Eye Disorders Flashcards
Nasolacrimal Duct Obstruction
Common among newborns (20-30%)
Reassure parents, encourage massage
90-95% spontaneous resolution by age 1
(if not, minor procedure to open the duct)
(Painful)
Dacryocystitis
Dacryocystitis
Unilateral bacterial infection of lacrimal sac due to nasolacrimal obstruction
Most common in infants and adults >40yo
Staphylococcus aureus (most common)
B Hemolytic Streptococcus
Dacryocystitis
Treatment
Systemic Antibiotics (Oral)
- Amoxicillin Clavulanic Acid (Beta Lactamas Inhibitors)
- Cephalexin *(First gen Cephalosporin) *
Dacryocystorhinostomy if chronic
Dilation if congenital and not resolved by 1 yr
(Painful)
Internal Hordeolum
(Painful)
External Hordeolum
(Sty)
Hordeolum
Localized painful staphylococcal abcess of abrupt onset
Internal = Meibomian gland
External = Sty, margin of eyelid
Hordeolum
S&S
Acute onset pain and edema
Red, tender bump on eyelid
+/- Purulent discharge
Hordeolum
Treatment
Warm Compress
Antibiotic Ointment (topically)
- Bacitracin ophthalmic ointment
- Erythromycin ophthalmic ointment
Incision/drainage if resolution doesn’t begin within 48hrs
**Dacryocystitis **
S&S
Pain/tenderness
Swelling
Redness in tear sac area
+/- Purulent discharge
(Painless)
Chalazion
Chalazion
Chronic inflammation and blockage of Meibomian gland
Painless, firm swelling on upper or lower lid (no infection)
Likely consequence from chronic hordeolum
Chalazion
S&S
Non-tender, firm nodule
Redness & swelling of adjacent conjunctiva
Distorted vision if large enough to compress cornea
Chalazion
Treatment
Often resolved without treatment if small
Warm compress
Incision and curettage (scraping it out)
Corticosteroid injection
Blepharitis
Blepharitis
Chronic bilateral inflammatory condition of lid margins
Etiology
Seborrhea dermatitis
+/- Staph or Strep infection
Dysfunctional Meibomian glands
Drying out of skin due to poor oil production from glands
Blepharitis
S&S
Red lid margins (red-rimmed eyes)
Eyelashes adhere to eyelids
Dandruff like deposits/scales on lashes
Conjunctiva clear to slightly erythematous
Pts tend to have scaly skin on scalp and in ears as well
Blepharitis
Treatment
Patient education
Keep lid margins, eyebrows, and scalp free of scales
(warm damp cloth + baby shampoo)
Antiobiotic Ointments
- Bacitracin Ointment
- Erythromycin Ointment
Long-term Low Dose Oral Antibiotics
(Tetracycline, Doxycycline, Erythromycin)
The only eye pathology that doesn’t need prophalactic bilateral Tx is?
Stenotic Duct
What is the difference between a Hordeolum and a Chalazion?
Hordeolum is infected (bacterial) and painful
Chalazion is inflammed and painless
True/False
We should never prescribe steroid opthalmic drops/ointment
TRUE
There are severe adverse effects that could occur
**If you believe a pt needs steroid drops/oint, refer them to an ophthalmologist **
Entropion
Entropion
Lid lashes turn in secondary to scar tissue or degeneration of lid fascia
Surgery is indicated if lashes rub cornea
Ectropion
Ectropion
Eyelids evert secondary to age, trauma, infection, or CN VII palsy (Bell’s)
Can cause chronic dryness, inflammation, ulceration
Keep it hydrated, may put a patch on at night
Only resolution is surgery
Viral Conjunctivitis
Viral Conjunctivitis
Inflammation/infection of membrane lining eyelids
Adenovirus most common cause
Children > Adults
Viral Conjunctivitis
S&S
Red conjunctiva
Copious watery discharge
Usually bilateral
FB (foreign body) sensation
Viral Conjunctivitis
Treatment
Symptomatic measures
Cold compress may help
Pt education - course of illness ~10 days
Bacterial Conjunctivitis
Bacterial Conjunctivitis
Inflammation and Bacterial Infection of membrane lining the eyelids
Common pathogens:
- Staphylococci
- Strep pneumoniae
- Haemophilus
- Psudomonas
- Moraxella
Bacterial Conjunctivitis
S&S
Red conjunctiva
Copious purulent discharge
Mild discomfort (less uncomfortable than viral)
Usually unilateral
Bacterial Conjunctivitis
Treatment
Self-limiting (10-14 days if left untreated)
2-3 days if treated with:
- 10% Sodium Sulamyd ophth sol/oint
- Erythromycin ophth oint
- Gentamycin ophth sol/oint
Warm compress
Good hygiene
(Usually non-contagious after 24hrs of antibiotics)
Neonatal Gonococcal Conjunctivitis
Gonococcal Conunctivitis
OPHTHALMOLGIC EMERGENCY
Infection and inflammation of conjunctiva with risk of corneal ulceration (2-7 day incubation period)
Babies can be born with this from infected mothers
(STD testing in pregnant women)
Gonococcal Conjunctivitis
S&S
Severe purulent discharge
Eyelid edema
Possibly cloudy cornea
(confirm with gram stain and culture)
Gonococcal Conjunctivitis
Treatment
Ceftriaxone (IM/IV)
+
Oral antibiotics for 10 days
Fluoroquinolone gtts (as adjunctive therapy)
Erythromycin ointment
Chlamydial Conjunctivitis
Chlamydial Conjunctivitis
Acquired via contact with infected genital secretions
Most common infectious cause of blindness
Most frequent cause of neonatal conjunctivitis
Chlamydial Conjunctivitis
S&S
Pink-Red Conjunctiva
Most commonly lower lid
Prominent mounds (follicles)
Preauricular node enlargement (Adenopathy)
Chlamydial Conjunctivitis
Treatment
Single dose Azithromycin
+
Topical Opthalmic Oint for 3 weeks
Pinguecula
Pinguecula
Yellowish elevated thickening (nodule) of the conjunctiva on the sclera
Nothing worrisome
More common >35yo
(Unkown cause, sun/wind exposure may exacerbate)
Pinguecula
S&S
May become inflamed
Yellow elevated nodule on sclera
Often bilateral
More common on nasal side
Pinguecula
Treatment
Doesn’t go away, but tx symptoms
Artificial tears
Topical NSAID
Prednisolone gtts prn
Voltaren opth drops
Pterygium
Pterygium
Thickened medial piece of conjunctiva that grows onto cornea
Usually due to wind, sand, dust exposure
Usually bilateral
Pterygium
Treatment
Artificial tears
Topical NSAID or steroid gtts prn
Excision if threatens vision, causes astigmatism, or severe ocular irritation
Corneal Ulceration
Most commonly due to preceding infection
(Keratitis)
Contacts = risk factor due to entrapment of bacteria
Fluorescein stain to reveal ulceration
Corneal Ulceration
Causative Microbes
(Bacteria)
Bacteria
- Pseudomonas aeroginosa
- Strep pneumococcus
- Moraxella sp
- Staph aureus
Corneal Ulceration
Causative Microbes
(Viruses and Fungi)
Virus
- Herpes simplex virus (HSV)
- Herpes zoster (varicella)
Fungi/Ameobas = uncommon
Corneal Ulceration
Other Causes
Severe dry eyes (no oil protection)
Severe eye allergies
Systemic inflammatory disorders
Corneal Ulceration
S&S
Eye pain
Redness
Photophobia
Blurred vision
Increased tearing
Bacterial Keratitis
OPTHALMIC EMERGENCY
Refer to ophthalmologist or ER immediately
Bacterial Keratitis
Bacterial corneal ulcer
Aggressive course infection of corneal stroma causing rapid vision loss and pain
Bacterial Keratitis
Risk Factors
Contact lens wearers
Corneal trauma
Previous ocular surgery
Dry eye
Bacterial Keratitis
S&S
Hazy cornea
Central ulcer
Eye pain
Red eyes
Bacterial Keratitis
1st Line Treatment
Immediate referral
Gram stain + culture ulcer
Fluoroquinolone Ophth Drops:
- Levofloxacin
- Ciprofloxacin
- Ofloxacin
Bacterial Keratitis
Gram (+) Treatment
Gram (-) Treatment
MRSA Treatment
(+) = Cephalosporin gtts (Cefazolin)
(-) = Aminoglycoside gtts (Tobramycin)
MRSA = Vancomycin IV
Herpes Simplex Virus (HSV) Keratitis
HSV Keratitis
Corneal ulceration caused by HSV
HSV infection one of the most common viral infections of the eye and periocular skin
Can colonize in trigeminal n. leading to recurrence
HSV Keratitis
S&S
Branching (dendritic) ulcer
Enhanced with fluorescein stain + UV light
Possible Trigeminal nerve palsy
Herpes Zoster Ophthalmicus (HZO)
Recurrence of varicella-zoster virus in the distribution of opthlamic branch of trigeminal nerve
Typically pts over 60yo
Herpes Zoster Ophthalmicus
S&S
Malaise
Fever
Headache (h/a)
Periorbital itching/burning
Vesicular rash
Involvement of tip of nose or lid margins = eye involvement
Herpes Zoster Ophthalmicus
Viral Keratitis
Treatment
Urgent referral
Herpes Zoster
- Acyclovir
- Valacyclovir
- Famciclovir
HSV
- Acyclovir
Acute Angle Closure Glaucoma
OPHTHALMIC EMERGENCY
Acute Angle Closure Glaucoma
Closure of pre-existing narrow anterior chamber angle
EMERGENCY
Impediment of flow of aqueous humor through trabecular mesh and Canal of Schlemn = Inc IOP
(Aqueous humor - Anterior chamber, AA)
Acute Angle Closure Glaucoma
Risk Factors
Dilation of pupils (mydriasis) can precipitate
Age (lens enlargement)
Farsightedness (short eyeball)
Genetics (Asians, Heredity)
Cataracts
Acute Angle Closure Glaucoma
S&S
Acute pain
Blurred vision
Halos around lights
Pupils fixed in mid position or dilated
(may have irregular margins)
Hyperemic conjunctiva
Significantly increased IOP
Photophobia, nausea/vomiting
Acute Angle Closure Glaucoma
Temporary Treatments
Must be treated emergently or permanent vision loss within hours
Reduce IOP using:
- Timolol gtt (decreases aqueous humor production)
- Pilocarpine gtts (rapid miosis and ciliary contraction to open trabecular network)
- IV Acetozolamide (decreases aqueous humor production by blocking enzyme in ciliary body)
Acute Angle Closure Glaucoma
Definitive Treatment
Laser Iridotomy
(creates a hole on the outer edge of iris, changes iris config causing iris to move away from trabecular meshwork and restore proper drainage)
Must still use drops for the rest of their life
Chronic Open Angle Glaucoma
Causes increased optic cup to disk ratio
Chronic Open Angle Glaucoma
Increased IOP due to decreased aqueous humor drainage through trabecular meshwork (blockage)
Chronic Open Angle Glaucoma
Risk Factors
Diabetes
Genetics
Chronic corticosteroid use
Chronic Open Angle Glaucoma
S&S
Usually asymptomatic
Signs
Inc IOP
Inc optic cup to disk ratio
Visual field abnormalities
Chronic Open Angle Glaucoma
Treatment
Prostaglandin Analogs
(Latanoprost - inc outflow)
Topical Beta Adrenergic Blocking Agents
(Timolol - dec aqueous humor production)
Selective Laser Trabeculoplasty
Trabeculectomy
