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NPE 621 > Eyes > Flashcards

Eyes Flashcards

1
Q

Vision Screenings

A
  • Inability to fix and follow after 3 months - warrants referral
  • Photoscreening and autorefraction - ages 6 months to 3 years
  • Visual acuity charts starting at 4-5 years

Vision screening detects amblyopia (lazy eye) which affects 1-4% of children

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2
Q

PMH and FMH Risk factors related to the EYE:

A

Pertinent PMH:

  • Maternal substance abuse during preg
  • TORCH exposure
  • Prematurity
  • Development delay
  • Neurological abnormalities
  • Metabolic abnormalities
  • Congenital/genetic abnormalities associated with eye problems
  • Allergies

Pertinent FMH:

  • Congenital abnormalities
  • Blindness
  • Retinoblastoma
  • Metabolic/genetic/congenital disorders
  • Need for corrective lenses
  • Glaucoma
  • Blood dyscrasias
  • HTN
  • Glasses
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3
Q

Physical Exam of the EYE

A
  • Observation of structures and response to exam by:
    EOM
    PERRL
    Accommodation (ability to focus the eyes to see up close and change from close to far)
  • External Eye Exam
  • Corneal Light Reflex (Reflection of light from both eyes - should be symmetrical)
  • Red reflex (Reflection from the retina - both eyes should have crisp, round, red, orange, or tan reflex)
  • Ophthalmoscope exam

Dx studies:

  • Culture/gram stain of eye discharge
  • US, CT, MRI for orbital cellulitis, trauma, or tumor
  • No US if ruptured globe
  • No MRI if metal foreign body
  • Fluorescein staining for corneal damage
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4
Q

Normal Vision Development (Table 35.3 - page 619)

A
  • Soon after birth: Fix and follow a light source
  • 1 month: Fixation is central, steady and can follow a slow target
  • 3 months: Binocular vision and eye coordination
  • 6 months: Reaches out accurately at an object
  • 9 months: Object permanence
  • 2 years: Picture matching
  • 3 years: Letter matching (E chart)
  • 5 years: Snellen chart
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5
Q

Ophthalmic Antibiotics:

A
  • Fluoroquinolines, sulfacetamide, and trimethoprim/polymyxin B; erythromycin
  • Avoid topical penicillins
  • Ointments preferred in children (last longer, don’t sting)
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6
Q

Chlamydia Trachomatis Conjunctivitis

A

Key Characteristics:

  • Commonly presents during 5 to 14 days of life
  • S/Sx: mild to moderate injections and chimosis (examine for signs of increased WOB)

Purulent discharge and complication of other STIs

Dx: Culture conjunctivae & r/o pneumonia with chest XR

Management: Erythromycin for 2 to 3 weeks and hospitalize for respiratory symptoms

Education: Good handwashing, mother and partner treatment, pneumonia

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7
Q

Gonococcal Ophthalmia Neonatorum

A

Key Characteristics:

  • 2 to 5 days after birth
  • Marked chemosis and eyelid edema, everted
  • Marked mucopurulent eye drainage

S/Sx: significant purulent discharge in very young infants

Labs: culture drainage

Management: hospitalize with IV antibiotics for 7 days (ceftriaxone or cefotaxime)

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8
Q

Bacterial Conjunctivitis (“Pink Eye”)

A

Etiology: Hib, strep pneum, staph aureus, moraxella catarrhalis (common in Dec-April)

S/Sx: red eyes with purulent yellow-green discharge, URI, photophobia; diffuse and marked conjunctival hyperemia

Tx: Medications & cool, wet compresses
- sodium sulfacetamide, trimethoprim sulfate plus polymyxin B, azithromycin, fluoroquinolone, erythromycin

Complications: systemic infection and blindness

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9
Q

Viral Conjuncitivitis

A

Etiology: adenoviruses, HSV, VZV, Coxsackie

S/Sx: Pinkish-red eyes, watery or serous discharge, pharyngitis; diffuse conjunctival hyperemia with follicles, discomfort

Tx: Warm or cool, wet compresses; Artificial tears; antihistamine

More common in children > 6 years

If suspect HSV with eye involvement - refer out

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10
Q

Allergic Conjunctivitis

A

S/Sx: Bilateral itching or burning, excessive (clear) tearing; diffuse conjunctival hyperemia; boggy conjunctiva, cobblestone, papillary hypertrophy

Tx: Eliminate agents, oral histamine, topical ophthalmic mast cell stabilizer

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11
Q

Strabismus (“Lazy Eye”)

A

Misalignment of the eyes (5% of children)

S/Sx: eyes turn in (eso); out (exo); up (hyper); down (hypo)
Amblyopia in affected eye

When to Refer: Persists or loss of vision acuity; refer if >4 months

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12
Q

Amblyopia

A

Functional reduction in visual acuity (caused by abnormal visual development early in life)

Predominately unilateral

S/Sx: strabismus, refractive errors, unequal red reflexes; decrease in visual acuity, unequal vision

Dx: All children < 5 should be screened

Tx: Occlusive therapy, visual blurring (Educate on compliance with treatment)

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13
Q

Blepharitis

A

Inflammation of eyelid margin (eyelash follicles) associated with eye irritation

S/Sx: Red, itchy, crusting eyelid margins, chronic or recurrent; gritty feeling; seborrhea, staph, pediculosis

Tx: Clean eyelid margins twice a day; warm compresses

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14
Q

Nystagmus

A

Involuntary, rhythmic movements
Pendular oscillations or jerky drifts

Congenital or acquired

Normal up to 1 month

Management: refer to ophthalmologist

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15
Q

Cataracts

A

Partial or complete opacity of the lens

Congenital or acquired

Clinical findings: Maternal prenatal infection, drug exposure; opacity on lens; varying visual acuity deficits

Management: refer to ophthalmologist

Associated with: hypoglycemia, hypoPTH, galactosemia, and microthalamus

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16
Q

Hordeolum (“Stye”)

A

Infection of meibomian glands, glands of Zeis or Moll (sebaceous) usually from staph aureus

S/Sx: painful and tender eyelid, red eye, pustule dependent on internal or external

Tx: Frequent warm compresses; topical anti-infective ointment; Antistaphylococcal ointment

17
Q

Chalazion

A

Chronic inflammation of meibomian glands from granulomatous inflammation

S/Sx: hard, painless mass in eyelid, not red or pustular, chronic; no eye discharge

Tx: warm compresses, surgical removal

18
Q

Congenital Nasolacrimal Duct Obstruction (Dacryostenosis and Dacryostitis)

A

Defect of the lacrimal drainage system resulting in blockage (6% of newborns)

  • Dacryostenosis: abnormal obstruction of NL duct
  • Dacryostitis: inflammation of NL duct

S/Sx: continuous watery eyes, mucopurulent discharge

Dx: pressure over nasolacrimal sac produces mucopurulent discharge from punctum

Tx: Massage lacrimal sac several times the day, saline in nose
Refer if not resolved by 6-7 months

19
Q

Preseptal / Periorbital Cellulitis

A

Inflammation and infection of eyelids and periorbital tissue

S/Sx: Red painful swelling around eye; tender, warm; regional adenopathy, fever

Dx: CBC, blood cx, head CT scan

Tx: MRSA concerns, complicated or <1 year, oral abx, warm compresses

20
Q

Corneal Abrasion

A

Scratched, abraded, or denuded cornea usually from accidental contact with object

S/Sx: Pain, tearing, photophobia, decreased vision; uneven light reflex or cloudiness, foreign body, green staining

Dx: Fluorescein staining and cobalt-blue light or Wood’s lamp

Tx: Topical ophthalmic anti-infective ointment

  • Follow-up in 24 - 48 hours or sooner
  • May refer, especially if noncompliant
21
Q

Foreign Body (Conjunctival or Corneal)

A

S/Sx: Excessive tearing, Photophobia, Pain, FB sensation

Tx: Test visual acuity, remove foreign body, inspect for corneal abrasion, topical ophthalmological abx
- Follow-up in 24 hours or sooner

22
Q

Hemorrhage (Subconjunctival)

A

Rupture of small blood vessels in the conjunctiva

Etiology: Sudden increase in intrathoracic pressure, direct ocular trauma

S/Sx: blotchy, bulbar erythema of conjunctiva

Tx: will resolve in 5 to 7 days
(Educate on measures to avoid increasing intrathoracic pressure)

23
Q

Hyphema

A

Blood in the anterior chamber of eye due to trauma

S/Sx: bright or dark red area near iris, painful, photophobia, tearing
- No bilateral red reflex

Tx: immediate referral to ophthalmologist

Education: weeks for return of normal vision, prevention, follow-up from ophthalmologist

24
Q

Chemical Burn

A

Instillation of alkali or acid solution or substance into eye

S/Sx: eye pain, unable to open eye; opacity of corneal tissue, photophobia, tearing, swollen cornea

Tx: irrigation with water or saline, emergency referral

Could cause loss of vision

25
Q

Ocular Trauma

A

Indirect or direct serious injury to the eye

S/Sx: double, blurred, or decreased vision; eye pain; tearing; unable to open eye, Corneal redness

Tx: Referral to ER or ophthalmologist

26
Q

Retinopathy of Prematurity

A

Multifactorial retinal vasculopathologic disease (from prematurity or LBW) - Abnormal growth of retinal vessels

Dx: in NICU by pediatric ophthalmologist
S/Sx: leukokoria, pupillary rigidity, vitreous haziness, hemorrhage, retinal and iris changes, pallor of optic nerve, strabismus, cataracts, detached retinas may occur

Management: follow up with ophthalmologist; Monitor and referred for low vision children

Complications: retinal detachment, strabismus, amblyopia, myopia, nystagmus, astigmatism, anisometropia, Cataracts, uveitis, hyphema, macular burns, occlusion of central retinal artery, glaucoma, cicatrix

Prevention: decrease occurrence of premature births

27
Q

Retinoblastoma

A

Intraocular tumor (malignant)

S/Sx: Positive family history, strabismus, unilateral or bilateral leukokoria, Decreased visual acuity, abnormal red reflex

Management: refer to ophthalmologist; enucleation of eye for advanced tumors

28
Q

Conjunctivitis of Newborn (ophthalmia neonatorum)

A

Occurs in first few months of life

Chlamydia = most common cause (also HSV & gonorrhea)

S/Sx: moderate eyelid swelling, purulent discharge (usually in 5-14 days)

Management: irrigate with sterile saline, systemic erythromycin, mother should be treated for STI

NPE 621 (7 decks)

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