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PANCE HEENT (7%) > Eye Disorders > Flashcards

Eye Disorders Flashcards

1
Q

Blepharitis

A
  • chronic lid inflammation
  • Staph/Strept, seborrhea, meibomian gland dysfxn
  • scurf (flake) & collarettes (fibrous), clear conjunctiva, thick/cloudy d/c if meibomian eti, lids can adhere
  • gentle shampoo, warm compress, massage, abx if inf
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2
Q

Blowout fx

A
  • MC orbital fx
  • anesthesia of infraorbital area, diplopia
  • assess VA, EOM (dec upward gaze), XR (teardrop sign: fat into max sinus - open bomb-bay door sign: bone frags in sinus)
  • CT if abnml XR
  • ophtho ref, surg repair if persistent diplopia or en/exophthalmos, abx ppx if sinus involved
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3
Q

Cataracts

A
  • opacification of lens
  • gradual loss of vision +/- double vis, blurry, glares, dec vision in bright/night; typically bilateral
  • Age, steroid/statins, DM, trauma
  • surgery (once mature, can’t see retina on fundoscopy)
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4
Q

Chalazion

A
  • chronic inflam, painless, deep from palpebral margin

- warm compress, ophtho ref for surg/steroid inj if refract

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5
Q

Hordeolum

A
  • acute onset, edema, pain, deep from palpebral margin
  • S. aureus, not contagious
  • internal (meibomian) or external (glands of Moll/Zeis adj to edge of palpebral margin)
  • warm compress x 48 hrs then I&D if no improvement, abx if 2ndary infection
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6
Q

Viral conjunctivitis

A
  • acute, unilateral, watery d/c, highly contagious (adenovirus = MC), midsummer-early fall, tender preauricular LAD
  • lavage, vasoconstrictor/antihist for sx relief, warm/cool compress
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7
Q

Bacterial conjunctivitis

A
  • common: strept pneumoniae, s. aureus, haemophilus aegyptius, moraxella
  • rare: gonorrheae (copious d/c, unilateral) and chlamydia (mucopurulent d/c, nontender preauricular LAD) - both via sex, vag delivery, risk of permanent visual impairment, may need sys abx
  • d/c throughout day, cx if sev
  • abx (erythro oint, sulfacetamide drops, FQ drops if contacts (pseudomonas): drops > oint
  • if no resp in 2 days, or need steroids, ophtho ref
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8
Q

Hyphema

A
  • blood in anterior chamber s/p trauma
  • vision loss, pain, N/V, photophobia, elevated IOP
  • emergent ophtho ref if blood dyscrasia, sickle, open globe
  • orbital CT to r/o open globe
  • severity grade 1-4 (< 33% - 100% filled)
  • eye shield/reading restrict x 1wk/til resolved, elevate head (ppx blood settling), sx control +/- steroids, surg if > 10 days/diff control IOP
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9
Q

Dacryoadenitis

A
  • inflam/inf of lacrimal gland
  • autoimmune or thyroid dz, orbital pseudotumor
  • pain, tearing, d/c, preauricular LAD
  • warm compress, massage, ophtho ref if no improvement
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10
Q

Dacryocystitis

A
  • inf w/in lacrimal drain sys bc of obstruction
  • EBV, mumps, staph, gonorrhea, candida
  • upper lid swelling, red, warm
  • emergent ophtho ref + clinda/vanc for MRSA, think CA if refractory
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11
Q

Dacryostenosis

A
  • common after 1 month old, duct not open, resolved by 9 mos
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12
Q

Entropion

A
  • eyelid folds in
  • genetic, congenital, inf (chlamydia), aging, scarring
  • wind sensitive, dec VA, red/pain, photophobia
  • surg repair to ppx permanent corneal damage
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13
Q

Ectropion

A
  • aging/tissue weak, allergic, facial nerve palsy, chemo tx, congenital
  • sagging lid, dull light reflex, irritation
  • surgical repair
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14
Q

Corneal abrasion

A
  • trauma, FB, contact lens
  • severe pain, FB sensation, photophobia, tearing, blurred vision, HA, blepharospasm, conjunctival injection
  • r/o FB, HSV keratitis w/ fluorescein stain w/ UV light
  • irrigate, pain control, pressure patch (NOT > 24 hrs), NO steroids
  • ophtho ref if corneal infiltrate/opacity
  • most heal w/in 24-72 hrs
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15
Q

Corneal ulcer

A
  • inf/inflam corneal abrasion
  • dendritic lesion = herpes keratitis
  • concerned in contact wearers
  • ophtho ref, stain/cx
  • no topical steroids (inc risk of perforation/tissue loss
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16
Q

FB

A
  • surface vs intraocular (blurred vision, discomfort)
  • VA test, look for FB, fluorescein stain, CT/XR
  • ophtho ref for intraocular, remove, metal w/ rust ring resorb (do NOT remove), erythro oint & patch s/p removal
  • fu w/ ophtho in 48 hrs
  • if chem burn: irrigate x 30 min then ED/ophtho
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17
Q

macular degeneration

A
  • damage to retina = IRREVERSIBLE, gradual, central vision loss
  • non-exudative (dry): drusen bodies (loss of cones = 90% of cases)
  • exudative (wet): blood vessels grow from choroid behind retina
  • RF: age, genetics, smoking, HTN, meds (chloroquine)
  • mgmt: zinc, copper, carotene vit supp, laser/surg extractions, antiangiogenesis tx (bevacizumab): most tx not very effective
18
Q

pinguecula

A
  • RF: chronic actinic (sun) exp, rpt’d trauma, dry/wind
  • elevated, fleshy conjunctival mass on sclera adj to cornia, nasal side (can become inflam’d)
  • surg resect if irritated
19
Q

pterygium

A
  • slow growing/thickening of bulbar conjunctiva, uni/bilat
  • highly vascular, triangular mass from nasal toward cornea, CAN interfere w/ vision
  • RF: UV exp, abnml angiogenesis, HPV
  • excision recurrence is common, can be more aggressive
20
Q

nystagmus

A
  • reg/rhythmic oscillation of eye
  • vertigo, oscillopsia, abnml head position, blurred vision
  • jerk nystagmus: imbalance in semicircular canals from periph vestibular dz
  • pendular nystagmus: slow/sinusoidal oscillations, acquired/congenital
  • ddx: Li/antisz, EtOH, brainstem stroke, thiamine/Mg def, chiari, encephalitis, demyelinating dz
  • tx cz/if sx, baclofen for periodic alternating, gabapentin for pendular, botox inj, prism contact lens/glasses, surg correction of EOM
21
Q

glaucoma ppx eye exam sched

A

Black:

  • 20-40: q 2-4 yrs
  • 40-54: q 1-3 yrs
  • 55+: q 1-2 yrs

White:

  • 40-54: q 2-4 yrs
  • 55-64: q 1-3 yrs
  • 65+: q 1-2 yrs
22
Q

Closed/Narrow/Acute Angle Glaucoma

A
  • malformed iris & trabecular network = fluid build up BEHIND lens (inc IOP + optic nerve damage)
  • asians/elderly
  • sx MC s/p dark exp or anticholinergic use, pain, halos around lights, h/o recent eye surg/uveitis, prev blurred vision episodes, N/V, nonreactive pupil, hazy cornea, inc optic cup:disc
  • acetazolamide + timolol, apraclonidine, pilocarpine
  • emergent ophtho ref, monitor IOP
23
Q

Open/Wide Angle Glaucoma

A
  • MC glaucoma, black 40+ or others 65+: screen w/ visual field confrontation (inc IOP + optic nerve damage)
  • fluid build up IN FRONT of lens from clogged drains (canal of Schlemm)
  • bilateral, colored halos around lights, progressive peripheral vision loss, asx til severe loss, pupil dilation, inc optic cup:disc
  • reg exercise to reduce IOP, inc outflow w/ intraocular prostaglandin analogs (latanoprost), suppress prod w/ intraocular BB (timolol)
24
Q

Optic neuritis

A
  • acute inflam demyelinating inj to optic nerve
  • painful, monocular visual loss x several hrs/days, +/- papillitis on fundoscopy
  • chronic: afferent pupillary defect, color desaturation, optic atrophy
  • ddx: ischemia, inf (meningitis, syphilis, lyme), inflam (sarcoid, CA, SLE), compression (pseudotumor cerebri), tox/met (drugs, nutritional def, radiation), trauma
  • MR brain/orbits w/ contrast
  • IV methylprednisone if sev vision loss of 2+ white matter lesions on MR (PO = no benefit), interferon if MR suggest MS (may delay)
  • prog: visual recovery in few wks, 30% develop MS w/in 5 yrs
25
Q

Orbital cellulitis

A
  • MC in peds s/p untx’d sinusistis/trauma
  • Strep pneumo, H. flu, S. aureus
  • proptosis (exopthalmos)/chemosis (conj swell), edema, hyperemia, pain, limited EOM, reduced vision
  • CT/MR
  • Admit for IV abx (amox, naficillin, metro/clinda, or ceftriaxone + vanc for severe)
26
Q

papilledema

A
  • optic disc swell from ICP (malignant HTN, hemorrhagic stroke, subdural hematoma)
  • bilat, HA, N/V, diplopia, pulsatile machine-like sound in ear, intermittent/brief visual sx
  • ddx: mass, cerebral edema, inc CSF prod/dec absorption, obstructive hydrocephalus, pseudotumor cerebri
  • fundoscopy (disc swollen, blurred margins), VA, brain MR, LP
27
Q

Retinal detachment

A
  • RF: myopia (near-sighted), trauma, FHx, cataract surg, DM retinopathy
  • sudden, painless, vision loss (“curtain”), flashes/floaters, defect in confrontational visual fields
  • emergent ophtho consult & surg repair
  • complete vision loss w/o surg, 80% recover w/o recur
28
Q

DM Retinopathy

A
  • leading cz of blindness in US
  • T1 & T2, not gestational
  • dilated ophth exam q yr
  • nonproliferative: venous dilation, microaneurysms, retinal hemorhages/edema, hard exudates (lipid), soft exudates (cotton wool spots)
  • proliferative: neovac, vitreous hemorrhage
  • tx: glucose control, reg BP, laser photocoag, vitrectomy
  • sev dz = permanent
29
Q

Central retinal artery occlusion

A
  • MC from embolus, can be thrombus/vasculitis
  • RF: Afib, endocarditis, coagulopathies, CAD, hypercoag states, temporal arteritis (F, HA, scalp pain, jaw claud)
  • painless/sev vision loss, unilateral
  • fundoscopy: cherry red spot (perifoveal atrophy), splinter hems, ground-glass retina, pallor, edema, box-carring (separation of arterial flow)
  • CV exam for bruits/temp arteritis, carotid US, EKG (dx/tx atherosclerotic dz to prev recurrence)
  • emergent ophtho ref, lower IOP, antiplts, poor prog (no tx improves vision)
30
Q

Central retinal vein occlusion

A
  • RF: HTN, DM, HLD, mech compression, glaucoma, inflam of optic nerve, orbital dz, hyperviscosity d/o
  • painless, unilateral vision loss, “blood and thunder” retina (dilated veins, hemorrhages, edema, exudates)
  • tx underlying d/o, ASA, laser ischemic retina, tx assoc glaucoma/macular edema
  • better prog (tx neovasc w/ VEGF inhibs: bevacizumab)
31
Q

Strabismus (Tropia)

A
  • lack of binocular fixation: esotropia (inward), exotropia (outward)
  • can be uni/bilateral, nml until 4 mos old (ophtho ref)
  • congenital: nerve palsy, prenatal drug exp, pseudostrab
  • acq’d: GBS, botulsim, myasthenia gravis, MS, thyrotoxicosis, DM, inf
  • cover/uncover test, corneal light reflex (misalignment)
  • tx: exercises/patch, surgery if severe
  • can develop amblyopia/diplopia if untx’d after 2 y.o.
  • psudostrabismus: eyes appear misaligned, but light reflex nml/symmetric
32
Q

Uveitis (Iritis)

A
  • inflam & leukocyte infiltration of iris, ciliary body, and/or choroid and vitreous humor
  • infectious: CMV, syphilis, HSV, cat scratch dz, toxoplasma
  • immune: spondyloarthropathies, IBD, sarcoidosis, MS
  • s/s: anterior chamber (pain, red) vs posterior chamber (painless floaters, vision loss)
  • wu: slit lamp, fundoscopy
  • tx: ophtho consult, tx inf, +/- steroids
33
Q

Globe rupture

A
  • do NOT palpate, apply pressure, use drops, or remove object
  • VA via Snellen chart, IOP via Schiotz tonometer
  • hospital for eval/tx
34
Q

Amaurosis fugax

A
  • painless temporary loss of vision in one or both eyes from occlusion or stenosis of the internal carotid artery (clot, vasospasm, plasma viscosity: MM, leukemia)
  • RF: 50+ y.o, HTN, HLD, smoking, h/o TIA
  • tx: lower BP, ASA/coumadin, surg (carotid endarterectomy), ppx stroke (high risk)
35
Q

Scleritis

A
  • uni/bilateral, +/- visual impairment
  • inf, inflam, s/p surg (pterygium)
  • 50% autoimmune
36
Q

HTN Retinopathy

A
  • greater risk if acute/accelerated HTN
  • arteriolar narrowing, copper/silver wiring, AV nicking (atherosclerosis)
  • control BP, sev dz = permanent
37
Q

Burred vision/decreased VA lesions location/sx

A
  • anterior to optic chiasm = one eye
  • at optic chiasm = parial, bilateral
  • posterior to optic chiasm = same side deficit
38
Q

Transient vs sudden vs gradual vision loss dds

A
  • transient: TIA, emboli (amaurosis fugax), temp arteritis
  • sudden: vascular occlusion, optic neuropathy, papillitis, retrobulbar neuritis
  • gradual: mac degen, tumors, cataracts, glaucoma
39
Q

Blue/cyanotic sclera in infants = ___

A

osteogenesis imperfecta (“brittle bone dz”)

40
Q

Amblyopia

A
  • reduced VA that is NOT correctable

- MC by strabismus (can be uremia, toxins, EtOH, tobacco, lead)

PANCE HEENT (7%) (5 decks)

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