Eye disorders 1 Flashcards
5 classifications of conjunctivitis
- bacterial
- viral
- allergic
- traumatic
- toxic
How is bacterial conjunctivitis spread
highly contagious, spread by direct contact
Typical pathogens for bacterial conjunctivitis
- S. aureus
- S. pneumoniae
- H. flu
Clinical manifestations of bacterial conjunctivitis
- red eye (usually unilateral)
- discharge: green, yellow, or white
- often complain of eye stuck shit
- itchy
- feels gritty
First line management for bacterial conjunctivitis
- erythromycin ointment
- trimethorim polmyxin drops
Alternative treatments for bacterial conjunctivitis
- bacitracin ointment
- sulfacetamide ointment
- fluoroquinolone drops (contact wearers)
How is viral conjunctivitis spread
highly contagious, spread by direct contact
Typical pathogen for viral conjunctivitis
adenovirus
Clinical manifestations of viral conjunctivitis
- red eye
- mucoserous or watery discharge
- burning
- sandy or gritty feeling
- both eyes ususally involved
- viral prodrome
Management of viral conjunctivitis
- self limited
- warm or cool compress
- gets worse in the first 3-5 days
- gradual resolution
What causes allergic conjunctivitis
airbone allergens that come in contact with the eye
-IgE casues local mast cell degranulation and release of histamine
What to pts often have with allergic conjunctivitis
atopy, seasonal allergies
What should you look out for in allergic conjunctivitis and why
corneal abrasions b/c eyes are very itchy
Clinical manifestations of allergic conjunctivitis
- bilateral eye redness
- itching
- grittiness
- burning
- watery discharge
- morning crusting
- marked chemosis
- infra orbital edema (allergic shiners)
Management of allergic conjunctivitis
- remove offending agent
- wear sunglasses
- antihistamine/vasoconstrictor combo (naphazoline/pheneramine)
- antihistamines with mast cell stabilizer (olapatadine)
- mast cell stabilizers
- cromolyn sodium
- glucocorticoids (loteprednol)
What causes traumatic conjunctivitis
foreign body
Treatment for foreign body conjunctivitis
removal of foreign body
What causes toxic conjunctivitis
smoke, liquid, fumes, chemicals
Pathophys of acid burns
- 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
Pathophys of alkali burns
WORSE
- dissociate into a hydroxyl ion
- liquefies the fatty acid acid of a cell membrane
Management of toxic conjunctivitis
- tetracaine drops
- immediate flushing of eye
- morgan lens
What should you do for eye complaint
- fluoroscein stain
- fundoscope exam
What is periorbital cellulitis
infection of the anterior portion of the eyelid
Does periorbital cellulitis invlove the orbit or other ocular structures
NO
Etiology of periorbital cellulitis
- insect/animal bites
- foreign body
- dacryocystitis
- conjunctivitis
- hordeolum
Common pathogens of periorbital cellulitis
- S. aureus
- S. pneumo
- MRSA
Clinical manifestations of periorbital cellulitis
- ocular pain
- eyelid swelling
- erythema
- warmth
Why would you get a CT or MRI for periorbital cellulitis
to distinguish between preseptal/periorbital and orbital cellulitis
Treatment of periorbital cellulitis
-doxy
-clinda
-bactrium plus
amox
augmentin
cefpodoxime
cefdinir
Orbital cellulitis
infection involving contents of the orbit (no globe involvement)
Cause of orbital cellulitis
RHINOSINUSITIS
- orbital trauma
- dacryocystitis
- tooth infection
- opthalmic surgery
Most common pathogens of orbital cellulitis
- S. aurea
- streptococci
Clinical manifestations of orbital cellulitis
- swelling
- erythema
- warmth
- ophthalmoplegia
- proptosis
- pain with eye movement
- diplopia
Complications of orbital cellulitis
- orbital abscess
- subperiosteal abscess
- brain abscess
- cavernous sinus thrombophlebitis
Management of periorbital cellulitis
vancomycin plus
ceftriaxone or
cefotaxime or
ampicillin- sulbactam or
zosyn
Improvement within 24-48 hrs if not consider surgery
How is herpes keratitis spread
direct contact with mucous membranes
What are the four types of herpes keratitis
- infectious epithelial keratitis
- stromal keratitis (viral infection of the stroma)
- endotheliitis (immune reaction)
- neurotrophic keratopathy (cornea hypesthesia from damage to optic nerve)
How long is the incubation period for herpes keratitis
1-5 days
Is herpes keratitis unilateral or bilateral
typically unilateral
Pathophys of herpes keratitis
three processes
active infection
inflammation
immune reaction
-results in structural changes in the corneaClinical manifestations of herpes keratitis
- pain
- visual burning
- tearing
Diagnosis of herpes keratitis
dendritic lesions on fluorescin
Management of herpes keratitis
topical antivirals -trifluridine -ganciclovir oral agents -valacyclovir -famcyclovir -ganciclovir
Where are the meibomian glands
inside rim of the eyelids
How many meibomian glands are on the upper lid? lower lid?
50 on upper
25 on lower
What are meibomian glands
sebaceous glands that secrete oily substance
What is the function of the meibomian gland
keeps the eye lubricated, prevents evaporation of tears
Blepharitis
chornic eye condition characterized by inflammation of the eyelids
Which type of blepharitis is more common
posterior
What are the two variants of anterior blepharitis
- staphylococcal
- seborrheic
Pathophys of anterior blepharitis
not completely understood
- staph colonization of the eyelids
- reaction to staph exotoxin
- allergic response to staph antigens
Clinical manifestations of anterior blepharitis
- eyelid edges pink irritated swollen with crust
- malposition of eyelids in chronic cases
- eyelashes may be misdirected, thinning
- diffuse conjunctival injection
What is posterior blepharitis associated with
rosacea and seborrheic dermatitis
Pathophys of posterior blepharitis
- 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
Clinical manifestation of blepharitis
- red eyes
- gritty sensation
- burning
- excessive tearing
- itchy eyelids
- red, swollen eyes
- crusting
- flaking eyelid skin
- photophobia
- blurred vision
Management of blepharitis
- alleviate acute sx
- warm compress
- lid massage
- lid washing
- artificial tears
Medications for blepharitis
topical oinment or drops
- azithromycin
- erythromycin
- bacitracin
oral terta or doxy in severe or chronic cases
Hordeolum
acute, purulent inflammation of the eyelid
Most common pathogen for hordeolum
staph
Internal hordeolum
infection of meibomian gland- conjunctival side
external hordeolum
infection of eyelash follicle- lid margin
Management of hordeolum
- warm compress
- topical abx
Chalazion
chronic inflammatory lesion due to blockage and swellign of meibomian glands
Chalazion is common is what pts
pts with eyelid margin blepharitis and rosacea
Is a chalazion due to infection
no, due to inflammation and blockage
Treatment of chalazion
none, ususally self limiting
if non resolving refer to ophtho for I&D or glucocorticoid injection
Ectropion
lower eyelid is rolled out, causing dry eye
What causes ectropion
aging
facial nerve paralysis
Clinical manifestations of ectropion
- wet inner conjunctiva is exposed
- excessive tearing
- chronic inflammation
- redness
- gritty feeling
- dry eye
- crusting
- multiple infections
Treatment of ectropion
temporary- artificial tears
permanent- usually fixed with surgery
Entropion
eyelid rolls inward toward the eye causing the eyelashes to rub against the conjunctiva
What causes entropion
- aging and weakening of certain muscles
- trauma
- scarring
- surgery
Clinical manifestations of entropion
- red eye
- irriatation
- gritty sensation
- tearing
- mucous discharge
- photophobia
- corneal abrasion
- absent eyelashes
Dacryoadenitis
inflammation of the lacrimal glands
Causes of dacryoadenitis
- viral (common)
- bacterial (common)
- fungal
- inflammatory
Who gets dacryoadenitis
children and neonates
Causes of bacterial dacryoadenitis
- staph aureus
- strep
- n gonorrhea
- treponema
- m tuberculosis
- chlamydia
- borrelia burgdorferi
Causes of viral dacryoadenitis
- mumps
- EBV
- coxackie
- herpes zoster
- mononucleosis
Causes of fungal dacryoadenitis
- histoplasmosis
- blastomycosis
- parasites
- protozoa
Causes of inflammatory dacryoadenitis
- sarcoidosis
- graves disease
- sjogrens
Clinical manifestation of acute dacryoadenitis
- unilateral
- severe pain
- redness
- swelling
- supraorbital pressure
- rapid onset
- submandibular LAD
- exopthalmos
Systemic sx in dacryoadenitis
- fever
- parotid gland enlargement
- URI
- malaise
Clinical manifestations of chronic dacryoadenitis
- usually bilateral
- painless enlargement
- present more than a month
- more common than acute
How to diagnose dacryoadenitis
- eversion of the upper lid–>see lacrimal gland swelling/enlargement
- CT of the orbit with contrast
Management of viral dacryoadenitis
most common is mumps
- self limiting
- supportive
Management of bacterial dacryoadenitis
first gen cefalosporin
Management of protozoal or fungal dacryoadenitis
antiamoebic or antifungal
Management of inflammatory dacryoadenitis
inverstigate for systemic causes and treat accordingly
Dacryostenosis
nasolacrimal duct obstruction
Treatment for dacryostenosis
- massage
- lacrimal duct probing
usually has spontaneous resolution
Keratoconjunctivitis Sicca
dry eyes
Risk factors for Keratoconjunctivitis Sicca
- age
- gender (female)
- decreased androgens
- systemic disease
- contact lens wearers
- ocular medications
- nutritional deficiency
Pathophys of Keratoconjunctivitis Sicca
any dysfunction of the lacrimal functional unit or tear film
Two classifications of Keratoconjunctivitis Sicca
- decreased tear production
- increased evaporative loss
What is lacrimal dysfunction with systemic findings
Sjogren’s
Diagnosis of Keratoconjunctivitis Sicca
- ocular surface staining
- tear break up time
- Schimer’s test
- corneal sensation
Management of Keratoconjunctivitis Sicca
ARTIFICIAL TEARS
- topical glucocorticoids
- autologous serum tears
- cholinergic agonist
