send to ophthalmologist for incision
Tx for Hordeolum
1st line: do NOT express it, warm compresses
2nd line: may give erythromycin ophthalmic 0.5% ointment
Essentials of diagnosis for Xanthelasma
Yellow lesions on the eyelid
Risk factors for Xanthelasma
hyperlipidemia
Tx for Xanthelasma
ophthalmology can surgically remove if wanted
control hyperlipidemia (PCP)
Essentials of diagnosis for Nystagmus
rhythmic regular oscillation of the eye (horizontal, vertical, circular)
Risk factors for Nystagmus
side effect of Rx, ETOH, infarct, demyelination, neoplasms, hydrocephalus
Epidemiology of Nystagmus
jerk = slow drift of eyes in one direction, repeatedly corrected with fast movement in the reverse direction, congenital or acquired
S&S of Nystagmus
eye movement, blurred vision
Diagnostic Studies for Nystagmus
MRI R/O mass,
Check serum B12 (low), magnesium (low), HIV
Tx and management for Nystagmus
consult neurosurgeon, tx varies based on the cause
Essentials of diagnosis for Optic Neuritis
UNILATERAL central vision loss, pain with eye movement
Risk factors for Optic Neuritis
presenting symptoms for multiple sclerosis; consider hypoparathyroidism
Epidemiology for Optic Neuritis
inflammation associated with demyelination
Disposition and referral for Optic Neuritis
inpatient, admit to hospital
emergent consult to ophthalmologist/ neurologist (MS)
or endocrinologist if hypoparathyroidism
Pharm tx for Optic Neuritis
IV Methylprednisolone x 3 days, then oral tapered dose (MS)
Essentials of diagnosis for Third Nerve Paralysis
Sudden dysfunction of muscles associated with CN III (oculomotor)
Epidemiology of Third Nerve Paralysis
subarachnoid hemorrhage, midbrain lesions, intracranial aneurysm, ischemia, trauma
S&S of Third Nerve Paralysis
diplopia, droopy eyelid (ptosis), HA (worst HA of my life = subarachnoid hemorrhage due to aneurysm)
Diagnostic studies for Third Nerve Paralysis
- MRI to r/o lesion
- Contrast MRI with MRA angiogram) or CTA (CT angiogram) to r/o aneurysm
- non-contrast CT & LP to r/o meningitis (HA, stiff neck & decreased LOC)
Disposition and referral for Third Nerve Paralysis
admit to hospital
emergent consult to neurosurgeon, tx based on cause
Essentials of diagnosis for Fourth Nerve Paralysis
Diplopia and lack of superior oblique m. (unilateral or bilateral), innervated by CN IV (trochlear)
Epidemiology of Fourth Nerve Paralysis
lesion
Diagnostic studies for Fourth Nerve Paralysis
MRI to r/o lesion
Tx and management of Fourth Nerve Paralysis
emergent consult neurosurgeon
Essentials of diagnosis for Sixth Nerve Paralysis
diplopia and lack of lateral rectus m. (unilateral or bilateral), innervated by CN VI (abducens)
Epidemiology for Sixth Nerve Paralysis
lesion
Diagnostic studies for Sixth Nerve Paralysis
MRI to r/o lesion
Tx and management of Sixth Nerve Paralysis
emergent consult to neurosurgeon
Essentials of Diagnosis for Papilledema
disc swelling, due to severe HTN or RX side effects or increased intracranial pressure (ICP), VF changes
Complications of Papilledema
vision loss
Tx and management of Papilledema
admit to hospital, control causative (BP, Rx, ICP)
Essentials of diagnosis for Periorbital Cellulitis
infection of the anterior portion of the eyelid, redness, pain, eyelid swelling
Other name for Periorbital Cellulitis
preseptal cellulitis
Epidemiology of Periorbital Cellulitis
common Staphylococcus aureus or Streptococcus pneumoniae
Diagnostic studies for Periorbital Cellulitis
contrast-enhanced CT
Pharm TX for Periorbital Cellulitis
PO Clindamycin 300 mg PO TID or Bactrim DS PO BID plus augmentin 875 mg PO BID; if not improved in 24 hr, admit to hospital for IV antibiotics
Essentials of diagnosis for Posterior Orbital Cellulitis
proptosis, swelling, pain with eye movement, redness
Risk factors for Posterior Orbital Cellulitis
bacterial rhinosinusitis, dacryocystitis, teeth infection, middle ear infection
Epidemiology of Posterior Orbital Cellulitis
S. pneumoniae, H. influenza, M. catarrhalis, Staphylococcus aureus
S&S of Posterior Orbital Cellulitis
proptosis, swelling, pain with eye movement, redness, edema, diplopia, vision loss
Diagnostic studies of Posterior Orbital Cellulitis
contrast-enhanced CT
Complications of Posterior Orbital Cellulitis
abscess and death if untreated
Pharm Tx and management of Posterior Orbital Cellulitis
admit to hospital
emergent consult to ophthalmologist
pharm: IV Vancomycin plus ceftriaxone; then discharge on clindamycin 300 mg PO TID or Bactrim DS PO BID plus augmentin PO BID for 2-3 weeks
Essential of diagnosis for Thyroid Eye Disease
BILATERAL proptosis (exophthalmos)
Risk factors for Thyroid Eye Disease
Graves disease- hyperthyroidism; Rx
Diagnostic studies for Thyroid Eye Disease
labs TSH, FT4
S&S of Thyroid Eye Disease
proptosis, lid lag, stare, +/- enlarged thyroid
Tx and management of Thyroid Eye Disease
treat thyroid disease, consult ophthalmologist, may have to consult an endocrinologist to control thyroid
Essentials of diagnosis for Arygyll Robertson Pupil
bilateral small pupils, constrict on accommodation but do not constrict when exposed to bright light (do not “react” to light)
Epidemiology of Arygyll Robertson Pupil`
Treponema pallidum; neurosyphilis
neurosyphilis can be asymptomatic to meningitis
Diagnostic studies for Arygyll Robertson Pupil
LP (lumbar puncture)- [Vernal disease research laboratory (VDRL) and Rapid plasma reagin (RPR) may be nonreactive]
Tx for Arygyll Robertson Pupil
if neurosyphilis:
(report to public health)
STD/STI work-up, treat partner
Pharm: CDC algorithm (IV antibiotics for 10-14 days)
