Eyes Flashcards
Blepharitis
Inflammation of BOTH eyelids. Common in pts with Down’s syndrome and eczema
Etiologies of blepharitis
Anterior: infectious (Staph aureus, viral) or seborrheic. Anterior involves the skin, eyelashes
Posterior: dysfunction of meibomian gland (associated with rosacea and allergic dermatitis)
Manifestations of blepharitis
Eye irritation/itching, eyelid changes: burning, erythema with crusting, scaling, red-rimming of eyelid, and eyelash flaking.
Management of blepharitis
Proper hygiene, warm dry compresses, baby shampoo scrubs, artificial tears
S. aureus first line: bacitracin or erythromycin
2nd line: FQ solution
Hordeolum
Acute bacterial infection in one or more eyelid glands MCC= staph aureus
External and internal hordeolums
External: Zeiss or Moll glands (sweat glands on margin of lids)
Internal: Meibomian glands (sebaceous glands)- only revealed if evert eyelid
Presentation of hordeolum
Acute and PAINFUL nodule filled with pus, usually red
Tx of hordeolum
External: warm compresses only
Internal: Dicloxicillin (250-500 mg q6h) and warm compresses
If community acquired MRSA: trimethoprim/sulfamehoxazole
Education points for hordeolum
Throw away mascara, eye makeup, don’t share with others
Chalazion
A subacute, non-tender, usually PAINLESS nodule within the tarsus (eyelid), usually points inside the eye rather than the lid margin
Granulomatous inflammation of Meibomian gland
Risk factors of chalazion
Occurs following internal hordeolum, pts with eyelid margin blepharitis, or rosacea
Presentation of chalazion
Hard, non-tender swelling on upper or lower eyelid, develops slowly and may be asymptomatic, +/- conjunctivitis, distort vision, may become pruritic/erythematous involving the lid
Treatment for chalazion
Small chalazia often resolve without intervention, warm compresses help larger chalazia. Symptomatic or unresolved cases refer to ophthalmology for surgical incision and curettage or direct glucocorticoid injection
Dacryoadenitis
Inflammatory enlargement of the lacrimal gland
Presentation of dacryoadenitis
Unilateral, severe pain, redness, and pressure in the supratemporal region of the orbit, rapid onset
-Chronic dacryoadenitis: can be bilateral painless enlargement present > 1 mo; more common than acute
Causes of dacryoadenitis
Bacterial: S. aureus, S. pneumo, GAS, N. gonorrheae
Viral: Mumps-MCC esp in childhood, EBV, CMV, Coxsachievirus, echoviruses
Work up of dacryoadenitis
CT of orbits with contrast
CBC
Culture/smear if purulent d/c present
BCx
Tx of dacryoadenitis
Viral: supportive, warm compresses, po NSAIDs
Bacterial: 1st gen cephalosporins- cephalexin 500 mg QID
Referral for ENT, ophthalmology, and ID
Pterygium
A fleshy, triangular encroachment of the conjunctiva onto the nasal side of the cornea. Usually bilateral. Associated with exposure to wind, sun, sand, and dust
Tx for pterygium
No tx for inflammation- artificial tears only
May use topical NSAIDs or weak CS (fluorometholone or lotepredonal QID) but MD needs to start this
Surgery indicated for growth that threatens the visual axis, marked induced astigmatism, or severe irritation
Education on pterygium
UV sunlight protection, avoid environmental elements, lubricating drops for dry eyes
Orbital floor “blowout” fractures
Fractures to the orbital floor (maxillary, zygomatic, palatine) affect the eye as a result of trauma
Clinical manifestations of orbital floor blowout fxs
Decreased visual acuity (trapped orbital tissue); enophthalmos ( sunken eye)
Diplopia especially with upward gaze (due to inferior rectus muscle entrapment)
Orbital emphysema (eyelid swelling with blowing the nose from connection to maxillary sinus) May have exophthalmos
Epistaxis, dyesthesias, hyperalgesia, anesthesia to anteriomedial cheek (due to stretch of infraorbital nerve)
Diagnosis of blowout fracture
CT scan
Management of blowout fracture
Nasal decongestants, avoid blowing nose, prednisone, abx. Surgical repair. Opthalmology referral
Macular degeneration
Progressive degeneration of the macula CENTRAL vision loss- elderly pts -Atrophic (dry or geographic) Gradual blurring of central vision -Neovascular (wet or exudative) Progresses more rapidly -ARMD is MCC of blindness > 65yoa (90% is neovascular)
Risk factors of macular degeneration
FHx
Smoking
Excessive exposure to UV sunlight
Presentation of macular degeneration
Loss of visual acuity (poor central vision) in 1 or both eyes, distortion of images, NO PAIN or REDNESS, fundi exam: macular changes, DRUSEN
Tx of macular degeneration
Referral to ophthalmology
Neovascular: photodynamic therapy, Vascular Endothelial Growth Factor inhibitors
Atrophic: no specific tx but magnifying glasses and visual aids help
Antioxidants (Vit C and E), zinc, copper, carotenoids
Education- macular degeneration
Can affect your driving, visual hallucinations, watch/screen for depression, encourage use of Amsler Grid
Diabetic retinopathy
Damage to retinal blood vessels leads to retinal ischemia, edema. Glycosylation (excess sugar attaching to proteins such as the collagen of the blood vessels) causes capillary wall breakdown.
Nonproliferative (background) retinopathy
Microaneurysms lead to blot and dot hemorrhages, flame-shaped hemorrhages, cotton wool spots, hard exudates, retinal vein beading, closure of retinal capillaries. Not associated with vision loss.
Proliferative retinopathy
Neovascularization: new, abnl blood vessel growth, vitreous hemorrhage
Tx of nonproliferative retinopathy
Panlaser tx. Glucose control.
Tx of proliferative retinopathy
VEGF inhibitors, laser photocoagulation tx, tight glucose control
Maculopathy
Macular edema or exudates, blurred vision, central vision loss. Due to micro aneurysm leakage at macula causing macular edema and damage
Hypertensive retinopathy
Management; control HTN
4 grades:
Arterial narrowing, copper wiring, silver wiring
AV nicking
Flame-shaped hemorrhages, cotton wool spots
Papilledema
Retinal detachment
Retinal tear- retinal inner layer detaches from choroid plexus
Predisposing factors to retinal detachment
Myopia (nearsightedness) and cataracts
Clinical manifestations of retinal detachment
Photopsia (flashing lights) with detachment
Floaters
Progressive unilateral vision loss
Shadow curtain in peripheral to central visual field and no pain/redness
Dx of retinal detachment
Fundoscopy: retina hanging in the vitreous
Pos Shafer’s sign (clumping of pigment cells in the anterior vitreous)
Nl or decreased intraocular pressure
Management of retinal detachment
Laser, cryotherapy ocular surgery. No miotics
Corneal abrasion
One of the most common eye injuries; disruption of the corneal epithelium or because the corneal surface has been scraped away or denuded
Causes of corneal abrasion
Dry eyes Contact lenses FB Fingernails Pieces of paper or cardboard Makeup applicators
Presentation of corneal abrasion
Eye pain Inability to open eye bc of FB sensation Pain with EOM Blurred vision Photophobia Tearing Hx of trauma to the eye Toxic chemicals
Work up for corneal abrasion
Fluorescein dye + blue light (Wood’s lamp) to detect FB or damage to cornea, evert eyelid for inspection
Tx for corneal abrasion
PPX abx given in contact lens wearers- FQ drops
- Moxifloxacin drops
- Contact lens wearers- Cipro or Levofloxacin
Orbital cellulitis
Acute infection of orbital contents septum, with edema and erythema of the conjunctiva and eyelids
Pathology of orbital cellulitis
Extension of infection from paranasal sinuses or other periorbital structures, trauma or hematogenous spread
Most common organisms of orbital cellulitis
S. pneumoniae, H. influenza, M. catarrhalis, S. aureus
Risk factors of orbital cellulitis
Sinusitis, orbital trauma, retained FB, dental or periorbital infection
Work up of orbital cellulitis
CT with contrast CBC CRP ESR Blood culture Lactic acid
Presentation of orbital cellulitis
Malaise Fever Diplopia Pain with EOMs MS change Proptosis vision loss Caution with systemic immunosuppression and DM ALERT: ophthamoplegia, MS change, contralateral CN palsy, or bilateral cellulitis leads to CNS involvement
Tx of orbital cellulitis
ADMIT! Consults! Monitor vision status and CNS change (neuro checks).
- Vancomycin + ceftriaxone + metronidazole
- Piperacillin/Tazobactam
