eyes Flashcards
argyll robertson
-small irregular pupils
-syphillis
adies tonic pupil
-poor light reflex
myopia / hyperopia
-myopia- nearsighted (long globe)
-hyperopia- farsighted (short globe)
vision
-Image focused by cornea and lens onto retina
-Light absorbed by photoreceptors in retina (rods and cones)
-Macula: cones only. Detailed vision
-Fovea: cones dense. Best visual acuity
-Choroid: provides nutrition to retina
-Cornea: covers iris, pupil, anterior chamber
-Palpebra: protect globe
-Cathus: where lids meet
TERMS
-Ptosis: drooping of eyelid.
-Ectropion: lower lid outward.
-Entropion: lower lid inward.
-Proptosis: exophthalmos.
-Visual acuity.
-Visual fields: scotomas.
-Direct pupillary response.
-Consensual pupil response
-Miosis: constriction.
-Mydriasis: dilation: sympathetic
-Emmetropia: light focused on retina perfect.
-Myopia: near sighted. Need lens for distance. Globe long.
-Hyperopia: Far sighted. Need lens for near. Globe short.
-Presbyopia: lens cannot accommodate for near objects. Can’t increase refractive power.
aniscoria
-unequal
-Adies tonic pupil: poor light reaction.
-Argyll Robertson: small irregular. Syphilis.
-Convergence.
-Divergence.
pterygium
-Conjunctiva begins to grow onto cornea.
-Etiology is UV sunlight and dry conditions.
-Clinical:
-Blurred vision.
-Eye irritation-Itching, burning.
-During growth appears swollen and red
-sand in the eye feeling
-Complications:
-Blockage of vision as grows onto cornea.
-Management:
-Eye drops to moisten eyes and decrease inflammation.
-Surgical excision.
hordeolum
-Acute localized infection or inflammation of eyelid margin to hair follicles of eyelash or meibomian glands. Blockage or infection with staph.
-Clinical manifestations:
-Tender, red, swollen, pain.
-Vision acuity normal.
-Diagnostics- none.
-Management: resolves spontaneously, topical antibiotic, warm compresses, might need I/D.
entropion
-Lower eyelid inward.
-Etiology: older, weakness of muscle. surrounding lower part of the eye.
-Clinical manifestations:
-Redness, light sensitivity, dryness.
-Increased lacrimation, foreign body. sensation. Lashes scratch cornea.
-Diagnostics- none
-Management: Artificial tears, epilation of eyelashes, Botox, surgery.
ectropion
-Lower eyelid outward exposing palpebral conjunctiva.
-Etiology: Older , 7th nerve palsy. Obicularis oculi muscle relaxation.
-Clinical manifestations:
-Excessive lacrimation.
-Drooping eyelid.
-Redness, photophobia, dryness, foreign body sensation.
-Diagnostics: none.
-Management: Artificial tears, surgery
blepharitis
-Inflammation of eyelids (lid margins).
-Etiology: S. aureus (ulcerative) or a chronic skin condition(non-ulcerative).
-Two forms:
-Anterior: affects outside lids where eyelashes attach. Caused by bacteria or seborrheic.
-Posterior: Inner eyelid. Caused by problems with meibomian glands in eyelid (gland plugging). Caused by acne Rosacea or seborrheic
-S Aureus:
-Itching, lacrimation, tearing, burning, photophobia.
-Seborrheic:
-lid margin erythema, dry flakes, oily secretions on lid margins, associated dandruff.
-Diagnostics: none.
anterior/posterior blepharitis management
-Anterior:
-Hygiene. Remove scales with baby shampoo. Apply Bacitracin or or erythromycin.
-Posterior:
-Expression of meibomian gland on regular basis. If corneal inflammation need oral antibiotic. Artificial tears, cool compresses.
chalazion
-Localized sterile swelling of upper or lower eyelid due to blockage of meibomian gland If ruptures, granulation tissue results.
-Secondary to hordeolum.
-Risks: Blepharitis, acne rosacea.
-Hard non-tender swelling.
-Painless, present for weeks to months.
-Conjunctiva red and elevated near lesion.
-May distort vision if near cornea.
-Diagnostics: none, biopsy
-Management:
-Warm compresses.
-Injection or corticosteroid or I/D if no improvement.
-Surgery.
conjunctivitis: viral
-Inflamed palpebral and bulbar conjunctiva. Etiology: Viral: Adenovirus type 3
-Clinical
-Unilateral or bilateral edema and hyperemia of conjunctiva.
-Watery discharge.
-Ipsilateral preauricular lymphadenopathy.
-May be associated with pharyngitis, fever, malaise .
-Management:
-Warm compresses.
-Sulfonamide drops to prevent secondary bacterial infection, topical vasoconstrictors
bacterial conjunctivitis
-Etiology: S.pneunoniae, S. aureus, moraxella
-Transmission is direct contact.
-Clinical manifestations:
-Copious purulent discharge from both eyes (yellow/green).
-Mild discomfort/sticky eyes.
-Complications: corneal ulcer.
-Diagnosis: gram stain.
-Management: topical antibiotics such as polytrim, fluoroquinolones.
chlamydial/gonococcal conjunctivitis
-Serotypes A, B, Ba and C cause trachoma, and serotypes D through K produce adult inclusion conjunctivitis.
-Chlamydial (inclusion) conjunctivitis is found in sexually active young adults.
-Diagnosis can be difficult. Look for systemic signs of STI
-Eye infection greater than 3 weeks not responding to antibiotics.
-Mucopurulent discharge.
-Conjunctival injection.
-Corneal involvement uveitis possible.
-Preauricular lymphadenopathy.
-Conjunctival papillae.
-Chemosis: membranes that line eyelids and surface of the eye (conjunctiva) are swollen
-Diagnosis:
-Fluorescent antibody stain, enzyme immunoassay tests.
-Giemsa stain: Intracytoplasmic inclusion bodies in epithelial cells, polymorphonuclear leukocytes and lymphocytes
-Management:
-Oral: Tetracycline, Azithromycin, Amoxicillin and erythromycin.
-Topical: erythromycin, tetracycline or sulfacetamide.
-Gonococcal: ceftriaxone 1g IM, and then 1gm IV 12-24 hours later.
allergic conjunctivitis
-Etiology: allergen.
-Release of inflammatory mediators leading to vascular permeability and vasodilation.
-Clinical:
-Itching /Tearing /Redness.
-stringy discharge.
-photophobia and visual loss.
-Hypertrophic palpebral conjunctiva with cobblestone papillae.
-No preauricular nodes.
-Management: Topical antihistamines, topical vasoconstrictors, mast cell degranulation inhibitors, topical steroids
dacryocystitis
-Nasolacrimal obstruction leading to sac infection
-Etiology: Acute:
-S. aureus, B-hemolytic strep.
-Chronic: S. epidermidis, candida.
-Chronic Dacryocystitis etiology:
-Mucosal degeneration, ductile stenosis, stagnant tears, bacterial overgrowth.
-Clinical manifestations:
-Pain, redness, swelling to tear sac.
-Purulent discharge from sac.
-Diagnostics: none , CT for etiology.
-Management:
-Children: Oral Augmentin, antibiotic drops.
-Adults: Keflex/Augmentin, topical antibiotic drops.
-Warm compresses
conjunctival foreign bodies
-Trauma to conjunctiva.
-Clinical manifestations:
-Acute pain, foreign body sensation
-Redness, tearing.
-Visual acuity might be affected.
-Diagnostics:
-Visual acuity.
-Fluorescein staining.
-Evert eyelids.
-Management:
-Local anesthetic.
-Normal saline flush/ sterile cotton tip applicator.
-Antibiotic ointment.
-Referral if not healing
periorbital/orbital cellulitis definition
-Orbital septum: is a membranous sheet in the upper eyelid attached to the edge of the orbit, where it is continuous with the periosteum. Etiology is hordeolum, chalazion, conjunctivitis, dacryocystitis.
-Periorbital cellulitis: Remains anterior to orbital septum. Limited to the eyelids.
-Orbital cellulitis: Posterior to orbital septum in orbit. Unilateral/ young. Risk is sinus infection or entrance through ethmoid bone. Treat aggressively to avoid extension to meninges and brain via cavernous sinus.
periorbital/orbital cellulitis sx, dx, tx
-Periorbital cellulitis: conjunctival injection, fever, edematous erythematous periorbital soft tissue, EOM nontender, normal IOP, normal visual acuity, normal sensation.
-Orbital cellulitis: little conjunctival injection, fever, edematous erythematous periorbital soft tissue, tenderness with EOM, elevated IOP, impaired visual acuity, sensation can be impaired.
-Diagnosis: CT soft tissue orbital infiltration, cultures.
-Management: Admission, broad spectrum antibiotics, surgery.
preseptal cellulitis
-Infection of the eyelids and soft tissue structures anterior to the orbital septum.
-May be due to skin infection, trauma, upper respiratory illness or sinus infection
-Mild to very severe eyelid edema.
-Eyelid erythema.
-Normal ocular motility.
-Normal pupil exam.
-Mild systemic signs (fever, preauricular and submandibular adenopathy).
-Swab drainage if present for gram stain and culture.
-CBC.
-Blood cultures in more severe cases.
-CT scan of orbit to assess the paranasal sinuses, posterior extension into the orbit, and presence of subperiosteal or orbital abscesses.
-TX
-Systemic antibiotics.
-The younger the patient and the more severe the disease the more likely to initiate inpatient treatment (IV antibiotics).
orbital cellulitis
-Infectious process posterior to orbital septum that affects orbital contents.
-Medical emergency !!!!
-Requires combined efforts of pediatrician, ophthalmologist and often otolaryngologist for management
-pain with movement
-need to be admitted -> IV antibiotics
-causes:
-Bacterial infection of the adjacent paranasal sinuses, particularly the ethmoids.
-Infants may develop secondary to dacryocysitis (infection of the nasolacrimal system).
-Redness and swelling of lids.
-Impaired motility often with pain on eye movement.
-Proptosis.
-Decreased vision.
-periorbital edema
-chemosis
-Afferent pupillary defect.
-Optic disc edema.
-tx:
-Hospitalization.
-Ophthalmology consult (urgent).
-Blood culture.
-Orbital CT scan.
-IV antibiotics.
orbital cellulitis complications
-Optic nerve damage (permanent visual loss).
-Meningitis in 1.9% of cases as infection may spread through the valveless orbital veins.
-Subperiosteal abscess.
-Cavernous sinus thrombosis.
Subperiosteal abscess of the left orbit. Note the dome shaped elevation of the periosteum along the left medial orbital wall.
cornea abrasion
-Superficial irregularity from trauma or foreign body, contact lens.
-Clinical manifestations:
-Severe pain.
-Redness/photophobia.
-Excessive tearing.
-Foreign body sensation.
-Decreased visual acuity.
-Eye usually closed.
-Rust ring if metallic object.
-Diagnostics:
-Fluorescein staining.
-Evert lids, check for foreign body.
-Management:
-Remove foreign body.
-Antibiotic ointment.
-Eye patch with pressure.
-Oral pain meds.
-Follow up.
corneal foreign body
-Trauma to cornea. Inflammatory response.
-Rule out intraocular foreign bodies.
-Clinical manifestations:
-Pain/photophobia/redness.
-Foreign body sensation.
-Blurred vision.
-History of trauma.
-Eye closed.
-Ring infiltrate surrounding site if >24 hours.
-Diagnostics:
-Visual acuity.
-Fluorescein stain.
-Evert eyelids.
-CT/MRI.
-Management:
-Topical anesthetic.
-Antibiotic ophthalmic ointment.
-Eye patch.
-Oral pain medication.
-Follow up.
blow out fracture
-Associated with trauma to orbit.
-Examine facial bones, sinuses, eyes.
-EOMs.
-Orbital films.
-Optho referral.
-dx- CT, 3D reconstruction, eval of orbital floor, EOM, assess visual acuity
-light shining in the eyes is asymmetrical
-hemorrhage in the muscle
-orbital bone- very thin
hyphema
-Blood in anterior chamber between iris and cornea due to torn blood vessels within the iris and ciliary body.
-Etiology: Spontaneous or post trauma.
-do not involve the cornea
-opth eval needed
-Clinical manifestations:
-History: blunt trauma .
-Eye pain.
-Decreased vision, photophobia.
-Evaluate for globe rupture.
-Management: Head elevated, decreased eye ROM, analgesics, mydriatic, topical steroids, eye shield.
-Complications: rebleeding, reduced vision, glaucoma (increased IOP due to obstructed drainage of aqueous humor).
iritis
-Acute anterior uveitis.
-Intraocular inflammation of iris and ciliary body
-globe penetration
-infection, loss of visual acuity, loss of eye -> possible -> referral to opth
-Clinical manifestations:
-Circumcorneal injection (redness around cornea): ciliary flush.
-Moderate deep aching pain/photophobia.
-Blurred vision.
-Small irregular non-reactive pupil.
-Diagnostics:
-Slit-lamp examination (keratitic precipitates WBC on epithelium).
-Management:
-Ophthalmologist consult.
-Mydriatics.
-Corticosteroids (R/O herpes!)
-Complications: loss of vision.
optic neuritis
-Inflammation of optic nerve.
-Associated with multiple sclerosis, viral infections
-MRI of brain and spine for MS
-Clinical manifestations:
-Unilateral acute visual loss.
-Improves in 2-3 weeks.
-Pain with eye movement.
-Color vision loss.
-Marcus Gunn pupil (when light is applied to affected eye, it fails to constrict completely. However, when light is shown in consensual eye, both constrict).
-Refer to neuro - ophthalmologist
marcus gunn pupil
relative afferent pupil defect (RAPD)
quiz
-eyelid edema, pain, afferent pupil defect
-ethmoid sinus
-refer to ophthalmologist for rust in eye
-subconjunctival hemorrhage
diabetic retinopathy
-Leading cause of blindness in adults in USA.
-Abnormal growth of retinal blood vessels secondary to ischemia
-assume nephropathy if you see this
-Nonproliferative: confined to retina:
-Capillary micro aneurysms.
-Dilated veins.
-Flame shaped hemorrhages.
-Proliferative:
-Neovascularization.
-Can lead to retinal detachment
-Clinical manifestations:
-Decreased visual acuity/color vision.
-Retinal hemorrhage.
-Retinal edema.
-Neovascularization.
-Macular exudate.
hypertensive retinopathy
-Atherosclerosis: Vasoconstriction and ischemia due to hypertension.
-Clinical manifestations:
-Decreased visual acuity.
-Retinal hemorrhage, retinal edema, cotton wool exudates, copper/silver wiring, A/V nicking, optic disc swelling
-flame hemorrhage
-papilledema
-cotton wool spot
-hard exudates
-diuretics, ACE/ARB, CCB -> NOT BB
retinopathy management
-Type II diabetes need annual follow up.
-Treatment is surgery- laser photocoagulation and vitrectomy.
retinal detachment
-Leakage of vitreous fluid leads to detachment.
-Spontaneously or second to trauma.
-Clinical manifestations:
-Visual loss.
-Floaters/flashing lights as initial symptoms.
-Retinal tear on fundoscopic exam
-bright scintilating curtain comes down
-Management: Ophthalmology consult and laser surgery.
retinal artery occlusion
-Occlusion of the central retinal artery by embolus leading to visual loss.
-Common in elderly with HTN, Diabetes, giant cell arteritis.
-Clinical manifestations:
-Painless loss of vision.
-Cherry red spot on the fovea.
-Swelling of the retina.
-Optic nerve is pale.
-Cotton wool spots to area affected.
-Diagnostics:
-Look for other reasons for emboli
-Management:
-Ophthalmologist consult immediately.
-Ocular massage.
-Need cardiac workup.
-Thrombolysis.
cataract
-Opacities of the lens.
-Clinical manifestations:
-Hazy, blurred distorted vision. Loss of color vision.
-Opaque lens on examination. Pupil white, fundus reflection is absent
-no red reflex
-Management is surgery.
cataract surgery
-intraocular lenses implanted
macular degeneration
-Loss of central vision due to degeneration of cells in macular.
-Risk factors include age, sun exposure.
-Gradual loss of central vision, blurred vision, scotoma. Peripheral vision preserved.
-Management: No effective treatment, Might respond to laser therapy.
glaucoma
-Eye emergency.
-Disease of optic nerve
-Abnormal drainage of aqueous from the trabecular meshwork.
-Leads to increased ocular pressure, ischemia, degeneration of optic nerve, blindness.
-can lose ur vision
-African Americans at risk, Diabetics, migraine, older age group
-surgery, BB eyedrops -> can cause hypotension
open angle glaucoma
-Poor drainage of the aqueous through the trabecular meshwork causing damage to optic nerve and visual loss. Narrow angle.
-Clinical manifestations:
-Asymptomatic until late.
-Slow progressive peripheral field visual loss.
-Increased cup: disc ratio.
-Management: Miotic drops such as pilocarpine to reduce amount of aqueous humor produced and increase the outflow.
angle closure glaucoma
-Closure of preexisting narrow anterior chamber.
-Clinical manifestations:
-Ocular pain/decreased vision.
-Halos around lights.
-Conjunctiva injected/cornea cloudy.
-Pupil mid-dilated.
-N/V.
-Visual field defects/ enlarged optic disk with pallor.
-injection
-Diagnostics:
-Tonometry- IOP
-Field testing
-Management:
-Open Angle Glaucoma: B Adrenergic blocking eye drops (timolol, levobunolol), epinephrine eye drops, alpha 2 agonists, surgery.
-Closed Angle: Decrease IOP by laser. Iridotomy, systemic acetazolamide, osmotic diuretics, pilocarpine.
trabeculectomy
glaucoma lasers
express shunt
strabismus
-Cannot align both eyes simultaneously.
-Leads to diplopia. May occur in one or both eyes.
-cover- uncover test
-Types:
-Non paralytic-
-Short length or improper insertion of extraocular muscles.
-Deviation is constant in all directions of gaze.
-Paralytic-
-Weakness of extraocular muscles.
-Deviation varies depending on the direction of gaze.
strabismus: convergent, divergent, hypertropia, hypotropia
-Types:
-Convergent: esotropia.
-Divergent: exotropia.
-Hypertropia: upward deviation.
-Hypotropia: downward deviation.
-Management: Exercise or surgery
-patch the good eye -> make the lazy eye work harder
strabismus sx, dx, tx
-Clinical manifestations:
-Esotropia or exotropia.
-Both eyes can not align simultaneously.
-One eye wanders when patient tired, eventually eyes turn outward constantly
-Diagnostics: Cover/uncover test.
-Management:
-Check visual acuity if Amblyopia patch good eye.
-Surgery.
-Corrective lenses.
-Can lead to amblyopia and blindness if not corrected.
red eye management for primary care
-Blepharitis:
-Warm compresses, lid care, Abx ointment or oral (if rosacea or Meibomian gland dysfunction).
-Stye:
-Warm compresses (refer if still present after 1 month)
-Subconjunctival hemorrhage:
-Will resolve in 10-14 days
-no follow up or eval needed
-Viral conjunctivitis:
-Cool compresses, tears, contact precautions.
-Bacterial conjunctivitis:
-Cool compresses, antibiotic drop/ointment.
lasik eye surgery
-laser-assisted in-situ keratomileusis
-Flap created on the surface of the cornea.
-Hinged flap, allows removal of the thin layers of the exposed part of the cornea, improving shape.
-After treatment corneal flap is brought back over the eye as a natural bandage.
-The ultra-thin edge of the flap heals swifty after surgery
-resculpting of the cornea
-use eye drops before the procedure- need humidity
complications of eye surgery
-chronic dry eye
-eye pain
-horrible night vision
dry eye symptoms
-Sandy, gritty feeling in the eyes.
-Burning sensation.
-Foreign body sensation.
-Sensitivity to light.
-Pain in the eyes (occasionally).
-Heavy feeling of the eyes
SMILE
-SMILE(small incision lenticule extraction) procedure of choice for those who qualify due to safety profile.
-SMILE is a minimally invasive.
-Does not involve creating a flap in order to reshape the cornea.
-SMILE is the first flapless laser vision procedure of its kind
-Uses femtosecond laser to create a small disc shaped piece of tissue (also known as the lenticule) within the cornea.
-The removal of the lenticule thereby changes the shape of the cornea.
-The procedure is gentle, with a swift recovery time
PRK (ASLA)
-PRK (photorefractive keratectomy):(ASLA)
-The first treatment available to correct vision.
-Surface treatment.
-PRK now ASLA (advanced surface laser ablation).
-Removing surface layer of cells (the epithelium), ophthalmologist is able to reshape the more permanent layer underneath.
-Improved corneal shape will allow for clear vision.
retinoblastoma
-Common presentations:
-Leukocoria
-Strabismus
-Poor vision
-Ocular inflammation
-Patients with hereditary retinoblastoma are at risk of second malignant neoplasms.
retinoblastoma imaging
-Digital fundus photography for documentation and classification.
-Ocular ultrasonography:
-Demonstrates the solid intraocular mass, usually with calcifications.
-Evaluates the surrounding orbital tissues.
-CT scanning:
-Characteristic intratumoral calcifications.
-Avoided for the associated increased long-term risk for cancer. Reserved for diagnostically challenging cases.
-MRI differentiates retinoblastoma from Coats disease, in the presence of exudative retinal detachment.
-During workup and follow-up, MRI precisely ascertains tumor size, optic nerve and choroid involvement, and any associated brain tumors
PRK vs LASIK vs SMILE
