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TAV MDT List > Eye MDT > Flashcards

Eye MDT Flashcards

1
Q

Common chronic bilateral inflammatory condition of lid margins

A

Blepharitis

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2
Q

Involves the lid skin, eyelashes, and associated glands

Seborrhea of the scalp, brows, and ears (dermatitis)

Scales or granules can be seen clinging to eyelashes

A

Anterior blepharitis

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3
Q

Results from inflammation of Meibomian glands

Strong association with acne rosacea

Meibomian glands and their orifices are inflamed

A

Posterior blepharitis

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4
Q

Symptoms and physical exam findings:

Itching, burning, mild pain, foreign body sensation, tearing, erythema of the lids, and crusting around the eyes upon awakening

Frothy/greasy tears

May have conjunctival injection

A

Blepharitis

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5
Q

Treatment for blepharitis

A

Eyelid margins cleaned twice daily with commercial eyelid scrub (Ocusoft) or baby shampoo

Warm compresses for 10-15 minutes, 1-2 times a day

-Lid massage
-Artificial tears
-Omega 3 supplements
-Bacitracin ointment

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6
Q

Long-term, low dose antibiotic therapy for blepharitis

A

Tetracycline 250mg BID

Doxycycline 100mg BID

Erythromycin 1g/day

Azithromycin 500mg day one, 250mg x4 days

Clarithromycin 250mg BID x 7 days

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7
Q

Blepharitis follow up

A

2-4 weeks

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8
Q

Sebaceous glands connected to the eyelashes, secretions from these glands lubricate the eyelid surface

A

Gland of Zeis

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9
Q

Oil glands along the edge of the eyelids where eyelashes are found

A

Meibomian glands

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10
Q

Acute infection that usually involves Staphylococcus species

External (Gland of Zeis)

Internal (Meibomian gland)

A

Hordeolum

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11
Q

Chronic focal granulomatous inflammation within the eyelid, secondary to the obstruction of a meibomian gland or gland of Zeis (hordeolums)

A

Chalazion

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12
Q

Symptoms and physical examination findings:

-Localized eyelid tenderness, swelling and erythema
-May have foreign body sensation depending on location
-Visible, or palpable, well-defined subcutaneous nodule in the eyelid
-May also note “pointing” of mucopurulent material
-Associated blepharitis or acne rosacea

A

Hordeolum

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13
Q

Symptoms and physical exam findings:

-Hard and nontender nodule on the eyelid, usually farther back than a hordeolum
-Edema on the upper or lower lid
-Erythema and edema of the adjacent conjunctiva

A

Chalazion

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14
Q

Risk factors of hordeolums and chalazions

A

1) Touch eyes with unwashed hands
2) Insert contact lenses without thoroughly disinfecting them
3) Leave makeup overnight
4) Used or expired cosmetics
5) Have blepharitis

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15
Q

Hordeolum or chalazion treatment

A

Warm compresses 15 minutes four times a day

Massage infected eyelid after warm compress to aid in drainage

Discontinue eye make up

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16
Q

When would you consider antibiotic ointment for a hordeolum or chalazion?

A

-Concern the patient will develop periorbital cellulitis

-48 hours of warm compresses does not clear it up

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17
Q

Most common cause of viral conjunctivitis

A

Adenovirus

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18
Q

Nongonococcal bacterial conjunctivitis is caused by:

A

-Staphylococcus aureus
-Staphylococcus epidermis
-Haemophilus influenzae (associated with otitis media)
-Streptococcus pneumoniae
-Moraxella catarrhalis

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19
Q

Ophthalmologic emergency because corneal involvement may rapidly lead to perforation

A

Gonococcal conjunctivitis

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20
Q

Sx: Itchy, burning, tearing, gritty or foreign body sensation; History of URI

Signs: Water discharge, red and edematous eyelids, pinpoint subconjunctival hemorrhages, punctate keratopathy (epithelial erosion in severe cases), membrane/pseudo membrane (severe cases)

A

Viral conjunctivitis

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21
Q

Sx: Itching, watery discharge, and a history of allergies are typical. Usually bilateral.

Signs: Chemosis (swollen conjunctiva), red and edematous eyelids, conjunctival papillae, periocular hyperpigmentation, no preauricular node

A

Allergic conjunctivitis

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22
Q

Sx: Redness, foreign body sensation, discharge, itching is much less prominent. Often complains of having to wipe purulent exudate in morning.

Signs: Purulent discharge of mild to moderate degree.

Preauricular node typically absent

A

Bacterial Conjunctivitis (nongonococcal)

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23
Q

Signs: Severe purulent discharge, hyperacute onset (12-24 hrs)

Preauricular adenopathy, eyelid swelling

A

Gonococcal conjunctivitis

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24
Q

Treatment for viral conjunctivitis

A

Mild: Artificial tears

Moderate: Epinastine (Ophthalmic antihistamine)

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25
Q

Treatment for a patient with viral conjunctivitis that has photophobia

A

Consult Ophthalmology:

Opthalmic Corticosteroids

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26
Q

Treatment for allergic conjunctivitis

A

Mild: Artificial tears

Moderate: Antihistamine (Topical are more effective than oral)

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27
Q

Treatment for:

Bacterial conjunctivitis for non-contact lens wearers (non-gonococcal)

A

Erythromycin Opthalmic ointment
-0.5 inch ointment inside lower lid QID for 5-7 days

Trimethropim/polymyxin B

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28
Q

Treatment for:

Bacterial conjunctivitis for contact lens wearers (non-gonococcal)

A

Fluroquinolones:

-Ciprofloxacin

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29
Q

Added to the antibiotic treatment if associated dacryocystitis (tear duct infection) is present

A

Amoxicillin/Clavulanate

Cephalexin

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30
Q

Treatment for:

Gonococcal conjunctivitis

A

Ceftriaxone 1g IM & Azithromycin 1g PO

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31
Q

Treatment for:

Gonococcal conjunctivitis for patients with penicillin/cephalosporin allergy

A

Gentamicin 240mg IM x1 dose & Azithromycin 2g PO x 1 dose

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32
Q

Causes of a conjunctival hemorrhage

A

1) Valsava
2) Traumatic
3) HTN and Diabetes
4) Bleeding disorder
5) Antiplatelet/anticoagulant medications
6) Topical steroid therapy
7) Hemorrhage due to orbital mass
8) Idiopathic

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33
Q

Sx: Red eye, foreign body sensation, usually asymptomatic unless there is associated chemosis

Signs: Blood underneath the conjunctiva, often in one sector of the eye, entire view of the sclera can be obstructed by blood

A

Conjunctival hemorrhage

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34
Q

Treatment for:

Conjunctival hemorrhage

A

None required (clears up usually in 2-3 weeks)

Artificial tear drops QID for irritation

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35
Q

Degeneration of fibrovascular, deep conjunctival layers resulting in vascular tissue proliferation, which extended onto the cornea

Usually related to sunlight exposure, chronic inflammation and oxidative stress

A

Pterygium

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36
Q

Sx: Irritation, redness, decreased vision; may be asymptomatic

Signs: Wing-shaped fold of fibrovascular tissue arising from the interpalpebral conjunctiva and extending onto the cornea. Usually nasal in location.

A

Pterygia

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37
Q

Pterygium treatment

A

Protect eyes from sun, dust, wind

Artificial tears

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38
Q

Treatment for:

Moderate to severe pterygium

A

Opthalmic corticosteroids

NSAID drops

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39
Q

Pterygium surgical removal is indicated when:

A

Interfering with vision and excessive irritation

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40
Q

Pterygium asymptomatic patients should be checked every:

A

1 to 2 years

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41
Q

Initially pterygiums should be measured:

A

Initially, then every 3-12 months

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42
Q

Follow-up:

Corneal foreign body noncontact lens wearer

A

F/U in 24 hours (or sooner if symptoms worsen)

-Revisit every 3-5 days until healed

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43
Q

Follow up:

Corneal foreign body contact lens wearer

A

Close follow-up until epithelial defect resolves

May resume contact lens wear after the eye feels normal for 1 week

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44
Q

Corneal epithelium regenerates quickly, healing time for abrasions is usually within:

A

24-48 hours

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45
Q

Symptoms and physical exam:

-Severe pain, tearing and photophobia
-History of trauma to the eye, commonly a foreign object

A

Corneal abrasion

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46
Q

Studies:

Corneal abrasion

A

Slit lamp to identify dimensions of abrasion

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47
Q

Treatment:

Non-contact lens wearer corneal abrasion

A

Antibiotic ointment (erythromycin, bacitracin)

Antibiotic drops (polymyxin B/Trimethoprim or a fluoroquinolone)

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48
Q

Treatment:

Contact lens wearer, corneal abrasion

A

Fluoroquinolone drops

49
Q

Infectious keratitis, Serious infection involving multiple layers of the cornea

A

Corneal ulcer

50
Q

Biggest risk factor for corneal ulcer

A

Improper contact lens use

51
Q

Corneal Ulcer, Bacteria causative organisms

A

Pseudomonas aeruginosa

Streptococcus pneumonia

Staphylococcus species

Moraxella species

52
Q

Corneal ulcer, causative viruses

A

Herpes simplex

Varicella zoster

53
Q

Corneal ulcer, causative fungi agents

A

Candida

Aspergillus

Penicillium

Cephalosporin

54
Q

Symptoms and physical exam:

-Erythema and edema of lids and conjunctivae; discharge; ocular pain or foreign body sensation; photophobia; blurred vision

-Depending on location, may decrease visual acuity

-Cornea reveals a round or irregular opacity or infiltrate (classically in the center)

A

Corneal ulcer

55
Q

Treatment for:

Corneal ulcer

A
  1. Topical antibiotics (Ciprofloxacin, Ofloxacin, Vigomox)
  2. Refer to ophthalmologist within 12-24 hours
  3. DO NOT patch the eye, risk of pseudomonas infection.
56
Q

Anterior Cavity:
What continually filters out of blood capillaries in the ciliary processes of the ciliary body and enters the posterior chamber.

Then flows forward between the iris and lens through the pupil and into the anterior chamber

A

Aqueous Humor

57
Q

Where does aqueous humor drain into from the anterior chamber?

A

Scleral venous sinus (canal of Schlemm) then into the blood

58
Q

How often is aqueous humor completely replaced?

A

Every 90 minutes

59
Q

Accumulation of red blood cells within the anterior chamber, between the cornea and the iris

Blood may cover part or all of the iris and pupil

A

Hyphema

60
Q

Most common risk factors for hyphema

A

Trauma or recent ocular surgeries

61
Q

Etiologies of hyphema

A

1) Iris neovascularization
2) Herpes simplex or zoster iridocyclitis
3) Blood dyscrasia or clotting disorder (Hemophilia)
4) Anticoagulation
5) Fuchs heterochronic iridocyclitis
6) Intraocular tumor

62
Q

Symptoms and physical exam findings:

-Blood/Clot in the anterior chamber, visible without slit lamp
May be black or red
-Pain
-Photophobia
-Blurred, clouded or blocked vision
-History of blunt trauma

A

Hyphema

63
Q

Labs/studies:

Hyphema

A

Complete eye scan

Consider CT to scan the orbits and brain

64
Q

Treatment for:

Hyphema

A

Immediate ophthalmology or optometry consult

-Elevate head
-Place rigid shield over eye
-Avoid aspirin and NSAIDS
-Mild analgesics, Tylenol only

65
Q

Hyphema patient:

After initial follow up period, patient may need to be on what medication?

A

Long-acting cycloplegic agent (atropine 1% BID)

66
Q

Middle layer of the eyeball

A

Vascular tunic (Uvea)

67
Q

Vascular tunic (uvea) is composed of what three parts?

A

1) Choroid

2) Ciliary body

3) Iris

68
Q

Inflammation of the anterior segment of the uveal tract. Usually immunologic but possibly infective or neoplastic.

Classified as acute or chronic and as Non granulomatous or granulomatous

A

Iritis/Uveitis

69
Q

Infectious etiologies:

Iritis/Uveitis

A

Herpes virus

Cytomegalovirus

Toxoplasmosis

Syphilis

West Nile Virus

70
Q

Systemic inflammatory disease that cause iritis/uveitis

A

Spondylarthritis

Sarcoidosis

SLE

Mutiple sclerosis

71
Q

Uveitis

Sx: Pain, redness, photophobia and visual loss

A

Acute nongranulomatous anterior uveitis

72
Q

Uveitis:

Blurred vision in a mildly inflamed eye

A

Granulomatous anterior uveitis

73
Q

Signs:

-Inflammatory cells flare within the aqueous (WBC released from vessels appear as snowflakes)
-Blurred vision in a mildly painful mildly inflamed eye
-Hypopyon (WBC pool) and fibrin within anterior chamber
-Keratic precipitates (KPs) (cells seen on the corneal endothelium)

A

Uveitis

74
Q

Labs/Studies:

Uveitis

A

Complete eye exam

Labs if required

75
Q

Treatment for:

Uveitis

A

Only to be initiated by or under direction of Ophthalmologist:

-Cycloplegic (for pain and inflammation)
-Topical steroid

76
Q

Infection that affects the eye socket. This can cause the eye or eyelid to swell, keeping the eye from moving properly

Typically arise from paranasal sinuses (especially ethmoiditis)

A

Orbital Cellulitis

77
Q

Orbital cellulitis:

Adult and children organisms

A

Adult: Staph, strep, Bacteroides species

Children: Haemophilus influenzae

78
Q

Sx: Red eye, pain with eye movement, blurred vision, double vision, eyelid and /or periorbital swelling, nasal congestion/discharge, sinus headache/pressure/congestion, tooth pain, orbital pain, or hypesthesia

CT scan shows adjacent sinusitis

A

Orbital cellulitis

79
Q

Labs/studies:

Orbital cellulitis

A

-History
-Complete eye exam
-CT of orbits and sinuses
-CBC, blood cultures, gram strain and culture of drainage
-Explore and debride of any wounds

80
Q

Treatment for:

Orbital cellulitis

A

IV Antibiotics

Amoxicillin/Clavulanate 875mg PO BID
or
Ceftriaxone 2g IM

Admit to a hospital.

Surgery may be required to drain sinuses

81
Q

Orbital cellulitis:

If orbit is tight, an optic neuropathy is present, or IOP is severely elevated, what must immediately be done?

A

Canthotomy

82
Q

Follow up for:

Orbital cellulitis

A

Reevaluate at least twice a day in the hospital for 48 hours

Clinical improvement may take 24-36 hours

83
Q

Fracture:

Affects the bony outer edges of the orbit

A lot of force (MVA’s)

A

Orbital rim fracture

84
Q

Fracture:

Affects the floor or inner wall of the orbit

A

Blowout fracture

85
Q

Fracture:
Trauma to the orbital rim pushes the bones back, causing the bones of the eye socket floor to buckle downward

A

Orbital floor fracture

86
Q

Sx: Pain, Eyelid edema, Crepitus, Binocular diplopia, numbness of face, acute tearing

Signs: Restricted eye movement, Subcutaneous or conjunctival emphysema, decreased sensation, point tenderness, enophthalmos and hypoglobus

A

Orbital fracture

87
Q

Labs/studies:

Orbital fracture

A

Complete eye exam

CT of the orbit, midface and brain

88
Q

Treatment:

Orbital fracture (meds)

A

Amoxicillin/Clavulanate, Azithromycin, or Doxycycline

Nasal decongestants

Ice packs for 20 min every 1-2 hours for the first 24 hours

Oral corticosteroids

89
Q

Surgical repair for orbital fracture:

Muscle entrapment with non-resolving bradycardia, heart block, nausea, vomiting, or syncope

A

Immediate repair within 24-48 hours

90
Q

Surgical repair for orbital fracture:

-Persistent, symptomatic diplopia
-Large orbital floor fractures (>50%)
-Large combined medial wall and orbital floor fractures
-Complex trauma involving the orbital rim, midface, or skull base
-Naso ethmoidal complex fractures
-Superior or superomedial orbital rim fractures involving the frontal sinuses

A

Repair in 1 to 2 weeks

91
Q

Surgical repair for orbital fractures:

Old fractures that have resulted in enophthalmos or hypoglobus

A

Delayed repair, at any later date

92
Q

Vision returns to normal within 24 hours, usually within 1 hour

A

Transient visual loss

93
Q

Sheet of neural tissue containing the rods and cones that lines the posterior two thirds of the inner surface of the glove, extending anteriorly as far as the ciliary body

A

Retina

94
Q

What are the three types of retinal detachments?

A

Rhegmatogenous retinal detachment (most common)

Exudative/serous retinal detachment

Tractional retinal detachment

95
Q

Retinal detachment:

Development of one or more peripheral retinal tears or holes, allows fluid to move in and separate the overlying retina. Usually spontaneous and occurs in persons over 50 years old.

Nearsightedness and cataract extraction are the two most common predisposing causes.

A

Rhegmatogenous Retinal Detachment

96
Q

Retinal Detachment:

Results from accumulation of subretinal fluid, such as in neovascular age-related macular degeneration or secondary to choroidal tumor

A

Exudative/serous retinal detachment

97
Q

Retinal detachment:

Occurs when there is preretinal fibrosis, such as in proliferative retinopathy due to diabetic retinopathy or retinal vein occlusion or as a complication of rhegmatogenous retinal detachment

A

Tractional Retinal Detachment

98
Q

RD:

Sx: Flashes of light, floaters, a curtain or shadow moving over the field of vision, peripheral or central visual loss, or both

Signs: The retina is seen hanging in the vitreous like a gray cloud. One or more retinal tears or holes

A

Rhegmatogenous retinal detachment

99
Q

RD:

Sx: Minimal to severe visual loss or a visual field defect; visual changes may vary with changes in head position

Signs: Retina is dome-shaped and the subretinal fluid shifts position with changes in posture

A

Exudative retinal detachment

100
Q

RD:

Sx: Visual loss or visual field defect; may be asymptomatic

Signs: Retina appears concave with a smooth surface. Cellular and vitreous membranes exerting traction on the retina are present

A

Traction retinal detachment

101
Q

Labs/Studies:

Retinal Detachment

A

Complete eye exam

Ocular ultrasonography

Ocular CT Scan

102
Q

Treatment for:

Retinal detachment

A

Involves fovea: URGENT ocular surgery

Otherwise, within 7-10 days of onset

103
Q

Ultraviolet keratopathy

A

Flash burns

104
Q

-Sunlamp without eye protection, exposure to a welding arc, or exposure to the sun when skiing can cause:

A

Flash burns (ultraviolet)

105
Q

Sx: Moderate-to-severe ocular pain, foreign body sensation, red eye, tearing, photophobia, blurred vision; often a history of welding or using a sunlamp without adequate protective eyewear.

Sx typically worsen 6-12 hours after the exposure. Usually bilateral.

Signs: Numerous, punctate lesions or microdots on the corneal surface (after staining)

A

Flash burns (ultraviolet)

106
Q

Treatment of:

Flash burns (ultraviolet)

A

Pain treatment (mild oral opioids): Oxycodone 5mg Q 4-6 hours
-NO topical anesthetics due to corneal toxicity

Antibiotic ointment (Erythromycin or Polytrim) 4-8 times a day

107
Q

Recovery time of flash burns

A

24-48 hours

108
Q

Risk factors for chemical burns

A

Improper use of PPE

Job exposure (Mechanics, CS Gas, Cement workers)

109
Q

Symptoms and physical exam:

-Excessive tearing
-Conjunctivitis and injection
-Moderate to severe eye pain
-Blepharospasm
-Photophobia
-Severe alkali burns will have opacified cornea and scleral blanching

A

Chemical burns

110
Q

Initial Management of:

Chemical burns

A

Immediate irrigation with normal saline or water

Goal of treatment is to reach neutral pH

Normalization takes 30-60 minutes

Can test pH of eye with litmus paper

111
Q

Treatment of:

Chemical burns

A

Topical antibiotics (Erythromycin)

Follow-up in 24 hours

Consult ophthalmology/optometry if not resolved.

112
Q

Outer layer, middle layer, inner layer of eye

A

Outer: Sclera (cornea anteriorly)

Middle: Uvea (Choroid posteriorly, ciliary body and iris anteriorly)

Inner layer: Retina

113
Q

Sx: Pain, decreased vision, loss of fluid from eye

History of trauma, fall, or sharp object entering globe

A

Penetrating eye wound

114
Q

Treatment of:

Penetrating wound to the eye

A

Protect eye with a shield or cup at all times

Elevate the head to 45 degrees

Systemic antibiotics within 6 hours of injury
-Cefazolin or Vancomycin PLUS Fluoroquinolone

Antiemetics (prevent Valsalva and possible expulsion of eye contents)

115
Q

Virus that can affect the eyelids, conjunctiva, and cornea

Colonizes the trigeminal ganglion and leads to reoccurrences precipitated by fever, excessive exposure to sunlight, or immunodeficiency

A

Herpes simplex virus

116
Q

Sx: History of oral or genital herpes infection, photophobia, pain, eye redness, decreased vision

Signs: Punctate keratitis. dendritic keratitis, geographic ulcer, corneal sensitivity may be decreased, eyelid may have herpetic vesicular eruptions, palpable preauricular node, conjunctiva can be injected

A

Herpetic lesion of the eye

117
Q

Treatment of:

Herpetic lesion of the eye

A

Topical antivirals
-Ganciclovir, Trifluridine, Vidarabine

Oral antiviral agents
-Acyclovir, Valacyclovir, Famciclovir

DO NOT prescribe steroids

118
Q

Follow up of:

Herpetic lesion of the eye

A

Any patients with herpes simples and acute red eye should be referred urgently to an ophthalmologist

Reexamined in 2-7 days to evaluate treatment response, then every 1 to 2 weeks

TAV MDT List (12 decks)

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