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Gen Med I - Unit 1 > Eye Disorders > Flashcards

Eye Disorders Flashcards

1
Q

Nasolacrimal Duct Obstruction

A

Common among newborns (20-30%)

Reassure parents, encourage massage

90-95% spontaneous resolution by age 1

(if not, minor procedure to open the duct)

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2
Q

(Painful)

A

Dacryocystitis

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3
Q

Dacryocystitis

A

Unilateral bacterial infection of lacrimal sac due to nasolacrimal obstruction

Most common in infants and adults >40yo

Staphylococcus aureus (most common)

B Hemolytic Streptococcus

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4
Q

Dacryocystitis

Treatment

A

Systemic Antibiotics (Oral)

  1. Amoxicillin Clavulanic Acid (Beta Lactamas Inhibitors)
  2. Cephalexin *(First gen Cephalosporin​) *

Dacryocystorhinostomy if chronic

Dilation if congenital and not resolved by 1 yr

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5
Q

(Painful)

A

Internal Hordeolum

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6
Q

(Painful)

A

External Hordeolum

(Sty)

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7
Q

Hordeolum

A

Localized painful staphylococcal abcess of abrupt onset

Internal = Meibomian gland

External = Sty, margin of eyelid

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8
Q

Hordeolum

S&S

A

Acute onset pain and edema

Red, tender bump on eyelid

+/- Purulent discharge

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9
Q

Hordeolum

Treatment

A

Warm Compress

Antibiotic Ointment (topically)

  1. Bacitracin ophthalmic ointment
  2. Erythromycin ophthalmic ointment

Incision/drainage if resolution doesn’t begin within 48hrs

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10
Q

**Dacryocystitis **

S&S

A

Pain/tenderness

Swelling

Redness in tear sac area

+/- Purulent discharge

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11
Q

(Painless)

A

Chalazion

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12
Q

Chalazion

A

Chronic inflammation and blockage of Meibomian gland

Painless, firm swelling on upper or lower lid (no infection)

Likely consequence from chronic hordeolum

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13
Q

Chalazion

S&S

A

Non-tender, firm nodule

Redness & swelling of adjacent conjunctiva

Distorted vision if large enough to compress cornea

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14
Q

Chalazion

Treatment

A

Often resolved without treatment if small

Warm compress

Incision and curettage (scraping it out)

Corticosteroid injection

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15
Q
A

Blepharitis

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16
Q

Blepharitis

A

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

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17
Q

Blepharitis

S&S

A

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

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18
Q

Blepharitis

Treatment

A

Patient education

Keep lid margins, eyebrows, and scalp free of scales

(warm damp cloth + baby shampoo)

Antiobiotic Ointments

  1. Bacitracin Ointment
  2. Erythromycin Ointment

Long-term Low Dose Oral Antibiotics

(Tetracycline, Doxycycline, Erythromycin)

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19
Q

The only eye pathology that doesn’t need prophalactic bilateral Tx is?

A

Stenotic Duct

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20
Q

What is the difference between a Hordeolum and a Chalazion?

A

Hordeolum is infected (bacterial) and painful

Chalazion is inflammed and painless

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21
Q

True/False

We should never prescribe steroid opthalmic drops/ointment

A

TRUE

There are severe adverse effects that could occur

**If you believe a pt needs steroid drops/oint, refer them to an ophthalmologist **

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22
Q
A

Entropion

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23
Q

Entropion

A

Lid lashes turn in secondary to scar tissue or degeneration of lid fascia

Surgery is indicated if lashes rub cornea

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24
Q
A

Ectropion

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25
Q

Ectropion

A

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

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26
Q
A

Viral Conjunctivitis

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27
Q

Viral Conjunctivitis

A

Inflammation/infection of membrane lining eyelids

Adenovirus most common cause

Children > Adults

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28
Q

Viral Conjunctivitis

S&S

A

Red conjunctiva

Copious watery discharge

Usually bilateral

FB (foreign body) sensation

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29
Q

Viral Conjunctivitis

Treatment

A

Symptomatic measures

Cold compress may help

Pt education - course of illness ~10 days

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30
Q
A

Bacterial Conjunctivitis

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31
Q

Bacterial Conjunctivitis

A

Inflammation and Bacterial Infection of membrane lining the eyelids

Common pathogens:

  1. Staphylococci
  2. Strep pneumoniae
  3. Haemophilus
  4. Psudomonas
  5. Moraxella
32
Q

Bacterial Conjunctivitis

S&S

A

Red conjunctiva

Copious purulent discharge

Mild discomfort (less uncomfortable than viral)

Usually unilateral

33
Q

Bacterial Conjunctivitis

Treatment

A

Self-limiting (10-14 days if left untreated)

2-3 days if treated with:

  1. 10% Sodium Sulamyd ophth sol/oint
  2. Erythromycin ophth oint
  3. Gentamycin ophth sol/oint

Warm compress

Good hygiene

(Usually non-contagious after 24hrs of antibiotics)

34
Q
A

Neonatal Gonococcal Conjunctivitis

35
Q

Gonococcal Conunctivitis

A

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)

36
Q

Gonococcal Conjunctivitis

S&S

A

Severe purulent discharge

Eyelid edema

Possibly cloudy cornea

(confirm with gram stain and culture)

37
Q

Gonococcal Conjunctivitis

Treatment

A

Ceftriaxone (IM/IV)

+

Oral antibiotics for 10 days

Fluoroquinolone gtts (as adjunctive therapy)

Erythromycin ointment

38
Q
A

Chlamydial Conjunctivitis

39
Q

Chlamydial Conjunctivitis

A

Acquired via contact with infected genital secretions

Most common infectious cause of blindness

Most frequent cause of neonatal conjunctivitis

40
Q

Chlamydial Conjunctivitis

S&S

A

Pink-Red Conjunctiva

Most commonly lower lid

Prominent mounds (follicles)

Preauricular node enlargement (Adenopathy)

41
Q

Chlamydial Conjunctivitis

Treatment

A

Single dose Azithromycin

+

Topical Opthalmic Oint for 3 weeks

42
Q
A

Pinguecula

43
Q

Pinguecula

A

Yellowish elevated thickening (nodule) of the conjunctiva on the sclera

Nothing worrisome

More common >35yo

(Unkown cause, sun/wind exposure may exacerbate)

44
Q

Pinguecula

S&S

A

May become inflamed

Yellow elevated nodule on sclera

Often bilateral

More common on nasal side

45
Q

Pinguecula

Treatment

A

Doesn’t go away, but tx symptoms

Artificial tears

Topical NSAID

Prednisolone gtts prn

Voltaren opth drops

46
Q
A

Pterygium

47
Q

Pterygium

A

Thickened medial piece of conjunctiva that grows onto cornea

Usually due to wind, sand, dust exposure

Usually bilateral

48
Q

Pterygium

Treatment

A

Artificial tears

Topical NSAID or steroid gtts prn

Excision if threatens vision, causes astigmatism, or severe ocular irritation

49
Q

Corneal Ulceration

A

Most commonly due to preceding infection

(Keratitis)

Contacts = risk factor due to entrapment of bacteria

Fluorescein stain to reveal ulceration

50
Q

Corneal Ulceration

Causative Microbes

(Bacteria)

A

Bacteria

  1. Pseudomonas aeroginosa
  2. Strep pneumococcus
  3. Moraxella sp
  4. Staph aureus
51
Q

Corneal Ulceration

Causative Microbes

(Viruses and Fungi)

A

Virus

  1. Herpes simplex virus (HSV)
  2. Herpes zoster (varicella)

Fungi/Ameobas = uncommon

52
Q

Corneal Ulceration

Other Causes

A

Severe dry eyes (no oil protection)

Severe eye allergies

Systemic inflammatory disorders

53
Q

Corneal Ulceration

S&S

A

Eye pain

Redness

Photophobia

Blurred vision

Increased tearing

54
Q
A

Bacterial Keratitis

OPTHALMIC EMERGENCY

Refer to ophthalmologist or ER immediately

55
Q

Bacterial Keratitis

A

Bacterial corneal ulcer

Aggressive course infection of corneal stroma causing rapid vision loss and pain

56
Q

Bacterial Keratitis

Risk Factors

A

Contact lens wearers

Corneal trauma

Previous ocular surgery

Dry eye

57
Q

Bacterial Keratitis

S&S

A

Hazy cornea

Central ulcer

Eye pain

Red eyes

58
Q

Bacterial Keratitis

1st Line Treatment

A

Immediate referral

Gram stain + culture ulcer

Fluoroquinolone Ophth Drops:

  1. Levofloxacin
  2. Ciprofloxacin
  3. Ofloxacin
59
Q

Bacterial Keratitis

Gram (+) Treatment

Gram (-) Treatment

MRSA Treatment

A

(+) = Cephalosporin gtts (Cefazolin)

(-) = Aminoglycoside gtts (Tobramycin)

MRSA = Vancomycin IV

60
Q
A

Herpes Simplex Virus (HSV) Keratitis

61
Q

HSV Keratitis

A

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

62
Q

HSV Keratitis

S&S

A

Branching (dendritic) ulcer

Enhanced with fluorescein stain + UV light

Possible Trigeminal nerve palsy

63
Q

Herpes Zoster Ophthalmicus (HZO)

A

Recurrence of varicella-zoster virus in the distribution of opthlamic branch of trigeminal nerve

Typically pts over 60yo

64
Q

Herpes Zoster Ophthalmicus

S&S

A

Malaise

Fever

Headache (h/a)

Periorbital itching/burning

Vesicular rash

Involvement of tip of nose or lid margins = eye involvement

65
Q
A

Herpes Zoster Ophthalmicus

66
Q

Viral Keratitis

Treatment

A

Urgent referral

Herpes Zoster

  1. Acyclovir
  2. Valacyclovir
  3. Famciclovir

HSV

  1. Acyclovir
67
Q
A

Acute Angle Closure Glaucoma

OPHTHALMIC EMERGENCY

68
Q

Acute Angle Closure Glaucoma

A

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)

69
Q

Acute Angle Closure Glaucoma

Risk Factors

A

Dilation of pupils (mydriasis) can precipitate

Age (lens enlargement)

Farsightedness (short eyeball)

Genetics (Asians, Heredity)

Cataracts

70
Q

Acute Angle Closure Glaucoma

S&S

A

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

71
Q

Acute Angle Closure Glaucoma

Temporary Treatments

A

Must be treated emergently or permanent vision loss within hours

Reduce IOP using:

  1. Timolol gtt (decreases aqueous humor production)
  2. Pilocarpine gtts (rapid miosis and ciliary contraction to open trabecular network)
  3. IV Acetozolamide (decreases aqueous humor production by blocking enzyme in ciliary body)
72
Q

Acute Angle Closure Glaucoma

Definitive Treatment

A

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

73
Q
A

Chronic Open Angle Glaucoma

Causes increased optic cup to disk ratio

74
Q

Chronic Open Angle Glaucoma

A

Increased IOP due to decreased aqueous humor drainage through trabecular meshwork (blockage)

75
Q

Chronic Open Angle Glaucoma

Risk Factors

A

Diabetes

Genetics

Chronic corticosteroid use

76
Q

Chronic Open Angle Glaucoma

S&S

A

Usually asymptomatic

Signs

Inc IOP

Inc optic cup to disk ratio

Visual field abnormalities

77
Q

Chronic Open Angle Glaucoma

Treatment

A

Prostaglandin Analogs

(Latanoprost - inc outflow)

Topical Beta Adrenergic Blocking Agents

(Timolol - dec aqueous humor production)

Selective Laser Trabeculoplasty

Trabeculectomy

Gen Med I - Unit 1 (1 decks)

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