Eyes Flashcards
retinal detachment - definition, tx
usually spontaneous or traumatic
- flashers, floaters, “curtain” closing
- results in acute vision loss
tx: refer to ophthalmology
retinal artery occlusion
acute, PAINLESS, loss of vision (unilateral)
- emergency!
- # 1 cause is carotid atherosclerosis (emboli occludes)
retinal vein occlusion
subacute, unilateral blurriness
- “blood and thunder” fundus - leaking due to blockage and back-up of blood
- may resolve on own
- w/u for underlying cause
- risks: elderly, HTN, glaucoma, DM
optic neuritis - definition, causes, sxs, tx
sudden inflammation of nervous tissue of eye; can destroy myelin
- unilateral vision loss
- loss of pupillary rx to light
- pain with EOEM
causes: infection, autoimmune dz (SLE, sarcoid), multiple sclerosis
tx:
- treat underlying cause
- may resolve on own
- corticosteroids, IV
- prognosis good unless MS or SLE
causes of acute vision loss
retinal detachment
retinal artery occlusion
optic neuritis
causes of chronic vision loss
glaucoma
cataract
macular degeneration
retinopathy
glaucoma - definition, risks
increased intraocular pressure (IOP) and optic nerve damage
- visual field loss leading to blindness
- PREVENTABLE
risks: DM, HTN, hypothyroid, FH, African American
glaucoma - two types
open angle: asymptomatic rise in IOP
- central vision spared
- most common / less severe
angle closure:
- ocular emergency!
- sudden, complete occlusion of aqueous humor flow
- pain, blurred vision, photophobia
- hazy cornea w/ fixed pupil
- N/V, sweating
glaucoma - screening (3 things to check)
- anterior chamber angle (bowing of iris)
- optic nerve exam
- cup: disc ratio (>0.5 = abnormal) - IOP>21 mmHg
angle closure glaucoma - tx
TRUE ocular emergency
- immediate referral
- decrease IOP: carbonic anhydrase inhibitor (IV), osmotic agent (mannitol), pilocarpine drops (contract ciliary muscles and facilitate flow)
glaucoma - general tx
promote drainage:
- cholinergic agents (pilocarpine)
decrease production:
- beta blockers
both
- alpha agonists
Can get surgical tx if not responding to meds
cataract - definition, sxs, tx
opacity of lens (brown to yellow discoloration)
- white in pupil; appears dark against red reflex w/ otoscope
- slow, progressive loss of vision
- VERY common
tx:
- early: magnifying glasses
- later: surgical removal
macular degeneration (age-related) - definition, sxs
yellowish, hyaline nodules that deposit in Bruch’s membrane and limit nutritional and metabolic support of macula
- sxs: gradual blurry vision, wavy or distorted vision, central bid spot
- PE: dec. acuity, drusen mottling, macular scarring
retinopathy - definition, 2 major causes in US, tx
ischemic injury to retinal vasculature
causes: diabetes and HTN
tx: treat underlying DM and HTN
blepharitis - definition, sxs, tx
inflammation or infection of eyelid
- “dandruff of eyelid”
sxs: irritation, burning, FB sensation, tearing, photophobia
tx: topical ABX (erythromycin), warm compress
dacryocystitis
inflammation of lacrimal gland +/- duct
sxs: pain, swelling, tearing, drainage
- unilateral
tx:
- warm or cool compress
- oral ABX if infectious
- abscess: I&D
hordeolum (stye)
infection of sebaceous gland (staph aureus)
- mildly painful nodule or pustule on lid
- can be internal (under lid) or external (facing outside)
- red, tender, comes to point
tx:
- warm compress (2-3 days)
- topical ABX if needed
chalazion
chronic granulomatous inflammation of meibomian gland
- may arise post-stye
- PAINLESS
tx: warm compress
ectropion - definition, tx
lid turns outward
- usually age-related
tx: botox (temporary); surgery
entropion - definition, tx
lid turns inward
- usually age-related
- cause cause foreign body sensation
tx: botox (temporary); surgery
orbital cellulitis - cause, sxs, dx, tx
cause: URI, sinusitis, lid trauma (kids)
- systemic dz
sxs: pain, erythema, fever, dec. vision
PE: erythema of lid and surrounding skin; RESTRICTED motility
dx: inc. WBC, CT: infiltration of orbital fat
tx:
- ADMIT: broad spectrum ABX (IV than PO 2-3 weeks)
Preferred: amoxicillan-clavulanate (augmentin)
PEN allergy or hx of MRSA: doxycycline
viral conjunctivitis (pink eye) - sxs and tx
sxs: redness, mild discomfort, watery d/c
- tender preauricular nodes
- rapidly bilateral
tx:
- self limiting, cold to warm compress
- artificial teams, antihistamine drops
bacterial conjunctivitis - sxs and tx
sxs: redness, irritated, purulent d/c, adhesions
- often bilateral
- often contact lens wearers
tx: ABX drops
- fluoroquinolone, polymixin, sulfa
chlamydial conjunctivitis - sxs and tx
sexually transmitted
sxs: unilateral, scant purulent d/c
tx:
- systemic tetracycline or erythromycin
- topical ABX ointment
allergic conjunctivitis - sxs and tx
seasonal, people w/ atopic hx
sxs: mild injection, edema, cobblestoning
- stringy d/c, edema
tx:
- remove allergen
- systemic antihistamines
- topical antihistamine
pterygium
triangular wedge-shaped fleshy growth in eye that fold over into cornea
- interferes with vision
- localized inflammatory process
tx: surgical excision, artificial tears, topcial NSAIDS or steroids
herpes simplex keratitis - sxs, dx, tx
sxs:
- unilateral, recurrent
- HSV-1»_space; HSV-2
- irritation, light sensitivity, redness
dx: dendritic lesion (fluorescein stain)
tx: REFER!!
- topical anti-viral
- NO STEROID - will cause tissue loss, ocular perforation
herpes zoster ophthamicus - definition, sxs, tx, prevention
latent varicella virus that stays dormant on trigeminal ganglion
sxs: pain, H/A, photophobia, malaise, fever
- often w/ vesicular, pustular rash in dermatomal dist.
Hutchinson’s sign: lesions on tip of nose = ocular involvment
tx: REFER
- oral or IV antivirals (protect site)
prevent: vaccine (Zostavax)
corneal ulcer - definition, sxs, tx
infection and inflammation of cornea
- history of trauma, contact lens use
sxs: pain, photophobia, tearing
dx: dense corneal infiltrate seen with fluorescein stain
tx: REFER
- avoid contact lens use
corneal abrasion - definition, sxs, tx
small cut due to mild trauma
sxs: conjunctival injection, photophobia, tearing
- foreign body sensation
dx: epithelial defect (fluorescein stain)
- R/O ulcer
tx: ABX ointment
- F/U daily until resolves
- If does not resolve in 1 day, refer for ulcer
foreign bodies
tearing, red, irritated, painful
evert lids for exploration
remove under topical anesthesia
- irrigate, forceps or q-tip
- apply ABX ointment after removal
subconjunctival hemorrhage - sxs and tx
spontaneous bleedings (confined to sclera) - usually following valsalva
tx:
- reassurance
- 2-3 wks to clear
orbital fracture (“blow out”) - cause, sxs, tx
fracture of tiny bones of orbit due to trauma (fist, ball)
- bones “blow out” into maxillary sinus
sxs: restricted, painful vertical eye movement
- double vision, edema
tx: REFER
- CT to assess extent of damage and tx (likely surgery)
hyphema
blood in anterior chamber
- typically caused by trauma (think shaken baby if infant)
sxs: pain, blurry vision, red eye, sluggish pupil, watery appearance
tx: REFER
- admit and monitor closely
chemical burns
irrigate, irrigate, irrigate
papilledema
increased pressure in or around the brain causes the part of the optic nerve inside the eye to swell
- see on opthomascopic exam
Sxs: fleeting disturbances in vision, headache, vomiting
what test to you do to confirm refractory error (e.g. near sighted / far sighted)
pinhole test: vision will improve if due to refractory error
amblyopia
loss of visual acuity (NOT correctable by glasses) in otherwise healthy eye
- “lazy eye”
- normal eye that is prohibited from developing
- MOST OFTEN due to untreated strabismus
tx:
- treat underlying problem (strabismus or refractive error) b/f age of 6
strabismus
unequal alignment of eyes - misalignment of eye axis due to unequal straight of eye muscles
- can interfere w/ proper formation of visual cortex
- hypotropia: downward
- hypertropia: upward
- exotropia: outward
- esotropia: inward
tx:
- patch good eye
- surgery (severe cases)
myopia
nearsightedness
hyperopia
farsightedness
