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Clin Med Exam II > Eye disorders 1 > Flashcards

Eye disorders 1 Flashcards

1
Q

5 classifications of conjunctivitis

A
  • bacterial
  • viral
  • allergic
  • traumatic
  • toxic
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2
Q

How is bacterial conjunctivitis spread

A

highly contagious, spread by direct contact

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3
Q

Typical pathogens for bacterial conjunctivitis

A
  • S. aureus
  • S. pneumoniae
  • H. flu
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4
Q

Clinical manifestations of bacterial conjunctivitis

A
  • red eye (usually unilateral)
  • discharge: green, yellow, or white
  • often complain of eye stuck shit
  • itchy
  • feels gritty
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5
Q

First line management for bacterial conjunctivitis

A
  • erythromycin ointment

- trimethorim polmyxin drops

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6
Q

Alternative treatments for bacterial conjunctivitis

A
  • bacitracin ointment
  • sulfacetamide ointment
  • fluoroquinolone drops (contact wearers)
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7
Q

How is viral conjunctivitis spread

A

highly contagious, spread by direct contact

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8
Q

Typical pathogen for viral conjunctivitis

A

adenovirus

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9
Q

Clinical manifestations of viral conjunctivitis

A
  • red eye
  • mucoserous or watery discharge
  • burning
  • sandy or gritty feeling
  • both eyes ususally involved
  • viral prodrome
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10
Q

Management of viral conjunctivitis

A
  • self limited
  • warm or cool compress
  • gets worse in the first 3-5 days
  • gradual resolution
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11
Q

What causes allergic conjunctivitis

A

airbone allergens that come in contact with the eye

-IgE casues local mast cell degranulation and release of histamine

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12
Q

What to pts often have with allergic conjunctivitis

A

atopy, seasonal allergies

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13
Q

What should you look out for in allergic conjunctivitis and why

A

corneal abrasions b/c eyes are very itchy

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14
Q

Clinical manifestations of allergic conjunctivitis

A
  • bilateral eye redness
  • itching
  • grittiness
  • burning
  • watery discharge
  • morning crusting
  • marked chemosis
  • infra orbital edema (allergic shiners)
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15
Q

Management of allergic conjunctivitis

A
  • remove offending agent
  • wear sunglasses
  • antihistamine/vasoconstrictor combo (naphazoline/pheneramine)
  • antihistamines with mast cell stabilizer (olapatadine)
  • mast cell stabilizers
  • cromolyn sodium
  • glucocorticoids (loteprednol)
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16
Q

What causes traumatic conjunctivitis

A

foreign body

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17
Q

Treatment for foreign body conjunctivitis

A

removal of foreign body

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18
Q

What causes toxic conjunctivitis

A

smoke, liquid, fumes, chemicals

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19
Q

Pathophys of acid burns

A
  • dissociate into hydrogen ions in the cornea
  • hydrogen damages the ocular surface by altering pH
  • produces protein coagulation which prevents deeper penetration of acid into eye
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20
Q

Pathophys of alkali burns

A

WORSE

  • dissociate into a hydroxyl ion
  • liquefies the fatty acid acid of a cell membrane
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21
Q

Management of toxic conjunctivitis

A
  • tetracaine drops
  • immediate flushing of eye
  • morgan lens
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22
Q

What should you do for eye complaint

A
  • fluoroscein stain

- fundoscope exam

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23
Q

What is periorbital cellulitis

A

infection of the anterior portion of the eyelid

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24
Q

Does periorbital cellulitis invlove the orbit or other ocular structures

A

NO

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25
Q

Etiology of periorbital cellulitis

A
  • insect/animal bites
  • foreign body
  • dacryocystitis
  • conjunctivitis
  • hordeolum
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26
Q

Common pathogens of periorbital cellulitis

A
  • S. aureus
  • S. pneumo
  • MRSA
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27
Q

Clinical manifestations of periorbital cellulitis

A
  • ocular pain
  • eyelid swelling
  • erythema
  • warmth
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28
Q

Why would you get a CT or MRI for periorbital cellulitis

A

to distinguish between preseptal/periorbital and orbital cellulitis

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29
Q

Treatment of periorbital cellulitis

A

-doxy
-clinda
-bactrium plus
amox
augmentin
cefpodoxime
cefdinir

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30
Q

Orbital cellulitis

A

infection involving contents of the orbit (no globe involvement)

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31
Q

Cause of orbital cellulitis

A

RHINOSINUSITIS

  • orbital trauma
  • dacryocystitis
  • tooth infection
  • opthalmic surgery
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32
Q

Most common pathogens of orbital cellulitis

A
  • S. aurea

- streptococci

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33
Q

Clinical manifestations of orbital cellulitis

A
  • swelling
  • erythema
  • warmth
  • ophthalmoplegia
  • proptosis
  • pain with eye movement
  • diplopia
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34
Q

Complications of orbital cellulitis

A
  • orbital abscess
  • subperiosteal abscess
  • brain abscess
  • cavernous sinus thrombophlebitis
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35
Q

Management of periorbital cellulitis

A 
vancomycin plus
    ceftriaxone or
    cefotaxime or
    ampicillin- sulbactam or
    zosyn

Improvement within 24-48 hrs if not consider surgery

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36
Q

How is herpes keratitis spread

A

direct contact with mucous membranes

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37
Q

What are the four types of herpes keratitis

A
  • infectious epithelial keratitis
  • stromal keratitis (viral infection of the stroma)
  • endotheliitis (immune reaction)
  • neurotrophic keratopathy (cornea hypesthesia from damage to optic nerve)
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38
Q

How long is the incubation period for herpes keratitis

A

1-5 days

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39
Q

Is herpes keratitis unilateral or bilateral

A

typically unilateral

40
Q

Pathophys of herpes keratitis

A 
three processes
    active infection
    inflammation
    immune reaction
-results in structural changes in the cornea
41
Q

Clinical manifestations of herpes keratitis

A
  • pain
  • visual burning
  • tearing
42
Q

Diagnosis of herpes keratitis

A

dendritic lesions on fluorescin

43
Q

Management of herpes keratitis

A 
topical antivirals
-trifluridine
-ganciclovir
oral agents
-valacyclovir
-famcyclovir
-ganciclovir
44
Q

Where are the meibomian glands

A

inside rim of the eyelids

45
Q

How many meibomian glands are on the upper lid? lower lid?

A

50 on upper

25 on lower

46
Q

What are meibomian glands

A

sebaceous glands that secrete oily substance

47
Q

What is the function of the meibomian gland

A

keeps the eye lubricated, prevents evaporation of tears

48
Q

Blepharitis

A

chornic eye condition characterized by inflammation of the eyelids

49
Q

Which type of blepharitis is more common

A

posterior

50
Q

What are the two variants of anterior blepharitis

A
  • staphylococcal

- seborrheic

51
Q

Pathophys of anterior blepharitis

A

not completely understood

  • staph colonization of the eyelids
  • reaction to staph exotoxin
  • allergic response to staph antigens
52
Q

Clinical manifestations of anterior blepharitis

A
  • eyelid edges pink irritated swollen with crust
  • malposition of eyelids in chronic cases
  • eyelashes may be misdirected, thinning
  • diffuse conjunctival injection
53
Q

What is posterior blepharitis associated with

A

rosacea and seborrheic dermatitis

54
Q

Pathophys of posterior blepharitis

A
  • inflammation of the meibomian glands
  • causes dysfunction and altered secretions
  • increase in free fatty acids
  • increase in unsaturated fatty acids
  • impaired lipid layer of tear film
55
Q

Clinical manifestation of blepharitis

A
  • red eyes
  • gritty sensation
  • burning
  • excessive tearing
  • itchy eyelids
  • red, swollen eyes
  • crusting
  • flaking eyelid skin
  • photophobia
  • blurred vision
56
Q

Management of blepharitis

A
  • alleviate acute sx
  • warm compress
  • lid massage
  • lid washing
  • artificial tears
57
Q

Medications for blepharitis

A

topical oinment or drops

  • azithromycin
  • erythromycin
  • bacitracin

oral terta or doxy in severe or chronic cases

58
Q

Hordeolum

A

acute, purulent inflammation of the eyelid

59
Q

Most common pathogen for hordeolum

A

staph

60
Q

Internal hordeolum

A

infection of meibomian gland- conjunctival side

61
Q

external hordeolum

A

infection of eyelash follicle- lid margin

62
Q

Management of hordeolum

A
  • warm compress

- topical abx

63
Q

Chalazion

A

chronic inflammatory lesion due to blockage and swellign of meibomian glands

64
Q

Chalazion is common is what pts

A

pts with eyelid margin blepharitis and rosacea

65
Q

Is a chalazion due to infection

A

no, due to inflammation and blockage

66
Q

Treatment of chalazion

A

none, ususally self limiting

if non resolving refer to ophtho for I&D or glucocorticoid injection

67
Q

Ectropion

A

lower eyelid is rolled out, causing dry eye

68
Q

What causes ectropion

A

aging

facial nerve paralysis

69
Q

Clinical manifestations of ectropion

A
  • wet inner conjunctiva is exposed
  • excessive tearing
  • chronic inflammation
  • redness
  • gritty feeling
  • dry eye
  • crusting
  • multiple infections
70
Q

Treatment of ectropion

A

temporary- artificial tears

permanent- usually fixed with surgery

71
Q

Entropion

A

eyelid rolls inward toward the eye causing the eyelashes to rub against the conjunctiva

72
Q

What causes entropion

A
  • aging and weakening of certain muscles
  • trauma
  • scarring
  • surgery
73
Q

Clinical manifestations of entropion

A
  • red eye
  • irriatation
  • gritty sensation
  • tearing
  • mucous discharge
  • photophobia
  • corneal abrasion
  • absent eyelashes
74
Q

Dacryoadenitis

A

inflammation of the lacrimal glands

75
Q

Causes of dacryoadenitis

A
  • viral (common)
  • bacterial (common)
  • fungal
  • inflammatory
76
Q

Who gets dacryoadenitis

A

children and neonates

77
Q

Causes of bacterial dacryoadenitis

A
  • staph aureus
  • strep
  • n gonorrhea
  • treponema
  • m tuberculosis
  • chlamydia
  • borrelia burgdorferi
78
Q

Causes of viral dacryoadenitis

A
  • mumps
  • EBV
  • coxackie
  • herpes zoster
  • mononucleosis
79
Q

Causes of fungal dacryoadenitis

A
  • histoplasmosis
  • blastomycosis
  • parasites
  • protozoa
80
Q

Causes of inflammatory dacryoadenitis

A
  • sarcoidosis
  • graves disease
  • sjogrens
81
Q

Clinical manifestation of acute dacryoadenitis

A
  • unilateral
  • severe pain
  • redness
  • swelling
  • supraorbital pressure
  • rapid onset
  • submandibular LAD
  • exopthalmos
82
Q

Systemic sx in dacryoadenitis

A
  • fever
  • parotid gland enlargement
  • URI
  • malaise
83
Q

Clinical manifestations of chronic dacryoadenitis

A
  • usually bilateral
  • painless enlargement
  • present more than a month
  • more common than acute
84
Q

How to diagnose dacryoadenitis

A
  • eversion of the upper lid–>see lacrimal gland swelling/enlargement
  • CT of the orbit with contrast
85
Q

Management of viral dacryoadenitis

A

most common is mumps

  • self limiting
  • supportive
86
Q

Management of bacterial dacryoadenitis

A

first gen cefalosporin

87
Q

Management of protozoal or fungal dacryoadenitis

A

antiamoebic or antifungal

88
Q

Management of inflammatory dacryoadenitis

A

inverstigate for systemic causes and treat accordingly

89
Q

Dacryostenosis

A

nasolacrimal duct obstruction

90
Q

Treatment for dacryostenosis

A
  • massage
  • lacrimal duct probing

usually has spontaneous resolution

91
Q

Keratoconjunctivitis Sicca

A

dry eyes

92
Q

Risk factors for Keratoconjunctivitis Sicca

A
  • age
  • gender (female)
  • decreased androgens
  • systemic disease
  • contact lens wearers
  • ocular medications
  • nutritional deficiency
93
Q

Pathophys of Keratoconjunctivitis Sicca

A

any dysfunction of the lacrimal functional unit or tear film

94
Q

Two classifications of Keratoconjunctivitis Sicca

A
  • decreased tear production

- increased evaporative loss

95
Q

What is lacrimal dysfunction with systemic findings

A

Sjogren’s

96
Q

Diagnosis of Keratoconjunctivitis Sicca

A
  • ocular surface staining
  • tear break up time
  • Schimer’s test
  • corneal sensation
97
Q

Management of Keratoconjunctivitis Sicca

A

ARTIFICIAL TEARS

  • topical glucocorticoids
  • autologous serum tears
  • cholinergic agonist

Clin Med Exam II (11 decks)

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