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Clinical Medicine 1 > Eyes > Flashcards

Eyes Flashcards

1
Q

What nerve controls the Superior Oblique?

A

CN-4 (Trochlear)

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2
Q

What nerve controls the Lateral Rectus?

A

CN-6 (Abducens)

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3
Q

Define Orbital Cellulitis

A

Acute infection of tissues immediately surrounding the eye including eyelids, eyebrow, & cheek.

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4
Q

How serious is Orbital Cellulitis?

A

EMERGENCY!!

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5
Q

Symptoms of Orbital Cellulitis

A
  • pain
  • swelling
  • bulging eyes
  • decreased vision
  • fever
  • redness
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6
Q

Tests for Orbital Cellulitis

A

CBC, blood cultures, CT, throat culture

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7
Q

Treatment for Orbital Cellulitis

A
  • hospitalize
  • Abx
  • Drain abscess
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8
Q

Complications of Orbital Cellulitis

A
  • Cavernous Sinus Thrombosis
  • Hearing Loss
  • Sepsis
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9
Q

Define Amaurosis Fugax

A

Transient monocular visual loss. Ocular TIA

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10
Q

How long is vision loss with Amaurosis Fugax?

A

5-30 mins

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11
Q

What’s the prognosis for Amaurosis Fugax?

A

Completely Reversible

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12
Q

What tests do you do for Amaurosis Fugax?

A
  • Ptt/Pt test
  • Diabetic tests
  • Heart Condition tests
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13
Q

What bacteria causes a hordeolum?

A

Staph

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14
Q

Which lid do hordeolums appear on and are they tender?

A

both & they are tender

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15
Q

An internal hordeolum starts in which gland?

A

Meibomian gland

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16
Q

An external hordeolum starts in which gland?

A

Glands of Zeiss or Moll

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17
Q

Symptoms of a hordeolum

A
  • “fullness” feeling
  • FB sensation
  • pain
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18
Q

Treatment of a hordeolum

A
  • Warm compress
  • Incision (possibly)
  • Abx (bacitracin/erythromycin) during acute stage.
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19
Q

A Chalazion is a granulomatous inflammation of which gland?

A

Meibomian gland

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20
Q

What can precede a chalazion?

A

internal hordeolum

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21
Q

Does a chalazion hurt?

A

no

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22
Q

How does a Chalazion present?

A

-hard, nontender swelling on either lid

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23
Q

Treatment for a chalazion?

A
  • 25% self resolve in a few months
  • Incision & curettage
  • Corticosteroids
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24
Q

What are symptoms of Blepharitis?

A

irritation, burning & pruritis

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25
Q

What is anterior blepharitis an inflammation of?

A

-eyelid, skin, eyelashes

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26
Q

What bacteria can cause anterior blepharitis to be ulcerative?

A

staph

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27
Q

What is posterior blepharitis an inflammation of?

A

Meibomian glands

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28
Q

What condition does posterior blepharitis have a strong association with?

A

acne rosacea

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29
Q

What would you notice with someone with anterior blepharitis?

A

-crusting on the eyelid & collarettes

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30
Q

What are Collarettes?

A

scales around eyelashes

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31
Q

What would you notice with someone with posterior blepharitis?

A
  • Pouting of the meibomian glands

- inflammation with telangiectasias

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32
Q

What are telangiectasias?

A

small dilated blood vessels near skin surface

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33
Q

Treatment for Anterior Blepharitis

A
  • cleansing with hot wash cloth & baby shampoo

- antistaph abx eye ointment (bacitracin/erythromycin)

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34
Q

Treatment for Posterior Blepharitis

A
  • Meibomian gland expression

- long-term low dose oral abx therapy & short-term topical corticosteroids

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35
Q

With entropion, the lid moves towards the eye or away?

A

towards

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36
Q

What might cause entropion?

A

degeneration of lid fascia

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37
Q

What is dangerous about entropion?

A

lashes can scratch cornea

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38
Q

What can be done for entropion?

A

surgery

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39
Q

With ectropion, the lid moves towards the eye or away?

A

away

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40
Q

Are eyelid tumors usually benign or malignant?

A

benign

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41
Q

Most common malignant eye tumor?

A

basal cell carcinoma

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42
Q

What is Dacryocystitis?

A

Inflammation of the lacrimal sac causing obstruction of the tube draining ears into the nose

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43
Q

Is Dacryocystitis usually bilateral or unilateral?

A

unilateral

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44
Q

Bacteria that causes acute dacryocystitis?

A

staph aureus

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45
Q

Bacteria that causes chronic dacryocystitis?

A

Staph epidermidits

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46
Q

How does dacryocystitis present?

A

pain, swelling, redness, pus

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47
Q

Treatment for acute dacryocystitis

A

oral abx. get a culture of lacrimal fluid

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48
Q

Treatment for chronic dacryocystitis?

A

topical steroid drops

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49
Q

Treatment for congenital chronic dacryocystitis

A

lacrimal massage, warm compresses & topical/oral abx

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50
Q

What is Xanthelasma?

A

deposit of lipids under the skin

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51
Q

What is the cause of Xanthelasma?

A

-Hyperlipidemia, type 2 diabetes, familial hypercholesterolemia, certain cancers

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52
Q

Tests for Xanthelasma?

A

fasting lipids

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53
Q

Treatment for Xanthelasma?

A

treat lipid levels

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54
Q

What is Conjunctivitis more commonly known as?

A

Pink Eye

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55
Q

Mode of transmission of conjunctivitis?

A

Direct contact w/fingers

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56
Q

Most common cause of viral conjunctivitis?

A

adenovirus

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57
Q

Is viral conjunctivitis bilateral or unilateral?

A

bilateral

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58
Q

Does viral conjunctivitis cause watery or purulent discharge?

A

watery

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59
Q

What is the concern with viral conjunctivitis when it lasts too long?

A

may turn into epidemic keratoconjunctivitis if it infects the cornea. this can lead to vision loss.

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60
Q

If viral conjunctivitis is unilateral, what might it be due to?

A

herpes simplex virus

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61
Q

Where do you get viral conjunctivitis?

A

schools, hospitals, pools, etc

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62
Q

What are the most common organisms that cause bacterial conjunctivitis?

A
  • staph
  • strep
  • chlamydial organisms
  • gonocci
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63
Q

Does bacterial conjunctivitis cause watery or purulent discharge

A

purulent

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64
Q

Does bacterial conjunctivitis cause blurring of vision or discomfort?

A

no blurring of vision and only mild discomfort

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65
Q

Treatment for bacterial conjunctivitis

A
  • self limited (10-14 days)

- topical sulfonamide

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66
Q

What 3 different conjunctivitis syndromes are caused by Chlamydial trachomatis?

A
  • Trachoma
  • Adult/neonatal inclusion conjunctivitis
  • lymphogranuloma venereum
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67
Q

Is Chlamydial trachomatis more commonly seen in males or females?

A

males

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68
Q

What is the most common cause of blindness in the world?

A

trachoma

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69
Q

treatment for trachoma?

A

abx

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70
Q

How does a newborn get chlamydial trachomatis?

A

passage through infected birth canal

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71
Q

How does an adult get chlamydial trachoma tis?

A

exposure to infected genital secretions

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72
Q

When should you suspect chlamydial trachomatis in an adult?

A

follicular conjunctivitis that doesn’t resolve w/topical antibiotics.

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73
Q

How do you get gonococcal conjunctivitis?

A

genital secretions

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74
Q

How serious is gonococcal conjunctivitis?

A

opthalmologic emergency

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75
Q

What is the major concern with gonoccocal conjunctivitis?

A

perforation of cornea

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76
Q

How is gonococcal conjunctivitis diagnosed?

A

smear stain & culture of discharge

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77
Q

Treatment for gonococcal conjunctivitis?

A

intramuscular abx

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78
Q

Treatment for viral conjunctivitis?

A
  • no specific treatment

- topical sulfonamides to prevent secondary bacterial infection

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79
Q

What is Keratoconjunctivitis Sicca more commonly known as

A

dry eye

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80
Q

What happens in Keratoconjunctivitis Sicca?

A

Hypofunction of lacrimal glands leading to loss of aqueous component of tears

81
Q

What causes Keratoconjunctivitis Sicca?

A

aging, hereditary disorders, systemic disease/systemic drugs

82
Q

What group of people most commonly gets Keratoconjunctivitis Sicca?

A

elderly women

83
Q

How does Keratoconjunctivitis sicca present?

A

dryness, redness, fb sensation

84
Q

does anything look abnormal when inspecting someone with keratoconjunctivitis sicca?

A

no

85
Q

Treatment of Keratoconjunctivitis Sicca

A

artificial tears

86
Q

What condition gives an “injected eye” appearance?

A

Allergic eye disease

87
Q

Symptoms of Allergic Eye disease

A
  • itching
  • tearing
  • hyperemia
  • sudden onset chemosis (edema of eye)
  • strings of discharge
  • photophobia & vision loss (occasionally)
88
Q

Vernal Keratosis, an allergic eye disease, is most common in what season?

A

spring

89
Q

What will you see in someone with Vernal Keratosis

A

“Cobblestone” papillae on the upper tarsal conjunctiva.

90
Q

If Vernal Keratosis affects the upper eyelid, what does Atopic keratoconjunctivitis affect?

A

both upper AND lower tarsal conjunctivas

91
Q

Common features of atopic keratoconjunctivitis?

A

fornical shortening & entropion w/trichiasis

92
Q

What are trichiasis?

A

abnormally growing eyelashes

93
Q

Treatment of ALLERGIC eye disease

A
  • topical histamine H1 receptor antagonists
  • oral antihistamines
  • topical corticosteroids for acute exacerbations
94
Q

What can topical corticosteroids cause?

A
  • cataracts
  • glaucoma
  • exacerbation of herpes simplex keratitis
95
Q

What is a pinguecula?

A

-yellowish, slightly raised thinkening of the conjunctiva

96
Q

What would cause a pinguecula?

A
  • lots of time in the sun
97
Q

What is a pterygium (the-RIJ-ee-um)?

A

fleshy-triangular encroachment of the conjunctiva

98
Q

Which side of the eye does a pterygium usually come from?

A

nasal side

99
Q

What would cause a pterygium?

A

-wind, sun, sand & dust

100
Q

Treatment for Pingueculas & Pterygiums?

A
  • usually nothing
  • artificial tears help
  • excision if growth occludes vision
101
Q

Exposure keratitis is a non-infectious cause of corneal ulcers…what causes it?

A

inadequate eyelid closure

102
Q

What does keratitis mean?

A

inflammation of cornea

103
Q

Presentation of a corneal ulcer?

A
  • pain
  • photophobia
  • tearing
  • reduced vision
  • watery/purulent discharge
104
Q

What factors can cause bacterial keratitis?

A
  • contact lenses

- corneal trauma

105
Q

What pathogens most commonly cause bacterial keratitis?

A
  • Pseudomonas aeruginosa
  • Pneumococcus Moraxella
  • Staph
106
Q

What might bacterial keratitis look like?

A

hazy cornea w/central ulcer. Possibly a leukocytic exudate in the anterior chamber.

107
Q

Diagnosis of bacterial keratitis?

A
  • direct observation under slit lamp

- fluorescein stain

108
Q

Do you patch bacterial keratitis?

A

NO!

109
Q

Treatment of Bacterial keratitis

A
  • Discontinue contact lens use
  • Fluoroquinolone opthalmic gtts
  • scrape ulcer for gamstain & culture
110
Q

Herpes Simplex Keratitis is the hallmark sign of what?

A

HSV infection

111
Q

Herpes Simplex Kertitis is what kind of corneal ulcer?

A

Dendritic (seen with fluorescein staining & blue light)

112
Q

Why must Herpes Simplex Keratitis be managed quickly and aggressively?

A

to prevent deeper penetration

113
Q

Treatment for Herpes Simplex Keratitis?

A
  • Debridement
  • Topical antivirals
  • refer
114
Q

Do you patch Herpes Simplex Keratitis?

A

YES!!

115
Q

In Herpes Zoster Ophthalmicus, what specific nerve is affected

A

Opthalmic division of trigeminal nerve

116
Q

How does Herpes Zoster Opthalmicus present?

A
  • fever, headache
  • Periorbital burning & pruritus
  • Conjunctivitis/keratitis, episcleritis, anterior uveitis
  • Hutchinson’s sign
117
Q

What is Hutchinson’s sign?

A

A skin lesion on the tip of the nose preceding development of opthalmic herpes zoster

118
Q

Why do you need to urgently refer someone with Herpes Zoster Opthalmicus to an Opthalmologist?

A

Can lose their sight.

119
Q

How might you get fungal keratitis?

A
  • post-corneal injury from plant material

- contact lense use

120
Q

Is diagnosing & treating Fungal Keratitis easy? Why?

A

No it is not. it develops sneakily & slowly.Can be determined by corneal scrapings.

121
Q

How would one get Acanthamoeba Keratitis?

A

Using water for contact lens solution instead of saline.

122
Q

Presentation of Acanthamoeba Keratitis?

A

-Severe pain w/perineural & ring infiltrates in cornea.

123
Q

Treatment for Acanthamoeba Keratitis?

A

Topical Biguanides

124
Q

What is Aqueous Humor?

A

Transparent, gelatinous fluid similar to plasma but w/low-protein concentration

125
Q

Where is Aqueous Humor secreted from and where does it first enter?

A

Secreted from the ciliary epithelium into the posterior chamber.

126
Q

-90% of glaucoma cases are which type of glaucoma?

A

Open angle

127
Q

What’s the etiology of open angle glaucoma?

A

slow occlusion of the drainage canals = increased intraocular pressure

128
Q

Is open-angle unilateral or bilateral peripheral vision loss?

A

bilateral

129
Q

What are the symptoms of open-angle glaucoma

A
  • nothing early on.
  • insidious progressive bilateral loss of peripheral vision (tunnel vision)
  • Cupping & pallor of the optic disk
  • Increased intraocular pressure
130
Q

Prevention of open-angle glaucoma

A

intraocular pressure measurements & optic disk exams q3-5 years

131
Q

Treatment of open-angle glaucoma

A
  • Prostaglandin analogs-keep channel open
  • Beta blockers-keep pressure down
  • laser therapy/surgery
132
Q

Prognosis of open-angle if untreated?

A

complete blindness by age 60-65

133
Q

Etiology of closed-angle glaucoma?

A

result of angle closing between the iris and the cornea. Aqueous Humor can’t get to anterior chamber

134
Q

Presentation of closed-angle glaucoma

A
  • in older,myopic people
  • rapid onset w/severe pain
  • profound visual loss w/”halos around lights”
  • Firm eye
  • red eye, cloudy cornea, dilated pupil
135
Q

Reasons closed-angle glaucoma develops?

A
  • pupillary dilation
  • stress
  • anticholinergic meds
136
Q

Goal in treatment of closed-angle glaucoma

A

-Reduction of intraocular pressure with acetazolamide & osmotic diuretics.

137
Q

What does Acetazolamide do?

A

Reduction of intraocular pressure in closed-angle glaucoma

138
Q

What do you do use of acetazolamdie doesn’t work for closed-angle glaucoma

A

Use osmotic diuretics (mannitol)

139
Q

Prognosis of closed-angle glaucoma isn’t treated?

A

severe & permanent visual loss 2-5 days after onset of symptoms

140
Q

What is the optic nerve “cup”

A

empty space in the middle of the optic nerve surrounded by optic nerve fibers.

141
Q

What is Uveitis?

A

inflammation of the iris & ciliary muscle

142
Q

Symptoms of Acute nongranulomatous anterior uveitis?

A

pain, redness, photophobia & visual loss (can’t focus)

143
Q

Symptoms of Glanulomatous anterior uveitis

A

Blurred vision in mildly inflamed eye.

144
Q

Symptoms of Posterior uveitis

A

Gradual loss of vision in a quiet (non-red) eye

145
Q

Treatment of Uveitis?

A

Treat underlying cause w/mydriatic eye drops, steroids, dark glasses

146
Q

Are cataracts painful?

A

no

147
Q

Etiology of cataracts

A 
aging
congenital
DM
meds
cigarette smoking
sun
trauma
148
Q

Are cataracts unilateral or bilateral (usually)

A

bilateral

149
Q

Symptoms of cataracts

A

progressive blurring of vision, glare

150
Q

What happens in retinal detachment?

A

light-sensitive membrane in the retina separates from its’ supporting layers

151
Q

Is retinal detachment usually bilateral or unilateral?

A

unilateral

152
Q

Describe the loss of vision w/Retinal detachment

A

-curtain spreading across field of vision OR sudden onset of visual loss in one eye

153
Q

Causes of retinal detachment?

A

-Nearsightedness
-cataract extraction
usually due to retinal tear

154
Q

Is there any pain or redness w/retinal detachment?

A

no

155
Q

What should you do in the case of glaucoma or retinal detachment.

A

refer immediately

156
Q

Treatment of retinal detachment

A
  • laser photocoagulation
  • scleral buckle
  • pneumatic retinoplexy
157
Q

What does macular degeneration result in?

A

-blurred vision, blindness

158
Q

Any pain/redness in macular degeneration?

A

no

159
Q

Exact cause of macular degeneration?

A

unknown

160
Q

What are the two types of macular degeneration?

A
  • Atopic (dry)

- Neovascular (wet)

161
Q

Which type of Macular degeneration is more common?

A

Neovascular (wet) 90%

162
Q

What is the speed of vision loss in atropic (dry) macular degeneration?

A

gradual

163
Q

What is the speed of vision loss in neovascular (wet) macular degeneration?

A

much more rapid

164
Q

Treatment of Macular degeneration

A
  • Oral antioxidants (Vit A), Vits C & E, zinc & copper…these don’t cure the disease, just slow it’s progression
  • Wet: VEGF inhibitors
  • laser retinal photocoagulation
165
Q

What does CRVO stand for?

A

Central Retinal Vein Occlusion

166
Q

Characteristics of CRVO

A
  • Sudden monocular vision loss first noticed upon waking.
  • no pain/redness
  • retinal hemorrhages
167
Q

Causes of CRVO

A

-diabetes, systemic hypertension, hyperlipidemia, glaucoma

168
Q

What would you see with an opthalmascope in someone with CRVO?

A

Hemorrhages, venous dilation, cotton-wool spots

169
Q

What causes CRAO?

A

blockage of retinal vascular lumen by an embolus, thrombus or inflamed vessel wall/spasm

170
Q

Characteristics of CRAO

A
  • sudden monocular loss of vision
  • no pain/redness
  • cherry red macula
171
Q

What do you want to screen for in someone with CRAO?

A
  • diabetes & hyperlipidemia

- source of embolism

172
Q

CRAO is needs emergency treatment. What are some things done to help?

A
  • Patient in supine position
  • ocular massage
  • high concentration oxygen
  • IV acetazolamide
  • anterior chamber paracentesis
173
Q

What might you find in the eye of someone with Diabetic Retinopathy

A

Macular edema, exudates, ischemia

174
Q

Characteristics of non-proliferative Diabetic Retinopathy?

A

venous dilation, microaneuysms, retinal hemmorrhages, retinal edema, hard exudates

175
Q

Which is worse without treatment: proliferative diabetic retinopathy or non-proliferative retinopathy?

A

proliferative

176
Q

Findings in a patient with hypertensive retinopathy?

A
  • microaneurysms
  • blot/flame hemorrhages
  • cotton-wool spots
  • hard exudates
  • AV nicking
177
Q

What is AV nicking?

A

arteriole seen crossing vein (or vice versa). results in compression of artery/vein w/bulging on either side

178
Q

What will you notice in someone w/exopthalmos?

A

bulging of eyes

179
Q

What causes exopthalmos?

A

Graves Disease (hyperthyroidism)

180
Q

What makes the eyes protrude in exopthalmos?

A

antibodies attack fibroblasts which turn into fat cells. These fat cells expand & occlude veins, thus the eye is unable to drain & edema occurs, pushing the eye out.

181
Q

What causes ultraviolet keratoconjunctivitis?

A

UV exposure, welder’s arc

182
Q

Treatment for UV keratoconjunctivitis?

A
  • cycloplegic gtts & cold compress
  • analgesics
  • NSAID gtts
183
Q

Symptoms of corneal abrasions?

A
  • FB sensation
  • pain
  • tearing
  • blurred vision
  • head ache
184
Q

How might you tell if a corneal abrasion has occured?

A
  • eye non-PERRLA, EOMI
  • topical anesthetic+florescence dye (look under eyelids too)
  • Negative Seidel’s test (corneal leakage)
185
Q

What does Seidel’s test determine?

A

Occurrence of corneal leakage

186
Q

Treatment of corneal abrasion

A
  • saline

- abx gtts

187
Q

Do you patch a corneal abrasion?

A

NO!

188
Q

You check visual acuity first with every eye problem except…?

A

burns. It’s an emergency

189
Q

treatment of burns

A
  • Irrigate with water only

- topical anesthetics q20min

190
Q

Symptoms of a blowout fracture

A
  • pain
  • enopthalmos
  • diplopia
  • abnormal EOM (nerve entrapment)
  • rupture of globe
191
Q

If a blowout fracture is suspected, what should you avoid doing during the PE

A

-palpation of globe or orbit

192
Q

Tests for blowout fracture

A

X-ray, CT

193
Q

When can someone with a blowout fracture be discharged only an opthalmology follow up in a week?

A

no diplopia, minimal displacement, & no muscle entrapment

194
Q

If someone w/a blowout fracture has injured sinuses, what should you do?

A

give them prophylactic abx & tell them not to blow their nose

195
Q

What do you need for the removal of a FB?

A
  • topical anesthetic opthalmic solution (alpine)
  • fluorescein strips
  • cotton-tipped applicator
  • irrigation fluid w/plastic syringe
  • device to remove FB
196
Q

What do you use for rust rings?

A

alger brush

197
Q

If someone with a FB has hyphema, what might that mean?

A

blood in anterior chamber

198
Q

Someone w/a foreign body has anisocoria; what does that mean?

A

abnormally shaped pupil/different sized pupils

Clinical Medicine 1 (4 decks)

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