Eyes Flashcards
1
Q
What nerve controls the Superior Oblique?
A
CN-4 (Trochlear)
2
Q
What nerve controls the Lateral Rectus?
A
CN-6 (Abducens)
3
Q
Define Orbital Cellulitis
A
Acute infection of tissues immediately surrounding the eye including eyelids, eyebrow, & cheek.
4
Q
How serious is Orbital Cellulitis?
A
EMERGENCY!!
5
Q
Symptoms of Orbital Cellulitis
A
- pain
- swelling
- bulging eyes
- decreased vision
- fever
- redness
6
Q
Tests for Orbital Cellulitis
A
CBC, blood cultures, CT, throat culture
7
Q
Treatment for Orbital Cellulitis
A
- hospitalize
- Abx
- Drain abscess
8
Q
Complications of Orbital Cellulitis
A
- Cavernous Sinus Thrombosis
- Hearing Loss
- Sepsis
9
Q
Define Amaurosis Fugax
A
Transient monocular visual loss. Ocular TIA
10
Q
How long is vision loss with Amaurosis Fugax?
A
5-30 mins
11
Q
What’s the prognosis for Amaurosis Fugax?
A
Completely Reversible
12
Q
What tests do you do for Amaurosis Fugax?
A
- Ptt/Pt test
- Diabetic tests
- Heart Condition tests
13
Q
What bacteria causes a hordeolum?
A
Staph
14
Q
Which lid do hordeolums appear on and are they tender?
A
both & they are tender
15
Q
An internal hordeolum starts in which gland?
A
Meibomian gland
16
Q
An external hordeolum starts in which gland?
A
Glands of Zeiss or Moll
17
Q
Symptoms of a hordeolum
A
- “fullness” feeling
- FB sensation
- pain
18
Q
Treatment of a hordeolum
A
- Warm compress
- Incision (possibly)
- Abx (bacitracin/erythromycin) during acute stage.
19
Q
A Chalazion is a granulomatous inflammation of which gland?
A
Meibomian gland
20
Q
What can precede a chalazion?
A
internal hordeolum
21
Q
Does a chalazion hurt?
A
no
22
Q
How does a Chalazion present?
A
-hard, nontender swelling on either lid
23
Q
Treatment for a chalazion?
A
- 25% self resolve in a few months
- Incision & curettage
- Corticosteroids
24
Q
What are symptoms of Blepharitis?
A
irritation, burning & pruritis
25
What is anterior blepharitis an inflammation of?
-eyelid, skin, eyelashes
26
What bacteria can cause anterior blepharitis to be ulcerative?
staph
27
What is posterior blepharitis an inflammation of?
Meibomian glands
28
What condition does posterior blepharitis have a strong association with?
acne rosacea
29
What would you notice with someone with anterior blepharitis?
-crusting on the eyelid & collarettes
30
What are Collarettes?
scales around eyelashes
31
What would you notice with someone with posterior blepharitis?
- Pouting of the meibomian glands
| - inflammation with telangiectasias
32
What are telangiectasias?
small dilated blood vessels near skin surface
33
Treatment for Anterior Blepharitis
- cleansing with hot wash cloth & baby shampoo
| - antistaph abx eye ointment (bacitracin/erythromycin)
34
Treatment for Posterior Blepharitis
- Meibomian gland expression
| - long-term low dose oral abx therapy & short-term topical corticosteroids
35
With entropion, the lid moves towards the eye or away?
towards
36
What might cause entropion?
degeneration of lid fascia
37
What is dangerous about entropion?
lashes can scratch cornea
38
What can be done for entropion?
surgery
39
With ectropion, the lid moves towards the eye or away?
away
40
Are eyelid tumors usually benign or malignant?
benign
41
Most common malignant eye tumor?
basal cell carcinoma
42
What is Dacryocystitis?
Inflammation of the lacrimal sac causing obstruction of the tube draining ears into the nose
43
Is Dacryocystitis usually bilateral or unilateral?
unilateral
44
Bacteria that causes acute dacryocystitis?
staph aureus
45
Bacteria that causes chronic dacryocystitis?
Staph epidermidits
46
How does dacryocystitis present?
pain, swelling, redness, pus
47
Treatment for acute dacryocystitis
oral abx. get a culture of lacrimal fluid
48
Treatment for chronic dacryocystitis?
topical steroid drops
49
Treatment for congenital chronic dacryocystitis
lacrimal massage, warm compresses & topical/oral abx
50
What is Xanthelasma?
deposit of lipids under the skin
51
What is the cause of Xanthelasma?
-Hyperlipidemia, type 2 diabetes, familial hypercholesterolemia, certain cancers
52
Tests for Xanthelasma?
fasting lipids
53
Treatment for Xanthelasma?
treat lipid levels
54
What is Conjunctivitis more commonly known as?
Pink Eye
55
Mode of transmission of conjunctivitis?
Direct contact w/fingers
56
Most common cause of viral conjunctivitis?
adenovirus
57
Is viral conjunctivitis bilateral or unilateral?
bilateral
58
Does viral conjunctivitis cause watery or purulent discharge?
watery
59
What is the concern with viral conjunctivitis when it lasts too long?
may turn into epidemic keratoconjunctivitis if it infects the cornea. this can lead to vision loss.
60
If viral conjunctivitis is unilateral, what might it be due to?
herpes simplex virus
61
Where do you get viral conjunctivitis?
schools, hospitals, pools, etc
62
What are the most common organisms that cause bacterial conjunctivitis?
- staph
- strep
- chlamydial organisms
- gonocci
63
Does bacterial conjunctivitis cause watery or purulent discharge
purulent
64
Does bacterial conjunctivitis cause blurring of vision or discomfort?
no blurring of vision and only mild discomfort
65
Treatment for bacterial conjunctivitis
- self limited (10-14 days)
| - topical sulfonamide
66
What 3 different conjunctivitis syndromes are caused by Chlamydial trachomatis?
- Trachoma
- Adult/neonatal inclusion conjunctivitis
- lymphogranuloma venereum
67
Is Chlamydial trachomatis more commonly seen in males or females?
males
68
What is the most common cause of blindness in the world?
trachoma
69
treatment for trachoma?
abx
70
How does a newborn get chlamydial trachomatis?
passage through infected birth canal
71
How does an adult get chlamydial trachoma tis?
exposure to infected genital secretions
72
When should you suspect chlamydial trachomatis in an adult?
follicular conjunctivitis that doesn't resolve w/topical antibiotics.
73
How do you get gonococcal conjunctivitis?
genital secretions
74
How serious is gonococcal conjunctivitis?
opthalmologic emergency
75
What is the major concern with gonoccocal conjunctivitis?
perforation of cornea
76
How is gonococcal conjunctivitis diagnosed?
smear stain & culture of discharge
77
Treatment for gonococcal conjunctivitis?
intramuscular abx
78
Treatment for viral conjunctivitis?
- no specific treatment
| - topical sulfonamides to prevent secondary bacterial infection
79
What is Keratoconjunctivitis Sicca more commonly known as
dry eye
80
What happens in Keratoconjunctivitis Sicca?
Hypofunction of lacrimal glands leading to loss of aqueous component of tears
81
What causes Keratoconjunctivitis Sicca?
aging, hereditary disorders, systemic disease/systemic drugs
82
What group of people most commonly gets Keratoconjunctivitis Sicca?
elderly women
83
How does Keratoconjunctivitis sicca present?
dryness, redness, fb sensation
84
does anything look abnormal when inspecting someone with keratoconjunctivitis sicca?
no
85
Treatment of Keratoconjunctivitis Sicca
artificial tears
86
What condition gives an "injected eye" appearance?
Allergic eye disease
87
Symptoms of Allergic Eye disease
- itching
- tearing
- hyperemia
- sudden onset chemosis (edema of eye)
- strings of discharge
- photophobia & vision loss (occasionally)
88
Vernal Keratosis, an allergic eye disease, is most common in what season?
spring
89
What will you see in someone with Vernal Keratosis
"Cobblestone" papillae on the upper tarsal conjunctiva.
90
If Vernal Keratosis affects the upper eyelid, what does Atopic keratoconjunctivitis affect?
both upper AND lower tarsal conjunctivas
91
Common features of atopic keratoconjunctivitis?
fornical shortening & entropion w/trichiasis
92
What are trichiasis?
abnormally growing eyelashes
93
Treatment of ALLERGIC eye disease
- topical histamine H1 receptor antagonists
- oral antihistamines
- topical corticosteroids for acute exacerbations
94
What can topical corticosteroids cause?
- cataracts
- glaucoma
- exacerbation of herpes simplex keratitis
95
What is a pinguecula?
-yellowish, slightly raised thinkening of the conjunctiva
96
What would cause a pinguecula?
- lots of time in the sun
97
What is a pterygium (the-RIJ-ee-um)?
fleshy-triangular encroachment of the conjunctiva
98
Which side of the eye does a pterygium usually come from?
nasal side
99
What would cause a pterygium?
-wind, sun, sand & dust
100
Treatment for Pingueculas & Pterygiums?
- usually nothing
- artificial tears help
- excision if growth occludes vision
101
Exposure keratitis is a non-infectious cause of corneal ulcers...what causes it?
inadequate eyelid closure
102
What does keratitis mean?
inflammation of cornea
103
Presentation of a corneal ulcer?
- pain
- photophobia
- tearing
- reduced vision
- watery/purulent discharge
104
What factors can cause bacterial keratitis?
- contact lenses
| - corneal trauma
105
What pathogens most commonly cause bacterial keratitis?
- Pseudomonas aeruginosa
- Pneumococcus Moraxella
- Staph
106
What might bacterial keratitis look like?
hazy cornea w/central ulcer. Possibly a leukocytic exudate in the anterior chamber.
107
Diagnosis of bacterial keratitis?
- direct observation under slit lamp
| - fluorescein stain
108
Do you patch bacterial keratitis?
NO!
109
Treatment of Bacterial keratitis
- Discontinue contact lens use
- Fluoroquinolone opthalmic gtts
- scrape ulcer for gamstain & culture
110
Herpes Simplex Keratitis is the hallmark sign of what?
HSV infection
111
Herpes Simplex Kertitis is what kind of corneal ulcer?
Dendritic (seen with fluorescein staining & blue light)
112
Why must Herpes Simplex Keratitis be managed quickly and aggressively?
to prevent deeper penetration
113
Treatment for Herpes Simplex Keratitis?
- Debridement
- Topical antivirals
- refer
114
Do you patch Herpes Simplex Keratitis?
YES!!
115
In Herpes Zoster Ophthalmicus, what specific nerve is affected
Opthalmic division of trigeminal nerve
116
How does Herpes Zoster Opthalmicus present?
- fever, headache
- Periorbital burning & pruritus
- Conjunctivitis/keratitis, episcleritis, anterior uveitis
- Hutchinson's sign
117
What is Hutchinson's sign?
A skin lesion on the tip of the nose preceding development of opthalmic herpes zoster
118
Why do you need to urgently refer someone with Herpes Zoster Opthalmicus to an Opthalmologist?
Can lose their sight.
119
How might you get fungal keratitis?
- post-corneal injury from plant material
| - contact lense use
120
Is diagnosing & treating Fungal Keratitis easy? Why?
No it is not. it develops sneakily & slowly.Can be determined by corneal scrapings.
121
How would one get Acanthamoeba Keratitis?
Using water for contact lens solution instead of saline.
122
Presentation of Acanthamoeba Keratitis?
-Severe pain w/perineural & ring infiltrates in cornea.
123
Treatment for Acanthamoeba Keratitis?
Topical Biguanides
124
What is Aqueous Humor?
Transparent, gelatinous fluid similar to plasma but w/low-protein concentration
125
Where is Aqueous Humor secreted from and where does it first enter?
Secreted from the ciliary epithelium into the posterior chamber.
126
-90% of glaucoma cases are which type of glaucoma?
Open angle
127
What's the etiology of open angle glaucoma?
slow occlusion of the drainage canals = increased intraocular pressure
128
Is open-angle unilateral or bilateral peripheral vision loss?
bilateral
129
What are the symptoms of open-angle glaucoma
- nothing early on.
- insidious progressive bilateral loss of peripheral vision (tunnel vision)
- Cupping & pallor of the optic disk
- Increased intraocular pressure
130
Prevention of open-angle glaucoma
intraocular pressure measurements & optic disk exams q3-5 years
131
Treatment of open-angle glaucoma
- Prostaglandin analogs-keep channel open
- Beta blockers-keep pressure down
- laser therapy/surgery
132
Prognosis of open-angle if untreated?
complete blindness by age 60-65
133
Etiology of closed-angle glaucoma?
result of angle closing between the iris and the cornea. Aqueous Humor can't get to anterior chamber
134
Presentation of closed-angle glaucoma
- 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
Reasons closed-angle glaucoma develops?
- pupillary dilation
- stress
- anticholinergic meds
136
Goal in treatment of closed-angle glaucoma
-Reduction of intraocular pressure with acetazolamide & osmotic diuretics.
137
What does Acetazolamide do?
Reduction of intraocular pressure in closed-angle glaucoma
138
What do you do use of acetazolamdie doesn't work for closed-angle glaucoma
Use osmotic diuretics (mannitol)
139
Prognosis of closed-angle glaucoma isn't treated?
severe & permanent visual loss 2-5 days after onset of symptoms
140
What is the optic nerve "cup"
empty space in the middle of the optic nerve surrounded by optic nerve fibers.
141
What is Uveitis?
inflammation of the iris & ciliary muscle
142
Symptoms of Acute nongranulomatous anterior uveitis?
pain, redness, photophobia & visual loss (can't focus)
143
Symptoms of Glanulomatous anterior uveitis
Blurred vision in mildly inflamed eye.
144
Symptoms of Posterior uveitis
Gradual loss of vision in a quiet (non-red) eye
145
Treatment of Uveitis?
Treat underlying cause w/mydriatic eye drops, steroids, dark glasses
146
Are cataracts painful?
no
147
Etiology of cataracts
```
aging
congenital
DM
meds
cigarette smoking
sun
trauma
```
148
Are cataracts unilateral or bilateral (usually)
bilateral
149
Symptoms of cataracts
progressive blurring of vision, glare
150
What happens in retinal detachment?
light-sensitive membrane in the retina separates from its' supporting layers
151
Is retinal detachment usually bilateral or unilateral?
unilateral
152
Describe the loss of vision w/Retinal detachment
-curtain spreading across field of vision OR sudden onset of visual loss in one eye
153
Causes of retinal detachment?
-Nearsightedness
-cataract extraction
usually due to retinal tear
154
Is there any pain or redness w/retinal detachment?
no
155
What should you do in the case of glaucoma or retinal detachment.
refer immediately
156
Treatment of retinal detachment
- laser photocoagulation
- scleral buckle
- pneumatic retinoplexy
157
What does macular degeneration result in?
-blurred vision, blindness
158
Any pain/redness in macular degeneration?
no
159
Exact cause of macular degeneration?
unknown
160
What are the two types of macular degeneration?
- Atopic (dry)
| - Neovascular (wet)
161
Which type of Macular degeneration is more common?
Neovascular (wet) 90%
162
What is the speed of vision loss in atropic (dry) macular degeneration?
gradual
163
What is the speed of vision loss in neovascular (wet) macular degeneration?
much more rapid
164
Treatment of Macular degeneration
- 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
What does CRVO stand for?
Central Retinal Vein Occlusion
166
Characteristics of CRVO
- Sudden monocular vision loss first noticed upon waking.
- no pain/redness
- retinal hemorrhages
167
Causes of CRVO
-diabetes, systemic hypertension, hyperlipidemia, glaucoma
168
What would you see with an opthalmascope in someone with CRVO?
Hemorrhages, venous dilation, cotton-wool spots
169
What causes CRAO?
blockage of retinal vascular lumen by an embolus, thrombus or inflamed vessel wall/spasm
170
Characteristics of CRAO
- sudden monocular loss of vision
- no pain/redness
- cherry red macula
171
What do you want to screen for in someone with CRAO?
- diabetes & hyperlipidemia
| - source of embolism
172
CRAO is needs emergency treatment. What are some things done to help?
- Patient in supine position
- ocular massage
- high concentration oxygen
- IV acetazolamide
- anterior chamber paracentesis
173
What might you find in the eye of someone with Diabetic Retinopathy
Macular edema, exudates, ischemia
174
Characteristics of non-proliferative Diabetic Retinopathy?
venous dilation, microaneuysms, retinal hemmorrhages, retinal edema, hard exudates
175
Which is worse without treatment: proliferative diabetic retinopathy or non-proliferative retinopathy?
proliferative
176
Findings in a patient with hypertensive retinopathy?
- microaneurysms
- blot/flame hemorrhages
- cotton-wool spots
- hard exudates
- AV nicking
177
What is AV nicking?
arteriole seen crossing vein (or vice versa). results in compression of artery/vein w/bulging on either side
178
What will you notice in someone w/exopthalmos?
bulging of eyes
179
What causes exopthalmos?
Graves Disease (hyperthyroidism)
180
What makes the eyes protrude in exopthalmos?
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
What causes ultraviolet keratoconjunctivitis?
UV exposure, welder's arc
182
Treatment for UV keratoconjunctivitis?
- cycloplegic gtts & cold compress
- analgesics
- NSAID gtts
183
Symptoms of corneal abrasions?
- FB sensation
- pain
- tearing
- blurred vision
- head ache
184
How might you tell if a corneal abrasion has occured?
- eye non-PERRLA, EOMI
- topical anesthetic+florescence dye (look under eyelids too)
- Negative Seidel's test (corneal leakage)
185
What does Seidel's test determine?
Occurrence of corneal leakage
186
Treatment of corneal abrasion
- saline
| - abx gtts
187
Do you patch a corneal abrasion?
NO!
188
You check visual acuity first with every eye problem except...?
burns. It's an emergency
189
treatment of burns
- Irrigate with water only
| - topical anesthetics q20min
190
Symptoms of a blowout fracture
- pain
- enopthalmos
- diplopia
- abnormal EOM (nerve entrapment)
- rupture of globe
191
If a blowout fracture is suspected, what should you avoid doing during the PE
-palpation of globe or orbit
192
Tests for blowout fracture
X-ray, CT
193
When can someone with a blowout fracture be discharged only an opthalmology follow up in a week?
no diplopia, minimal displacement, & no muscle entrapment
194
If someone w/a blowout fracture has injured sinuses, what should you do?
give them prophylactic abx & tell them not to blow their nose
195
What do you need for the removal of a FB?
- topical anesthetic opthalmic solution (alpine)
- fluorescein strips
- cotton-tipped applicator
- irrigation fluid w/plastic syringe
- device to remove FB
196
What do you use for rust rings?
alger brush
197
If someone with a FB has hyphema, what might that mean?
blood in anterior chamber
198
Someone w/a foreign body has anisocoria; what does that mean?
abnormally shaped pupil/different sized pupils
