Eyes Flashcards
Hemianopia
Loss of half the visual field. This relates to the brain’s impaired ability to receive the information transmitted to it through both eyes
Visual field loss on the same side in both eyes
Homonymous hemianopia
The visual field loss is on the same side that the lesion is on
Ipsilateral
The visual field loss is on the opposite side that the lesion is on
Contralateral
An area of reduced or absent vision within an otherwise intact visual field (an aura or blind spot that obstructs vision)
Scotoma
unequal size of the pupils
Anisocoria
etiology & #1 trmnt
“Pink Eye” Viral conjunctivitis
Adenovirus
#1 Cold Compress
Allergic Conjunctivitis Mild trmnt
Artificial tears
etiology & trmnt
Bacterial conjunctivitis
-S. aureus, S. pneumoniae, H. Flu, M. Catarrhalis
- Polymyxin B/Trimethorprim (polytrim), Bleph-10, Erythromycin ointmnet
What is this benign variant called?
Conjunctival Nevus = mole on eye
is Pinguecula or Pterygium harmful to your vision?
Pterygium
____ vs _____
Pinguecula - yellow-white, flat or slightly raised growth on the bublar conjunctiva
Pterygium - wing shaped fold of fibrovascular tissue. invades the cornea
both: degeneration of the deep conjunctival layers 2ndary to sunlight and chronic irritation
What & Trmnt?
what and trmnt?
mild pain, foreign body sensation, conjunctival and subconjunctival hemorrhages present. No changes in V/A exam. Hx of BB gun fights
Conjunctival Laceration
Fluorescein stain
CT or XR to r/o foreign body
- <1cm in length: erythromycin ointment
- >1cm in length: sx closure
trmnt?
- ABX ointment
- temporary taping
- Sx often req
what & trmnt?
obese male with sleep apnea has chronically red irritated eye that is worse in the morning
Floppy Eyelid Syndrome
Trmnt: Lubricants, topical ABX, eyelid taping during sleep, Sx
what & trmnt
Xanthelasma
Most common eyelid tumor
an asymptomatic or mildly irritated eyelid lump
BCC
what & trmnt
painless lump inside the lid
internal chalazion
- warm compress, ophthalm ref
what & trmnt
tender nodule on the lid
Hordeolum
- Warm compress
- topical ABX: bacitracin, erythromycin ointment, polymyxin B
- refer if no imprvmnt ~2 weeks for Sx I&D
What & trmnt
eyelid margin itchy, burning, crusting, foreign body sensation
Blepharitis
- warm compress
- baby shampoo wash
- erythromycin or bacitracin if severe
Hordeolum vs Chalazion
Hordeolum is ON THE LID and caused by S. aureus
Chalazion is INSIDE THE LID and caused by noninfectious meibomian gland occlusion
what & trmnt
hyphema
bleeding into anterior chamber -> permanent vision loss
- Cycloplegia - Atropine sulfate (mydriatics)
- Analgesia, anti-emetics as needed
what
blowout frx
rule out globe fracture
augmentin
what & trmnt
globe rupture
vision test, slit-lamp exam, CT scan, eye shield
trmnt?
rule out globe fracture, eval lacrimal system, CT scan, eval ptosis, suture repair, refer to specialist, tetanus shot
eval ptosis for levator muscle injury
pathogens for preseptal (periorbital) & orbital cellulitis?
- S. aureus & strep most common
- **H. Flu **in unimmunized children (Hib)
what & trmnt?
inflamed lacrimal gland
Dacryoadenitis
most commonly idiopathic -> oral steroids
if infx -> Augmentin, Keflex
what, path, trmnt
Pain, redness, and swelling over the lacrimal sac
Dacryocystitis
staph, strep
orbital cellulitis trmnt
- CT scan
- IV ABX: unasyn, vanco, zosyn
- CBC w/diff
- Blood cultures
- LP if meningitis suspected
preseptal cellulitis trmnt
- CT to r/o cellulitis
- Mild Cases: ABX (polytrim, Augmentin, Bactrim)
- Severe: Hosp, Ampicillin/subactam (unasyn) IV
Pt’s with early symptoms of Myasthenia Gravis frequently present with ____
Eyelid Ptosis
Vertical nystagmus is a concern for?
CNS tumor
Trmnt for chronically blocked tear duct that fails to respond to topical ABX
if not improved by 1 yo old, perform lacrimal probe
what & trmnt
Acute onset of localized inflammation of the episcleral vessels. Mild pain, norm V/A exam, no discharge. Manipulation of the conjunctiva demonstrates vessel dilation beneath the conjunctiva affecting the sclera.
Episcleritis
Mild: cold compress, artifical tears
Mod-Severe: topical steroids, NSAIDs
This dendritic or branching fluorescein stain pattern is a classic findings for _____
Copeland may call them “dendritic lesions”
Herpes simplex virus keratits
Aka herpetic corneal ucer,
Most common risk factors for Iritis(Uveitis)
Taxoplasmosis, HSV(herpes simplex), VZV(varicella-zoster)
50% idiopathic
Pinguecula & Pterygium trmnt
artificial tears
topical steroid drops if symp severe.
Severe cases require sx rmvl if you cant see
Corneal abrasion trmnt
Non-contacts -> Erythromycin, bacitracin, polysporin ointment, polytrim drops
Fingernail injury -> Fluoroquinolone drops
Contact lens wearers need pseudomonas coverage -> Ciprofloxacin, Tobramycin
Corneal abrasion trmnt for pt who scraped their eye with their dirty fingernails while taking out their contacts.
Ciprofloxacin drops
fingernails need fluoroquinolones
Contact-lens needs ciprofloxacin or tobramycin
A small piece of metal fell into pts eye while they were working under their car. Very superficial and no globe penetration. Trmnt?
Rmvl under topical anesthesia
+ Topical ABX: Polytrim (polymyxin B/Trimethoprim)
After you rmv metal from the cornea, you see it left a rust stain. Wdyd?
Diamond** burr** polishing is performed in office using anesthetic drops. The surface layer of the cornea is removed with a surgical sponge and blade. The diamond-dusted burr is then used to smooth the corneal surface
Why are cycloplegics beneficial for intraocular foreign bodies?
Cycloplegics block ACH binding. If there’s something deeper in your eye, you want to paralyze the eye to avoid further trauma
a piece of metal deep in the eye may be held in place by any layers (ex. cornea). You don’t want your pupils to constantly constrict and dilate and cut your iris even further.
How to tell if a foreign body is superficially within the cornea or deeper (intraocular)?
Corneal: milder symptoms, foreign body sensation, irritation, and pain
Intraocular: irregular pupil, asniscoric, viteous hemorrhage
You only have to paralyze the pupil if its deeper (intraocular)l
Thing grayish white circle near cornea is concern for
hyperlipoproteinuria
red, brown ring, sometimes shades green or blue. Concern for?
Wilson’s disease - build up of copper in the body
What causes myopia?
point of focus is in front of retina due to cornea being TOO curvy or axial length TOO long
What causes hyperopia
Farsightedness is due to flatter cornea or short axial length
What causes presbyopia?
with age, the lens becomes more rigid and cant move to focus on objects up close very well
Anisometropia
a significant difference b/w the refractive errors of the 2 eyes
Emmetropia
normal vision
Laser sx opts for refractive errors
Photorefractive keratotomy (PRK)
Laser in situ keratomileusis (Lasik)
PRK corrects the cornea
4 month old child (+) for strabismus on PE. Trmnt?
nothing, normal visual axis alignment is achieved by 6 months
Strabismus
misaligned eyes
Concomitant Strabismus
Nonparalytic (naturally occurring)
misalignment EQUAL in all directions of gaze
Incomitant strabismus
paralytic strabismus (not naturally occuring). Misalignment VARIES with direction of gaze
nerve dysfunction of mechanical restriction
Amblyopia
“lazy eye” defective vision w/o identifiable organic cause. what the PATIENT SEES. Starts off as double vision (diplopia). Eventually, the brain compensates and only chooses one eye to look at
Anisometropia
condition that occurs when your eyes have varying refractive powers, which can cause your eyes to focus unevenly
How does chronic HTN affect your eyes?
as your arteries constrict more, it increases your risk for atherosclerosis. The build up of plaque looks like silver wire. The arteries look like they’re “nicking” the veins. A/V ratio change from 2:3 -> 1:3 or 1:4.
Other exam findings: exudates, hemorrhages, cotton-wool spots
The most frequent cause of preventable blindness in the world
Cataract
Cataract trmnt
Glasses (early dz)
Sx lens replacement (late dz)
retinopathy is present in ___% of DM pts at initial dx
20
Most common cause of adult blindness in USA
Diabetic retinopathy
most pts <65yo
Proptosis
eyes bulging out
a wing shaped fold of fibrovascular tissue that extends and invades the cornea resulting in impairment of vision
Pterygium
a yellowish elevation extending from the medial canthus to the nasal cornea
Pinguecula
Which CNs help you open and close your eyelids?
CN 3: Open
CN 7: Close
ptosis relates to CN ___
CN III Occulomotor
Contact lens wearers need pseudomonas coverage when treating bacterial infx. What classes are your go tos?
Topical aminoglycosides or fluoroquinolones
Aminoglycosides: gentamycin, tobramycin
Fluoroquinolones: ciprofloxacin
tear-drop pupil + abnormal red light reflex
globe rupture
what, WU, trmnt?
Sudden unilateral vision loss with scalp tenderness and headache
Temporal Arteritis
Labs: ESR>50
temporal artery biopsy
IV Methylprednisolone
What does a high ESR mean?
measures how fast your RBCs sink. if you sink faster than normal, it may mean you have a medical condition causing inflammation.
Hypopyon
collection of pus in anterior chamber of eye
Cherry red spot
retinal artery occlusion
Pale white spot
Retinoblastoma
Cotton wool spots
Hypertensive Retinopathy or Diabetic Retinopathy
caused by lack of blood flow to small retinal arteries
most common cause of blindness in ppl >65yo
Macular degeneration
Meds that make glaucoma worse
Metoclopramide, Atropine
what, etiology, trmnt
painful red eye with ircumcorneal conjunctival injection, blurry vision, light sensitivity,
Acute (anterior) Uveitis
toxoplasmosis, HSV, VZV
Cycloplegic paralytics (scopalamine, atropine), topical steroid (predisone)
