Eyes Flashcards
this eye condition occurs when the lens becomes hard and can’t properly accommodate due to aging
presbyopia
what are 2 symptoms of presbyopia?
eye strain and headache
what is a tx for presbyopia?
corrective lenses
this eye condition occurs due to damage to the optic nerve due to pressure inside the eye
glaucoma
what are 4 RFs for glaucoma?
1st degree relatives
DM
ethnic backgrounds
chronic steroid use
what is the main cause of acute angle glaucoma?
rapid narrowing of anterior chamber angle leads to inadequate aqueous humor drainage
what are at least 4 RFs of acute angle closure glaucoma?
farsightedness
lens enlargement
elderly
genetics
(often is precipitated by pupil dilation)
what are common signs/ symptoms of acute angle closure glaucoma?
extreme pain
red eye
cloudy cornea
dilated pupil
blurred vision (halos around lights)
headache, n/v
is acute angle glaucoma usually unilateral or bilateral?
unilateral
what is the first line tx of acute angle closure glaucoma?
IV acetazolamide (diuretic)
after 1st line tx of acute angle closure glaucoma, what options are next?
oral diuretics
topical drops- timolol
topical pilocarpine
cataract removal or laser peripheral iridotomy
this type of glaucoma is progressive optic nerve damage that causes peripheral vision loss
chronic glaucoma
what type of fibers are most impacted by chronic glaucoma?
small nerve fibers of the periphery
what are three types of chronic glaucoma?
open angle
angle closure
normal tension
what are the three main factors to consider when diagnosing chronic glaucoma?
must have 2 of the 3:
optic disc (disc: cup ratio)
visual field loss
IOP
what are the 3 MC tx of chronic glaucoma?
1st line- PG analog drops: latanoprost/ travoprost
topical beta blocker (decreases production)
laster treatment or surgery
this eye condition is a misalignment of the eyes
strabismus
what is the main cause of strabismus?
issues with the eye muscles or structures that control the muscles
term for eye deviated inward
esotropia
term for eye deviated outward
exotropia
this is a lack of development of the bridge of the nose that makes it appear like the pt has strabismus
pseudostrabismus
what 2 diagnostic measures are used for strabismus?
hirschberg test (see if light on same side on pupil on both eyes)
cover test- cover good eye, bad eye will fixate on spot
this eye condition is associated with fixation preference for one eye leading to limiting extraocular movement for the weak eye and occurs in 1/2 of children with strabismus
amblyopia
this type of ambylopia occurs due to long term suppression of 1 eye which causes the visual cortex to suppress image in order to avoid having diplopia
strabismic amblyopia
what is the main symptom of amblyopia?
unilateral impaired fine depth perception
what is the diagnostic standard for amblyopia?
at least a 2 line difference in visual accuity
tx for amblyopia
patching good eye
atropine (blurring vision in good eye with cycloplegic agent)
fixing structural issues
this eye condition is a childhood tumor of blast cells in the retina
retinoblastoma
what is the most tell tale sign of retinoblastoma?
leukocoria- white reflex
(lack of red reflex)
true or false- most retinoblastomas are diagnosed by age 2
true
this eye condition is sudden unilateral vision loss that typically lasts a few minutes
amaurosis fugax
what is the most common cause of amaurosis fugax?
hypoperfusion
what are three common causes of hypoperfusion that may lead to amaurosis fugax?
carotid artery disease
giant cell arthritis (swelling of arteries of the head)
vasospasm
what diagnostics would be considered for amaurosis fugax?
ophthalmologic exam
ESR and CRP levels
carotid ultrasound
this eye condition is due to inflammatory demyelination of optic nerve that causes acute, unilateral vision loss
optic neuritis
what are 5 conditions that are RFs for optic neuritis?
MS
infection
methanol poisoning
B12 deficiency
diabetes
signs and symptoms of optic neuritis
subacute central vision loss
loss of color or brightness
eye pain (worse with movement)
swollen optic disc
relative afferent pupillary defect (RAPD)
tx of optic neuritis
IV steroids
if vision doesn’t improve within 2-3 weeks, MRI indicated to r/o lesion
this is repetitive, uncontrolled eye movement
nystagmus
this eye condition is due to the optic disc swelling due to raised intracranial pressure (ICP)
papilledema
what are 5 causes of papilledema?
idiopathic intracranial hypertension
space occupying lesions
blockage of CSF flow
cerebral edema
meningitis/ encephalitis
this type of papilledema is characterized by enlargement of the optic disc without loss acuity
acute
this type of papilledema is characterized by visual field loss with profound loss of acuity
chronic
tx of papilledema
weight loss
acetazolamide (diuretic)
shunt if necessary
this eye disorder is inflammation of the mucus membrane that lines the surface of the eyeball and inner eyelids
conjunctivitis
list 7 subtypes of conjuntivitis
viral
bacterial
gonococcal
chlamydial- inclusion
chlamydial- trachoma
allergic
keratoconjunctivitis
what is the MC cause of viral conjunctivitis?
adenovirus
what are key s/s of viral conjunctivitis?
bilateral copious watery discharge
foreign body sensation
follicles on inferior palpebral conjunctival surface
1st line tx of viral conjunctivitis
cold compress and artificial tears
if viral conjunctivitis is caused by HSV, varicella zoster, or herpes zoster, then what is a common symptom?
unilateral lid vesicles
if viral conjunctivitis is caused by HSV, varicella zoster, or herpes zoster, then what are tx options?
topical antivirals- ganciclovir
oral antivirals- acyclovir, valacyclovir
ophtho consult
what are the MC pathogens of bacterial conjunctivitis?
staph, strep, h flu, pseudomonas (contact lens), moraxella
what are key s/s of bacterial conjunctivitis?
copious purulent discharge
mild blurring of vision and discomfort
1st line tx of bacterial conjunctivitis
topical abx- trimethoprim with polymixin B
if pseudomonas- fluroquinolones: ciprofloxacin
what is the MC cause of gonococcal conjunctivitis?
contact with genital secretions (hand to eye)
what are the key s/s of gonococcal conjunctivitis?
copious purulent discharge (excessive)
chemosis (edema)
lid swelling
preauricular adenopathy
what is a primary way to Dx gonococcal conjunctivitis?
stained smear and culture of drainage
(will show G- intracellular diplococci and PMN leukocytes)
what are 4 tx measures for gonococcal conjunctivitis?
IM ceftriaxone
topical abx- erythromycin or bacitracin
irrigation
treat STDs
what is the MC cause of inclusion chlamydial conjunctivitis?
contact with contaminated genital secretions (STD type)
s/s of chlamydial inclusion conjunctivitis
follicular involvement
acute redness
purulent
irritation
mild keratitis
nontender preauricular lymph nodes
what is the diagnostic measure of inclusion chlamydial conjunctivitis?
immunological tests- PCR or conjunctival samples
1st line tx of inclusion chlamydial conjunctivitis
oral doxycycline
(treat STIs)
causes of trachoma- chlamydial conjunctivitis
contact with infected person, towels/ cloths, and flies
key s/s of chlamydial conjunctivitis- trachoma
chronic keratoconjunctivitis
(Recurrence can lead to cloudy cornea and blindness)
1st line tx of tachoma chlamydial conjunctivitis
oral azithromycin
cause of allergic conjunctivitis
seasonal/ hay fever
s/s of allergic conjunctivitis
bilateral hyperemia
chemosis
stringy discharge
follicular appearance on tarsal conjunctiva
itching and tearing
tx of allergic conjunctivitis
topical antihistamines
topical mast cell stabilizer- cromolyn
combined antihistamine and mast cell- olopatadine
systemic antihistamines- loratadine
cause of keratoconjunctivitis sicca
hypo-function of lacrimal glands (aging, genetics, systemic disease, drugs)
excessive evaporation of tears (environmental factors)
s/s of keratoconjunctivitis sicca
dryness
redness
foreign body sensation
variable vision
what are s/s of severe dry eye?
discomfort
photophobia
difficulty moving lid
excessive mucus secretion
what are 3 special tests that can be used to help diagnose keratoconjunctivitis sicca?
slit lamp- tear film volume
fluorescein stain- corneal damage
schirmer test- amount of tearing
tx for keratoconjunctivitis
artificial tears (preservatives may mimic dry eye)
stop drying medications
humidifiers
ophtho may recommend short term topical steroid
this eye condition is opacities of the lens
cataracts
what are some causes/ RFs of cataracts?
age
congenital
traumatic
systemic disease
steroid use
uveitis
what are some s/s of cataracts?
bilateral progressive vision loss
glaring (especially in bright light)
change of focusing (nearsightedness)
what would you expect to see on a PE of a pt with cataracts?
pupil appears white
management of cataracts includes…
ophtho referral
if functional vision impairment–> lens replacement
this is a scratch or abrasion to the corneal surface
corneal abrasion
what are 3 common causes of corneal abraison?
trauma
foreign body
contact lenses
s/s of corneal abraison
severe pain
photophobia
foreign body sensation
Dx exam for corneal abrasion
check visual acuity
tetracaine to anesthetize
lid eversion (r/o foreign body)
stain with fluorescein
corneal abrasion tx
ointment abx- bacitracin-polymyxin/ erythromycin
pseudomonas- ointment or eyedrop fluoroquinolones (ciprofloxacin)
analgesics- oral or topical NSAIDs
larger abrasions- cycloplegic drops, patching
this eye condition is a defect that causes an open sore on the epithelium of the eye surface
corneal ulcer
what are 3 causes of a corneal ulcer?
infection
long term contact use
persistent eye irritation
s/s of corneal ulcer include…
pain
photophobia
tearing
reduced vision
corneal injection
discharge
tx of corneal ulcer includes…
emergent ophtho consult
ointment abx- erythromycin
how to diagnose a corneal foreign body
exam or fluorescein stain
tx for a corneal foreign body
remove with sterile wet cotton tip or with 25G needle (if under lid, apply local and evert lid)
abx ointment- bacitracin-polymyxin/ erythromycin
what is a risk factor of intraocular FB?
someone working with with metal
when are circumstances when you would suspect intraocular FB?
no apparent FB but seems to be a wound
visual loss
media opacity
management of intraocular FB
emergent referral to ophtho
this eye condition is a corneal infection
keratitis
what are the MC pathogens of bacterial keratitis?
staph, strep, pesudomonas (contact wearers), moraxella
s/s of bacterial keratitis
purulent discharge
corneal opacity
red eye
photophobia
foreign body sensation
hypopyon
what is a diagnostic sign of bacterial keratitis?
corneal opacity
management of bacterial keratitis
emergent ophtho referral
scrape for sample to culture
topical abx- fluoroquinolones
what is usually the cause of viral keratitis?
HSV
s/s of viral keratitis
dendritic lesion
watery discharge
red eye
photophobia
foreign body sensation
tx/ management of viral keratitis
usually self-limited
antivirals or topical corticosteroids may shorten duration
refer to ophtho
what are key s/s of fungal keratitis
feathery edges
satellite lesions
hypopyon
this eye condition is a degenerative and benign lesion that is usually bilateral and characterized by a yellow nodule on the medial side of the eyes
pinguecula
Tx of pinguecula
no tx required
artificial tears
topical anti-inflammatories
what are the s/s of pterygium?
fleshy triangular conjunctival tissue on medial side of eye
usually bilateral
what are RFs for pterygium?
long term exposure to:
wind
sun
dust
sand
tx of pterygium
artificial tears
topical NSAIDs
excision (if threatens vision, astigmatism, severe irritation)
this eye condition is bilateral inflammation of lid margins
blepharitis
this type of blepharitis involves the lid skin, eyelashes, and associated glands
anterior
this type of blepharitis is inflammation of meibomian glands
posterior
what is the MC cause of anterior blepharitis?
staph infection or seborrheic (oil gland) inflammation
s/s of anterior blepharitis
crusting
scaling
erythema of lid margins
burning, itching, irritated eyelids
tx of anterior blepharitis
eyelid hygiene (massage, baby shampoo)
warm compress
acute exacerbations- abx ointment (bacitracin or erythromycin)
s/s of posterior blepharitis
hyperemic lid margins with telangiectasis (spider veins)
Inflamed meibomian glands and or orifices
lid margin rolled inward (entropion)
frothy tear film
1st line tx of posterior belpharitis
meibomian gland expression and warm compress
(if conjunctiva and cornea inflamed, oral abx: tetracycline, doxycycline, minocycline, erythromycin and short term corticosteroids: prednisone; topical abx- ciprofloxacin)
this eye condition is blockage or infection of zeis (sebaceous) or moll (sweat) glands
hordeolum
what is the MC pathogen that causes hordeolum?
staph aureus
s/s of hordeolum
localized red, swollen and tender area on eye lid
sign of internal hordeolum
meibomian gland abscess that points onto conjunctival surface of lid
sign of external hordeolum
smaller and on margin of lid
pain, swelling, erythema
tx of hordeolum
warm compress
abx ointment- erythromycin or bacitracin
incision if doesn’t improve in 48 hours
this eye condition is nontender granulomatous inflammation of the meibomian gland and may follow internal hordeolum
chalazion
s/s of chalazion
hard, non tender swelling on upper or lower lid
painless, rubbery, nodular lesion
redness and swelling may be noted
tx of chalazion
warm compress
2-3 weeks w/o improvement: incision and curettage and corticosteroid injection
this eye condition is inward turning of the eyelid
entropion
what may cause entropion?
loss of lid fascia
conjunctival scarring
tx of entropion
monitor
surgery if lashes scratch cornea
botox
this eye condition is outward turning of the lower eyelid
ectropion
s/s of ectropion
excess tearing
dry eye (exposure keratitis)
cosmetic issues
tx of ectropion
keep eye moist
surgery (if excessive tearing, exposure keratitis, or cosmetic issue)
this eye condition is infection of the lacrimal sac and is usually unilateral
dacryocystitis
what causes dacryocysitis?
congenital or acquired obstruction of nasolacrimal system
what pathogens causes acute and chronic dacryocystitis?
acute- staph aureus
chronic- staph epidermidis
what s/s differentiates acute from chronic dacryocystitis?
excessive tearing and discharge indicates chronic
s/s of acute dacryocystitis include…
pain
swelling
tenderness
redness
purulent material may be expressed
s/s of chronic dacryocystitis include…
tearing and discharge
mucus or pus expression
tx of acute dacryocystitis
oral abx- amox-clav, cephalexin, ciprofloxacin, clindamycin
tx of chronic dacryocystitis
systemic abx
only cure is dacryocystorhinostomy
this eye condition is inflammation of the lacrimal gland
dacryoadenitis
what are causes of acute dacryoadenitis
bacterial- staph aureus, strep, n. gonorrhea, chlamydia, brucella
viral- EBV, mumps, coxsakievirus, CMV, varicella
s/s of acute dacryoadenitis
pain
swelling and redness of outer portion of upper lid
purulent drainage
fever
malaise
diagnostic measure of acute dacryoadenitis
usually clinical, but can culture drainage
tx of acute dacryoadenitis
oral cephalosporin (cephalexin)
if severe, IV nafcillin
if MRSA suspected, IV vancomycin
causes of chronic dacryoadenitis
inflammatory disorders
neoplastic process
s/s of chronic dacryoadenitis
may be bilateral
painless
soft tissue swelling in lateral upper lid
Dx of chronic dacryoadenitis
lab workup for inflammatory etiology
biopsy
tx of chronic dacryoadenitis
depends on cause
this eye condition is a result of nasolacrimal duct obstruction or narrowing
dacryostenosis
s/s of dacryostenosis
epiphora (excessive tearing)
eyelash matting
thick and yellowish tears
*lack of infectious symptoms
dx of dacryostenosis
fluorescein application- will accumulate in eye instead of being cleared
tx of dacryostenosis
supportive- gentle massage
if still present > 12 months, dilation of duct by ophtho
this eye disorder leads to progressive vision loss and can be dry or wet
macular degeneration
in this type of macular degeneration, cellular debris (drusen) accummulates between the retina and choroid and can lead to scarring and atrophy
dry
tx of dry macular degeneration
pegcetacoplan and avacincaptad pegol injection- inhibits complement pathway
this type of macular degeneration is more severe and faster progressing and is due to neovascularization
wet macular degeneration
tx of wet macular degeneration
VEGF inhibitor injection- ranibizumab
which type of ARMD is rapid onset?
wet
(dry is more gradual and progressive)
s/s of macular degeneration
blurred central vision
distortion of images
scotomas (dark spots)
declining visual acuity
what are 3 diagnostic tests for macular degeneration?
snellen test- visual acuity
amsler grid- will look curvy
ophtho exam- dilate pupil, fluorescein angiography
this eye disorder is separation of the neurosensory retina from the underlysing retinal endothelium
retinal detachment
this type of retinal detachment is caused by entry of liquid vitreous into the subretinal space through a retinal break
primary
this type of secondary retinal detachment is due to preretinal fibrosis (diabetic retinopathy, retinal vein occlusion)
tractional
this type of secondary retinal detachment is due to accumulation of subretinal fluid (wet ARMD, choroidal tumor)
exudative
s/s of retinal detachment
acute onset tunnel vision/ curtain like loss of peripheral vision
floaters
photopsias (flashes of light)
what are the diagnostic/ exam findings of retinal detachment?
elevated retina with irregular surface
appears gray or cloud
MC area- superior temporal quadrant
management of retinal detachment
refer to ophtho
head positioning where tear at lowest point
minimize eye movement
what are the two types of diabetic retinopathy?
non-proliferative
proliferative
what is the main difference between proliferative and non-proliferative diabetic retinopathy?
proliferative- neovascularization
non-proliferative- microaneurysms, retinal hemorrhages, venous bleeding, retinal edema, hard exudates
tx of diabetic retinopathy
*control blood glucose levels
VEGF inhibitor injections
laser photocoagulation
this type of hypertensive retinopathy is due to sudden severely elevated BP
acute
this type of hypertensive retinopathy is due to long standing HTN or atherosclerosis
chronic
s/s of acute hypertensive retinopathy
cotton wool spots
dot blot flame hemorrhages
papilledema
s/s of chronic hypertensive retinopathy
AV nicking
narrowing of arterioles
dot blot flame hemorrhages
copper/silver wiring
macular star- exudates
tx of hypertensive retinopathy
tx HTN or underlying cause
RFs for retinal artery occlusion
giant cell arteritis
internal carotid artery disease
emboli or thrombosis
DM, HTN, hyperlipidemia
s/s of central retinal artery occlusion
sudden profound monocular vision loss
pale swelling
cherry red spot at fovea
box car segmentation
over time, pale optic disc
s/s of branch retinal artery occlusion
unilateral sudden loss of discrete area in visual field
retinal swelling
cotton wool spots
Tx of retinal artery occlusion
urgent referral to ER for imaging and stroke workup
lay pt flat, ocular massage, O2, IV acetazolamide, anterior chamber paracentesis
if retinal artery occlusion is not due to giant cell arteritis, what would be added to the treatment?
thrombolytic agent
if retinal artery occlusion is secondary to giant cell arteritis, what would be added to the treatment?
high dose systemic steroids
what is Virchow’s triad for thrombogenesis
vessel damage
stasis
hypercoagulability
s/s of retinal vein occlusion
sudden monocular vision loss with no pain or redness
Dx of central retinal vein occlusion
widespread retinal hemorrhages
venous dilation and tortuosity
cotton-wool spots
optic disc swelling
tx of retinal vein occlusion
macular edema- VEGF injection, steroid injection, laser
neovascularization- panretinal laser photocoagulation
this is cellulitis of the eyelids and periocular tissues that is anterior to the orbital septum
periorbital cellulitis
RFs of periorbital cellulitis
URI
eyelid issues (hordeolum, chalazion, trauma)
childhood
periorbital cellulitis pathogens
staph aureus
staph epidermidis
strep
anaerobes
s/s of periorbital cellulitis
*no changes in vision
URI symptoms
fever
redness and edema of eyelid
epiphora (excessive tearing)
Dx of periorbital cellulitis
CT with contrast of orbitis and sinuses
Tx of periorbital cellulitis
oral abx- amox-clav or cephalosporin
hot packs
pathogens of orbital cellulitis
staph
strep
anaerobes
causes of orbital cellulitis
spread of paranasal sinusitis
trauma
intraorbital FB
skin infection
s/s of orbital cellulitis
gradual onset of URI symptoms
pain with eye movement
limited EOM
chemosis (inflamed conjunctiva)
proptosis
abnormal pupillary response
decreased visual acuity
tx of orbital cellulitis
*IV nafcillin + metronidazole or clindamycin
trauma- add cephalosporin
MRSA- vancomycin or clindamycin
penicillin sensitivity- vancomycin, levofloxacin, or metronidazole
this eye condition is full thickness disruption of sclera or cornea
globe rupture
what are 2 rules of examination for globe rupture pts?
1- do not apply pressure (no lid retraction or tonometry)
2- do not apply any topical medications until directed by ophtho
what are a few s/s of globe rupture?
eccentric/ teardrop pupil
extrusion of vitreous
external prolapse of uvea
tenting of cornea or sclera
low IOP
positive Seidel sign
Tx of globe rupture
emergent consult
bandage and shield eye
HOB elevation
leave FBs
avoid moving eye
IV abx- vancomycin + ceftazidime
this eye condition is blood or clots in the anterior chamber
hyphema
s/s of hyphema
decreased acuity
eye pain with pupillar constriction to bright light
damage to adjacent structure
abnormal IOP
tx of hyphema
prevent rebleed and intraocular HTN
elevate HOB
consult ophtho
this eye condition is a painless rupture of blood vessels between the conjunctiva and sclera
subconjunctival hemorrhage
s/s of orbital fx
bony tenderness
swelling
periocular ecchymosis
diplopia
decreased sensation in distribution of infraorbital nerve
orbital emphysema
four bones commonly involved in orbital fractures
frontal
zygomatic
maxillary
sphenoid
Tx of orbital fractures
address life threatening conditions
consult
prophylactic oral abx- cephalexin
oral corticosteroids if limited EOM
