Eye disorders 1 Flashcards
1
Q
5 classifications of conjunctivitis
A
- bacterial
- viral
- allergic
- traumatic
- toxic
2
Q
How is bacterial conjunctivitis spread
A
highly contagious, spread by direct contact
3
Q
Typical pathogens for bacterial conjunctivitis
A
- S. aureus
- S. pneumoniae
- H. flu
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
5
Q
First line management for bacterial conjunctivitis
A
- erythromycin ointment
- trimethorim polmyxin drops
6
Q
Alternative treatments for bacterial conjunctivitis
A
- bacitracin ointment
- sulfacetamide ointment
- fluoroquinolone drops (contact wearers)
7
Q
How is viral conjunctivitis spread
A
highly contagious, spread by direct contact
8
Q
Typical pathogen for viral conjunctivitis
A
adenovirus
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
10
Q
Management of viral conjunctivitis
A
- self limited
- warm or cool compress
- gets worse in the first 3-5 days
- gradual resolution
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
12
Q
What to pts often have with allergic conjunctivitis
A
atopy, seasonal allergies
13
Q
What should you look out for in allergic conjunctivitis and why
A
corneal abrasions b/c eyes are very itchy
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)
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)
16
Q
What causes traumatic conjunctivitis
A
foreign body
17
Q
Treatment for foreign body conjunctivitis
A
removal of foreign body
18
Q
What causes toxic conjunctivitis
A
smoke, liquid, fumes, chemicals
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
20
Q
Pathophys of alkali burns
A
WORSE
- dissociate into a hydroxyl ion
- liquefies the fatty acid acid of a cell membrane
21
Q
Management of toxic conjunctivitis
A
- tetracaine drops
- immediate flushing of eye
- morgan lens
22
Q
What should you do for eye complaint
A
- fluoroscein stain
- fundoscope exam
23
Q
What is periorbital cellulitis
A
infection of the anterior portion of the eyelid
24
Q
Does periorbital cellulitis invlove the orbit or other ocular structures
A
NO
25
Etiology of periorbital cellulitis
- insect/animal bites
- foreign body
- dacryocystitis
- conjunctivitis
- hordeolum
26
Common pathogens of periorbital cellulitis
- S. aureus
- S. pneumo
- MRSA
27
Clinical manifestations of periorbital cellulitis
- ocular pain
- eyelid swelling
- erythema
- warmth
28
Why would you get a CT or MRI for periorbital cellulitis
to distinguish between preseptal/periorbital and orbital cellulitis
29
Treatment of periorbital cellulitis
-doxy
-clinda
-bactrium plus
amox
augmentin
cefpodoxime
cefdinir
30
Orbital cellulitis
infection involving contents of the orbit (no globe involvement)
31
Cause of orbital cellulitis
RHINOSINUSITIS
- orbital trauma
- dacryocystitis
- tooth infection
- opthalmic surgery
32
Most common pathogens of orbital cellulitis
- S. aurea
| - streptococci
33
Clinical manifestations of orbital cellulitis
- swelling
- erythema
- warmth
- ophthalmoplegia
- proptosis
- pain with eye movement
- diplopia
34
Complications of orbital cellulitis
- orbital abscess
- subperiosteal abscess
- brain abscess
- cavernous sinus thrombophlebitis
35
Management of periorbital cellulitis
```
vancomycin plus
ceftriaxone or
cefotaxime or
ampicillin- sulbactam or
zosyn
```
Improvement within 24-48 hrs if not consider surgery
36
How is herpes keratitis spread
direct contact with mucous membranes
37
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)
38
How long is the incubation period for herpes keratitis
1-5 days
39
Is herpes keratitis unilateral or bilateral
typically unilateral
40
Pathophys of herpes keratitis
```
three processes
active infection
inflammation
immune reaction
-results in structural changes in the cornea
```
41
Clinical manifestations of herpes keratitis
- pain
- visual burning
- tearing
42
Diagnosis of herpes keratitis
dendritic lesions on fluorescin
43
Management of herpes keratitis
```
topical antivirals
-trifluridine
-ganciclovir
oral agents
-valacyclovir
-famcyclovir
-ganciclovir
```
44
Where are the meibomian glands
inside rim of the eyelids
45
How many meibomian glands are on the upper lid? lower lid?
50 on upper
| 25 on lower
46
What are meibomian glands
sebaceous glands that secrete oily substance
47
What is the function of the meibomian gland
keeps the eye lubricated, prevents evaporation of tears
48
Blepharitis
chornic eye condition characterized by inflammation of the eyelids
49
Which type of blepharitis is more common
posterior
50
What are the two variants of anterior blepharitis
- staphylococcal
| - seborrheic
51
Pathophys of anterior blepharitis
not completely understood
- staph colonization of the eyelids
- reaction to staph exotoxin
- allergic response to staph antigens
52
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
53
What is posterior blepharitis associated with
rosacea and seborrheic dermatitis
54
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
55
Clinical manifestation of blepharitis
- red eyes
- gritty sensation
- burning
- excessive tearing
- itchy eyelids
- red, swollen eyes
- crusting
- flaking eyelid skin
- photophobia
- blurred vision
56
Management of blepharitis
- alleviate acute sx
- warm compress
- lid massage
- lid washing
- artificial tears
57
Medications for blepharitis
topical oinment or drops
- azithromycin
- erythromycin
- bacitracin
oral terta or doxy in severe or chronic cases
58
Hordeolum
acute, purulent inflammation of the eyelid
59
Most common pathogen for hordeolum
staph
60
Internal hordeolum
infection of meibomian gland- conjunctival side
61
external hordeolum
infection of eyelash follicle- lid margin
62
Management of hordeolum
- warm compress
| - topical abx
63
Chalazion
chronic inflammatory lesion due to blockage and swellign of meibomian glands
64
Chalazion is common is what pts
pts with eyelid margin blepharitis and rosacea
65
Is a chalazion due to infection
no, due to inflammation and blockage
66
Treatment of chalazion
none, ususally self limiting
if non resolving refer to ophtho for I&D or glucocorticoid injection
67
Ectropion
lower eyelid is rolled out, causing dry eye
68
What causes ectropion
aging
| facial nerve paralysis
69
Clinical manifestations of ectropion
- wet inner conjunctiva is exposed
- excessive tearing
- chronic inflammation
- redness
- gritty feeling
- dry eye
- crusting
- multiple infections
70
Treatment of ectropion
temporary- artificial tears
| permanent- usually fixed with surgery
71
Entropion
eyelid rolls inward toward the eye causing the eyelashes to rub against the conjunctiva
72
What causes entropion
- aging and weakening of certain muscles
- trauma
- scarring
- surgery
73
Clinical manifestations of entropion
- red eye
- irriatation
- gritty sensation
- tearing
- mucous discharge
- photophobia
- corneal abrasion
- absent eyelashes
74
Dacryoadenitis
inflammation of the lacrimal glands
75
Causes of dacryoadenitis
- viral (common)
- bacterial (common)
- fungal
- inflammatory
76
Who gets dacryoadenitis
children and neonates
77
Causes of bacterial dacryoadenitis
- staph aureus
- strep
- n gonorrhea
- treponema
- m tuberculosis
- chlamydia
- borrelia burgdorferi
78
Causes of viral dacryoadenitis
- mumps
- EBV
- coxackie
- herpes zoster
- mononucleosis
79
Causes of fungal dacryoadenitis
- histoplasmosis
- blastomycosis
- parasites
- protozoa
80
Causes of inflammatory dacryoadenitis
- sarcoidosis
- graves disease
- sjogrens
81
Clinical manifestation of acute dacryoadenitis
- unilateral
- severe pain
- redness
- swelling
- supraorbital pressure
- rapid onset
- submandibular LAD
- exopthalmos
82
Systemic sx in dacryoadenitis
- fever
- parotid gland enlargement
- URI
- malaise
83
Clinical manifestations of chronic dacryoadenitis
- usually bilateral
- painless enlargement
- present more than a month
- more common than acute
84
How to diagnose dacryoadenitis
- eversion of the upper lid-->see lacrimal gland swelling/enlargement
- CT of the orbit with contrast
85
Management of viral dacryoadenitis
most common is mumps
- self limiting
- supportive
86
Management of bacterial dacryoadenitis
first gen cefalosporin
87
Management of protozoal or fungal dacryoadenitis
antiamoebic or antifungal
88
Management of inflammatory dacryoadenitis
inverstigate for systemic causes and treat accordingly
89
Dacryostenosis
nasolacrimal duct obstruction
90
Treatment for dacryostenosis
- massage
- lacrimal duct probing
usually has spontaneous resolution
91
Keratoconjunctivitis Sicca
dry eyes
92
Risk factors for Keratoconjunctivitis Sicca
- age
- gender (female)
- decreased androgens
- systemic disease
- contact lens wearers
- ocular medications
- nutritional deficiency
93
Pathophys of Keratoconjunctivitis Sicca
any dysfunction of the lacrimal functional unit or tear film
94
Two classifications of Keratoconjunctivitis Sicca
- decreased tear production
| - increased evaporative loss
95
What is lacrimal dysfunction with systemic findings
Sjogren's
96
Diagnosis of Keratoconjunctivitis Sicca
- ocular surface staining
- tear break up time
- Schimer's test
- corneal sensation
97
Management of Keratoconjunctivitis Sicca
ARTIFICIAL TEARS
- topical glucocorticoids
- autologous serum tears
- cholinergic agonist
