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Eye Disorders Flashcards

1
Q

Eye Anatomy

A
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2
Q

Conjunctiva anatomy

A
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3
Q

Patient will present with → eyelid changes: crusting, scaling, red-rimming of eyelid and eyelash flaking along with dry eyes and associated seborrhea and rosacea

  1. Etiology
  2. HPI/PE
  3. Dx
  4. Management
A

Blepharitis (ble-phar-itis) = Bilateral eyelid inflammation

  1. Etiology
    1. Chronic inflammation of the eyelids c/o mass and without significant pain, caused by dysfunctional meibomian gland (oil glands at base of eyelashes) or bacterial infection
      1. Associated c seborrhea and rosacea
  2. HPI/PE
    1. Eyelid changes = burning, erythema c crusting, scaling, red-rimmed eyelid & eyelash flaking
  3. Dx
    1. Slit-lamp
  4. Managment
    1. warm compresses
    2. irrigation (tear supplements during the day)
    3. lid massage (gentle cleansing c dilute baby shampoo)
    4. topical antibiotics for flare ups (bacitracin/polymix B, erythromycin, or getamcin qid for 7-10 days)
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4
Q

Patient will present with → painless granuloma of the internal meibomian sebaceous gland (PAINLESS LID NODULE)

  1. Etiology
  2. HPI/PE
  3. Management
A

Chalazion (Ka-lazion)

  1. Etiology
    1. NONINFECTIOUS OBSTRUCTION OF A MEIBOMIAN GLAND causing extravasation of irritating lipid material in the eyelid soft tissues with focal secondary granulomatous inflammation.
  2. HPI/PE
    1. “C” = Chalazion = Chronic and “Cold” (vs hordeolum which is “hot”, acute and not chronic)
  3. Dx
    1. clx = hard, nontender eyelid swelling, often not very red
  4. Managment
    1. 1st line = warm compress + eyelid hygiene
    2. 2nd line = intralesional triamcinolone or I&C
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5
Q

Name

  1. Etiology
  2. HPI/PE
  3. Management
A

Hordeolum “STYE” (hord-e-ulum) = painful abscess at eyelid margin

  1. Etiology
    1. S. aureus => external sebaceous gland abscess eyelid
  2. HPI/PE
    1. focal abscess; inflamed lump on eyelid
  3. Managment
    1. Non-draining = Warm compresses (1st line)
    2. Actively draining = Abx drops (bacitracin, erythromycin)
    3. Non-draining >48 hrs = I&D
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6
Q

Hordeolum vs Chalazion

A
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7
Q

Name

  1. Etiology
  2. HPI/PE
  3. Management
A

Pterygium “eye web” = elevated, superficial fleshy, triangular mass

  1. Etiology
    1. Growing fibrovascular mass, mc starting at inner canthus & grows laterally to cover portions of cornea => thickened bulbar conjunctiva
    2. Patho = localized conjunctival inflammation (eg. dry eyes), environmental (UV, sand, dirt, wind)
  2. HPI/PE
    1. Involves conjunctiva & Cornea
    2. Involves conjunctiva only = Pinguecula (yellow nodule of fat & protein, non-growing)
  3. Managment
    1. Eye lubricant (eg. lacri-lube)
    2. Opto referral if it affects vision
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8
Q

Patient will present with → eyelid swelling, decreased visual acuity, enophthalmos (sunken eye), anesthesia/paresthesia in the gums, upper lips and cheek due to damage to the infraorbital nerve.

  1. HPI/PE
  2. Dx
  3. Management
A

Orbital floor “blow out” fracture = orbital floor (maxillary, zygomatic, palatine) due blunt force trauma to the globe/infra-orbital rim.

  1. HPI/PE
    1. Hyphema
    2. ​Proptosis/exophthalmos = anterior displacement (blowing nose)
    3. Hypoglobus = downward displacement
    4. Enophthalmos = posterior displacement (trapped orbital tissue)
    5. Paresthesia in the gums, upper lips and cheeks (Infraorbital n. damage)
    6. Snellen chart (visual acuity) = Decreased visual acuity (trapped orbital tissue)
    7. Diplopia test (H) = Diplopia/pain c upward gaze (inferior rectus entrapment)
  2. Dx
    1. CT scan of orbit = fx, may show herniation of orbital contents into adjacent paranasal sinuses
  3. Managment
    1. 1st = optho referral w/conservative tx (nasal decongestant for pain relief, prednisone for edema) + surgery + prophylaxis abx (clindamycin. amoxicillin, erythromycin)
    2. Surgery
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9
Q

Macular Degeneration

  1. 2 types
  2. RF
A

Macular Degeneration = mc cause of permanent legal blindness & visual loss in elderly (>75yo). Macula is responsible for central vision (detail & color vision)

  1. 2 types
    1. Dry (atrophic) = gradual macula breakdown => gradual blurring of central vision; Drusen = small, round, yellow-white spots on outer retina (scattered, diffuse); these are accumulation of waste products from retinal pigment epithelium
    2. Wet (Neovascular or exudative) = new abnormal vessels growth under central retina which leak & bleed => retinal scarring; Less common but rapid progression,
  2. RF = > 50 yo, white, females, smoking
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10
Q

Macular Degneration

  1. HPI/PE
  2. Dx
  3. Management
A

Macular Degeneration = mc cause of permanent legal blindness & visual loss in elderly (>75yo). Macula is responsible for central vision (detail & color vision)

  1. 2 types
    1. Dry (atrophic) = gradual macula breakdown => gradual blurring of central vision; Drusen = small, round, yellow-white spots on outer retina (scattered, diffuse); these are accumulation of waste products from retinal pigment epithelium
    2. Wet (Neovascular or exudative) = new abnormal vessels growth under central retina which leak & bleed => retinal scarring; Less common but rapid progression,
  2. RF = > 50 yo, white, females, smoking
  3. HPI/PE
    1. Sudden onset of blurring or loss of central vision (including detailed & colored vision)
    2. Scotomas (blind spots, shadows)
    3. metamorphopsia (perceived distortion of objects)
  4. PE = Stereoscopic exam
    1. retinal atrophy
    2. drusen
    3. retinal hyper/hypopigmentation
    4. choroidal neovascularization
  5. Dx
    1. Amsler grid
    2. Optical coherence tomography (for Wet only)
  6. Managment
    1. Dry = Amsler Grid @ home to monitor stability + Vit A,C,E & zinc may slow progression
    2. Wet = Optical tomography to monitor tx response + Anti-angiogenics (ex. bevacizumab - inhibit VEGF)
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11
Q

Name

  1. Etiology
  2. 3 Types
  3. Management
A

Diabetic Retinopathy = mc cause of new, permanent vision loss/blindness in 25-74 yo (MC due to maculopathy)

  1. Etiology
    1. glycosylation (excess sugar) of bv collagen => damage to retinal bv & capillaries => retinal ischemia/edema
  2. Types (NPDR < PDR severity)
    1. Nonproliferative (NPDR) “background” = microaneurysms =>
      1. Cotton wool spots (soft exudate) = nerve fiber micro infarction => fluffy gray-white spots
      2. Hard exudate = lipids/lipoprotein deposits or leaky bv => yellow spots c sharp margins often circinate
      3. Blot & Dots hemorrhages = bleeding into deep retinal layer
      4. Flame hemorrhage = bleeding into nerve fiber layer
    2. Proliferative (PDR) = new, abnormal bv growth, vitreous hemorrhage
    3. Maculopathy (@ any stage) = micro aneurysm leakage at macula => macular edema or exudates => blurred vision, central vision loss
  3. Management
    1. Glucose control
    2. Ophto referral = severe NPDR, any PDR, any macular edema
    3. Laser photocoagulation at risk of vision loss = Severe NPDR, High risk PDR
    4. Intravitreal anti-VEGF = any macular edema
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12
Q

Name

  1. Etiology
  2. 4 Grades (least => most severe)
  3. Management
A

Hypertensive Retinopathy

  1. Etiology = long standing HTN => damage to small bv (retinal)
  2. Grades
    1. Arterial narrowing = abnormal light reflexes on dilated tortuous arteriole shows up as colors => Copper-wiring (moderate), Silver-wiring (severe)
    2. AV nicking = increase arterial pressure => venous compression @ artery-venous junction => +/- central retinal vein occlusion
    3. Flame shaped hemorrhages (bleeding into nerve fiber layer), cotton wool spots (micro infarction of nerve fiber layer => soft exudate)
    4. Papilledema (malignant HTN)
  3. Management
    1. HTN control
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13
Q

Marcus Gunn test

A

Rapid flash light test

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14
Q

Name

  1. Etiology x 4
  2. HPI
  3. PE
  4. WU
  5. Management
A

Papilledema = increase intracranial pressure => bilateral optic nerve (disc) swelling

  1. Etiology
    1. Idiopathic intracranial HTN (pseudotumor cerebri)
    2. space-occupying lesion (ex. cerebral tumor/abscess)
    3. inc. CSF production
    4. Cerebral edema, severe (malignant) HTN
  2. HPI
    1. HA, N/V, enlarged blind spot (vision is usuall well preserved)
  3. PE
    1. Marcus gunn test = negative
    2. fundoscopic = blurred disc cup (swollen optic disc)
  4. WU = MRI or CT 1st to r/o mass effect => lumbar puncture (increase CSF pressure)
  5. Management
    1. Reduce ICP c diuretics (acetazolamide)
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15
Q

Name

  1. Etiology x 4
  2. HPI
  3. PE
  4. WU
  5. Management
A

Retinal Detachment = optho emergency

  1. Etiology
    1. Rhegmatogenous MC type = retinal tear => retinal inner layer detaches from choroid plexus
      1. MC predisposing factors are myopia (nearsightedness) & cataracts
    2. Traction = adhesions separates retina from its base (es. proliferative DM retinopathy, SCD, trauma)
    3. Exudative (serous) = fluid accumulates beneath the retina => detachment (ex. HTN, CRVO, papilledema)
  2. HPI
    1. Photopsia (flashing lights) c detachement =>
    2. floaters (fine dots, veils, cobwebs, clouds, strings, irregular ring/cresent shaped opacity) =>
    3. progressive unilateral vision loss: shadow “curtain” in peripheral => central visual field
    4. no pain/redness
  3. PE
    1. fundoscopic = retina hanging in vitreous
    2. Positive Shafer’s sign = clumping of pigment cells in anterior vitreous
    3. Normal or decreased intraocular pressure
  4. Management
    1. Ophtho emergency = laser, cryotherapy ocular surgery, keep pts supine
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16
Q

Corneal Abrasion that requires emergent referral x 4

A

Corneal Abrasion

  1. Nonreactive or irregular pupil
  2. Hyphema (blood) or Hypopyon (pus) in the anterior channel
  3. Jelly-like substance c pigmented or blood debris visible (tape a shield over it!)
  4. corneal ulcer = infected corneal abrasion
17
Q

Patient will present with → history of mild trauma followed by sudden onset of eye pain, photophobia, tearing, foreign body sensation, blurring of vision, and/or conjunctival injection

  1. Etiology
  2. HPI/PE
  3. Dx
  4. Management
  5. DDx
A

Foreign Body (ocular) & Corneal Abrasion

Corneal abrasion mc emergency ophthalmologic visit

  1. Etiology
    1. Traumatic (e.g., fingernail scratch, makeup brush)
    2. Foreign Body (e.g. Dirt, sand, sawdust, metal)
  2. HPI/PE
    1. Severe eye pain, foreign body or gritty sensation, photophobia, excessive tearing, blurred vision, HA, blepharospasm, hazy cornea, conjunctival injection, decreased visual acuity
  3. DDx = corneal ulcer (seen c/o F. stain), HSV keratitis
  4. Dx
    1. Pain relieved c instillation of ophthalmic analgesic drop
    2. Fluorescein staining - increased absorption in devoid area => “ice-rink” linear abrasions (evert eyelid and look)
  5. Management = Patch up to 24 h if >5mm abrasion present, no patching if pseudomonas infection suspected
  6. Topical anesthetic - immediate relief (don’t dispense)
  7. Topical antibiotic ointment (preferable to drops) as lubrication will likely help.
    1. ciprofloxacin 0.3%, ofloxacin 0.3%, gentamicin 0.3%, erythromycin 0.5%, polymyxin B/trimethoprim (Polytrim), tobramycin 0.3%
  8. Don’t Patch corneal abrasions delays corneal healing
  9. Global laceration suspected metal shield and refer
  10. FU daily, refer if large or central
18
Q

Name

  1. Etiology
  2. HPI
  3. PE
  4. Dx
  5. Management
A

Keratitis = corneal ulcer/inflammation

  1. Etiology
    1. MC due to bacteria, viruses, fungi (acanthamoeba in contact lens wearers) => rapid progression & sight threatening.
    2. Exposure keratitis (ex w Bell’s Palsy)
  2. HPI = Pain, photophobia, reduced vision, tearing
  3. PE = Conjunctival injection/erythema, limbic flush (ciliary injection), corneal ulceration on slit lamp exam, purulent or watery discharge
  4. Dx
    1. HSV keratitis = dendritic lesions (branching seen on fluorescein staining)
    2. Bacterial keratitis = hazy cornea, ulcer, stromal abscess, +/- hypopyon (white fluid level on iris)
  5. Tx
    1. HSV keratitis = Trifluridine, vidarabine, acyclovir ointment. PO acyclovir
    2. Bacterial keratitis = FQ (moxifloxacin). NO eye patch
19
Q

Patient will present with → purulent (yellow) discharge, crusting, usually worse in the morning

  1. Etiology
  2. Transmit
  3. Laterality
  4. Sxs
  5. Discharge
  6. Visual changes
  7. PE
  8. Tx
A

Conjunctivitis = pink eye c crusted eyelids

20
Q

Name

  1. Etiology
  2. HPI
  3. PE/Dx
  4. Management
A

Central Retinal Vein Occlusion (CRVO) = Retinal vein thrombus => fluid back up in retina

  1. RF = HTN, DM, Glaucoma, Hypercoagulable states
  2. HPI
    1. sudden painless monocular vision loss (often inferior)
  3. PE
    1. decreased visual acuity (snells), No eye redness
    2. fundoscopy
      1. macular edema (disc swelling) => vision loss
      2. dilated retinal vein
      3. Intraretinal hemorrhages “blood & thunder” appearance
  4. Dx = fluorescein angiography to confirm dx
  5. Management = no known effective tx​
    1. observe + manage RFs
21
Q

Name

  1. Etiology
  2. HPI
  3. PE/Dx
  4. Management
A

Central Retinal Artery Occlusion (CRAO) = Retinal artery thrombus or embolus => Optho Emergency!

  1. Etiology = Mc due to atherosclerotic disease (external carotid a.), 50-80yo.
    1. RF = HTN, DM, CAD, Peripheral vascular disease
  2. HPI
    1. Sudden painless monocular vision loss (often inferior), usually preceded by Amaurosis fugax (painless temporary loss of vision in 1 or both eyes)
    2. +/- central vision loss
  3. PE
    1. decreased visual acuity (snells), Loss of peripheral field
    2. No eye redness
    3. intraretinal hemorrhage, loss of arterial filling, dilated retinal vein
  4. Dx
    1. fundoscopy
      1. Pale retina c cherry-red macula (red spot) due to obstruction of retinal blood flow
      2. +/- segmentation “box car appearance”
      3. retinal opacity, visible embolus, narrow vessels
      4. No hemorrhage
    2. If dx unclear, or pt > 50 yo obtain fundus fluorescein angiography to delineate retinal circulation to RO giant cell arteritis
  5. Management - No tx has been shown to be effective,
    1. Ocular massage (pt supine, try to dislodge clot)
    2. Decrease IPO to prevent anterior chamber involvement (acetazolamide + IV mannitol)
    3. Vasodilation (isosorbide dinitrate sublingual or tolazoline retrobulbar)
22
Q

Name

  1. Etiology
  2. HPI/PE
  3. Dx
  4. Management
  5. DDx
A

Orbital (postseptal) Cellulitis

  1. Etiology
    1. MC 2ndary to sinusitis (ethmoid) = S. pneumo, S. pyogenes, H. flu, S aureus
    2. +/- caused by dental infections or bacteremia, dacrocystitis, facial infections
    3. Mc in children 7-12 yo
  2. HPI/PE
    1. Decreased vision, pain c ocular movement, proptosis (bulging eye)
    2. chemosis (conjunctival swelling), increased intraocular pressure, eyelid edema, exophthalmos, erythema, d/c
  3. Dx
    1. CT scan showing infection of fat & ocular muscles
  4. Tx
    1. IV abx (vancomycin, clindamycin, cefotaxime). MC strep, H. flu, S. aureus
  5. DDx
    1. Preseptal cellulitis (infection of eyelid & periocular tissue) assoc (not assoc c visual changes & no pain c ocular movements)
23
Q

Glaucoma

  1. Def
  2. Types
A
  1. Increase intraocular pressure => optic nerve damage => decreased visual acuity => Ophto Emergency!
  2. Chronic Open Angle Glaucoma (mc) = Fluid builds up in FRONT of lens due to slowly clogging drain => sequential damage to optic nerve with progressive loss of visual field => bilateral tunnel vision
  3. Acute Narrow Angle Closure Glaucoma = Fluid builds up BEHIND lens due to malformed iris and trabecular network contacting each other à sudden blocking of drainage canal => unilateral tunnel vision ​
24
Q

Acute Narrow/Closed Angle

  1. Pathology/Etiology
  2. Precipitating factors
  3. HPI
  4. PE
  5. Dx
  6. DDx
  7. Management
A

fluid buildup BEHIND lens => sudden block of drainage canal => ↑ IOP => optic n. damage

  1. Path/Etiology
    1. Drainage obstruction of aqueous humor from anterior chamber
      1. Physical blockage by iris = preexisting narrow-angle or large lens => Asians, elderly, hyperopes (far-sighted)
      2. Narrowing of anterior chamber angle
    2. ↑ aqueous humor production
  2. Precipitating
    1. dim lights, anticholinergics, sympathomimetic => mydriasis (pupillary dilation further closes angle)
  3. HPI - UNILATERAL, rapid vision loss
    1. Acute = Severe eye pain & vision loss in hrs to days, intermittent blurred vision, Photophobia, HA, N/V, abdominal pain
    2. Subacute = Mild eye pain, Halos around lights (due to corneal edema), Tunnel vision (peripheral loss)
  4. PE
    1. ↓ visual acuity, Mid-dilated sluggish reactive pupils
    2. Globe feels hard to palpation (due to increase IOP)
    3. Conjunctival erythema/chemosis (pink eye/edema)
    4. Cornea edema = hazy/cloudy/steamy cornea
    5. Ciliary flush
    6. Shallow Anterior chamber depth
  5. Dx
    1. Tonometry = ↑ intraocular pressure (>21 mm Hg)
    2. Fundoscopy = optic disc cupping
  6. DDx
    1. Open Angle Glaucoma
    2. Often middx as => migraine HA, Gastroenteritis
  7. Management = 1) ↓IOP(acetazolamide, BB, mannitol) =>2) open the angle (cholinergic)
    1. Acetazolamide IV (1st line agent) = ↓aqueous humor production => ↓IOP
    2. Topical Beta blocker (Timolol) = ↓IOP w/o affecting visual acuity
    3. Miotics/cholinergic (pilocarpine, carbachol) = ACh-induced pupillary constriction & ↑aq. humor drainage => ↓IOP & reverses angle closure
      1. Started post ↓IOP
      2. SE = visual changes, lens opacity
    4. Peripheral iridotomy = definitive tx
    5. Alpha 2 agonists (apraclonidine, brimonidine) = suppress aq. humor production
25
Q

Chronic Open/Wide Angle

  1. Pathology/Etiology
  2. Precipitating factors
  3. HPI
  4. PE
  5. Dx
  6. DDx
  7. Management
A

fluid buildup in FRONT of lens => slow ↑IOP => progressive optic n. damage

  1. Etiology
    1. 2nd MC cause of blindness, MC glaucoma
    2. RF = Black > 40 yo, White > 65 yo; DM, Severe myopia (nearsightedness), Eye injury
  2. Path
    1. Nl anterior chamber c slowly clogged drain => ↓ drainage of aqueous humor via trabecular meshwork
    2. ↑ aqueous humor production
  3. HPI = BILATERALLY, slowly progressive vision loss
    1. Asymptomatic
    2. BILATERAL gradual peripheral vison loss (tunnel) => central vision loss
    3. Irreversible unless caught early
  4. PE
    1. Pupil dilation
    2. Progressive peripheral vision loss
  5. Dx
    1. Tonometry = ↑ intraocular pressure (>21 mm Hg)
    2. Fundoscopy = optic disc cupping, notching of disc rim, ↑cup:disc
  6. DDx
    1. Acute angle closure Glaucoma (presents as painful red eye, reqs immediate evaluation and management)
  7. Management
    1. Lifestyle modifications = Aerobic exercise (↓IOP)
    2. Start c 1st line agents then add additional medications as needed like systemic HTN management
    3. 1st line Agents
      1. Prostaglandin Analogues = Latanoprost, Travoprost
      2. Intraocular B-blockers = Timolol, Betaxolol, Carte_olol_
    4. 2nd line Agents
      1. Miotics/cholinergic = pilocarpine, carbachol
  8. Surgery for refractory cases = Trabeculoplasty => trabeculectomy
26
Q

Name

  1. Etiology
  2. PE
  3. Complications
  4. Prognosis
  5. Management
    1. behavioral
    2. medical
  6. discharge
A

Hyphema = Bleeding in anterior chamber (b/w cornea and iris) of eye => Optho Emergency!

  1. Etiology
    1. Blunt Eye Injury (most common)
      1. Injury to the iris root (outer edge of the iris where it meets the Sclera)
      2. Subsequent bleeding arises from the iris blood vessels
    2. Post-surgical
    3. Spontaneous bleeding w/o injury history
      1. Leukemia
      2. Lymphoma
      3. Child Abuse
      4. Diabetic neovascularization
  2. PE
    1. Visual acuity — variable
    2. External examination — check for concomitant head and facial/ periorbital injury => order CT or Xray
    3. Pupils — direct response to light may be decreased in large hyphemas or the pupil may be obscured by blood.
    4. Tonometry — check for secondary glaucoma.(due to blood clogging trabecular drainage)
    5. Slit lamp exam — measure extent (height) of hyphema, assess for clots. Check for microhyphema. R/O penetrating injury
    6. fundoscopy and red reflex — blood may cause loss of red reflex, look for retinal injury.
  3. Complications
    1. Blindness - due to hyphema rebleeding from dislodged clot
    2. Corneal blood staining
    3. Glaucoma
    4. traumatic iritis
  4. Prognosis
    1. Worse for sickle cell anemia - make sure to get sickle cell prep labs in non-caucasian pts
  5. Management
    1. Restrictive movements & pt remain upright (helps RBCs settle to prevent plugging trabecular meshwork which may lead ↑IOP)
    2. Eye shield/small paper cup (not patch) to cover injured eye
    3. Analgesia PO + topical cycloplegics for comfort
    4. Surgery for refractory hyphema, rebleed, or 2ndary glaucoma
    5. Admit if
      1. noncompliant pts/children < 8 yo
      2. ↑IOP/sickle cell disease
      3. bleeding diathesis/blood dyscrasia
  6. Discharge
    1. Ophtho FU daily basis (or on day 3 for a microhyphema )
27
Q

Name

  1. Etiology
  2. HPI/PE
  3. Management
A

Dacrocystitis (Dacrio-cystitis)= lacrimal gland infection

  1. Etiology
    1. S. aureus/epidermidis, S. pyogenes (GABHS)/pneumoniae, H.fl
  2. HPI/PE
    1. inflamed lesion on nasal side of lower lid +/- purulence
  3. Managment
    1. Systematic abx = Clindamycin + 3rd gen Cephalosporin
    2. Refractory = Dacrocystorhinoscopy
28
Q

Name

  1. Acute vs Chronic
  2. HPI
  3. PE/Dx
  4. WU
  5. Tx
29
Q

Patient will present with → unilateral severe pain, swelling (corner of eye), redness, tearing and drainage from affected eye

If left untreated will turn into?

A

Dacryoadenitis => Dacrocystitis

  1. Pearls
    1. Dacryoadenitis = nasolacrimal duct/nasolacrimal gland (supratemporal) inflammation => untx => dacryocystitis or periorbital cellulitis (redness to nasal sie of lower lid)
    2. Dacryocystitis = infectious obstruction of nasolacrimal duct (inferomedial region)
  2. Dx = Clx
    1. location: Dacryoadenitis => superior-lateral; Dacryocystitis => medial
  3. Tx
    1. Warm to cool compress; infants often resolve, rarely need surgical correction
    2. Dacryoadenitis - cannulation of the duct, stenting, surgery.
    3. Dacryocystitis - systemic antibiotics: Clindamycin + 3rd gen. cephalosporin.
30
Q

Name

  1. Etiology
  2. HPI
  3. Indications for repair
A

a = endo

b= ectro

31
Q

Patient presents with → slowly progressive vision loss over months or years, blurriness, double vision, halos around lights along with clouding of the Lens

  1. Etiology
  2. RF
  3. HPI
  4. PE
  5. Mgmt
  6. DDx
A

Cataracts

  1. Lens opacification (thickening) due to protein precipitation, usually bilateral. leading cause of blindness worldwide
  2. RF = smoking, corticosteroids, ETOH, UV light, DM, aging, Congenital (ToRCH syndrome = Toxo, Rubella, CMV, HSV)
  3. HPI = Blurred vision over months or years, halos around lights. Clouding of the Lens (versus clouding of cornea = glaucoma)
  4. PE = absent red reflex, opaque lens
  5. Management = cataract removal
  6. DDx = Retinoblastoma => absent red reflex, “white pupil”
32
Q

Name

  1. Def
  2. HPI
  3. PE
A
  1. Def = any form of ocular misalignment
  2. HPI = Acute unilateral vision loss and pain in affected eye
  3. PE = cover/uncover test is used to diagnose strabismus, Exotropia: out-turning of eyes, Esotropia: in-turning of eyes
33
Q

Name

  1. Def
  2. Etiology
  3. HPI
  4. PE
  5. Mgmt
  6. DDx
A
  1. Def = Acute inflammation and demyelination of the optic nerve, MC 20-40yo
  2. Etiology = MC cause Multiple sclerosis
  3. HPI = Acute unilateral vision/color/peripheral loss c pain in affected eye
  4. PE
    1. Marcus Gunn pupil = relative afferent pupillary defect (when light shone on unaffected eye to affected eye, pupils appear to dilate rather than constrict) => delayed response to afferent n.
    2. Fundoscopy = 2/3 normal (retrobulbar neuritis) or 1/3 c optic disc swelling/blurring (papillitis)
  5. Mgmt = IV methylprednisolone followed by PO steroids => vision usually returns
34
Q

Optic Cuffing

36
Q

Conjunctiva Pearls

A

I. Viral:

  1. bilateral preauricular LAD, copious watery discharge, scant mucoid discharge. Cobblestoning of palpebral conjunctiva.
  2. MC adenovirus (pools, URI, cause 2ry bacterial infection)
  3. Tx: cool compresses, artificial tears, antihistamines for itching/redness (ex. olopatadine)
    1. sulfacetamide if adenovirus to prevent 2ry Bacterial infection

II. Bacterial:

  1. purulent (yellow) discharge, crusting, usually worse in the morning.
  2. Mc Staph aureus, Strep pneumoniae, H.Flu. Moraxella (URI)
    1. sodium sulfacetamide, gentamicin, fluoroquinolone (topical abx)
  3. Consider Neisseria gonorrhoeae in a newborn shortly after birth or if not resolving with conventional treatment
    1. Ceftriaxone (IM)
    2. topical abx
  4. Chlamydial conjunctivitis - may present with scant mucopurulent discharge
    1. tetracycline or erythromycin (PO)
    2. fluoroquinolone (topical abx)
  5. Pseudomonas coverage for contact lens users
    1. Aminoglycoside/fluoroquinolone (topical drops)

III. Allergic:

  1. red eyes, itching and tearing. Usually bilateral. Will also see cobblestone mucosa on the inner/upper eyelid.
  2. Tx = topical antihistamine H1 blockers – Olopatadine (Patanol), Pheniramine/Naphazoline (Naphcon A).

Diagnostic

  1. Chlamydial conjunctivitis - Giemsa stain - inclusion body
  2. Neisseria conjunctivitis - gram stain and culture if suspected

Treatment

  1. Neisseria conjunctivitis warrants prompt referral and topical + systemic antibiotics
  2. Chlamydial conjunctivitis systemic tetracycline or erythromycin x 3 weeks, topical ointments as well, assess for STD or child abuse
  3. Allergic conjunctivitis systemic antihistamines and topical antihistamines or mast cell stabilizers
37
Q

Patient will present with → contact lense wearer who now presents with severe pain, redness, worsened when eye is open. Fluorescein stain is diagnostic

  1. Pearls
  2. Dx
  3. Tx
A

Corneal Ulcer

  1. Pearls = Must differentiate corneal ulcer from abrasion.
    1. Corneal ulcers usually infection deeper in the cornea by bacteria, viruses, or fungi as a result of breakdown in the protective epithelial barrier
    2. Risk factor for contact lense wearers!
  2. Dx
    1. Fluorescein stain is diagnostic
      1. round “ulcerated”-ulcer
      2. dendritic = Herpes Simplex Keratitis – common board review question.
    2. Corneal cultures should be obtained before starting antibiotics
  3. Tx
    1. Immediate referral to optho -if not possible, start antibiotics
    2. Ophthalmic antibiotics
      1. ciprofloxacin 0.3%, ofloxacin 0.3%,
      2. gentamicin 0.3%, erythromycin 0.5%, tobramycin 0.3%.
      3. polymyxin B/trimethoprim (Polytrim)

Family Medicine (8 decks)

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