HEENT eyes Flashcards
the globe of the eye is called…
the cornea is more curved ….
bulbus oculi
anterior
the cornea curve is the main reason to wear glasses (t/f)
True
what is the anterior and posterior segment made of
A
P
a: cornea, iris, ciliary body, and lens
P: vitreous retina, choroid, and optic nerve
The two fluid-filled chambers within the anterior segment:
Anterior Chamber: space between ……..
Posterior Chamber: area …..
Both are filled with clear aqueous fluid.
A: between cornea and iris
P: behind iris and in front of vitreous
what is the purpose of the chambers of the eye
filled with aqueous fluid to nourish the cornea and lens
maintain IOP
blood in the anterior chamber is called
hyphema
pus/white cell accum in the AC is called
hypopyon
Hordeolum / Chalazion is
associated with
Rx:
blepharitis/ acne rosacea
warm/hot compresses with digital massage / Btracin or Emycin
well defined lid nodule is … in hordeolum/chalazion
chronic
external hordeolum (stye) is inflammatory lesion of the anterior eyelid due to obstruction of …. glands
tender or nontender?
Moll and Zeis
tender
chalazion, which is internal hordeolum, is localized inflammation on the posterior eyelid due to the obstruction of …. gland
tender or nontender?
meibomain gland
nontender
blepharitis is common, chronic inflammation of ..
eyelid margin
blepharitis Symptoms is
flux through day and weeks
burning, itching, FBS, tearing, lid erythema
blepharitis signs
crusty, red thickened lid margin with bvs or oil glands
blepharitis is assoc. with ..
dry eyes, rosacea, chalazia
blepharitis treatment
-Lid scrubs (e.g. Ocusoft; Avenova, dilute baby shampoo) to clean base of lashes
-Hot Compress (e.g. Bruder Mask) 3 x day for 10 min.
-Topical Emycin ung or azithromycin gel drop
or oral doxycycline 100mg bid x 1wk then qd x 3 weeks (if its rlly bad)
entropion
is
symptoms
inward turning of eyelid margin
Ocular irritation, FBS, tearing, red eyeSuperficial Punctate Keratitis (SPK), abrasions, scarring can result from lashes contacting globe (sclera/cornea).
ectropion
is
s/s
outward turning of eyelid margin
+ Tearing, eye or eyelid irritation or may be asymptomatic, Superior Punctate Keratitis (SPK) inferiorly from corneal exposure
Ectropion / Entropion Treatment
Treat if corneal involvement
lubricating agents (artificial tears/gels)
antibiotic ointments (emycin or bacitracin ophthalmic ung qhs)
bandage contact lens
Epilate any inward turning lashes touching cornea (trichiasis)
Definitive treatment may require lid surgery with oculoplastics.
lacrimal system takes tear from external eyes to nasal cavity. it consist of …4…
puncta
canaliculi
lacimal sac
nasolacrimal duct
inflammation of the lacrimal sac is
called:
s/s:
tx:
Dacryocystitis
pain, swelling, excessive tearing (epiphora)
oral antibiotics cephalexin
hot compress
Acute angle closure glaucoma
Uveitis / Iritis
Herpes simplex keratitis
Conjunctivitis
Subconjunctival hemorrhage
are all causes of …
red eye
acute angle closure glaucoma symptoms
severe ocular pain
redness
halo rings
N/V
headache
blurred vision
acute angle closure glaucoma, the aqueous fluid can not drain out, therefore the IOP … increases/decreases
increases
normal is 10-21
bad IOP >50
high risk groups for acute angle glaucoma is
Shallow anterior chamber
Hyperopia (farsightedness)
Elderly /Thickening cataract with age
(+) family hx of angle closure
Asian / Inuits
treatment for acute angle glaucoma
Lower IOP with meds (all topical IOP gtts and oral acetazolamide two 250mg tabs)
-Immediate but temporizing
Peripheral Iridotomy (PI)
-Definitive
Remember the fellow eye
Swelling/inflammation of uvea (middle layer of eye)
Pain, red eye, photophobia
Anterior Uveitis:
choroid/retina involvement
Floaters, visual disturbance
Posterior Uveitis:
s/s of uveitis, which is often caused by underlying systemic conditions and can lead to permanent vision loss are
red eye, blurry vision, photophobia, floaters
when looking at an eye with uveitis, you will see
Keratic precipitates (KPs are white cells on
corneal endothelium)
cells & flare in AC, synechiae
ciliary flush
vitritis, retinal hemes
cause of Uveitis
autoimmune disorders, infections, malignancy, toxins, or idiopathic.
Common etiology of anterior uveitis is
HLA-B27 positive autoimmune disease
Ankylosing spondylitis
JRA = juveniles rheumatoid arthritis
Crohn’s disease = inflame. Bowel disease
Ulcerative colitis = inflame. Bowel disease = inflame + ulcers
Reiter’s syndrome – reactive arthritis = men
cause for posterior uveitis are
Sarcoidosis, Lyme, Toxoplasmosis
you see iris and lens synechiae. the treatment for uveitis is
Cycloplegic (cyclopentolate 1% tid or atropine 1% if severe)
topical steroid (pred acetate 1% q 1-6 hrs or Durezol tid.
Taper based on response.
you see unilateral red eye, FBS, photophobia, and history of previous episodes. you do corneal staining and see macro punctate and classic dendritic keratitis. the pt has
Herpes simplex keratitis
HSV type 1 reactivation causes
herpetic keratitis (classic dendritic ulcer)
to treat dendritic keratitis, you should use
topically with trifluridine drops 9x/d or ganciclovir gel 5x/d
Oral antivirals: acyclovir 400mg po 5x/d or valacyclovir 500mg po tid x 7d
Avoid topical steroids = makes it worse
conjunctive covers the front of the eyes and lines the inside of the…
eyelids
3 types of conjunctivitis
Bacterial
Viral
Allergic
t/f all 3 types of conjunctivitis (bacterial, viral, allergic) has hyperemia
true
t/f all 3 types of conjunctivitis (bacterial, viral, allergic) has discharge
true
bacterial -purulent
viral - serous
allergy - stringy
t/f all 3 types of conjunctivitis (bacterial, viral, allergic) has preauricular lymphadenopathy
F,
only viral
t/f all 3 types of conjunctivitis (bacterial, viral, allergic) has Upper respiratory symptoms
False
bacterial = none
viral - URI
allergy - hay fever
conjunctivitis treatment for bacterial is
Topical antibiotics
Polytrim, ofloxacin, q4h
polysporin ointment tid
fluoroquinolones
Cool compresses
viral conjunctivitis treatment
Cool compresses
Topical lubrication
Caused by adenovirus
Antibiotics will not help
CONTAGIOUS Precautions to prevent spread
Handwashing
Clean with alcohol or dilute bleach
allergy conjunctivitis treatment
Topical antihistamines/mast cell stabilizers (Pataday, Zaditor, Bepreve) for acute and chronic allergies
(steroid gtts can be used but IOP needs to monitored!)
Oral antihistamines
Cool compresses, artificial tears
causes of Subconjunctival Hemorrhage
Valsalva: coughing, sneezing; rubbing
Idiopathic
Blood thinners (aspirin, warfarin)
Blood clotting disorder (rarely)
do you need to treatment Subconjunctival Hemorrhage
No, unless recent trauma and recurrent
goes away in 1-2 weeks by itself
Pinguecula/Pterygium
Dry eyes (keratoconjunctivitis sicca)
Corneal abrasions/ulcers
Corneal foreign bodies
causes
red eye
Pinguecula /Pterygium s/s
irritation, redness, without s/s
Yellow-white, flat or slightly raised conjunctival lesion NOT involving cornea
is…
Pinguecula
Wedge shaped fold of fibrovascular tissue arising from the interpalpebral conjunctiva and extending onto the cornea.
Pterygium
Pinguecula/Pterygium Treatment
Protect eyes from sun, dust, wind, UV c sunglasses / safety goggles
Lubricate with artificial tear drops to reduce irritation (qid)
If inflamed can use NSAID (ketorolac qid) or topical antihistamine/mast cell stabilizer (Pataday qd)
Surgical removal only if severe or if pterygium threatens visual axis
s/s of dry eye syndrome
itching, dry eyes, burning sensation, FBS, excessive tearing following by dryness, burning, redness
unlateral
worsened by wind, smoke, low humidity prolonged reading
dry eye treatment is
Artificial tears, refresh, systane, or blink
stop smoking
humidifer
restasis, xiidra, ceque
punctal plugs
EFA (fish oil/flax)
pt has pain, photophobia, tearing, redness and a hx of itching their eyes.
what is it and how do you treat it
corneal abrasion
Fluoroquinolone gtt or ophthalmic ung at least qid
Cycloplegic agent if iritis
Never Rx topical anesthetic (delays healing)
pt has pain, redness, photophobia, tearing and a Hx of contact lens use. upon staining the eye, you see a white lesion.
what is it and how do you treat it
corneal ulcer
Fluoroquinolone gtt or ophthalmic ung at least qid
Cycloplegic agent if iritis
Never Rx topical anesthetics
Discard and d/c CL use
what is the most common cause of contact lens related corneal infection
pseudomonas aeruginosa
danger signs for the eye that are not conjunctivitis are
reduced visual acuity = serious ocular disease
refer pt esp if acutely reduced
ciliary flush = redness maximal near cornea
abnormal pupils needs
referral
therapeutic warns to not use topical anesthetics because
its toxic and can cause corneal ulceration
never prescribe
use only for exam
topical steroids should only be prescribed by eye doctor bc it causes
cataracts
glaucoma
makes HSV and fungal infections worse
what is the leading cause of legal blindness in the usa, and the risk factors
macular degeneration (ARMD)
heredity
advanced age
drusen body
tobacco
ARMD etiology is unknown, but it is manifested by
drusen
retinal pigment epithelial atrophy
subretinal neovascular membrane
loss of central vision
what are the two types of ARMD?
dry and wet
explain characteristics of dry ARMD
slowly
drusen, pigment layer atrophy
bilateral
peripheral vision intact
can lead to wet type of ARMD
ARMD dry type management
no cure
vitamins AREDS1 - reduce progression by 25 %. does not contain beta-carotene which can increase lung cancer in smokers
low vision aids
monitor for wet type with AMSLER grid
ARMD wet type characteristics
choroidal neovascular membrane (CNV)
edema, hemorrhage
metamorphopsia = sudden decrease of vision
fibrosis
macular scar
ARMD wet type management
changes to wet type = ER
F1 angiography/ OCT imaging
Anti-VEGF injections: Avastin, lucentis, eylea, macugen
PDT or laser obliteration of CNV
unilateral so monitor for recurrence and other eye
what test can detect early retinal conditions
OTC - optical coherence tomography
dry age related macular degeneration is also called
nonexudative
diabetics can develop
diabetic macular edema
what is the leading cause of irreversible blindness in the world?
glucoma
what causes glaucoma
IOP that damages the optic nerve = visual field loss
Primary open angle glaucoma characteristics
mostly no S/S
S/s noticed when late in disease
early detecting = important if blindness is to be prevent
glaucoma risk factors
age, FHx, diabetics, CV, surgery, steriods, truama
Characteristics of Glaucomatous ONH
Enlarged cup; c/d ratio >0.65 (average is 0.3)
Hemorrhage within 1dd of ONH
Thinning of neuro-retinal rim esp. sup. / inf.
(does not obey the ISNT Rule)
Asymmetric cupping between patients eyes
how does vision loss happen in POAG
loss of retinal ganglion cells leads to enlarged cup to disk ration.
this happens typically at the superior and inferior poles, leading to a vertical oval cup or notching
what test would you do to test visual field in POAG
automated perimetry
youll see loss of vision in the bottom
how to treat POAG
medications to lower BP = IOP lowering eye drops
prostaglandins, beta-blockers, alpha agonists, carbonic anhydrase inhibitors (CAI) , combinations
Laser Trabeculoplasty (SLT, ALT)
*hole in the trabecular meshwork to release pressure
Filtration Surgery (Trabeculectomy)
MIGS (Minimally-invasive Glaucoma Surgeries)
i-Stent, Cypass, Trabectome)
istent = for awueous to drain out and to lower pressure
what causes floaters and flashes in the eyes
Vitreous separates from the anterior retinal (floaters)
Some strands remain attached to retina (flashes)
typical horseshoe tear of the retina will be shown on
retinal detachment
untreated retinal detachment can lead to
to partial or total loss of retinal function (blindness)
retina detachment is an emergent condition because once the macula is off, the prognosis for good vision ….
treatment include
decreases
surgical repair with laser, cryopexy, buckle, or pneumatic retinopexy
risk factors for RD
high myopia (near sight)
trauma
age
prepvous ocular surgery
RD symptoms
Sudden appearance of many floaters
Sudden flashes of light, typically in the periphery
A shadow or curtain blocking part of your field of vision
cataracts is
an opacity (clouding) of the normal clear lens
risk factors for cataracts include
age
uv
radiation
steriods
uveitis
diabetes
trauma
cataract symptoms are
glare, esp in night driving
cortical cataract is
PERIPHERAL SPICULES EARLY,
VISION GOOD INITIALLY
nuclear cataract is
shift toward myopia and color shift to yellow
subcapsular cataract is
early trouble reading
cataract management if s/s/vision loss interfere with job is
surgery
multifocal and toric implant
posterior capsular opacification is common after… and is …
cataract surgery
secondary clouding of posterior capsule = decrease in vision/ glare
tx for posterior capsular opacification is
YAG laser capsulotomy
diabetes mellitus is a
diabetic retinopathy and leading cause of blindness
Risk factors for diabetic retinopathy are
duration of diabetes
control of blood sugar
insulin dependency
hypertension
anemia
after 5 years of TYPE 1 Diabetics, people will have a … percent chance of having diabetic retinopathy (DR)
after 15 years of TYPE 1 Diabetics, people will have a … percent chance of having diabetic retinopathy (DR)
a) 23 %
b) 80%
if the capillaries leak and are occluded, and you see the following
RED SPOTS (HEMORRHAGES, MICROANEURYSMS)
HARD EXUDATES IN CIRCINATE CONFIGURATION
COTTON WOOL SPOTS
MACULAR EDEMA = vision affected
VENOUS ENGORGEMENT, BEADING
then the pt has
nonproliferative DR
if you see
INCREASED RETINAL ISCHEMIA
NEOVASCULARIZATION, INITIALLY AT OPTIC DISC
FIBROUS TISSUE PROLIFERATION
VITREOUS HEMORRHAGE
TRACTION RETINAL DETACHMENT
then the pt has
proliferative DR
how do you treat DR
yearly dilated eye exam
control glucose levels
control HTN
Anti VEGF injections or Laser treatment of the focal leakage areas
Pan Retinal photocoagulation (PRP)
vitrectomy
what are the complications for DR
NEOVASCULAR GLAUCOMA
TRACTION RETINAL DETACHMENT
VITREOUS HEMORRHAGE
CATARACT
central retinal artery is a ..
true end artery
Hypertension changes in the eyes, you wil see
arterial narrowing
flame (splinter) hemorrhages
cotton wool spots
hard exudates, macular star
edema of the disc
ARTERIOSCLEROTIC CHANGES
WIDENING OF ARTERIAL STRIPE
A/V NICKING
COPPER COLORED ARTERIES
SILVER WIRE ARTERIES
AMAUROSIS FUGAX is
Transient loss of vision in one eye (monocular)
AMAUROSIS FUGAX is characteristic
No pain
Lasts 1-10 minutes
Total or altitudinal vision loss (“like a window shade”)
Vision returns to normal
what causes AMAUROSIS FUGAX
vascular or hear disease
temporary lack of blood flow to retina from emboli in central retinal artery
Often no emboli visible on fundus exam
is AMAUROSIS FUGAX a form of TIA? and how do you treat is
yes
ASAP ER/ Stroke center
MRI, urgent carotid and cardiac studies
neurology consultation
Uncorrected ….. are a leading cause of visual impairment worldwide.
refractive errors
what is refractive errors
a problem with focusing light onto the retina due to the shape of the eye
is emmetropia a refractive error?
no, this is 20/20 vision. the eye is able to focus light on retina with effort
what are the 4 types of refractive errors
Myopia (nearsighted)
Hyperopia (farsighted)
Astigmatism (nonspherical curvature)
Presbyopia (loss of focusing ability of lens)
if the cornea is spherical and light is refracted and focused equally in all meridians , then the person will have
zero astigmatism
In astigmatism, the surface of the cornea has a …. in one meridian than in the other meridian.
stronger curvature
what causes presbyopia, farsightedness
normal result of age
lens of eyes becomes thicker and less flexible
lens that cannot adjuct in presbyopia, causes the image to be focused …. the retina
beyond
what test do you do to determine the Rx for glasses
a refraction
what is the most common refractive surgery procedures
Laser in situ keratomileusis (LASIK) and
Photorefractive keratectomy (PRK)
