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HEENT > Eyes MDT > Flashcards

Eyes MDT Flashcards

1
Q

What is blepharitis?

A

Common chronic inflammatory condition of the lid margins

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2
Q

What structures are involved in Anterior blepharitis?

A

Lid skin, eyelashes and associated glands

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3
Q

What are the common causes of anterior blepharitis?

A

Ulcerative, staphloccoci, sebborheic

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4
Q

What structures are involved with posterior blepharitis?

A

Meibomian glands

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5
Q

What are common causes of posterior blepharitis?

A

Staphylococci, glandular dysfunction, strong association with acne rosacea

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6
Q

Physical findings of anterior blepharitis

A

Eyes are redrimmed and scales or granulations can be seen on lashes

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7
Q

Physical findings of posterior blepharitis

A

Margins are hyperemic with telangiectasia and the Meibomian glands and their orifices are inflamed

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8
Q

Treatment of blepharitis

A
  • Scrub eyelids twice a day with commercial eyelid scrub, baby shampoo
  • warm compresses
  • lid massage
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9
Q

What is hordeolum caused by?

A

Acute infection usually involving staphylococcus

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10
Q

Where is external Hordeolum located?

A

Smaller, on the margin “stye”

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11
Q

What gland are external hordeolums on?

A

Gland of Zeis

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12
Q

Where is internal hordeolum located?

A

Points onto conjunctival surface of lid

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13
Q

What gland is internal hordeolums located?

A

Meibomian gland

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14
Q

What is chalazion secondary to?

A

Hordeolum

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15
Q

Physical findings of hordeolum

A
  • well defined nodule on eyelid
  • pointing purulent material
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16
Q

Physical findings of chalazion

A
  • hard and non-tender
  • normally further back on eyelid than hordeolum
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17
Q

Treatment of hordeolum/chalazion

A
  • warm compresses
  • massage
  • do not pop
  • can use bacitracin
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18
Q

What is conjunctivitis?

A

Inflammation of conjunctive

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19
Q

What is common cause of viral conjunctivitis?

A

Adenovirus

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20
Q

Where viral conjunctivitis is easily spread?

A

Clinics and contaminated pools

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21
Q

What causes allergic conjunctivitis?

A

Allergens

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22
Q

What causes bacterial conjunctivitis (nongonoccocal)

A
  • Staph
    -HiB
  • Strep
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23
Q

What causes gonococcal conjunctivitis?

A

Take a wild fucking guess

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24
Q

Sx of viral conjunctivitis

A
  • watery discharge
  • hx of recent URI
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25
Q

Sx of allergic conjunctivitis

A
  • watery, itchy eyes
  • hx of allergy
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26
Q

Sx of bacterial conjunctivitis

A
  • purulent discharge
  • usually unilateral
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27
Q

Sx of gonococcal conjunctivitis

A
  • infected w/genital secretions
  • Emergency can lead to perforation
  • severe purulent discharge
  • hyper acute onset
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28
Q

Which conjunctivitis requires gram stain, cultures and sensitivities?

A

Gonococcal and non-gonococcal bacterial conjunctivitis

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29
Q

Treatment of viral conjunctivitis

A
  • Artificial tears
    Opthalmic Antihistamine
    • Epinastine .005% 1 drop BID
      Opthalmic corticosteroid (MED ADVICE PRIOR)
    • Loteprednol 0.5% 1-2 drops QID
    • Prednisolone 1% 1-2 drops BID-QID
    • Fluormetholone 0.1% 1-2 drops BID
    • Dexamethasone 0.1% 1-2 drops q4-6hrs
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30
Q

Treatment of allergic conjunctivitis

A
  • Artificial tears
    Opthalmic Antihistamine
    • Patanol 0.1% BID
    • Epinastine .05% QID
      ***Topical antihistamines are more effective than oral therapies
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31
Q

Treatment of bacterial conjunctivitis non gonococcal for non-contact users

A
  • Erythromycin ophthalmic ointment QID 5-7days
  • Bacitracin
  • Polytrim
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32
Q

Treatment of bacterial conjunctivitis non gonococcal for contact users

A

Fluoroquinolone
- Ciprofloxacin or Ofloxacin 0.3% 1-2 drops QID for 5-7 days
If associated with dacryocystitis
- Augmentin 875/125 BID or 500/125TID

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33
Q

Treatment of gonococcal conjunctivitis

A

Cephalosporin
- Ceftriaxone 2g IV q12hrs
Macrolide
- Azithromycin 500mg PO then 250mg daily for next 4 days

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34
Q

Who else do you treat in addition to your patient with gonococcal conjunctivitis?

A

Patient’s partners

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35
Q

What is conjunctival hemorrhage?

A

Rupture of the fragile conjunctiva vessels

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36
Q

What causes conjunctival hemorrhage?

A

Trauma, HTN, bleeding disorder, antiplatelet or anticoagulant medication

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37
Q

Sx of conjunctival hemorrhage

A
  • red eye, foreign body sensation
  • usually asymptomatic
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38
Q

Treatment for conjunctival hemorrhage

A
  • none, usually clears within 2-3 weeks
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39
Q

What is pterygium

A

Degeneration of fibro vascular, deep conjunctival layers resulting in vascular tissue proliferation, which extends onto the cornea

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40
Q

What could cause pterygium?

A

Sunlight exposure, chronic inflammation and oxidative stress

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41
Q

Signs of pterygium

A

Wing shaped folds of fibrovascular tissue arising from interpalpebral conjunctiva and extending into the cornea, usually starting medial

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42
Q

What might the lesion of a pterygium be?

A

Highly vascularized and injected

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43
Q

What equipment should be used to exam pterygium?

A

Slit lamp exam

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44
Q

Treatment of pterygium

A
  • Protect eyes from sun, dust, wind
  • Artificial tears
    Opthalmic Corticosteroids
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45
Q

When is surgical removal of pterygium indicated?

A
  • threaten visual axis or induces astigmatism
  • excessive irritation
  • interference w/ contact lens wear
  • prior to cataract or refractive surgery
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46
Q

How often should asymptomatic pterygium be re-evaluated?

A

1-2 years

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47
Q

When should pterygia be measured?

A

Every 3-12 months

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48
Q

What should you be checking if patient is on topical steroid?

A

IOP

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49
Q

What is ocular foreign body?

A

Foreign body superficially or partially embedded on the cornea or conjunctiva

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50
Q

What is most indicative of ocular foreign body?

A

Hx of trauma

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51
Q

What is a critical sign of ocular foreign body?

A

Foreign body with or without rust ring

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52
Q

What radiologic study should be avoided if possible metallic foreign body?

A

MRI

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53
Q

What should be done prior to treatment of ocular foreign body?

A

Visual acuity

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54
Q

Medications for ocular foreign body?

A

Opthalmic anesthetic
- Proparacaine 0.5% 1-2 drops
Non Contact lens wearers
- Erythromycin TID-QID
Contact Lens wearers
- Ciprofloxacin 0.3%

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55
Q

What conservative treatment should be done for ocular foreign body?

A

Irrigation

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56
Q

Should an attempt be made to remove foreign body with needle?

A

No

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57
Q

How long is recovery for corneal abrasion?

A

24-48 hours

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58
Q

What is the difference between an intact corneal epithelium and damaged epithelium?

A

Intact=resistant to infection
Damaged=portal of entry for bacteria, viruses and fungi

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59
Q

Sx of corneal abrasion

A
  • pain, tearing
  • photophobia
  • hx of eye trauma involving foreign object
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60
Q

What should be used to identify a corneal abrasion?

A

Slit lamp

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61
Q

Medications for corneal abrasion

A

Non Contact lens wearer
- erythromycin, bacitracin, polymyxin
Contact Lens wearer
- ciprofloxacin, ofloxacin

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62
Q

How would you debride a corneal abrasion?

A
  • CTA soaked in topical anesthetic
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63
Q

When may contact wearers resume contact lens wear?

A

One week after sx resolve

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64
Q

What is infectious keratitis?

A

Serious infection involving multiple layers of the cornea

65
Q

What is the biggest risk factor for corneal ulcer?

A

Improper contact lens use

66
Q

Bacterial causes of corneal ulcer

A

Pseudomonas aeruginosa, streptococcus pneumonia, staphylococcus, Moraxella

67
Q

Viral causes of corneal ulcer

A

Herpes, varicella

68
Q

Fungal causes of corneal ulcer

A

Candia, aspergillus, penicillium, cepjalosporium

69
Q

Sx of corneal ulcer

A
  • changes in visual acuity
  • round or irregular opacity or infiltrate on cornea
  • white hazy base due to WBC infilitration
70
Q

Medications for corneal ulcer

A
  • Ciproflocacin
  • Fluoroquinolone
71
Q

When should a patient with corneal ulcer be seen by an ophthalmologist?

A

12-24hrs

72
Q

Should you patch a corneal ulcer?

A

No, risks pseudomonas infection

73
Q

What is hyphema?

A

Accumulation of red blood cells within the anterior chamber

74
Q

Where does hyphema occur?

A

Between the cornea and the iris

75
Q

Physical exam findings of hyphema

A
  • blood or clot or both in anterior chamber
    • visible w/o slit lamp
  • hx of blunt trauma
76
Q

What exam should be done with hyphema?

A

Visual exam

77
Q

What radiologic study should be done with hyphema?

A

CT

78
Q

Treatment of hyphema

A
  • referral to optometry/ophthalmology
  • bed rest with elevation of head
  • no strenuous activity
  • rigid eye shield
79
Q

What medication should hyphema patients avoid?

A

Antiplatelet medications

80
Q

After initial f/u, what cycloplegic agent should be used with hyphema patients?

A

Atropine 1%

81
Q

What is uveitis/iritis?

A

Inflammation of anterior segment of uveal tract

82
Q

What are infectious etiologies of uveitis/iritis?

A

Herpes virus, cytomegalovirus, toxplasmosis, syphilis, west nile

83
Q

What are systemic inflammatory disease etiologies of uveitis/iritis?

A

Spondyloarthritis, sarcoidosis, SLE, multiple sclerosis

84
Q

Acute non granulomatous anterior uveitis sx?

A

Pain, redness, photophobia and visual loss

85
Q

Granulomatous anterior uveitis sx?

A

Blurred vision in mildly inflamed eye

86
Q

Medications for uveitis/irits

A

ONLY STARTED BY OPHTHALMOLOGIST
Cycloplegic
- Cyclopentolate 1% tid
- Atropine 1% bid-qid
Topical Steroid
- Prednisolone 1% q1-6hrs

87
Q

What structures are involved with periorbital cellulitis?

A
  • soft tissues anterior to the orbital septum
  • arise from external sockets
88
Q

What structures are involved with orbital cellulitis?

A
  • eye socket, eye and eyelid
  • arise from paranasal sinuses
89
Q

What organisms cause cellulitis?

A

Adult: staph, strep
Children: HiB

90
Q

Significant sx of orbital cellulitis

A
  • periorobital swelling
  • pain w/ eye movement
  • sinus HA/pressure/congestion
  • tooth pain
91
Q

What might a CT show in patient with orbital cellulitis?

A

Adjacent sinusitis

92
Q

What labs should be done for orbital cellulitis?

A

CBC, blood cultures, gram stain and culture drainage

93
Q

Treatment of orbital cellulitis

A

Amoxcillin/Clavulanate (Augmentin) 875mg PO Bid
Ceftriaxone 2g IM

94
Q

How often should you re-evaluate orbital cellulitis?

A

Twice daily in hospital for first 48 hours

95
Q

How long will clinical improvement of orbital cellulitis take?

A

24-36hrs

96
Q

What is an orbital fracture?

A

Break in one of the bones surrounding the eyeball (orbit or eye socket)

97
Q

What is the main cause of orbital fracture?

A

Blunt force trauma

98
Q

What is an orbital rim fracture?

A

Fracture of bony outer edges of the orbit

99
Q

What is the common cause of orbital rim fracture?

A

Car accidents, needs lots of force due to thick bone

100
Q

What is a blowout orbital fracture?

A

Affects inner walls or floor of the orbit

101
Q

What can occur due to the thin bone that makes up the walls of the orbit?

A

Pinch muscles or other structures

102
Q

What is a common cause of blowout orbital fracture?

A

Hit with a baseball or fist

103
Q

What can orbital floor fracture cause the bones of the eye to do?

A

Buckle downwards

104
Q

Sx of orbital fracture

A
  • pain on attempted eye movement and local tenderness
  • crepitus
  • binocular diplopia
105
Q

Critical sx of orbital fracture

A
  • restricted eye movement (upward, lateral or both)
  • air pockets
106
Q

Treatment of orbital fractures

A

Prophylactic antibiotics
- Amoxicillin/Clavulante (500mg/125mg tid or 875/125mg PO BID)
- Azithromycin
If PCN Allergy
- Doxycycline 100mg bid
Nasal Decongestant
¬ - Afrin
Corticosteroid
- Prednisone

107
Q

What conservative treatment should be given to patients w/ orbital fractures?

A
  • instruct pt not to blow their nose
  • Ice packs
108
Q

What is the timeframe of Transient Visual Loss?

A

Within 24 hours, usually within 1 hour

109
Q

What causes Transient Visual loss for a few seconds?

A

Acute BP change

110
Q

What causes Transient Visual Loss for a few minutes?

A

TIA or vertebrobasilar artery insufficiency

111
Q

What causes Transient Visual Loss for 10-60 minutes?

A

Migraines

112
Q

What is a common reason for sudden, painless Visual Loss lasting >24 hours?

A
  • Retinal Detachment
113
Q

What conditions could cause gradual, painless vision loss?

A
  • Cataract
  • Glaucoma (Open/Chronic Angle)
114
Q

What are some causes for painful visual loss?

A
  • Optic neuritis (pain with eye movement)
  • uveitis
115
Q

If concerned for a traumatic globe rupture, what should you use?

A

Eye shield

116
Q

Who should be consulted for acute vision loss?

A
  • MO
  • Optometry
  • Ophthalmology
117
Q

What are the 3 types of retinal detachment?

A
  • Rhegmatogenous retinal detachment (most common)
  • Exudative/serous retinal detachment
  • Tractional Retinal Detachment
118
Q

What is rhegmatogenous retinal detachment?

A
  • One or more peripheral retinal tears holes
  • Holes allow fluid to separate retina from RPE
119
Q

What age population does rhegmatogenous retinal detachment normally affect?

A
  • 50 years of age
  • usually due to degenerative changes
120
Q

What are the most common predisposing conditions that cause rhegmatogenous retinal detachment?

A
  • Nearsightedness
  • Cataract Extraction
  • Penetrating or Blunt Ocular Trauma
121
Q

What is Exudative/Serous Retinal Detachment?

A

Accumulation of sub retinal fluid due to macular degeneration or choroidal tumor

122
Q

What is Tractional Retinal Detachment?

A
  • Pre-retinal fibrosis, due to retinopathy or retinal vein occlusion
  • Can also be a complication of rhegmatogenous retinal detachment
123
Q

Flashes of light, floaters, a curtain or shadow moving over the visual field are sx of what?

A

Rhegmatogenous retinal detachment

124
Q

For rhegmatogenous retinal detachment, what physical findings will there be?

A
  • Retina will be hanging in the vitreous like a gray cloud
  • one or more retinal tears of holes
125
Q

Which retinal detachment may have minimal or severe loss of vision or visual field defect but may vary with head position?

A

Exudative/Serous Retinal Detachment

126
Q

What are some signs of Exudative/Serous Retinal Detachment?

A

Retina is dome-shaped and the subretinal fluid shifts with changes in posture

127
Q

Which retinal detachment may be asymptomatic?

A

Traction retinal detachment

128
Q

What are some signs of Traction retinal detachment?

A
  • Retina appears concave with smooth surface
129
Q

What treatment is needed for retinal detachment?

A

Urgent Ocular surgery

130
Q

What position should retinal detachment patient be transported in?

A

Positioned so the detached portion of the retina will fall back

131
Q

Visual prognosis of retinal detachment is worsened by what conditions?

A
  • Macula detached
  • Detachment is of long duration
132
Q

What is another name for flash burns?

A

Ultraviolet Keratopathy

133
Q

Common causes of flash burns?

A
  • Sun lamp w/o eye protection
  • Exposure to welding arc
  • “Snow blindness”
134
Q

What is significant for diagnosing flash burns?

A
  • History of welding or inadequate eye protection
  • Sx worsen 6-12 hours exposure, usually bilateral
135
Q

What should be used to examine the eye?

A
  • Fluorescein stain
136
Q

How should you treat flash burns?

A
  • Mild oral opioids
    • Oxycodone 5mg q4-6hrs prn
  • Antibiotic Ointment
    • Erythromycin or Polytrim 4-8x per day
137
Q

How long does it take patients to recover from flash burns?

A
  • 24-48hours
  • If bandage soft contact lens was placed, 1-2days
138
Q

What causes chemical burns on the eyes?

A
  • Improper PPE use
  • Job Exposure
    • CS gas, mechanics cement workers
139
Q

What will severe alkali burns have?

A

Opacified cornea and scleral blanching

140
Q

How do you manage alkali burns?

A
  • Irrigate eyes w/water or saline
  • Reach neutral PH
  • Normalization takes 30-60 minutes
  • Test pH with litmus paper
141
Q

What medications can be used to treat chemical burns of the eye?

A

Topical ophthalmic
- Erythromycin 0.5% q1-2hrs

142
Q

What is a penetrating eye wound?

A
  • Anything that has potential to penetrate the eye
143
Q

Lid lacerations require what?

A

Examination, especially if it involves both eyelids

144
Q

How do you determine if it’s a penetrating eye wound?

A
  • Hx of trauma, fall or sharp object entering the globe
145
Q

What equipment do you use when examining for penetrating eye wound?

A
  • Penlight
  • Ophthalmoscope
  • Slit lamp (very carefully)
146
Q

What should be used to protect the eye with penetrating eye wound?

A
  • Shield (metal or paper cup)
147
Q

How should you position the patient with penetrating eye wound?

A

45 degrees

148
Q

What medications should be given for penetrating eye wound

A

Cephalosporin
- Cefazolin 1g IV q8hrs for 7 days
Glycopeptide
- Vancomycin 1gram IV BID for 7 days
Fluoroquinolone
- Ciprofloxacin 750mg BID for 4-8weeks
Antiemetic
- Ondansetron 4mg PO/IV q8hrs prn

149
Q

Which vaccination should be up to date for penetrating eye wounds

A

Tetanus, re-vaccinate if >5 years since last

150
Q

Which vaccination should be up to date for penetrating eye wounds

A

Tetanus, re-vaccinate if >5 years since last

151
Q

What should be considered if admitting patient for surgery with penetrating eye wound?

A

NPO
Avoid strenuous activities, bending and Valsalva

152
Q

What causes herpetic lesions of the eye?

A

Herpes simplex

153
Q

Where does the virus colonize in herpectic lesions of the eye?

A

Trigeminal ganglion

154
Q

What is significant hx for dx of herpectic lesions of the eye?

A

Hx of oral or genital herpes

155
Q

What are signs of herpetic lesions?

A
  • Ulcers
  • Eyelids may have vesicular eruptions
  • Palpable preauricular node
156
Q

What medications should be given to patients with herpetic lesions of the eye?

A

Topical antiviral
- Ganciclovir 0.15% opathalmic gel 5x per day
- Trifluridine 1% drops 9x per day
- Vidarabine 3% ointment 5x per day
Oral Antiviral Agents
- Acyclovir 400mg PO 5x per day
- Valacyclovir 500mg PO TID
- Famiclovir 250mg PO TID for 7-10 days

157
Q

What is the difference in chronicity when giving Acyclovir vs Valacyclovir for herpetic lesions?

A
  • Acyclovir (acute)
  • Valacyclovir (chronic)
158
Q

Which medications should not prescribe for herpetic lesions?

A

Topical Steroids

159
Q

Who should patient with herpetic lesions be referred to?

A

Ophthalmologist

HEENT (9 decks)

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