Eye disorders Flashcards
ENT
How does Dacryocystitis present?
persistent tearing and discharge and swelling in the medial portion of the eye
Acute or chronic infection resulting in inflammation of the lacrimal sac is caused by …
Dacryocystitis can be either an acute or chronic stasis of tears leading to infection resulting in inflammation of the lacrimal sac
S. aureus and streptococcus are commonly associated with acute Dacryocystitis
Pneumococcus, H. influenza and Pseudomonas are commonly associated with chronic Dacryocystitis.
Besides infectious, what is another cause for Dacryocystitis?
congenital
How is congenital dacryocystitis managed?
The diagnosis is clinical but can be supported with syringing or probing
The treatment starts with massage, followed by stenting, then dacryocystorhinostomy.
How does acute Dacryocystitis present?
Erythema, edema, warmth, and significant pain below the medial canthus of the eye
Pressure on the swelling causes pain and purulent discharge from the punctum.
Epiphora
Fever (may be present)
How is acute Dacryocystitis managed?
Diagnosis is clinical but can be supported with a pus culture. Blood cultures may be indicated in patients with systemic symptoms (fever).
Treatment is symptomatic, using warm compresses, NSAIDs. If necessary, systemic antibiotics such as Oral clindamycin, IV or oral amoxicillin + clavulanic acid, or IV vancomycin can be used empirically. Culture-specific antibiotics are used once the report is ready. Incision and drainage if lacrimal sac abscess occurs. Dacryocystorhinostomy (treatment of the NLD obstruction): after treating the infection
How does chronic Dacryocystitis present?
Persistent epiphora
Mucopurulent discharge from the punctum
No signs of acute inflammation; no fever
How is chronic Dacryocystitis managed?
Antibiotics (culture-specific)
DCR (to prevent recurrence)
Children < 12 months old with chronic dacryocystitis: Nasolacrimal duct probing
When would advanced diagnostics be indicated for Dacryocystitis?
A Dacryocystography (DCG) can be used in advanced diagnostics where a contrast imaging of the lacrimal sac and NLD but is mainly performed in patients with dacryostenosis secondary to trauma (altered anatomy) or suspected tumors (to locate the tumor).
What is a major complication of Dacryocystitis?
Preseptal cellulitis
localized, tender, erythematous, pus-filled nodules at the distal lid margin
Hordeolum (Stye)
A common acute inflammation of the tear gland or eyelash follicles (Zeis or meibomian glands), most commonly due to S. aureus. Presents as a painful, erythematous, and tender pus-filled nodule on the eyelid.
A patient describes seeing this, what are the likely causes?
Age-related macular degeneration
Optic neuritis
Open-angle glaucoma: Peripheral vision loss, disc cupping on fundoscopy.
Central retinal artery occlusion: Acute painless vision loss, cherry-red macula.
Retinal detachment: Acute vision loss with a “curtain falling” sensation.
Cataracts: Gradual vision dimming with glare and opacified red reflex.
What is the leading cause of blindness in individuals over 65 years of age in developed countries?
Age-related macular degeneration (AMD).
What are the two major forms of macular degeneration, and what is their prevalence?
“Dry” and “Wet”
Dry AMD (nonexudative or atrophic): ~90%.
Wet AMD (exudative or neovascular): ~10%.
What is the pathophysiology of Dry AMD?
Deposition of drusen (lipid and protein deposits) under the retinal pigment epithelium (RPE) and Bruch’s membrane, leading to slow progressive atrophy of the retina.
What is the pathophysiology of Wet AMD?
Choroidal neovascularization between the RPE and Bruch’s membrane, resulting in leakage of fluid and blood, leading to rapid vision loss and potential retinal detachment.
What findings on fundoscopy are diagnostic of Dry AMD?
Drusen: Yellow-white deposits under the retina.
RPE atrophy and mottling.
