Eye I and II Flashcards
Red eye etiologies
Red eye etiologies
- inflammation
- blepharitis
- chalazion / hordeolum
- cellulitis
- conjunctivitis
- dacroadenitis / dacrocystitis
- corneal ulcer (keratitis)
- scleritis
- uveitis
- traumatic
- subjunctival hemorrhage
- corneal abrasion
- fb
- hyphema
- other
- glaucoma
- tumor
Blepharitis
- What is it
- Anterior vs posterior blepharitis
- Clinical presentation
- Physical exam
- Complications
- Treatment
Blepharitis
- Blepharitis is a chronic condition - inflammation of the eyelids, typically with intermittent exacerbations
- Anterior blepharitis may have either infectious (S. aureus) or seborrheic (e.g. dandruff)
- Posterior blepharitis is from meibomian gland dysfunction
- Treatment is the same for both types
Clinical presentation
- red eyes
- gritty or fb sensation
- burning sensation
- excessive tearing
- crustiness in lashes
- light sensitivity
- blurry VA
Physical exam
- diffuse conjunctival injection
- eyelid margins inflammed and red
- crusting and matting of eyelashes
- plugged glands with magnification
- collarettes (debris along lashes)
Complications
- if meibomian gland clogs, then chalazion can form
- painless
- rubbery
- nodule
- if chalazion gets infected, turns into hordeolum
- painful
- infected
- purulent
Treatment
- warm compress
- lid massage
- lid hygiene
- topical abx (erythromycin ointment)
- oral abx for severe cases
- prevention: omega 3 supplements
-
chalazion / hordeolum tx
- frequent warm compresses
- topical steroids or abx
- possible oral abx
- may require sx
Cellulitis: periorbital and orbital
- Difference betweent the two?
- Etiologies
- Clinical presentation
- Physical exam
- Diagnosis
- Treatment
Cellulitis: periorbital and orbital
-
Periorbital cellulitis
- Infection of the soft tissues around the eye that does not extend into the orbit
- Can be complication of blepharitis
- More common
- Can tx easily with abx
-
Orbital cellulitis
- Infection of the fat and muscle tissue surrounding the globe
- Will usually start in the sinuses
- Infection travels deeper, more complicated to tx
- Infection can spread to the brain via the cavernous sinus
- Neither involves infection into the globe
- Both are more common in kids
- Tx is very different for both
Etiologies
- Periorbital cellulitis
- External sources
- Blepharitis
- Insect bites
- FB
- Sinusitis
- External sources
- Orbital cellulitis
- Most often caused by an extension of infection from the paranasal sinuses (ethmoid sinuses)
Clinical presentation
- Periorbital cellulitis
- eye pain
- eyelid swelling and erythema
- no VA change
- no fever
- no pain with eye movement
- Orbital cellulitis
- eye pain
- eyelid swelling and erythema
- VA changes
- fever
- pain with eye movements
Physical exam
- Periorbital cellulitis
- no proptosis
- no ophthalmoplegia
- Orbital cellulitis
- proptosis
- ophthalmoplegia
- conjunctivitis
- discharge
Diagnosis
- If in doubt, tx as if it were orbital cellulitis
- Workup includes:
- CBC
- blood cultures
- culture of any discharge
- CT of orbits and sinuses
Treatment
- Periorbital cellulitis
- Outpatient
- Empiric abx therapy
- Staph aureus
- Staph pneumoniae
- MRSA
- If MRSA not suspected, use Amoxicillin-Clavulanic acid
- If MRSA is suspected, use oral Bactrim (trimethoprim sulfamethoxazole) or oral Clindamycin PLUS Amoxicillin, Amoxicillin-Clavulanic acid, Cefinir, or Cefpodoxime
- Orbital cellulitis
- Hospitalization and opthalmology consult
- Start immediate tx with IV abx to prevent optic nerve damage and spread of infection to cavernous sinus, and thus to meninges or brain
- Abx should be broad spectrum until cultures returned
- Sx drainage if abscess formation
Conjunctivitis
- Viral, bacterial, and allergic
- MC etiologic agent
- Clinical presentation
- Treatment
- Unilateral or bilateral
Conjunctivitis
- Inflammation of the white of the eye (conjunctiva)
- Most common eye disease
- Viral is most common
- Can also be caused by bacterial infection, allergies, or chemicals
- Transmits via direct contact
Viral conjunctivitis
- MC etiologic agent: adenovirus
- Clinical presentation
- Pharyngitis
- Fever
- Malaise
- Watery discharge
- Preauricular adenopathy
- Tx: cold compress
Bacterial conjunctivitis
- MC etiologic agents
- S. aureus
- S. pneumoniae
- H. influenzae
- Pseudomonas (CL wearers)
- Clinical presentation
- Copious amounts of discharge is common
- Eyes matted shut in the morning
- Treatment
- Abx drops or ointment
- Erythromycin ointment
- Fluroquinolone drops
- Moxifloxacin
- Ciprofloxacin
- Abx drops or ointment
Allergic conjunctivits
- Bilateral
- Can be seasonal
- Clinical presentation
- Itchiness
- Conjunctival injection and swelling (chemosis)
- Treatment
- Cold compress
- Topical or oral antihistamines
Daryocystitis
- What is it
- Secondary to what
- More common in what population
- Treatment
Daryocystitis
- Infection of the lacrimal sac
- Usually secondary to a nasolacrimal duct obstruction
- More common in children
- Tx with agressive abx
- Clindamycin
- IV vancomycin
- May require sx (NLD probing)
- Infection can spread to the brain
Entropion
- What is it
- Causes
- Treatment
Entropion
- Inward turning of the eyelids (especially lower lid)
- May occur with age as result of degeneration of lid tissues or due to childhood facial structure
- Damage may occur with rubbing of lashes on the surface of the eye
- Treatment: lubrication
Extropion
- What is it
- Causes
- Treatment
Extropion
- Outward turning of the eyelids (especially lower lid)
- May occur with age as result of degeneration of lid tissues
Treatment
- Lubrication
- Surgery if excessive tearing or exposure keratitis
Pingueculum
- What is it
- Common in what population
- Treatment
Pingueculum
- Yellow, elevated nodule most commonly located on the nasal side of the conjunctiva
- Common in people over age 35
- Rarely grow and do not require tx
Pterygium
- What is it
- Risk factors
- Treatment
Pterygium
- Bad cousin of the pingueculum
- Fleshy, triangluar growth of the conjunctiva that typically spreads and may threaten cornea and visual axis
- Associated with wind, sun, and dust exposure
Treatment
- AT
- Anti inflammatories
- Excision
Chemical conjunctivitis
- Clinical presentation
- Physical exam
- Treatment
Chemical conjunctivitis
- Caustic chemical exposure
Clinical presentation
- Acute pain and burning
- Blurry and impaired VA
Physical exam
- VA decreased
- Corneal abrasion
- Red, pink, or white
Treatment
- Irrigate!!!
- Topical lubricants
- Abx
- Refer to ophthalmology
Subjunctival hemorrhage
- What is it
- Causes
- Clinical presentation
- Physical exam
- Treatment
Subjunctival hemorrhage
- Blood under the conjunctiva due to vessel rupture
- Can result from trauma or trivial events (cough, sneeze, valsalva)
Clinical presentation
- Acute
- Asymptomatic
Physical exam
- VA unaffected
- Diffuse, flat red patch that stops at the limbus
Treatment
- None, will resolve in 2-4 weeks
Hyphema
- What is it
- Clinical presentation
- Physical exam
- Treatment
Hyphema
- Results from injury to anterior chamber that disrupts the vasculature suporting the iris or ciliary body
Clinical presentation
- Acute onset of pain
- Photophobia
- Tearing
- Nausa, vomiting may indicate rise in IOP
Physical Exam
- Vision decrease
- Layered heme in the anterior chamber
Treatment
- Ophthalmology referral
- Bed rest, supine with head elevated
- Goals of treatment
- Control IOP
- Ease discomfort
- Prevent complications
- Oral diuretic - acetazolamide
- Topical diuretic - dorzolamide
- Topical cycloplegic - atropine (dilate)
- Possible topical steroid
Conjunctival and corneal FB
- Clinical presentation
- Physical exam
- Examination
- Treatment
Conjunctival and corneal FB
- FB on the cornea or under the upper lid presents with a patient complaint of “something in my eye” or a FB sensation
Clinical presentation
- Hx of something entering eye
- Pain
- Unable to open eye
- May have attempted irrigation
Physical exam
- VA usually unaffected
- Tearing (eye is trying flush out)
- Conjunctival injection
- Presence of FB
- Staining with fluorescein if there is an abrasion
Examination
- Use topical anesthetic to help with exam (tetracaine drops)
- Check VA pre and post tx
- Evert eyelid to look for FB
- Check with fluoresceine for abrasion/FB
- Examine pupils (if suspected intraocular FB, refer)
Treatment
- FB removal with irrigation or cotton swab
- Lubricant or abx eye drops
- Refer to ophthalmology if unable to remove or concern for large abrasion
Perforated globe
- Causes
- What to look for on exam
- Treatment
- Avoid what during exam
Perforated globe
- Results from penetrating trauma, must have high suspicion based on hx (hammering or shaving metal)
- Look for signs of loss of anterior chamber depth, misshapen pupil, or vitreous leakage (jelly)
- Emergency referral for sx repair
- Avoid manipulaton until seen by specialist
Corneal abrasion
- What is it
- Clinical presentation
- Physical exam
- Treatment
Corneal abrasion
- Defects in the corneal epithelial tissue
- Often from trauma to eye (fingernail, paper, CL)
Clinical presentation
- Acute onset pain
- FB sensation
- Tearing
- Light sensitivity
- Inability to open eyelids
Physical exam
- VA maybe affected
- Visible epithelial defect
- Abrasions best seen with fluorescein dye and black light
Treatment
- Topical abx drops
- Moxifloxacin
- Azthromycin
- Topical lubricants
- Cornea heals quickly, f/u in 1-2 days
- Never send patients home with anesthetics!
- Inhibit healing
- Lack of sensation
- Anesthetic keratitis may occur and require corneal transplant