Eye Disorders Blueprint Flashcards
Lid margin ulcers
Painful dry scales
Blepharitis
Staph/infx
Lid margin; No ulcers
Pruritic greasy scales
Blepharitis
Seborrheic/inflamm
Black eye
Pain, diplopia, dec EOM
Incarcerated muscle or nerve
Blowout fracture
orbital floor/wall
Dx/Tx of Blowout fx
CT
Urgent consult
Abx, Tetanus
Tx Blepharitis
Difficult (recurrent, chronic, resistant to tx)
Warm compress
Abx (Staph); Steroid (Seborr)
Ophthalmo PE order
Visual Acuity Color Vision Visual Fields PERRLA EOMI Anterior Chamber External Lids
Opthalmo Tools
Penlight (swinging, near reflex) Ophthalmoscope (red reflex, post chamber) Slit Lamp (outer eye, ant chamber) Tonometer (IOP; nml < 22) Amsler Grid (macular degen)
Transient vision loss
TIA
Migraine
Acute vision loss
usually emergent
Trauma Retinal Artery Occlusion Retinal Vein Occlusion Retinal Detachment Angle Closure Glaucoma Temporal Arteritis Hyphema Cavernous Sinus Thrombosis
Chronic reversible vision loss
Cataract
Refractive Error
Corneal Dystrophy
Chronic irreversible vision loss
Macular Degeneration (Age-related)
Glaucoma
DM Retinopathy
Benign “red eye”
FB Corneal abrasion Subconjunctival Hem Conjunctivitis Episcleritis/Scleritis
Pathologic “red eye”
Uveitis Angle Closure Glaucoma Hyphema Infxn Cellulitis Herpetic Infxn
Exophthalmos
Bilateral protrusion:
Grave’s dz
Proptosis
Unilateral protrusion: Orbital cellulitis Tumor Hemorrhage Cavernous Sinus Thrombosis
Older person Recent sinus or dental infxn fever painful/injected eye; swollen shut decreased vision proptosis Marcus Gunn pupil CT: fluid collection/stranding
Orbital cellulitis (emergent) or retro-orbital cellulitis
Blood cx
IV abx: Ceftriax, Vanco
Admit surg
Younger person Superficial trauma Red, hot, swollen (cellulitis of) lid Normal vision No proptosis or Marcus Gunn pupil
Preseptal cellulitis
Warm compress
Augmentin
Young person Inflamed nasolacrimal sac 2/2 infxn or obstruct of nasolacrimal duct medial canthus Pain, swelling, redness Tearing, crusting, ? pus
Dacryocystitis
Staph, Strep, Pseudo
Tx: Dacryocystitis
Warm compress
Nasal decongestant
Oral abx
Adult Infxn/inflamm of lacrimal glands Red, tearing, FB sens Acute = pain swelling upper/outer lid Chronic = painless enlargement of upper lid
Dacryoadenitis
Acute = viral (mumps, EBV) or bacterial (Staph, gonn) Chronic = Sarcoid, TB, granulation, lymphoma
Tx: Dacryoadenitis
Warm compress
NSAIDs
Bx (chronic)
Acute infection lid margin (intern./extern.)
Pustule; not entire eyelid
Red, painful
Staph
Hordeolum (Stye)
Chronic inflammation
Lipo-Granulomatous Cyst
Not red or painful
Usually points inside the lid / upper lid
Chalazion
Chronic inflammation/infxn of lid margin
Ulcers / Dry scales / Painful =
No ulcers / Greasy scales / Pruritic =
Blepharitis
= Staph (Tx: abx)
= Seborrheic (Tx: steroids)
Yellow / White deposit on conjunctiva
Round, non-vascular, benign
Nasal or temporal
Pinguecula
Semitransparent / Opaque lesion
Triangular, Vascular, benign
Nasal side
Ptyrigium
Bilateral infection
Pruritic, watery
Other allergic conditions
Allergic conjunctivitis
Unilat or Bilat infxn
Burning
URI
Pre-auricular node
Viral conjunctivitis
Unilateral infxn
Painful, Purulent, Crusting over
Bacterial conjunctivitis
Immune rxn to contact lens abuse
Giant Papillary conjunctiviits
Rust ring
Corneal clouding
FB
Pain, Injection, Photophobia, FB sensation,
+ fluorescein uptake
Corneal abrasion
Pain, Injection, Photophobia, dec. acuity,
+ pooling of fluorescein
Contact lens abuse / Pseudomonas infxn
Corneal ulceration
Quinolones
MC reversible blindness
Opacity of lens
Progressive, painless, worse at night, halos
Cataracts
Sudden onset vision loss, unilateral Painless, RAPD (Marcus Gunn) Assoc c Afib, carotid dz, temporal arteritis Cherry red spot on pale macula Preceded by amaurosis fugax
Central retinal artery occlusion
Blurry vision on waking, unilateral
Progresses to complete blindness over hours
Assoc c DM
Blood & Thunder; Cotton wool spots
Central retinal vein occlusion
Sudden onset visual loss (curtain)
Flashes / Floaters
Scleral buckle / retinal fold
IOP dec (<10)
Retinal detachment
#1 cause irreversible blindness (bilat) Central vision loss / periph sparing Dry = Drusen (pale yellow deposits) Wet = Neovascularization
Macular Degeneration (Age-related)
Daily Amsler grid
Scotoma (black and white distortion)
& straight line distortion
1 cause of irreversible blindness < 65 yr
Worse with hyperglycemia
Non-proliferative (Dry) = hard exudates &
cotton wool spots
Proliferative (Wet) = Neovascularization
Diabetic retinopathy
Assoc c Central retinal v. occlusion
MC HTN ocular manifestation
Acute = HTN emerg, Cotton wool spots,
optic disc edema, end organ damage
Chronic = AV nicking, Copper & Silver wiring
HTN retinopathy
Tx: aggressive BP control
MC cause of blindness in AA
Fm Hx, insidious onset, inc IOP
Increased cup/disc ratio (> 0.5)
Periph vision loss (late finding)
Open Angle Glaucoma
Tx: dec IOP (BB, PG analogue)
Congen. shallow ant chamber (crescent shadow); sudden increase IOP (> 40)
Sudden, severe, unilat pain, blurry, N/V
Fixed mid-dilated pupil, cloudy cornea
Older female in dark environment
Angle Closure Glaucoma
Tx: Anhydrase inhibitors, BB
Ocular misalignment
May lead to amblyopia
Heterotropia (manifest deviation)
Heterophoria (latent deviation)
Strabismus
Tx: patching works
Misalignment of light reflex =
Bad eye fixates when cover good eye =
Heterotropia
= Hirschberg
= Cover test
Evident with eye strain only
Normal Hirschberg
Cover bad eye causes deviation
Heterophoria
= Cover/uncover test
Brain suppresses info from bad eye
(blurry or conflicting info)
Strabismus, refractive error, deprivation
(black reflex = congen. cataract)
(white reflex = leukocoria; retinoblastoma)
Amblyopia
Tx: Patching, Glasses, Surgery
Blood in anterior chamber
Blunt trauma
Must sleep in sitting position, eye shield
Hyphema
Pain, swelling, black eye
Diplopia or dec EOM (? entrapment)
Nml acuity and pupil size
Fracture of orbital floor / wall
Blow out Fracture
Get CT scan!!!
Urgent surgical consult
Prophylactic abx & tetanus
“Young female” c rapid progressive unilat central vision loss & color vision loss
Pain c eye movement; Optic disc edema
RAPD (Marcus Gunn pupil)
Assoc c MS
Optic neuritis
Tx: IV corticosteroids
Increased ICP
Disc edema, retinal hemorrhage
Late visual loss
HA, N/V, focal neuro deficit
Papilledema
Non-contrast CT
