Eyes Flashcards
What nerve controls the Superior Oblique?
CN-4 (Trochlear)
What nerve controls the Lateral Rectus?
CN-6 (Abducens)
Define Orbital Cellulitis
Acute infection of tissues immediately surrounding the eye including eyelids, eyebrow, & cheek.
How serious is Orbital Cellulitis?
EMERGENCY!!
Symptoms of Orbital Cellulitis
-pain-swelling-bulging eyes-decreased vision-fever-redness
Tests for Orbital Cellulitis
CBC, blood cultures, CT, throat culture
Treatment for Orbital Cellulitis
- hospitalize- Abx- Drain abscess
Complications of Orbital Cellulitis
-Cavernous Sinus Thrombosis-Hearing Loss-Sepsis
Define Amaurosis Fugax
Transient monocular visual loss. Ocular TIA
How long is vision loss with Amaurosis Fugax?
5-30 mins
What’s the prognosis for Amaurosis Fugax?
Completely Reversible
What tests do you do for Amaurosis Fugax?
-Ptt/Pt test-Diabetic tests-Heart Condition tests
What bacteria causes a hordeolum?
Staph
Which lid do hordeolums appear on and are they tender?
both & they are tender
An internal hordeolum starts in which gland?
Meibomian gland
An external hordeolum starts in which gland?
Glands of Zeiss or Moll
Symptoms of a hordeolum
-“fullness” feeling- FB sensation- pain
Treatment of a hordeolum
-Warm compress-Incision (possibly)-Abx (bacitracin/erythromycin) during acute stage.
A Chalazion is a granulomatous inflammation of which gland?
Meibomian gland
What can precede a chalazion?
internal hordeolum
Does a chalazion hurt?
no
How does a Chalazion present?
-hard, nontender swelling on either lid
Treatment for a chalazion?
-25% self resolve in a few months-Incision & curettage-Corticosteroids
What are symptoms of Blepharitis?
irritation, burning & pruritis
What is anterior blepharitis an inflammation of?
-eyelid, skin, eyelashes
What bacteria can cause anterior blepharitis to be ulcerative?
staph
What is posterior blepharitis an inflammation of?
Meibomian glands
What condition does posterior blepharitis have a strong association with?
acne rosacea
What would you notice with someone with anterior blepharitis?
-crusting on the eyelid & collarettes
What are Collarettes?
scales around eyelashes
What would you notice with someone with posterior blepharitis?
-Pouting of the meibomian glands-inflammation with telangiectasias
What are telangiectasias?
small dilated blood vessels near skin surface
Treatment for Anterior Blepharitis
-cleansing with hot wash cloth & baby shampoo-antistaph abx eye ointment (bacitracin/erythromycin)
Treatment for Posterior Blepharitis
-Meibomian gland expression-long-term low dose oral abx therapy & short-term topical corticosteroids
With entropion, the lid moves towards the eye or away?
towards
What might cause entropion?
degeneration of lid fascia
What is dangerous about entropion?
lashes can scratch cornea
What can be done for entropion?
surgery
With ectropion, the lid moves towards the eye or away?
away
Are eyelid tumors usually benign or malignant?
benign
Most common malignant eye tumor?
basal cell carcinoma
What is Dacryocystitis?
Inflammation of the lacrimal sac causing obstruction of the tube draining ears into the nose
Is Dacryocystitis usually bilateral or unilateral?
unilateral
Bacteria that causes acute dacryocystitis?
staph aureus
Bacteria that causes chronic dacryocystitis?
Staph epidermidits
How does dacryocystitis present?
pain, swelling, redness, pus
Treatment for acute dacryocystitis
oral abx. get a culture of lacrimal fluid
Treatment for chronic dacryocystitis?
topical steroid drops
Treatment for congenital chronic dacryocystitis
lacrimal massage, warm compresses & topical/oral abx
What is Xanthelasma?
deposit of lipids under the skin
What is the cause of Xanthelasma?
-Hyperlipidemia, type 2 diabetes, familial hypercholesterolemia, certain cancers
Tests for Xanthelasma?
fasting lipids
Treatment for Xanthelasma?
treat lipid levels
What is Conjunctivitis more commonly known as?
Pink Eye
Mode of transmission of conjunctivitis?
Direct contact w/fingers
Most common cause of viral conjunctivitis?
adenovirus
Is viral conjunctivitis bilateral or unilateral?
bilateral
Does viral conjunctivitis cause watery or purulent discharge?
watery
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.
If viral conjunctivitis is unilateral, what might it be due to?
herpes simplex virus
Where do you get viral conjunctivitis?
schools, hospitals, pools, etc
What are the most common organisms that cause bacterial conjunctivitis?
-staph-strep-chlamydial organisms-gonocci
Does bacterial conjunctivitis cause watery or purulent discharge
purulent
Does bacterial conjunctivitis cause blurring of vision or discomfort?
no blurring of vision and only mild discomfort
Treatment for bacterial conjunctivitis
-self limited (10-14 days)-topical sulfonamide
What 3 different conjunctivitis syndromes are caused by Chlamydial trachomatis?
-Trachoma-Adult/neonatal inclusion conjunctivitis-lymphogranuloma venereum
Is Chlamydial trachomatis more commonly seen in males or females?
males
What is the most common cause of blindness in the world?
trachoma
treatment for trachoma?
abx
How does a newborn get chlamydial trachomatis?
passage through infected birth canal
How does an adult get chlamydial trachoma tis?
exposure to infected genital secretions
When should you suspect chlamydial trachomatis in an adult?
follicular conjunctivitis that doesn’t resolve w/topical antibiotics.
How do you get gonococcal conjunctivitis?
genital secretions
How serious is gonococcal conjunctivitis?
opthalmologic emergency
What is the major concern with gonoccocal conjunctivitis?
perforation of cornea
How is gonococcal conjunctivitis diagnosed?
smear stain & culture of discharge
Treatment for gonococcal conjunctivitis?
intramuscular abx
Treatment for viral conjunctivitis?
-no specific treatment-topical sulfonamides to prevent secondary bacterial infection
What is Keratoconjunctivitis Sicca more commonly known as
dry eye
What happens in Keratoconjunctivitis Sicca?
Hypofunction of lacrimal glands leading to loss of aqueous component of tears
What causes Keratoconjunctivitis Sicca?
aging, hereditary disorders, systemic disease/systemic drugs
What group of people most commonly gets Keratoconjunctivitis Sicca?
elderly women
How does Keratoconjunctivitis sicca present?
dryness, redness, fb sensation
does anything look abnormal when inspecting someone with keratoconjunctivitis sicca?
no
Treatment of Keratoconjunctivitis Sicca
artificial tears
What condition gives an “injected eye” appearance?
Allergic eye disease
Symptoms of Allergic Eye disease
-itching-tearing-hyperemia-sudden onset chemosis (edema of eye)-strings of discharge-photophobia & vision loss (occasionally)
Vernal Keratosis, an allergic eye disease, is most common in what season?
spring
What will you see in someone with Vernal Keratosis
“Cobblestone” papillae on the upper tarsal conjunctiva.
If Vernal Keratosis affects the upper eyelid, what does Atopic keratoconjunctivitis affect?
both upper AND lower tarsal conjunctivas
Common features of atopic keratoconjunctivitis?
fornical shortening & entropion w/trichiasis
What are trichiasis?
abnormally growing eyelashes
Treatment of ALLERGIC eye disease
-topical histamine H1 receptor antagonists-oral antihistamines-topical corticosteroids for acute exacerbations
What can topical corticosteroids cause?
-cataracts-glaucoma-exacerbation of herpes simplex keratitis
What is a pinguecula?
-yellowish, slightly raised thinkening of the conjunctiva
What would cause a pinguecula?
- lots of time in the sun
What is a pterygium (the-RIJ-ee-um)?
fleshy-triangular encroachment of the conjunctiva
Which side of the eye does a pterygium usually come from?
nasal side
What would cause a pterygium?
-wind, sun, sand & dust
Treatment for Pingueculas & Pterygiums?
-usually nothing-artificial tears help-excision if growth occludes vision
Exposure keratitis is a non-infectious cause of corneal ulcers…what causes it?
inadequate eyelid closure
What does keratitis mean?
inflammation of cornea
Presentation of a corneal ulcer?
-pain-photophobia-tearing-reduced vision-watery/purulent discharge
What factors can cause bacterial keratitis?
-contact lenses-corneal trauma
What pathogens most commonly cause bacterial keratitis?
- Pseudomonas aeruginosa- Pneumococcus Moraxella- Staph
What might bacterial keratitis look like?
hazy cornea w/central ulcer. Possibly a leukocytic exudate in the anterior chamber.
Diagnosis of bacterial keratitis?
-direct observation under slit lamp-fluorescein stain
Do you patch bacterial keratitis?
NO!
Treatment of Bacterial keratitis
- Discontinue contact lens use- Fluoroquinolone opthalmic gtts- scrape ulcer for gamstain & culture
Herpes Simplex Keratitis is the hallmark sign of what?
HSV infection
Herpes Simplex Kertitis is what kind of corneal ulcer?
Dendritic (seen with fluorescein staining & blue light)
Why must Herpes Simplex Keratitis be managed quickly and aggressively?
to prevent deeper penetration
Treatment for Herpes Simplex Keratitis?
-Debridement-Topical antivirals-refer
Do you patch Herpes Simplex Keratitis?
YES!!
In Herpes Zoster Ophthalmicus, what specific nerve is affected
Opthalmic division of trigeminal nerve
How does Herpes Zoster Opthalmicus present?
-fever, headache-Periorbital burning & pruritus-Conjunctivitis/keratitis, episcleritis, anterior uveitis-Hutchinson’s sign
What is Hutchinson’s sign?
A skin lesion on the tip of the nose preceding development of opthalmic herpes zoster
Why do you need to urgently refer someone with Herpes Zoster Opthalmicus to an Opthalmologist?
Can lose their sight.
How might you get fungal keratitis?
-post-corneal injury from plant material-contact lense use
Is diagnosing & treating Fungal Keratitis easy? Why?
No it is not. it develops sneakily & slowly.Can be determined by corneal scrapings.
How would one get Acanthamoeba Keratitis?
Using water for contact lens solution instead of saline.
Presentation of Acanthamoeba Keratitis?
-Severe pain w/perineural & ring infiltrates in cornea.
Treatment for Acanthamoeba Keratitis?
Topical Biguanides
What is Aqueous Humor?
Transparent, gelatinous fluid similar to plasma but w/low-protein concentration
Where is Aqueous Humor secreted from and where does it first enter?
Secreted from the ciliary epithelium into the posterior chamber.
-90% of glaucoma cases are which type of glaucoma?
Open angle
What’s the etiology of open angle glaucoma?
slow occlusion of the drainage canals = increased intraocular pressure
Is open-angle unilateral or bilateral peripheral vision loss?
bilateral
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
Prevention of open-angle glaucoma
intraocular pressure measurements & optic disk exams q3-5 years
Treatment of open-angle glaucoma
-Prostaglandin analogs-keep channel open-Beta blockers-keep pressure down-laser therapy/surgery
Prognosis of open-angle if untreated?
complete blindness by age 60-65
Etiology of closed-angle glaucoma?
result of angle closing between the iris and the cornea. Aqueous Humor can’t get to anterior chamber
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
Reasons closed-angle glaucoma develops?
-pupillary dilation-stress-anticholinergic meds
Goal in treatment of closed-angle glaucoma
-Reduction of intraocular pressure with acetazolamide & osmotic diuretics.
What does Acetazolamide do?
Reduction of intraocular pressure in closed-angle glaucoma
What do you do use of acetazolamdie doesn’t work for closed-angle glaucoma
Use osmotic diuretics (mannitol)
Prognosis of closed-angle glaucoma isn’t treated?
severe & permanent visual loss 2-5 days after onset of symptoms
What is the optic nerve “cup”
empty space in the middle of the optic nerve surrounded by optic nerve fibers.
What is Uveitis?
inflammation of the iris & ciliary muscle
Symptoms of Acute nongranulomatous anterior uveitis?
pain, redness, photophobia & visual loss (can’t focus)
Symptoms of Glanulomatous anterior uveitis
Blurred vision in mildly inflamed eye.
Symptoms of Posterior uveitis
Gradual loss of vision in a quiet (non-red) eye
Treatment of Uveitis?
Treat underlying cause w/mydriatic eye drops, steroids, dark glasses
Are cataracts painful?
no
Etiology of cataracts
agingcongenitalDMmedscigarette smokingsuntrauma
Are cataracts unilateral or bilateral (usually)
bilateral
Symptoms of cataracts
progressive blurring of vision, glare
What happens in retinal detachment?
light-sensitive membrane in the retina separates from its’ supporting layers
Is retinal detachment usually bilateral or unilateral?
unilateral
Describe the loss of vision w/Retinal detachment
-curtain spreading across field of vision OR sudden onset of visual loss in one eye
Causes of retinal detachment?
-Nearsightedness-cataract extractionusually due to retinal tear
Is there any pain or redness w/retinal detachment?
no
What should you do in the case of glaucoma or retinal detachment.
refer immediately
Treatment of retinal detachment
- laser photocoagulation- scleral buckle- pneumatic retinoplexy
What does macular degeneration result in?
-blurred vision, blindness
Any pain/redness in macular degeneration?
no
Exact cause of macular degeneration?
unknown
What are the two types of macular degeneration?
-Atopic (dry)-Neovascular (wet)
Which type of Macular degeneration is more common?
Neovascular (wet) 90%
What is the speed of vision loss in atropic (dry) macular degeneration?
gradual
What is the speed of vision loss in neovascular (wet) macular degeneration?
much more rapid
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
What does CRVO stand for?
Central Retinal Vein Occlusion
Characteristics of CRVO
-Sudden monocular vision loss first noticed upon waking.-no pain/redness-retinal hemorrhages
Causes of CRVO
-diabetes, systemic hypertension, hyperlipidemia, glaucoma
What would you see with an opthalmascope in someone with CRVO?
Hemorrhages, venous dilation, cotton-wool spots
What causes CRAO?
blockage of retinal vascular lumen by an embolus, thrombus or inflamed vessel wall/spasm
Characteristics of CRAO
-sudden monocular loss of vision-no pain/redness-cherry red macula
What do you want to screen for in someone with CRAO?
-diabetes & hyperlipidemia-source of embolism
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
What might you find in the eye of someone with Diabetic Retinopathy
Macular edema, exudates, ischemia
Characteristics of non-proliferative Diabetic Retinopathy?
venous dilation, microaneuysms, retinal hemmorrhages, retinal edema, hard exudates
Which is worse without treatment: proliferative diabetic retinopathy or non-proliferative retinopathy?
proliferative
Findings in a patient with hypertensive retinopathy?
-microaneurysms-blot/flame hemorrhages-cotton-wool spots-hard exudates-AV nicking
What is AV nicking?
arteriole seen crossing vein (or vice versa). results in compression of artery/vein w/bulging on either side
What will you notice in someone w/exopthalmos?
bulging of eyes
What causes exopthalmos?
Graves Disease (hyperthyroidism)
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.
What causes ultraviolet keratoconjunctivitis?
UV exposure, welder’s arc
Treatment for UV keratoconjunctivitis?
-cycloplegic gtts & cold compress-analgesics-NSAID gtts
Symptoms of corneal abrasions?
-FB sensation-pain-tearing-blurred vision-head ache
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)
What does Seidel’s test determine?
Occurrence of corneal leakage
Treatment of corneal abrasion
-saline-abx gtts
Do you patch a corneal abrasion?
NO!
You check visual acuity first with every eye problem except…?
burns. It’s an emergency
treatment of burns
-Irrigate with water only-topical anesthetics q20min
Symptoms of a blowout fracture
-pain-enopthalmos-diplopia-abnormal EOM (nerve entrapment)-rupture of globe
If a blowout fracture is suspected, what should you avoid doing during the PE
-palpation of globe or orbit
Tests for blowout fracture
X-ray, CT
When can someone with a blowout fracture be discharged only an opthalmology follow up in a week?
no diplopia, minimal displacement, & no muscle entrapment
If someone w/a blowout fracture has injured sinuses, what should you do?
give them prophylactic abx & tell them not to blow their nose
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
What do you use for rust rings?
alger brush
If someone with a FB has hyphema, what might that mean?
blood in anterior chamber
Someone w/a foreign body has anisocoria; what does that mean?
abnormally shaped pupil/different sized pupils
