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Clinical Medicine > Eye Disorders - Jones Lecture 5 > Flashcards

Eye Disorders - Jones Lecture 5 Flashcards

1
Q

conjunctivitis

A
  • red eye

- benign & self-limited

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2
Q

what must contact lens wearers be careful?

A

high risk of pseudomonas keratitis

  • can be sight threatening
  • will see corneal opacity
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3
Q

what is the conjunctiva?

A

thin tissue that lines the insides of the lid and on top of the globe
-generally transparent but in conjunctivitis it is red

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4
Q

conjunctivitis red flags

A
  • Reduction of visual acuity
  • Ciliary flush (red rings around cornea)
  • Photophobia
  • Severe foreign body sensation (trouble opening eye or keeping eye open)
  • Corneal opacity
  • Fixed pupil (associated with glaucoma)
  • Severe headache with nausea (associated with glaucoma)
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5
Q

who is bacterial conjunctivitis common in?

A

children

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6
Q

how is bacterial conjunctivitis spread?

A

direct contact

-highly contagious

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7
Q

pathogens of bacterial conjunctivitis

A
  • S. aureus (more common in adults)
  • S. pneumoniae (more common in kids)
  • H. influenza (more common in kids)
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8
Q

bacterial conjunctivitis clinical manifestations

A
  • red eye (unilateral)
  • green, yellow, white discharge
  • eye stuck shut
  • itchy
  • feels gritty
  • dry crust on lid margins and corner of eye
  • purulent discharge
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9
Q

what tests do you do on every complaint?

A

fluorescein and funduscopy

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10
Q

bacterial conjunctivitis management

A
  • Erythromycin ophthalmic ointment

- Trimethoprim-polymyxin drops

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11
Q

alternative txts for bacterial conjunctivitis

A
  • Bacitracin ointment
  • Sulfacetamide ointment
  • Fluoroquinolone drops good in contact wears (Cipro drops and Ofloxacin drops)
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12
Q

pathogen for viral conjunctivitis?

A

adenovirus

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13
Q

is there a prodrome for viral conjunctivitis?

A

yes, viral prodrome

-sore throat, fever, LAD, pharyngitis

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14
Q

is viral conjunctivitis contagious?

A

yes, VERY contagious

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15
Q

how is viral conjunctivitis spread?

A

direct contact

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16
Q

viral conjunctivitis clinical manifestations

A
  • mucoserous or watery discharge
  • burning
  • bilateral in 24-48 hours
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17
Q

what test is now available for viral conjunctivitis?

A

New rapid (10 min) test for adenovirus

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18
Q

viral conjuncitivitis management

A
  • Self-limited
  • Warm or cool compresses
  • Gets worse in first 3-5 days
  • Gradual resolution
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19
Q

differences in viral & bacterial conjunctivitis

A

viral is bilateral ands mumcoserous/watery discharge

bacterial is unilateral and has purulent discharge

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20
Q

allergic conjunctivitis caused by?

A

airborne allergens that come in contact with the eye

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21
Q

what is the pathophysiology of allergic conjunctivitis?

A

IgE will cause local mast cell degranulation and release of histamine

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22
Q

what is pts hx usually for allergic conjunctivitis?

A

atopy, seasonal allergies

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23
Q

what must you look out for in allergic conjunctivitis?

A

corneal abrasion b/c allergic conjunctivitis is very itchy that pts want to “dig their eyes out”

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24
Q

allergic conjunctivitis clinical manifestations

A
  • bilateral itching w/burning
  • morning crusting
  • marked chemosis (swollen conjunctiva)
  • ALLERGIC SHINERS (infra-orbital edema)
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25
Q

allergic conjunctivitis management

A
  • remove offending agent
  • wear sunglasses
  • change filters
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26
Q

allergic conjunctivitis antihistamine/vasoconstrictor combo

A

Naphazoline/pheneramine (Naphcon-A) - EYE DROPS

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27
Q

allergic conjunctivitis antihistamines w/mass cell stabilizer

A

olapatadine (patanol) -> eye drops

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28
Q

allergic conjunctivitis mast cell stabilizers

A

cromolyn sodium (Optocrom) -> eye drops

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29
Q

allergic conjunctivitis glucocorticoids

A

Loteprednol (Lotemax) - eye drops
-use carefully b/c can raise IOP and cause glaucoma

UP TO 2 WEEKS ONLY!!!

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30
Q

traumatic conjunctivitis due to & txt?

A

foreign body
-common in woodworkers, landscapers

txt: removal

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31
Q

toxic conjunctivitis

A

due to smoke, liquid, fumes, chemicals (alkali and acidic burns)

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32
Q

what must you test for toxic conjunctivitis caused by acid or alkali?

A

pH of eye

-normal is 7.0

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33
Q

pathophysiology of acid burns in toxic conjunctivitis

A
  • Dissociate into hydrogen ions in the cornea
  • Hydrogen damages the ocular surface by altering the pH
  • Produces protein coagulation which prevents deeper penetration of the acids into the eye
  • Hydrofluoric acid acts as an alkali
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34
Q

common acids in toxic conjunctivitis

A
  • Battery acids – sulfuric acid
  • Bleach – sulfurous acid
  • Glass polish – hydrofluoric acid
  • Vinegar – acetic acid
  • Hydrochloric acid
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35
Q

pathophysiology of alkali burns in toxic conjunctivitis

A
  • alkali burns are worse than acid burns
  • dissociate into hydroxyl ion
  • liquefies the fatty acid of a cell membrane
  • can penetrate the cell membrane (penetrate globe of eye)
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36
Q

why are alkali burns so bad?

A

can penetrate into globe of the eye

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37
Q

common alkali in toxic conjunctivitis

A
  • Ammonia – cleaning products, fertilizer
  • Lye-drain cleaners
  • Lime – plaster, mortar
  • Airbag rupture – sodium hydroxide
  • Fireworks – magnesium hydroxide
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38
Q

management of toxic conjunctivitis

A
  • Tetracaine drops
  • Immediate flushing of eye until pH is normal
  • Morgan lens
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39
Q

preseptal/periorbital cellulitis

A

infection of the anterior portion of the eyelid

-INVOLVE ONLY THE SKIN OF UPPER AND LOWER EYELIDS

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40
Q

is preseptal/periorbital cellulitis mild?

A

yes, and rarely leads to complications

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41
Q

what can preseptal/periorbital cellulitis advance into?

A

orbital cellulitis (serious)

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42
Q

who is preseptal/periorbital cellulitis more common in?

A

children

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43
Q

is preseptal/periorbital cellulitis more common than orbital cellulitis

A

yes, it is more common than orbital cellulitis

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44
Q

pathogens for preseptal/periorbital cellulitis

A

s. bureaus, s. pneumoniae, MRSA

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45
Q

etiology of preseptal/periorbital cellulitis

A
  • Insect bites
  • Animal bites
  • Foreign body
  • Dacryocystitis – tear sac gets inflamed
  • Conjuncitivitis
  • Hordeolum
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46
Q

clinical manifestation of preseptal/periorbital cellulitis?

A

CELLULITIS ON EYELIDS

  • ocular pain
  • eyelid swelling
  • erythema & warmth
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47
Q

dx for preseptal/periorbital cellulitis?

A

-hx & E
-CT or MRI
(CT b/c want to make sure it’s not orbital cellulitis)

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48
Q

preseptal/periorbital cellulitis management?

A
  • Doxycycline (C/I in children < 8 years old)
  • Clindamycin PO
  • Bactrim plus: Amoxicillin or, Augmentin or, Cefpodoxime or, Cefindir PO
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49
Q

orbital cellulitis

A

infection involving contents of the orbit: fat, muscles

NO GLOBE INVOLVEMENT

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50
Q

what is the source of most cases of orbital cellulitis?

A

rhinosinusitis (sinus infection)

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51
Q

who is orbital cellulitis more common in?

A

children

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52
Q

most common pathogens of orbital cellulitis?

A

s. aureus and streptococci

53
Q

clinical manifestations of orbital cellulitis?

A
  • swelling, erythema, warmth
  • ophthalmoplegia
  • proptosis
  • pain w/eye movement
  • diplopia
54
Q

complications of orbital cellulitis?

A
  • orbital abscess
  • subperiosteal abscess (common)
  • brain abscess (common)
  • cavernous sinus thrombophlebitis
55
Q

dx of orbital cellulitis

A

clinical dx and confirmed w/CT or MRI

56
Q

management of orbital cellulitis

A

Vancomycin plus:

  • Ceftriazone or
  • Cefotaxime or
  • Ampicillin-sulbactam or
  • Puperacillin-tazobactam
57
Q

when should you see improvement of orbital cellulitis?

A

within 24-48 hours and if not, consider abscess -> surgery

58
Q

herpes keratitis

A
  • corneal infection and inflammation

- spread by direct contact with mucous membrane

59
Q

what is herpes keratitis a major cause of?

A

blindness from corneal scarring worldwide

60
Q

what is the most common type of herpes keratitis?

A

infectious epithelial keratitis

61
Q

what are a majority of cases of herpes keratitis, bilateral or unilateral/

A

UNILATERAL

62
Q

pathophysiology of herpes keratitis?

A
  • Active infection
  • Inflammation caused by infection
  • Immune reaction

results in structural changes in the cornea

63
Q

herpes keratitis clinical manifestations?

A
  • pain
  • visual burning
  • tearing
64
Q

herpes keratitis dx

A

conjunctival injection

-DENDRITIC LESIONS ON FLUORESCEIN (PATHOGNOMONIC)

65
Q

management of herpes keratitis

A

topical antiviral agents (eye drops) & oral agents

66
Q

topical antiviral agents for txt of herpes keratitis

A

EYEDROPS

  • Trifluridine
  • Ganciclovir
  • Acyclovir
67
Q

oral agents for txt of herpes keratitis

A
  • Valacyclovir
  • Famcyclovir
  • Ganciclovir
68
Q

what do meibomian glands secrete?

A

oily substance that keeps the eye lubricated

69
Q

dysfunction of meibomian glands leads to?

70
Q

blepharitis

A

chronic eye condition that’s inflammation of the eyelids

-intermittent exacerbations

71
Q

types of blepharitis

A

anterior and posterior (more common)

72
Q

anterior blepharitis caused by?

A

staph, seborrheic

73
Q

patho of anterior blepharitis?

A

staph colonization of eyelids and react to staph exotoxin

-allergic response to staph antigens

74
Q

anterior blepharitis clinical manifestations?

A

eyelid edges are pink, irritated, swollen with crust

  • eyelashes misdirected and thinning
  • DIFFUSE CONJUNCTIVAL INJECTION
75
Q

what is posterior blepharitis associated with?

A

skin conditions

-rosacea and seborrheic dermatitis

76
Q

posterior blepharitis pathophysiology

A

inflammation of the meibomian glands

  • causes dysfunction and altered secretions
  • increase in fatty acid
  • impairs lipid layer of tear film
77
Q

posterior blepharitis clinical manifestation

A

WAXY SECRETIONS

78
Q

dx for blepharitis

A
  • distinguish anterior from posterior
  • base of eyelash swelling, redness, crust in anterior blepharitis
  • meibomitis - plugging with waxy secretions
79
Q

txt of blepharitis

A
  • alleviate acute sx, warm compress, lid massage and washing, artificial tears
  • topical ointments or drops of azithromycin, erythromycin, bacitracin
80
Q

what is more effective txt in anterior blepharitis?

A

-topical ointments or drops of azithromycin, erythromycin, bacitracin

81
Q

Hordeolum

A
  • stye

- acute, purulent inflammation of eye d/t STAPH

82
Q

internal hordeolum

A

infection of meibomian gland - conjunctival side

83
Q

external hordeolum

A

infection of eyelash follicle-lid margin

84
Q

best txt for hordeolum?

A

warm compress

-can give abx if pus

85
Q

what can hordeolum Harden into?

86
Q

chalazion

A

chronic inflammatory lesion d/t blockage and swelling of meibomian glands

87
Q

what pts is chalazion common in?

A

patients with eyelid margin blepharitis and rosacea

88
Q

is chalazion due to an infection?

89
Q

how does chalazion present?

A
  • starts small red, tender, swollen area
  • 2-3 days becomes painless and larger, rubbery, nodular lesion
  • inflammation and blockage
90
Q

dx of chalazion?

91
Q

txt of chalazion?

A
  • warm compresses (self-limiting)

- eyelid massage

92
Q

what if chalazion does not resolve?

A

refer to ophthalmic for I&D or glucocorticoid injection

93
Q

ectropion

A

lower eyelid is rolled out

-sagging of eyelid leaves the eye dry, exposed and irritated

94
Q

ectropion common in?

A

aging - connective tissue sagging

facial nerve palsy (Bell’s palsy, stroke)

certain dog breeds

95
Q

ectropion clinical manifestations

A
  • wet inner conjunctiva is exposed and visible
  • excessive tearing
  • crusting
  • EYELIDS DON’T CLOSE PROPERLY
96
Q

ectropion temporary management

A

artificial tear, ointments to lubricate eye

97
Q

ectropion permanent management

A
  • surgery
  • incision of skin of outside corner
  • shorten and tighten the lower lid
98
Q

entropion

A

eyelid rolls inward

  • eyelashes rub against the conjunctiva
  • chronic iritation
99
Q

clinical manifestations of entropion

A
  • MUCOUS DISCHARGE
  • LOWER EYELID ROLLED IN
  • ABSENT EYELASHES
  • corneal abrasion
100
Q

entropion temporary fixes

A

artificial tears

101
Q

entropion permanent fixes

A

surgical - tighten eyelid and its attachments to restore eyelid position

102
Q

dacryoadenitis

A

inflammation of the lacrimal glands

-caused by bacteria or virus

103
Q

causes of bacterial dacryoadenitis

A

-staph, strep, n. gonorrhea

104
Q

causes of viral dacryoadenitis

A
  • mumps
  • EBC
  • coxackie
  • herpes zoster
  • mono
105
Q

causes of fungal dacryoadenitis

A
  • histoplasmosis
  • blastomycosis
  • parasites
  • protozoa
106
Q

causes of inflammatory dacryoadnitis

A

sarcoidosis, grave’s sjogren’s

107
Q

acute clinical manifestations of dacryoadnitis

A
  • UNILATERAL
  • supraorbital pressure
  • rapid onset
  • severe pain
  • conjunctival swelling and redness
  • submandibular LAD
  • EXOPTHALMOS
  • ocular motility restriction
108
Q

systemic clinical manifestations of dacryoadnitis

A
  • fever
  • parotid gland enlargement
  • URI
  • malaise
109
Q

chronic manifestations of dacryoadnitis

A
  • BILATERAL
  • PAINLESS
  • present more than a month
  • more common than acute
110
Q

difference between acute and chronic dacryoadnitis?

A

acute is rapid onset and unilateral and painful

chronic is for more than a month, bilateral, and painless

111
Q

dx of dacryoadnitis

A

lacrimal gland enlarge and easily seen if evert upper lid

112
Q

imaging of dacryoadnitis for dx

A

CT of the orbit w/contrast

113
Q

txt for viral dacryoadnitis

A

b/c most common is mumps - self-limiting, supportive

114
Q

txt for bacterial dacryoadnitis

A

Keflex (1st gen)

115
Q

dacryostenosis

A

nasolacrimal duct obstruction

116
Q

what is the most common cause of persistent tearing in infants?

A

dacryostenosis

117
Q

child has persistent tearing, what can they have?

A

dacryostenosis

118
Q

when does dacryostenosis resolve?

A

spontaneously by 6-12 months of age

119
Q

txt of dacryostenosis

A

-massage of lacrimal duct

120
Q

keratoconjunctivitis sicca

121
Q

what kind of disease is keratoconjunctivitis sicca?

A

multifactorial disease of the tears and ocular surface

122
Q

what does keratoconjunctivitis sicca result in?

A

ocular discomfort and vision impairment

123
Q

is there a confirmatory dx test for keratoconjunctivitis sicca?

124
Q

pathophysiology of keratoconjunctivitis sicca

A

dysfunction of tear film, eye lids, lacrimal glands, eye surface

125
Q

classification of keratoconjunctivitis sicca

A

decreased tear production and increased evaporative loss

126
Q

decreased tear production causes?

A
  • lacrimal gland dysfunction or destruction

- Sjogren’s syndrome

127
Q

how does Sjogren’s syndrome cause decreased tear production?

A

inflammatory infiltration of the lacrimal glands and leads to cell death and HYPOSECRETION

128
Q

lacrimal dysfunction dry eyes

A

non-sjogren’s

-most common form is age related dry eye

Clinical Medicine (11 decks)

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