EYES Flashcards
What is the pattern of redness of conjunctivitis?
conjunctival injection: diffuse dilation of conjuctival vessels with redness that tends to be maximal peripherally
What is the pattern of redness in subconjuctival hemorrhage?
leakage of blood outside of the vessels, producing a homogenous, sharply demarcated, red area that resolves over 2 weeks
What is the pattern of redness of Corneal injury or Infection, Acute Iritis, and Acute Angle Closure Glaucoma?
ciliary injection: dilation of deeper vessels that are visible as radiating vessels or a reddish violet flush around the limbus. Ciliary injection is an important sign of these 3 conditions, but may not be apparent.
Is Conjuctivitis painful?
mild discomfort rather than pain
is Subconjuctival Hemorrhage painful?
NO
is a corneal injury or infection painful?
moderate to severe, superficial
is acute iritis painful?
moderate, aching, deep
is acute angle closure glaucoma painful?
severe, aching, deep
Is your vision impaired with conjunctivitis?
not affected, except for temporary mild blurring due to discharge
is ur vision impaired with subconjunctival hemorrhage?
no
is your vision affected with corneal injury or infection?
usually decreased
is your vision affected by acute iritis?
decreased; photophobia
is your vision affected by acute angle closure glaucoma?
decreased
is there ocular discharge with conjunctivitis?
watery, mucoid, or mucopurulent
is there ocular discharge with subconjuctival hemorrhage?
no
is there ocular discharge with a corneal injury or infection?
watery or purulent
is there ocular discharge with acute iritis?
no
is there ocular discharge with acute angle closure glaucoma?
no
is the pupil affected in conjunctivitis or subconjuctival hemorrhage?
no
is the pupil affected in a corneal injury or infection?
not affected unless iritis develops
is the pupil affected in acute iritis?
small and irregular
is the pupil affected in acute angle closure glaucoma?
dilated and fixed
T/F the core an is clear in conjunctivitis and subconjuctival hemorrhage?
true
How is the core an affected in a corneal injury or infection?
changes depends on cause
How is the cornea affected in acute iritis?
clear or slightly clouded; injection confined to corneal limbus
how is the cornea affected in acute angle closure glaucoma?
steamy and cloudy
What causes conjunctivitis?
bacterial, viral, and other infections, highly contagious; allergy; irritation
What causes subconjuctival hemorrhage?
often none; may result from trauma, bleeding disorders, or sudden increase in venous pressure as from cough
what is the significance of a corneal injury or infection?
abrasions, and other injuries; viral and bacterial infections
what is the significance of acute iritis?
associated with systemic infection; Herpes zoster, tuberculosis; refer promptly
what is the significance of acute angle glaucoma?
acute increase in intraocular pressure constitutes an emergency
a drooping of the upper lid
ptosis
what causes ptosis
myasthenia gravis, damage to the oculomotor nerve, and damage to the sympathetic nerve supply (Horner’s syndrome)
- a weakened muscle, relaxed tissue, and the weight of herniated fat may cause senile ptosis
- may be congenital
an inward turning of the lid margin; the lower lashes, often invisible when turned inward, irritate the conjunctiva and lower cornea
entropion; more commonly found in elderly
how do you check for an entropion that is not obvious?
ask the patient to squeeze the lids together and then open them, then check for the entropion
margin of the lower lid is turned outward, exposing the palpebral conductive. when the punctum of the lower lid turns outward, the eye no longer drains well, and tearing occurs.
ectropion, more common in elderly
wide eyed stare; rim of sclera between the upper lid and the iris.
lid retraction
Retracted lids and “lid lag” when eyes move from up to down markedly increase the likelihood of _____, especially when accompanied by fine tremor, moist skin, and heart rate > 90 beats per minute
hyperthyroidism
protrusion of the eyeball; triggered by auto reactive T lymphocytes
exophthalmos
Exophthalmos is a common feature of _____
Graves’ ophthalmopathy
In Unilateral exophthalmos what 4 things should be in your differential diagnosis?
- Graves Disease (usually bilateral)
- trauma
- orbital tumor
- granulomatous disorder
a harmless yellowish triangular nodule in the bulbar conductive on either side of the iris. appears frequently with aging, first on the nasal and then on the temporal side
pinguecula
a localized ocular inflammation of the episcleral vessels. vessels appear movable over the scleral surface. may be nodular or show only redness and dilated vessels
Episcleritis
What are the 3 diseases associated with episcleritis?
- rheumatoid arthritis
- Sjogren’s syndrome
- herpes zoster
a painful tender red infected in a gland at the margin of the eyelid
sty
a subacute nontender, usually painless nodule involving a blocked meibomian gland. May become acutely acutely inflamed but unlike a sty usually points inside the lid rather than on the lid margin
Chalazion
slightly raised yellowish, well circumscribed plaques that appear along the nasal portion of one or both eyelids. may accompany lipid disorders
xanthemasma
a swelling between the lower eyelid and nose
inflammation of the lacrimal sac (dacryocystitis)
acute inflammation of the lacrimal sac (Dacryocystitis) description
painful red and tender
chronic inflammation of the lacrimal sac (Dacryocystitis) discription
obstruction of the nasolacrimal duct
tearing is prominent and pressure on the sac produces regurgitation of material through the puncta of the eyelids
a thin grayish white arc or cycle not quite at the edge of the cornea. accompanies normal aging but also seen in younger people, especially african american.
corneal arcus
when corneal arcs in found in young people it suggests possible ________.
hyperlipoproteinemia. usually benign
a golden to red brown ring, sometimes shading to green or blue, from copper deposition in the periphery of the cornea
Kayser-Fleischer Ring
What disease is Kayser- Fleischer Ring found in?
Wilson’s disease
Kayser - Fleischer Ring is due to a rare autosomal recessive mutation of the ATO7B gene on chromosome 13 causing what????
- abnormal copper transport
- reduced biliary copper excretion
- abnormal accumulation of copper in the liver and tissue throughout the body
What are some symptoms that patients present with who are diagnosed with a Kayser- Fleischer ring?
- liver disease
- renal failure
- neurologic symptoms of tremor
- dystonia
- psychiatric disorders ranging from behavior changes to depression and schizophrenia
A superficial grayish white opacity in the cornea, secondary to an old injury or to inflammation. Size and shape are variable.
Corneal Scar
**do not confuse with the opaque lens of a cataract, visible on a deeper plane and only through the pupil
a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from the nasal side
Pterygium
Will pterygium interfere with vision?
may interfere with vision as it encroaches on the pupil
opacities of the lenses visible through the pupil.
cateracts
what are the risk factors of cataracts?
- old age
- smoking
- diabetes
- corticosteroid use
looks gray when seen by a flash light. if the pup is widely dilated, the gray opacity is surrounded by a black rim
nuclear cataract
produces spokelike shadows that point - gray against black, as seen with a flashlight, or black against red with an opthalmoscope. a dilated pupil, as shown here, facilitates this observation
peripheral contact
When anisocoria is greater in bright light than in dim light, the pupil ___________.
cannot constrict properly
What are the cause of unequal pupils (Anisocoria), when anisocoria is greater in bright light than in dim light?
- blunt trauma to the eye
- open angle glaucome
- impaired parasympathetic nerve supply to the iris, as in tonic pupil and oculomotor nerve paralysis
Unequal pupils - when anisocoria is greater in dim light, the pupil _______.
the smaller pupil cannot dilate properly,as in hornet’s syndrome , caused by an interruption of the sympathetic nerve supply
pupil is large, regular, and usually unilateral; reaction to light is severely reduced or slowed, or even absent. Near reaction, although very slow, is present. slow accommodation cause blurred vision. deep tendon reflexes are often decreased
Tonic Pupil (Adie’s Pupil)
The dilated pupil is fixed to light and near effect ; Ptosis of the upper eyelid and lateral deviation of the eye are almost always present
Oculomotor Nerve (CN III) Paralysis
The affected pupil, though small, reacts briskly to light and near effort. Ptosis of the eyelid is present, perhaps with loss of sweating on the forehead.
Horner’s syndrome
In congenital Horner’s syndrome , the involved iris is _______.
lighter in color than its fellow (heterochromia)
small, irregular pupils, that accommodate but do not react to light indicate _________
Argyll Robertson Pupils
What disease are Argyll Robertson pupils seen in?
Central Nervous System Syphilis
When does unilateral blindness not cause anisocoria?
as long as the sympathetic and parasympathetic innervation to both irises is normal
How can you test if unilateral blindness is causing anisocoria?
a light directed into the seeing eye produces a direct reaction in that eye and a consensual reaction in the blind eye. A light directed into the blind eye, however, causes no response in either eye.
