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Medicine I > Eye Disorders > Flashcards

Eye Disorders Flashcards

1
Q

disorders of eye lids and lacrimal apparatus

A

hordeolum, chalazion, blepharitis, entropion/ectropion, dacryocystitis

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2
Q

disorders of the conjunctiva

A

conjunctivitis, pinguecula and pterygium

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3
Q

disorders of the cornea and sclera

A

scleritis, episcleritis, keratitis, corneal ulcers/abrasions

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4
Q

disorders of the anterior chamber

A

glaucoma, uveitis

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5
Q

disorders of the lens

A

cataract, refractive errors

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6
Q

disorders of the retina and macula and blood vessels

A

retinal detachment, vitreous hemorrhage, retinopathy (DM/HTN), macular degeneration, vessel occlusions

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7
Q

disorders of the optic nerve

A

optic neuritis, papilledema

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8
Q

disorders of nerves of the eye

A

CN 3, 4, 6 palsies

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9
Q

vital sign of the eye

A

visual acuity

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10
Q

legal blindness score

A

20/200

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11
Q

slit lamp exam

A

magnification of anterior chamber

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12
Q

blepharitis, pt complaints

A
  • chronic bilateral inflammation of lid margin
  • lower lid: oily white plugs visible at meibomian gland openings
  • pt c/o irritation, burning, itching
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13
Q

dacrocystitis, cause

A
  • infection of lacrimal apparatus/sac due to obstruction of duct system
  • edemetous and erythemytous
  • usually unilateral, may be acute or chronic
  • commonly caused by staph, strep, may be candida if chronic
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14
Q

Hordolum, cause, tx

A
  • stye
  • meibomian gland plugging and therefore abscess at lid margin
  • usually caused by staph, may be internal or external
  • tx: warm compress, I&D if no resolution w/in 48 hrs, topical abx (erythromycin)
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15
Q

chalazion, tx

A
  • granulomatous inflammation of meibomian gland
  • chronic inflammatory lesion
  • result of chronic styes, hardens or scars down to this
  • usually painless
  • seen usually in patients with blepharitis and rosacea
  • tx: I&D, steroid injection may be effective
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16
Q

entropion, tx

A
  • inward turning of eyelid (usually lower)
  • usually in older pts as result of degenerative lid fascia
  • tx: botox injection, surgery to correct if corneal irritation occurs
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17
Q

ectropion, tx

A
  • outward turning of eyelid (usually lower)
  • increased exposure of the ocular surface and mucous membrane of inner lid
  • disruption of normal tear drainage patterns
  • usually occurs in older pts
  • tx: surgery
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18
Q

conjunctivitis, cause

A
  • most common eye disease
  • acute, subacute, chronic
  • serous, allergic, purulent, membranous
  • usually caused by virus or bacteria or noninfectious (allergic or irritant most likely)
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19
Q

Acute conjunctivitis, pt complaint

A

-c/o red eye, irritation, ocular discharge

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20
Q

Bacterial conjunctivitis, cause

A
  • most common cause:
    • aduts: S. aureus
    • kid: S. aureus, S. pneumo, H.flu, M.cattarhalis
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21
Q

bacterial conjunctivitis PE

A

-PE: shows purulent ocular discharge, erythema at lid margins and corners of eyes

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22
Q

contact wearers risk

A

-high risk of corneal ulceration, keratitis due to higher risk of pseudomonas infection

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23
Q

Bacterial conjunctivitis: Gonorrhea and Chlamydia, tx

A
  • can cause hyperacute, severe conjunctivitis infections
  • sight threatening, emergency dx
  • in newborns, this is scary bc it can cause blindness
  • GU symptoms usually also present
  • tx: GC tx w/ cephalosporin
  • tx: Chlamydia tx w/ doxycycline or azithromycin
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24
Q

Viral conjunctivitis, cause

A
  • usually caused by adenovirus

- associated with viral syndrome: adenopathy, fever, pharyngitis, URI

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25
Q

Viral conjunctivitis PE, tx, prevention

A
  • PE shows mucoid/watery ocular discharge, conjunctival injection and inflammation
  • tx: none, self limiting course of illness, similar to cold, NEVER PRESCRIBE STEROIDS FOR THIS
  • Prevention: wash hands, avoid contamination
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26
Q

Allergic conjunctivitis, sxs

A
  • airborne allergens cause IgE mediated response, degradation of mast cells, infiltration of histamine and other inflammatory mediators in the eye
  • diffuse ocular injection, watery discharge, itching, usually bilateral, cobblestoning
  • often other allergy sxs will be present: sneezing, rhinorrhea, recent exposure, etc.
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27
Q

Allergic conjunctivitis, PE, tx

A
  • PE shows diffuse erythema, cobblestoning of conjunctiva, watery discharge
  • nose, ears, palate may also appear allergic
  • tx: ocular drops: antihistamine + decongestant (naphcon-A)
  • mast cell stabilizer + antibistamine (patanol)
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28
Q

Corneal abrasion/ulceration, complaint, PE, tx

A
  • often due to foreign body, trauma, improper contact lens use
  • c/o severe eye pain, FB sensation
  • PE: exclusion of open globe and hyphema, measure visual acuity, penlight and fluorescein exam, lid eversion for conjunctival FB
  • Tx: small uncomplicated corneal abrasions txd w/ topical antibiotic therapy and topical or oral pain medication
  • most abrasions heal fully w/in 24 hrs
  • if contact wearers, treat with fluoroquinolone
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29
Q

Pinguecula

A
  • conjunctival nodule
  • usually occur nasally in palpebral fissure
  • common over age 35, often bilateral
  • may cause irritation, ok to use artificial tears
  • no treatment needed
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30
Q

pterygium

A
  • conjunctival growth
  • usually from exposure
  • may become inflamed and grow
  • use topical NSAID or steroid if needed
  • definitive treatment is excision if it threatens vision
  • may regrow
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31
Q

episcleritis

A
  • inflammation of the episclera
  • acute onset of redness, irritation, watering of the eye (1/2 bilateral; 70% female)
  • associated with rheumatoid arthritis
  • no pain, no visual acuity changes; PE shows localized erythema
  • not dangerous
32
Q

scleritis

A
  • inflammation of the sclera
  • acute onset of intense pain, photophobia, deep red/purplish scleral hue
  • diagnosis confirmed with slit lamp exam
  • dangerous cause of red eye
  • DANGEROUS - pain and photophobia are key
33
Q

topical steroids

A

-should ONLY be prescribed by an ophthalmologist and then with caution, and should not be used chronically due to increased risk of cataracts, glaucoma, and risk of secondary infection

34
Q

Keratitis, pt complaint

A
  • inflammation of the cornea, often associated with corneal ulcers
  • bacterial or HSV related
  • most commonly due to infection
  • c/o pain, photophobia, tearing, decreased vision
35
Q

bacterial keratitis, sxs

A
  • hazy cornea, pain, photophobia, tearing, decreased vision

- often see central ulcer, hypopyon (pus in the eye)

36
Q

HSV keratitis

A
  • dendritic corneal ulcer and scarring
  • colonizes trigeminal ganglion leading to recurrences; precipitated by fever, excessive exposure to sunlight, or immunocompromised
37
Q

Herpes zoster ophthalmicus, sxs tx

A
  • serious sight-threatening condition
  • seen with Hutchinson’s sign: vesicular lesions on the nose
  • has been linked to VZV reactivation within the trigeminal ganglion
  • frontal branch in V1 most frequently involved
  • begins with headache, malaise, and fever, unilateral pain or hypesthesia in the affected eye, forehead, and top of the head
  • hyperemic conjunctivities, episcleritis and lid droop can occur
  • 2/3 of HZO pts develop corneal involvement (keratitis) that results from necrotic ganglionitis
  • epithelial keratitis may have punctate or dendriform lesions
  • iritis in about 40% pts w/ HZO
  • tx: acyclovir
38
Q

uveitis, cause, types

A
  • intraocular inflammation
  • aka iritis
  • various etiologies, usually immunologic
  • anterior uveitis: inflammatory cells in aqueous (acute pain, erythema, photophobia, visual loss)
  • granulomatous or nongranulomatous classification of anterior uveitis
  • posterior uveitis (cells in vitreous) has more gradual onset, quiet eye
39
Q

Glaucoma, sx

A

-insidious progressive bilateral peripheral vision loss, resulting in tunnel vision, preserved VA
-Reduced or blocked drainage of aqueous through trabecular meshwork
-The conjunctival vessels are dilated, especially near the cornea (ciliary flush) and the cornea is slightly hazy (edematous).
-Hereditary; may be secondary to trauma or steroid use, higher prevalence in diabetics
-no sx in early stages; screen routinely over age 40
Pathologic cupping of optic disks
-elevation of intraocular pressure (IOP)>20 mmHg

40
Q

Acute angle-closure glaucoma, sx

A
  • older age group, hyperopes, narrow anterior chamber angle
  • rapid onset severe eye pain, profound visual loss; “halos around light;” associated n/v
  • red eye, ,steamy cornea, dilated pupil; hard eye to palpation; IOP>20 mmHg
41
Q

hyperope

A

farsightedness

42
Q

myope

A

nearsightednes

43
Q

cataract, sx, tx

A
  • opacity of the lens; usually bilateral; blurred vision, sensitivity to light, faded colors, diplopia
  • senile cataract most common; may be congenital, traumatic, or secondary (DM, steroid use, uveitis); smoking increases risk
  • lens opacity seen through pupil with opthalmoscope causing retinal blurring, white or black pupil reflection
  • visual impairment indication for tx
  • tx: surgical removal of cataract and insertion of intraocular lens (phacoemulsification)
44
Q

Retinal detachment, sx, tx

A
  • retinal tear, usually spontaneous or due to trauma, may lead to detachment
  • age >50 yrs, myopia, cataract extraction
  • fluid vitreous passes through tear behind retina
  • superior temporal area most common site
  • curtain spreading across visual field or sudden unilateral visual loss; no pain or erythema
  • retina seen hanging in vitreous like gray cloud, may see tears on ophthalmoscope
  • urgent referral to ophthalmology for surgery
45
Q

vitreous hemorrhage, sx, tx

A
  • multiple causes including DM retinopathy, retinal tears, trauma, macular degeneration
  • sudden visual loss, abrupt onset floaters
  • eye is not inflamed; visual acuity varies
  • ophthalmoscopy shows clear lens but inability to see fundal details clearly
  • urgent referral to opthalmology
46
Q

macular degeneration, risk factors, sxs, types

A
  • leading cause of permanent visual loss >50 yo
  • other risks are white race, female, FHx, smoking
  • gradually progressive bilateral central vision loss; distortion or abnormal size of images
  • dry and wet classifications; both are progressive and usually bilateral
47
Q

Atrophic (dry) macular degeneration

A

-degeneration of outer retina and retina pigment epithelium; moderate severity, gradual

48
Q

exudative (wet) macular degeneration

A

-choroidal new vessel growth leads to accumulation of serous fluid, hemorrhage, fibrosis; more rapid onset, more severe

49
Q

macular degeneration PE, tx

A
  • retinal drusen seen by ophthalmoscope
  • tx includes laser therapy by ophthalmologist, various surgical techniques
  • supplements may be helpful (vitamin E, antioxidants)
50
Q

central and branch retinal vein occlusion

A
  • sudden monocular loss of vision; commonly noticed upon waking
  • no pain or redness
  • widespread or sectoral retinal hemorrhages seen by opthalmoscopy
  • all patients should be screened for DM, HTN, hyperlipidemia, glaucoma
  • all pts should be referred urgently to ophthalmology
51
Q

central and branch retinal artery occlusions

A
  • sudden profound monocular loss of vision
  • no pain or redness
  • widespread or sectoral retinal pallid swelling seen by opthalmoscopy
  • exclude temporal arteritis in patients >55yo
  • consider CV risks in all patients; evaluate carotids, cardiac sources of emboli
  • all pts should be referred urgently to ophthalmology
52
Q

Diabetic retinopathy

A
  • background retinopathy: mild retinal hemorrhages, edema, exudates, dilation of veins, microaneurysms, without visual loss
  • maculopathy: macular edema, exudates, ischemia of macula
  • proliferative retinopathy: retinal new vessels
  • leading cause of new blindness in adults aged 20-65yo; present in 40% undiagnosed DM
53
Q

hypertensive retinopathy

A
  • silver-wiring and copper-wiring due to tortuous and narrowed retinal arteries
  • AV nicking due to venous compression
  • flame shaped hemorrhages, edema, cotton-wool spots, exudates from acute elevations of BP
54
Q

Optic neuritis, sx, tx

A
  • Subacute unilateral visual loss with papilledema, flame hemorrhages, central scotoma; pain exacerbated by eye movements
  • Optic disc usually normal in acute stage but subsequently develops pallor
  • Strongly associated with MS and other demyelinating disease; also occurs with viral infections, lupus/autoimmune disorders, spread of inflammation from meninges, orbits, sinuses
  • Treatment with corticosteroids
55
Q

CN III (oculomotor) palsy

A
  • Ptosis with a divergent and slightly depressed eye
  • EOM restricted in all directions except lateral
  • If pupil involvement: dilated pupil does not react to light or accommodation
  • May be painful if aneurysm
  • Medical causes: DM, HTN, temporal arteritis
  • any time a pt has isolated CN palsy, they need an MRI of brain to see if its a tumor, etc.
56
Q

CN IV (trochlear) palsy

A
  • Upward deviation of eye with failure of depression on adduction
  • Vertical diplopia
  • Congenital lesions or trauma, neoplasm, DM, HTN, temporal arteritis
57
Q

CN VI (abducens) palsy

A
  • Convergent squint with failure of abduction
  • Horizontal diplopia
  • Sign of increased ICP; may be due to trauma, neoplasm, brainstem lesions, medical causes
  • Brain MRI for any isolated oculomotor nerve palsy
  • Myasthenia and dysthyroid eye disease should be considered in any of these cases
58
Q

Blepharitis cause

A

-may be caused by staph infection, seborrhea, rosacea, associated gland dysfunction

59
Q

Blepharitis tx

A

-tx w/ warm compress, baby shampoo, may need topical or oral antibiotic (tetracycline)

60
Q

Dacrocystitis pt c/o:

A

-pt c/o pain, swelling, redness in area of sac, may have purulent discharge from lacrimal duct, increased tearing

61
Q

dacrocystitis tx

A

-acute tx = systemic abx; eye ointment is preferred for kids and elderly

62
Q

acute conjunctivitis cause

A
  • possible causes: bacterial, viral, allergic, mechanical/chemical
  • other causes of red eye = scleritis/episcleritis, keratitis, etc.
63
Q

bacterial conjunctivitis spread

A

-spread by direct contact, highly contagious

64
Q

bacterial conjunctivitis PE/pt complaint

A

-redness, purulent discharge unilaterally; can be bilateral, purulent discharge persists throughout the day, may or may not have decreased visual acuity

65
Q

bacterial conjunctivitis tx

A

-tx: antibioitc ocular ointment or drops (erythromycin, sulfa, polymixin/trimethoprim, fluoroquinolones in contact wearers

66
Q

viral conjunctivitis spread

A

-Spread by direct contact, highly contagious

67
Q

viral conjunctivitis sxs

A
  • sxs: redness, watery/mucoid ocular discharge, morning crusting, irritation of the eyes
  • Usually becomes bilateral in 24-48 hours
68
Q

episcleritis tx

A
  • self limited, episodic
  • topical lubricants, NSAIDs, steroids
  • oral NSAIDs
69
Q

keratitis PE

A

-PE shows ocular erythema, predominantly pericorneal injection, maybe discharge

70
Q

keratitis tx

A

-prompt referral to ophthalmology is essential

71
Q

bacterial keratitis cause

A

-aggressive, most common in contact lens wearers especially with overnight wear and with corneal trauma; pathogens most commonly pseudomonas, pneumococcus, morazella, staph

72
Q

bacterial keratitis tx

A

-tx w/ fluoroquinolone plus cephalosporin or aminoglycoside

73
Q

HSV keratitis tx

A
  • topical steroid will make this worse and can cause permanent visual loss
  • acyclovir ointment, debridement if necessary
74
Q

uveitis tx

A

-Tx: steroids, dilation of pupil to relieve pain in anterior uveitis

75
Q

glaucoma tx

A
  • Topical prostaglandin analogs 1st line therapy; may combine with topical beta blockers
  • other types of medications, surgical iridotomy may be used as 2nd or 3rd line therapies; refer to ophthalmology
76
Q

acute angle closure glaucoma tx

A
  • tx: lowering IOP; permanent visual loss w/in 2-5 days if untreated
  • tx: acetazolamide 500mg IV followed by 250mg PO QID
  • tx: definitive treatment with laser iridotomy

Medicine I (5 decks)

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