Eye Disorders Flashcards
What is blepharitis? Who is it common in?
Inflammation of both eyelids
Down syndrome & eczema
What causes anterior blepharitis (skin & base of eyelids)?
- Infectious: S. aureus or S. epidermis, viruses
2. Seborrheic
What causes posterior blepharitis?
Meibomian gland dysfunction (a/w rosacea & allergic dermatitis)
What are the s/s of blepharitis?
Eye irritation/itching
Eyelid: burning, erythema, crusting, scaling, red-rimming* & eyelash flaking
+/- entropion or ectropion
How do you treat anterior blepharitis?
Eyelid hygiene, warm compresses
Azithromycin sol or ointment
How do you treat posterior blepharitis?
Eyelid hygiene, regular massage/expression of the meibomian gland
If severe, unresponsive –> systemic tetracyclines or azithromycin
What is entropion? Who is it MC in?
Eyelid & lashes turned inward
MC in elderly
What causes entropion?
May be caused by spasms of the orbicularis oculi muscle
What does entropion look like?
Eyelashes may cause corneal abrasion/ulcerations, erythema, tearing, increased sensitivity
How do you treat entropion?
Surgical correction if needed
Lubricating eye drops
What is ectropion? Who is it MC in?
Eyelid & lashes turned outward (tends to be B/L)
MC in elderly, but can be congenital, infectious, CN 7 palsy
What causes ectropion?
Relaxation of the orbicularis oculi muscle
What is a chalazion?
Painless granuloma of the internal meibomian sebaceous gland –> focal eyelid swelling
What are s/s of a chalazion?
Nontender* eyelid swelling –> rubbery nodule
How do you treat a chalazion?
Eyelid hygiene, warm compress
If large & affecting vision –> Corticosteroid inj or incision + curettage
How can you tell the difference btwn a chalazion & a hordeola?
Chalazions are larger, firmer, slower growing & less painful
What is a hordeolum (stye)?
Local abscess of the eyelid margin
Describe an external hordeolum vs internal hordeolum
External: inf of eyelash follicle or external sebaceous glands near the lid margin
Internal: inflammation/inf of the meibomian gland
What are the s/s of a hordeolum?
painful, warm, swollen red lump on eyelid
How do you treat a hordeolum?
Warm compresses +/- topical abx
+/- I&D if no spontaneous drainage after 48hrs
What is a pterygium?
Elevated, SF, fleshy, triangular “growing” fibrovascular mass
What causes a pterygium? & where is it MC?
A/w increased UV exposure in sunny climates, sand, wind, & dust
MC in inner corner/nasal side of eye & extends laterally
How do you treat a pterygium?
Obs for most +/- artificial tears
Affecting vision –> remove
What is the MC cause of permanent legal blindness & visual loss in elderly?
Macular degeneration
What are RFs for macular degeneration?
> 50
Caucasians
Females
Smokers
Describe dry (atrophic) macular degeneration
Gradual breakdown of the macula –> gradual blurring of central vision
Drusen: small, round, yellow-white spots on the outer retina (scattered, diffuse)
Describe wet (neovascular or exudative) macular degeneration
new, abnormal vessels grow under the central retina, which leak & bleed –> scarring
What are the s/s of macular degeneration?
B/L blurred or loss of central vision (including detailed & colored vision)
Scotomas, metamorphopsia, micropsia
How do you diagnose wet macular degeneration?
Fluorescein angiography
How do you treat dry macular degeneration?
Amsler grid
Zinc, Vit A/C/E
How do you treat wet macular degeneration?
Intravitreal anti-angiogenics (Bevacizumab - inhibits blood vessel growth)
Laser photocoagulation
Optical tomography
What is the MC cause of new, permanent vision loss/blindness in 25-74yo?
Diabetic retinopathy
What causes diabetic retinopathy?
maculopathy
What is diabetic retinopathy?
Blood vessel damage –> ischemia, edema
Glycosylation –> capillary breakdown
Describe nonproliferative diabetic retinopathy
Microaneurysms –> blot & dot, flame-shaped hemorrhages
Cotton wool spots, hard exudates
Not a/w vision loss
How do you treat nonproliferative diabetic retinopathy?
Panlaser
Glucose control
Describe proliferative diabetic retinopathy
Neovascularization: new, abnormal blood vessel growth, vitreous hemorrhage
How do you treat proliferative diabetic retinopathy?
VEGF inhibitors (Bevacizumab)
Laser photocoagulation
Glucose control
Describe maculopathy (type of diabetic retinopathy)
macular edema or exudates, blurred vision, central vision loss
What causes maculopathy?
macular microaneurysm leakage
How do you treat maculopathy?
Laser
What is hypertensive retinopathy?
damage to retinal blood vessels from long-standing HTN
Describe grade I of hypertensive retinopathy
Arterial narrowing, copper wiring moderate, silver wiring severe
Describe grade II of hypertensive retinopathy
AV nicking
Describe grade III of hypertensive retinopathy
Flame shaped hemorrhages, cotton wool spot
Describe grade IV of hypertensive retinopathy
Papilledema (malignant HTN)
What are s/s of a corneal abrasion?
FB sensation, tearing, red & painful
How do you diagnose a corneal abrasion?
Fluorescein staining: “ice rink” / linear abrasions
How do you treat a corneal abrasion?
If large –> patching (no longer than 24hrs)
DO NOT PATCH IN CONTACT LENS WEARERS OR PSEUDOMONAS - Place on FQ eye drops (cipro)
What is the MC cause of viral conjunctivitis?
Adenovirus
Swimming pool MC source
MC in children
What are the s/s of viral conjunctivitis?
FB sensation, erythema & itching
May be accompanied by viral sx
What does viral conjunctivitis look like on PE?
Preauricular lymphadenopathy, copious watery discharge
Often B/L
May have punctate staining on slit lamp
How do you treat viral conjunctivitis?
Supportive (cool compress, artificial tears)
+/- antihistamines (olapatadine)
What are s/s of allergic conjunctivitis?
Erythema
May have allergic sx
What does allergic conjunctivitis look like on PE?
Cobblestone mucosa to the inner/upper eyelid
Itching, tearing, redness, stringy discharge
Usually B/L +/- chemosis
How do you treat allergic conjunctivitis?
Topical antihistamines (H1 blockers): Olopatadine, pheniramine/naphazoline
Topical NSAID: ketorolac
Topical corticosteroids
What is the MC cause of bacterial conjunctivitis?
S. aureus, Strep penumo
What are s/s of bacterial conjunctivitis?
Purulent discharge, lid crusting
How do you treat bacterial conjunctivitis?
Topical erythromycin, FQ, sulfas, aminoglycosides
If contact wearer –> cover pseudomonas w/ FQ or aminoglycoside
What causes orbital cellulitis?
Secondary to sinus infections (ethmoid 90%)
S. aureus, S. pneumo, GABHS, H. flu
May be caused by dental/facial inf or bacteremia
What are s/s of orbital cellulitis?
Decreased vision, pain w/ ocular movement, proptosis
How do you diagnose orbital cellulitis?
High resolution CT/MRI
How do you treat orbital cellulitis?
IV vanco, clinda, cefotaxime, ampicillin, amox
What is the cause of iritis?
Systemic inflammatory disease: a/w HLA-B27 spondyloarthropathies, sarcoid, Behcet’s
Infectious: CMV, toxoplasmosis, syphilis, TB
Trauma
What are s/s of anterior iritis?
unilateral ocular pain/redness/photophobia
Excessive tearing
Usually occurs after blunt trauma
What are s/s of posterior iritis?
blurred/decreased vision, floaters
What does iritis look like on PE?
Ciliary injection (limbic flush), consensual photophobia
Inflammatory cells & flare within the aqueous humor
How do you treat anterior iritis?
Topical steroids, scopolamine, topical cycloplegics
How do you treat posterior iritis?
system corticosteroids
What do cataracts look like on PE?
absent red reflex, opaque lens
What causes retinal artery occlusion?
MC 50-80y w/ atherosclerotic disease
What are the s/s of retinal artery occlusion?
Acute, sudden monocular vision loss
Often preceded by amaurosis fugax
How do you diagnose retinal artery occlusion?
Funduscopy:
- Pale retina w/ cherry-red macula
- Box car appearance of retinal vessels
How do you treat retinal artery occlusion?
Decrease IOP (acetazolamide)
Revascularization (orbital massage to dislodge clot)
What are the s/s of acute angle closure glaucoma?
severe, sudden onset of unilateral ocular pain
+/- N/V, HA
Vision changes: halo around lights, peripheral vision loss
What does acute angle closure glaucoma look like on PE?
Erythema, “steamy” cornea
Mid-dilated, fixed, nonreactive pupil, eye feels hard to palpation
How do you diagnose acute angle closure glaucoma?
Increased IOP by tonometry
“Cupping” of optic nerve on funduscopy
How do you treat acute angle closure glaucoma?
- Acetazolamide = 1st line (decreases aqueous humor production)
- Topical BB (Timolol)
- Miotics/cholinergics (pilocarpine, carbachol)
- Alpha 2 agonists
- Peripheral iridotomy = definitive tx
AVOID ANTICHOLINERGICS, SYMPATHOMIMETICS
What are the s/s of chronic open angle glaucoma?
Gradual B/L painless peripheral vision loss
What does chronic open angle glaucoma look like on PE?
Cupping of optic discs
How do you treat chronic open angle glaucoma?
Prostaglandin analogs 1st line (Lantanoprost)
BB, alpha2agonists, acetazolamide
Laser
Surgery = last line
How do you diagnose a foreign body or corneal abrasion?
Pain relieved w/ analgesic drops
Fluorescein staining: corneal abrasion = “ice rink”/linear abrasions
How do you treat an ocular foreign body?
Check visual acuity 1st
Remove w/ sterile irrigation or moistened sterile cotton swab
Abx drops (topical erythromycin, polymyxin/trimethoprim, sulfacetamide, cipro)
24hr ophtho follow up
