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CAM I > Eyes > Flashcards

Eyes Flashcards

1
Q

Blepharitis

A

Inflammation of BOTH eyelids. Common in pts with Down’s syndrome and eczema

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2
Q

Etiologies of blepharitis

A

Anterior: infectious (Staph aureus, viral) or seborrheic. Anterior involves the skin, eyelashes
Posterior: dysfunction of meibomian gland (associated with rosacea and allergic dermatitis)

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3
Q

Manifestations of blepharitis

A

Eye irritation/itching, eyelid changes: burning, erythema with crusting, scaling, red-rimming of eyelid, and eyelash flaking.

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4
Q

Management of blepharitis

A

Proper hygiene, warm dry compresses, baby shampoo scrubs, artificial tears
S. aureus first line: bacitracin or erythromycin
2nd line: FQ solution

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5
Q

Hordeolum

A

Acute bacterial infection in one or more eyelid glands MCC= staph aureus

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6
Q

External and internal hordeolums

A

External: Zeiss or Moll glands (sweat glands on margin of lids)
Internal: Meibomian glands (sebaceous glands)- only revealed if evert eyelid

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7
Q

Presentation of hordeolum

A

Acute and PAINFUL nodule filled with pus, usually red

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8
Q

Tx of hordeolum

A

External: warm compresses only
Internal: Dicloxicillin (250-500 mg q6h) and warm compresses
If community acquired MRSA: trimethoprim/sulfamehoxazole

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9
Q

Education points for hordeolum

A

Throw away mascara, eye makeup, don’t share with others

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10
Q

Chalazion

A

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

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11
Q

Risk factors of chalazion

A

Occurs following internal hordeolum, pts with eyelid margin blepharitis, or rosacea

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12
Q

Presentation of chalazion

A

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

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13
Q

Treatment for chalazion

A

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

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14
Q

Dacryoadenitis

A

Inflammatory enlargement of the lacrimal gland

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15
Q

Presentation of dacryoadenitis

A

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

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16
Q

Causes of dacryoadenitis

A

Bacterial: S. aureus, S. pneumo, GAS, N. gonorrheae
Viral: Mumps-MCC esp in childhood, EBV, CMV, Coxsachievirus, echoviruses

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17
Q

Work up of dacryoadenitis

A

CT of orbits with contrast
CBC
Culture/smear if purulent d/c present
BCx

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18
Q

Tx of dacryoadenitis

A

Viral: supportive, warm compresses, po NSAIDs
Bacterial: 1st gen cephalosporins- cephalexin 500 mg QID
Referral for ENT, ophthalmology, and ID

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19
Q

Pterygium

A

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

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20
Q

Tx for pterygium

A

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

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21
Q

Education on pterygium

A

UV sunlight protection, avoid environmental elements, lubricating drops for dry eyes

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22
Q

Orbital floor “blowout” fractures

A

Fractures to the orbital floor (maxillary, zygomatic, palatine) affect the eye as a result of trauma

23
Q

Clinical manifestations of orbital floor blowout fxs

A

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)

24
Q

Diagnosis of blowout fracture

A

CT scan

25
Q

Management of blowout fracture

A

Nasal decongestants, avoid blowing nose, prednisone, abx. Surgical repair. Opthalmology referral

26
Q

Macular degeneration

A 
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)
27
Q

Risk factors of macular degeneration

A

FHx
Smoking
Excessive exposure to UV sunlight

28
Q

Presentation of macular degeneration

A

Loss of visual acuity (poor central vision) in 1 or both eyes, distortion of images, NO PAIN or REDNESS, fundi exam: macular changes, DRUSEN

29
Q

Tx of macular degeneration

A

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

30
Q

Education- macular degeneration

A

Can affect your driving, visual hallucinations, watch/screen for depression, encourage use of Amsler Grid

31
Q

Diabetic retinopathy

A

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.

32
Q

Nonproliferative (background) retinopathy

A

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.

33
Q

Proliferative retinopathy

A

Neovascularization: new, abnl blood vessel growth, vitreous hemorrhage

34
Q

Tx of nonproliferative retinopathy

A

Panlaser tx. Glucose control.

35
Q

Tx of proliferative retinopathy

A

VEGF inhibitors, laser photocoagulation tx, tight glucose control

36
Q

Maculopathy

A

Macular edema or exudates, blurred vision, central vision loss. Due to micro aneurysm leakage at macula causing macular edema and damage

37
Q

Hypertensive retinopathy

A

Management; control HTN
4 grades:
Arterial narrowing, copper wiring, silver wiring
AV nicking
Flame-shaped hemorrhages, cotton wool spots
Papilledema

38
Q

Retinal detachment

A

Retinal tear- retinal inner layer detaches from choroid plexus

39
Q

Predisposing factors to retinal detachment

A

Myopia (nearsightedness) and cataracts

40
Q

Clinical manifestations of retinal detachment

A

Photopsia (flashing lights) with detachment
Floaters
Progressive unilateral vision loss
Shadow curtain in peripheral to central visual field and no pain/redness

41
Q

Dx of retinal detachment

A

Fundoscopy: retina hanging in the vitreous
Pos Shafer’s sign (clumping of pigment cells in the anterior vitreous)
Nl or decreased intraocular pressure

42
Q

Management of retinal detachment

A

Laser, cryotherapy ocular surgery. No miotics

43
Q

Corneal abrasion

A

One of the most common eye injuries; disruption of the corneal epithelium or because the corneal surface has been scraped away or denuded

44
Q

Causes of corneal abrasion

A 
Dry eyes
Contact lenses
FB
Fingernails
Pieces of paper or cardboard
Makeup applicators
45
Q

Presentation of corneal abrasion

A 
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
46
Q

Work up for corneal abrasion

A

Fluorescein dye + blue light (Wood’s lamp) to detect FB or damage to cornea, evert eyelid for inspection

47
Q

Tx for corneal abrasion

A

PPX abx given in contact lens wearers- FQ drops

  • Moxifloxacin drops
  • Contact lens wearers- Cipro or Levofloxacin
48
Q

Orbital cellulitis

A

Acute infection of orbital contents septum, with edema and erythema of the conjunctiva and eyelids

49
Q

Pathology of orbital cellulitis

A

Extension of infection from paranasal sinuses or other periorbital structures, trauma or hematogenous spread

50
Q

Most common organisms of orbital cellulitis

A

S. pneumoniae, H. influenza, M. catarrhalis, S. aureus

51
Q

Risk factors of orbital cellulitis

A

Sinusitis, orbital trauma, retained FB, dental or periorbital infection

52
Q

Work up of orbital cellulitis

A 
CT with contrast
CBC
CRP
ESR
Blood culture
Lactic acid
53
Q

Presentation of orbital cellulitis

A 
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
54
Q

Tx of orbital cellulitis

A

ADMIT! Consults! Monitor vision status and CNS change (neuro checks).

  • Vancomycin + ceftriaxone + metronidazole
  • Piperacillin/Tazobactam

CAM I (5 decks)

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