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.
