Eye Disorders II Flashcards
Corneal Abrasion
Refers to a cut on the cornea of the eye.
- Abrasions can occur through all sorts of ways.
- Some examples:
- Trimming a bush and a piece of the bush goes into the eye.
- Mascara brushes that go to close to the cornea and cause a cut.
- Severe dry eyes. - rips open
- Accidental name tags into the eye.
Presentation/Symptoms
- Eye redness
- Sudden, sharp eye pain
- Watery eye
- Sometimes light sensitivity (depending on how large the cut is)
everytime you blimk, it opens the cuut
Management: Pharmacological Treatment
will heal in 72 hours
other ways to manage
• Topical (Ophthalmic) Antibiotics
• Polymyxin B (Polysporin), Tobramycin, Moxifloxacin (Vigamox)
• Combination Ophthalmic Antibiotic and Corticosteroid
• Tobradex - may heal slower, pt will feel better
• Dose: Generally 4x/day
• Adverse Effects: Based on agent used, but range from well
tolerated to blurry vision/irritation
• Length of Therapy: 5-7 days
• Artificial tears can be included to help with comfort.
• Sometimes if the cut is severe enough, an optometrist canvput on a temporary bandage contact that will help cover thebcut and reduce pain.
• The cornea will heal and regenerate in 48-72 hours
contact lens - need to return to office and replace
Subconjunctival Hemorrhage
Pathophysiology
• This type of hemorrhage occurs because conjunctival blood vessel burst due to things including: • Heavy lifting • Coughing/sneezing hard • Trauma/injury • Certain medications can increase the risk of this condition (Eg. Anticoagulants)
self limiting, like a bruise
not noticed until ontices
Presentation/Symptoms
Subconjunctival Hemorrhage
- No pain
- No discharge
- No light sensitivity/ FB sensation
- Did not notice until someone pointed it out.
- Treatment/Management:
- Artificial tears (Optional)
- Self-limiting, resolves in roughly 2 weeks.
Uveitis
pathophys
•Refers to inflammation of the Uvea: the iris, ciliary
body, and choroid
pigmented structs of eye (iris, ciliary body,extend behind reitna - choroid)
all of those pts can be inflamed
anterior vs posterior uveitis
• The inflammation process occurs in the Uvea which is triggered
generally by an underlying systemic inflammatory condition or
infection.
• Examples include: Rheumatoid Arthritis, Herpes Simplex, Syphilis
• Can also be idiopathic in nature
anterior uveitis presentation/symptoms
- Eye Redness
- Blurry Vision
- Extreme photophobia and painful. - light is painful, need sunglassess
- Watery eyes when they look at light.
Anterior Uveitis: Pharmacologic Treatment
- Topical corticosteroid
• Prednisiolone (Pred Forte) 1% suspension: q1h
• Pred Forte vs generic prednisone 1% - NOT THE SAME (no generic sub, smaller particle size and gets better faster, bioavailability)
• Pred Forte has smaller particle sizes vs generic formulation.
• Mechanism of Action:
• Inhibits inflammation pathways
• Treats the inflammation associated with the disease.
• Adverse Effects: Blurry vision, irritation
• Duration of Therapy: Until uveitis resolves, taper med - PLUS one of the following mydriatics:
• Atropine 1% drops
• Cyclopentolate (Cyclogyl) 1% drops
• Mechanism of Action:
• Blocks response of sphincter muscle and relaxes ciliary body.
• Addresses pain associated with constrictions and dilation.
stop movement of inflamed area so pt feel better, faster healing
• Adverse Effects: Blurred vision or irritation.
• Duration of Therapy: until certain signs resolve.
Bumps on Lids:
Hordeolums vs. Chalazions
•Hordeolum:
• An infection of a gland in the eyelid causing inflammation.
• Causes can include poor lid hygiene or not using clean
make up brushes.
• Can be classified into internal or external.
• A stye is one type of hordeolum
•Chalazion:
• Blockage of a meibomian gland which does not allow oil
to be secreted. This oil then hardens overtime.
not infected, no pain
Symptoms/Presentation
Hordeolums vs. Chalazions
- Hordeolum/stye
- Bump on the eyelid that is tender to touch or sore
- The eyelid can look swollen.
- Depending on the infection, discharge can be seen.
- Chalazion
- Bump on the eyelid that is hard and not tender to touch.
- Generally no discharge
Non-Pharmacologic Treatment: Hordeolum
• Lid hygiene: Using lid scrubs is the most
effective approach for treatment.
• Examples:
• Lid-Care, a gentle eyelid towelette cleanses
• Systane lid wipes
• Warm Compress: Can help with clearing out
the blockage.
• Note: Good for prevention as well, managing
the bacteria on the eyelid reduces the risk of
future infection
Non-Pharmacologic Treatment: Chalazion
Warm Compress: Addresses the block by “melting”
away that harden oil that has blocked the gland.
Pharmacologic Treatment: Hordeolum Only
- Oral Antibiotics with gram positive bacteria coverage.
- Oral formulations because topicals won’t penetrate soft tissue.
- Examples and Dosages:
- Cephalexin 500mg BID
- Amoxicillin 500mg TID
- Azithromycin 500mg stat, 250mg QD x 4days
- Adverse Effects: Stomach upset, Diarrhea
- Duration of Therapy: 5-10 days
Pharmacologic Treatment: Chalazion
none
Government Coverage by Alberta Health
Care
- Annual comprehensive eye exams are covered for:
- Children under age 19
- Seniors age 65 and older
- Medically necessary eye visits for everyone: covered for any age
- Removing foreign bodies in eye
- Sudden changes in vision: floaters, spots, flashes of light
- Acute eye pain/ itchy eyes
- Eye infections, injuries
- ** Yearly retinal examination for all diabetics ***
- Pre/post operation care for cataract patients
- Monitor glaucoma, retinal disease
Accessibility for Ocular Emergencies
•Why it is better to visit a optometry clinic vs going
to the emergency room (ER).
• Same day appointments vs wait time at the ER.
• Better equipment to assess structures of the eye.
• More clinics around the city vs ER
assess: Start with the big red flags: Light sensitivity and eye pain.
• 34 year old female asks you where the polysporin drops are as she
thinks her son has pink eye. Before showing her where the drops are,
what questions could you ask?
- Does he have any discharge?
- If no -> Points you away from bacterial conjunctivitis (common in children), viral (artificial tears)
- If yes -> Could you describe the discharge -> Watery vs yellow discharge
- Does he have any other symptoms?
- Itchy -> Dry eyes, allergic conjunctivitis
• 45 year old male asks you where the artificial tears as his eyes are irritated.
Before showing him where the drops are, what questions could you ask?
- Could you describe what irritation means?
- If he says their itchy -> Could possibly be dry eye or allergic conjunctivitis
- If he says their sensitive to light (photophobia) -> Could be uveitis aka refer
- If he says they feel like something is in his eye -> Could be dry eye or keratitis
- If he says they hurt –> Keratitis or uveitis or a corneal abrasion aka refer
- If its dry eyes, as you show him the drops certain factors are going to point
you towards a recommendation - If he cares about cost he might be looking at Visine (decongestant but not lubricant) but that’s not good.
- If he’s using a lot of eye drops already (think 4x or more per day) then maybe he
could consider preservative free drops.
