glaucoma, red eye, pupillary & refractory d/o Flashcards
Marcus gunn
decreased DIRECT reaction to light but consensual response intact
swinging flashing test
nerve problem or retinal problem
horner’s syndrome
lesion of sympathetic pathway causing miosis, ptosis, no sweating
think tumor, nothing is wrong with eye itself
Argyll robertson
pupillary constriction w/ near accommodation but not to light stimulation
4 errors of refraction
myopia
hyperopia
presbyopia
astigmatism
myopia
nearsightness; eyeball too long that focal point is infront of retina
when object is closer, image can focus on retina but ciliary muscle can’t extend back anymore for farther objects
hyperopia
farsightedness; eyeball too short so focal point is behind retina
accommodation is maxed out so lens can’t focus on close objects
presbyopia
age-related farsightedness; lens cant change shape for near objects
correction for presbyopia
reading glasses or bifocals
astigmatism
non-spherical cornea
astigmatic refractive error in cornea so accommodation can’t correct it
correction for astigmatism
lenses or refractory surgery
two types of glaucoma
primary open-angle & acute angle closure
both involve damage to optic nerve from increased IOP
primary open-angle vs acute angle closure glaucom
primary open-angle: chronic, slow progressive & bilateral; no pain; no sx till visual fields are affected
angle-closure: unilateral & sudden onset of severe pain; dilating pupil worsens it; EMERGENCY
which type of glaucoma is worsened when dilated? (via dim lights, cycloplegics, anticholinergics)
acute-angle glaucoma
signature visual deficit of glaucoma
Halos around light & tunnel vision
NO marcus-gunn
sx of angle-closure glaucoma
sudden onset of severe unilateral pain, nausea, vomiting, HA
PE– hazy/steamy cornea, MID-DILATED FIXED pupil, erythema
Eyes feel HARD when palpated
what would a fundoscopic exam reveal with glaucoma?
blurred optic disc/cupping of optic nerve
how is angle-closure glaucoma diagnosed? (two ways)
tonometry for increased IOP
Gonioscopy to observe narrow chamber
name 4 eyelid inflammation d/o
hordeolum/chalazion
blepharitis
ectropion/entropion
dacrystenosis/dacryocystitis
when do you refer a hordeolum/chalazion
if sx still there after one month
how do you treat blepharitis
scrub w/ baby shampoo
AT & warm compress
how do you treat ectropion & entropions
lubricating eye drops & moisture shields
surgery if needed
how do you treat dacryostenosis/dacryocystitis?
if its a child– NLD massage
antibiotics (clindamycin, vancomycin + ceftriaxone)
warm compress
when should you refer dacryostenosis
if recurrent or not improving
name 6 conjunctival d/o
viral conjunctivitis
bacterial conjunctivitis
allergic conjunctivitis
dry eye syndrome
pterygium/pinguecula
subconjunctival hemorrhage
two most common causes of viral conjunctivitis
adenovirus & enterovirus
what sx makes viral diff from other forms of conjunctivitis
tender enlarged preauricular lymphadenopathy
typically starts in one eye and moves to other
tx for viral conjunctivitis
ATs, COOL compress ok
which conjunctivitis requires immediate referral?
bacterial conjunctivitis
how is bacterial conjunctivitis diagnosed?
fluorescein staining to look for keratitis or corneal abrasions
culture the discharge
sx of bacterial conjunctivitis
painless
mucopurulent discharge that can crust over
how is bacterial conjunctivitis tx? what if person wears contacts?
topical abx– erythromycin ointment, fluoroquinolones
contact wears– cover pseudomonas w/ ciprofloxacin or topical aminoglycosides
which conjunctival condition is seen in post-menopausal women, systemic conditions like Sjorgen’s pts w/ blepharitis?
dry eyes syndrome
pterygium vs pinguecula
both dysplastic bulbar conjunctiva & sudden eye pain
pterygium is when it spreads onto the cornea & could affect vision
how are pterygium & pinguecula treated
AT for comfort
surgical excision if visually significant pterygium
what causes subconjunctival hemorrhages?
benign– sneezing, blowing nose, eye rubbing
which conjunctival d/o is associated with antiplatelets & anticoagulation
subconjunctival hemorrhages
sx of subconjunctival hemorrhage
Mild FB sensation & NO vision changes
what two things should you evaluate for with subconjunctival hemorrhages?
blood dycrasias
HTN if recurrent
how are corneal abrasions and FB diagnosed?
pain improves with proparacaine
fluorescein reveals linear abrasions of epithelial stains/ice-rink
common sx of corneal abrasions & FB
tearing, red painful eye
photophobia
hard to open eye (blepharospasms)
how are corneal abrasions & FB managed?
antibiotic drops
erythrmycin ointment,
contacts—-ciprofloxacin or topical aminoglycosides
patch if abrasion is large
when should you NOT patch for corneal abrasion or FB?
if pseudomonas aeruginosa is suspected
what is the biggest risk factor for corneal ulcers? what are the other 2?
- wearing contacts!
- dry ocular surfaces
- topical corticosteroid use and immunosuppressants
what is a corneal ulcer?
serious corneal infection causing white corneal infiltrate
can be sight-threatening
related to hx of FB or trauma
Dx of corneal ulcer
fluorescein stains the white corneal infiltrate
scrape & culture it
sx of corneal ulcers
pain, photophobia, redness, vision changes
difficulty keeping eye open
PE– limbal flush, hazy cornea; hypopyon if severe
how are corneal ulcers managed?
intensive eye drops— moxifloxacin
same day referral!
don’t patch the eye
symptoms of herpes simplex/herpetic keratitis
pain, photophobia, redness, blurred vision
PE– ciliary flush, hazy cornea, PREAURICULAR node swollen
how is herpetic keratitis treated?
give topical or oral acyclovir
refer in 1-2 days
hallmark of herpes keratitis used to make diagnosis
dendritic/branching corneal ulceration w/ fluorescein staining
symptoms of herpes zoster
hutchingson’s sign– midline painful vesicular rash
how is herpes zoster treated
oral acyclovir or valacyclovir (rarely IV)
refer for eye movement evaluation
what is anterior uveitis/iritis
inflammation of the iris or ciliary body
how does anterior uveitis react to proparacaine eye drops
NO improvement!!
what two collagen vascular dz is associated w/ anterior uveitis AND Scleritis
RA
lupus
HLA-IBS, sarcoidosis
signs of anterior uveitis
Unilateral severe ocular pain & photophobia
redness, blurred or decreased vision
PE– perilimbal flush, consensual photophobia, miosis
how is anterior uveitis diagnosed?
AC cells & flare on slit lamp– haziness d/t proteins in aqueous humor
how is anterior uveitis treated?
topical glucocorticoids (steroids)
cycloplegics
same day referral
what is scleritis & episcleritis
autoimmune inflammation of sclera or episclera
vision threatening
which is associated w/ systemic connective tissue dz like RA and lupus– scleritis or episcleritis?
scleritis!
how is cotten tip test used to distinguish between scleritis and episcleritis?
with episcleritis, the vessels will move!
is scleritis/episcleritis vision threatening?
kind of– refer in 1-2 days
sx of scleritis vs episcleritis
EPIscleritis— focal tenderness, redness, swelling, mild pain
scleritis– deep aching pain, redness; +/- scleral thinning
treatment of scleritis vs episcleritis
scleritis– systemic immunosuppressants
episcleritis– oral or topical NSAIDs
what is hyphema
visible blood in anterior chamber of eye
what is the most common cause of hyphema?
blunt trauma
also related to sickle cell
how is hyphema diagnosed?
first wanna r/o life or vision threatening injuries
can do CT w/o contrast if globe rupture is suspected
how is hyphema treated?
eye shield, bed rest, dim lighting
elevate head at least 30 degrees
tetracaine for pain
what is hypopyon
WBC in anterior chamber; this is a type of anterior uveitis
two common causes of hypopyon
HLA-B27 associated uveitis is most common
infectious keratitis or endophthalmitis
how is hypopyon diagnosed?
anterior chamber or vitreous tap for PCR and culture
how is hypopyon managed?
same day referral
tx underlying cause
chemical keratitis
alkali/basic is more damaging
red eyes is preferred
if theres white around cornea—stem cell deficiency
endogenous vs exogenous endophalmitis
infection in eye d/t
endogenous– infection from other body area
exogenous– entry wound after trauma or surgery
how is endophalmitis treated?
aspiration of ocular fluid for culture
antibiotic injections
preseptal vs orbital cellulitis
orbital– fat & ocular muscles infected POSTERIOR to orbital septum
preseptal– eyelid & periocular tissue infected ANTERIOR to orbital septum
which cellulitis often starts as skin infection, trauma or sinus infection?
preseptal
which cellulitis could start as preseptal or sinusitis?
orbital
diagnosis to differentiate between preseptal and orbital cellulitis?
CT contrast
how do symptoms of preseptal and orbital cellulitis differ?
preseptal– NORMAL motility, pupils, VA
orbital– IMPAIRED motility, vision; proptosis, chemosis, RAPD
both: lid edema and erythema
which cellulitis should be referred for emergency consultation
orbital cellulitis
which cellulitis can be drained?
ocular
what are complications of orbital cellulitis?
optic nerve damage, meningitis
cavernous sinus
thrombosis
