EYES Review FINAL Flashcards
Symptoms of Acute Dacryocystitis Vs Chronic
-Acute: tearing, edema, erythema, warmth to medial canthal (nasal) side of the lower lid area. Purulent discharge.
-Chronic: mucopurulent drainage without other signs of infection
Treatment for Dacryocystitis
-Acute
-Chronic
-Acute: Warm compresses + Clindamycin or Vancomycin + Ceftriaxone
-Chronic: Dacryocystorhinostomy
Two types of Blepharitis. Which is more common?
Posterior (MC): Meibomian Gland Dysfunction
Anterior: Infectious (Staph Aureus) Or Seborrheic
MCC of Hordeolum (Stye)
Staph Aureus
Symptoms of a Globe Rupture
-Enopthalmos or Exophthalmos
-Positive Seidel Test
-Teardrop or irregular shaped pupil
-Severe conjunctival hemorrhage (360 degrees bulbar)
-VA markedly reduced
What is the best diagnostic for a orbital floor “blowout” fracture?
CT san: Teardrop sign (inferior herniation of orbital fat inferiorly)
Treatment for a orbital floor fracture
-Nasal decongestants (avoid blowing nose or sneezing)
-Antibiotics (Ampicillin-Sulbactam or Clindamycin)
Symptoms and Diagnostics for a retinoblastoma
-Leukocoria: presence of abnormal white reflex instead of normal red reflex. Strabismus or Nystagmus.
-Ocular US: intraocular calcified mass
What is one unique finding on funduscopy that can be seen in a retinal detachment?
Schafer’s Sign: clumping of brown-colored pigment vitreous cells in the anterior vitreous humor resembling tobacco dust
Risk Factors for a retinal detachment
Myopia (nearsightedness), previous cataract surgery, advancing age, trauma
Managemnet for a retinal detachment
Ophthalmologic emergency: keep patient supine, head turned toward side of the detachment
Neonatal Conjunctivitis
-Day 1
-Day 3-5
-Day 5-7
Treatments and prophylaxis for all
-Day 1: Chemical conjunctivitis due to silver nitrate. Give AT’s
-Day 3-5: Gonorrhea. IM or IV Ceftriaxone as treatment. Topical E-mycin as prophylaxis.
-Day 5-7: Chlamydia. Oral E-mycin for the infection. No prophylaxis effective.
Treatment for Ocular Foreign Body and Bacterial Conjunctivitis if:
-Contact Lens Wearer
-Non-Contact Wearer
-Contact: Cover Pseudomonas (Topical Ciprofloxacin or Ofloxacin)
-No Contacts: Topical Erythromycin
Symptoms of Viral Conjunctivitis
-Caused by Adenovirus
-Swimming pools, direct contact
-Preauricular LAD, copious watery tearing, punctate staining on slit lamp
Symptoms of Allergic Conjunctivitis
-Marked pruritus, sneezing, congestion, cobblestone mucosa, watery or mucoid discharge, chemosis (conjunctival edema)
Treatment for Allergic Conjunctivitis
-Topical Antihistamines (Olopatadine) or Pheniramine-Naphazoline
Ocular Chemical Burns
-Alkali Burns:
-Acidic Burns:
Treatment
-Alkali Burns: worse than acids, causes liquefactive necrosis.
-Acidic Burns: coagulative necrosis
Immediate irrigation until pH 7.0-7.4 (neutral) with lactated ringers or normal saline, then topical ABX (Polymyxin-Trimethoprim, E-mycin ointment, or Moxifloxacin)
Referral for strabismus needed if persists > what age?
> 4-6 months of age
Strabismus initial screening
What other test can be done?
Hirschberg corneal light reflex testing
Cover-uncover test: misaligned eye will deviate inward or outward
Orbital (Septal) Cellulitis
-Symptoms
-Diagnostics
-How to differentiate from Pre-Septal
-Treatment
-Symptoms: ocular pain with eye movement, ophthalmoplegia (EOM weakness), diplopia, proptosis, visual changes
-High resolution CT scan
-PreSeptal Cellulitis has no proptosis, ophthalmoplegia, or ocular pain with eye movements
-Treatment: Admission + IV Vanco + Ceftriaxone/Cefotaxime
Pre-Septal Cellulitis
-Symptoms
-Diagnostics
-Treatment
-Symptoms: unilateral ocular pain, eyelid erythema, and edema
-CT scan to differentiate
-Treatment: Outpatient management if > 1 year old and mild = Oral Clindamycin mono therapy or Bactrim + Amoxicillin
Bacterial keratitis is ______________ and the pathogen that is increased in contact lens wearers is ________. Risk factors include ______, dry ocular surfaces, and ________.
What is seen on examination with this condition?
Corneal inflammation and ulceration.
Pseudomonas Aeruginosa is increased in contact lens wearers.
-RF: Improper contact lens use (MC), topical corticosteroid use, immunosuppression.
Symptoms: ocular pain, photophobia, eye redness, vision changes. Ciliary injection (limbal flush), hazy cornea/opacification, increased fluorescein uptake on slit lamp
Treatment for bacterial keratitis
Fluoroquinolone topical (Moxifloxacin, Gatifloxacin). Do NOT patch the eye.
With herpes keratitis, what is seen with fluorescein staining?
Dendritic branching corneal ulceration
Treatment for herpes keratitis
-Topical Trifluridine, Ganciclovir ointment, or PO Acyclovir.
Uveitis (Iritis)
-Etiologies
-Symptoms
-What is seen on slit lamp?
-Management
-Etiologies: Systemic inflammatory and autoimmune diseases (IBD, Sarcoidosis, HLA-B27, etc.)
-Symptoms: unilateral severe ocular pain, photophobia, eye redness, blurry vision, ciliary injection, consensual photophobia, constricted pupil (miosis)
-Slit Lamp: inflammatory cells and flare (WBC’s and proteins in vitreous humor)
-Treatment: Topical glucocorticoids for anterior. Systemic glucocorticoids for posterior.
Risk Factors for Cataracts
-Aging, smoking, glucocorticoid use, Diabetes, UV light, malnutrition, trauma.
What is seen on exam with a cataract?
Absent red reflex
Opaque lens
Optic Neuritis
-Etiologies
-Symptoms
-Etiologies: Multiple Sclerosis, Autoimmune, Ethambutol, Chloramphenicol
-Symptoms: Painful loss of vision, decrease in color vision (desaturation), central scotoma (blind spot), unilateral.
-Exam: Ocular pain worse with movement, Marcus-Gunn Pupil
What is a Marcus-Gunn Pupil?
During swinging flashlight test from unaffected eye to the affected eye, the pupils appear to dilate
What can be seen on funduscopy for optic neuritis?
What confirms the diagnosis with MS is the cause?
Optic disc swelling/blurring (papillitis)
MRI confirms when MS is the diagnosis
Treatment for optic neuritis
IV Methylprednisolone followed by oral corticosteroids
What is a way to remember Relative Afferent Pupillary Defect (RAPD)?
Ray in the Affected Pupil Dilates
What is an Argyll-Robertson Pupil?
What is the MCC?
Pupil constricts on accommodation but does not react to bright light
Neurosyphillis is the MCC, Diabetic neuropathy is another cause
What is the pathophysiology of acute narrow angle-closure glaucoma?
What are precipitants of an attack?
Symptoms?
Decreased drainage of aqueous humor via trabecular meshwork and canal of Schlemm
-Mydriasis (pupillary dilation), dim lights, sympathomimetics, anticholinergics
-Sudden onset of severe, unilateral ocular pain. Halos around lights and loss of peripheral vision. Nausea, vomiting, headache. Conjunctival erythema, steamy cornea, mid-dilated fixed pupil, eye hard on palpation.
Diagnostics for acute narrow angle glaucoma
-Tonometry
-Funduscopy
-What is gold standard?
-Tonometry: increased IOP > 21
-Funduscopy: optic disc blurring, cupping of nerve (0.9)
Gonioscopy is GOLD
Management of ANAG
-Definitive?
-Topical agent (Timolol, Apraclonidine, Pilocarpine) + systemic agent (PO or IV Acetazolamide or IV Mannitol)
-Definitive: Iridotomy
Symptoms of chronic open angle glaucoma
-First line treatment?
-Slow, progressive painless bilateral peripheral vision loss progressing to central loss
-Prostaglandin analogs first line (Latanoprost)
CRAO
-Etiologies
-What does the patient normally have a history of?
-Symptoms
-What is seen on Funduscopy?
-Management?
-Etiologies: embolic from carotid artery atherosclerosis MC, cardiogenic embolic MCC in young patients and those without atherosclerosis
-History of atherosclerotic disease
-Acute, sudden painless monocular vision loss. Ipsilateral carotid bruit.
-Funduscopy: pale retina with cherry red macula. Boxer appearance of retinal vessels (segmentation of blood flow).
-No consensus on optimal management.
CRVO
-Risk Factors
-Symptoms
-Funduscopy
-Management
-RF: Hypertension, DM, Glaucoma, Hypercoagulable states, smoking
-Sudden onset of painless monocular vision loss
-Funduscopy: extensive retinal hemorrhages (blood and thunder appearance). May have Marcus-Gunn Pupil.
-Management: No definitive management
