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Clinical Med I > HEENT - Red Eye - Exam 2 > Flashcards

HEENT - Red Eye - Exam 2 Flashcards

1
Q

What is the conjunctiva?

A

Clear, mucous membrane of the eye

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2
Q

What is the episclera?

A

Fibrous layer above sclera and below conjunctiva

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3
Q

What is the sclera?

A

Fibrous connective tissue that proves structural rigidity to the eye

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4
Q

What is choroid?

A

The layer containing blood vessels between the retina and sclera

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5
Q

What is the uvea?

A

The part of the eye that includes the choroid, ciliary body, and iris

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6
Q

What is the ciliary body?

A

The muscular structure behind the iris, adjusts the lens, and produces aqueous humor

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7
Q

What is the corneal limbus?

A

Border between the cornea and sclera

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8
Q

What does the aqueous humor do?

A

Maintains intraocular pressure and nourishes the cornea and lens

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9
Q

What does the vitreous humor do?

A

Maintains the shape of the eye.

Contacts resting and keeps it in place.

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10
Q

What is the trabecular network?

A

Tissue in the anterior chamber of the eye that allows for aqueous outflow

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11
Q

What is epiphora?

A

Excessive tearing of the eye

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12
Q

What is chemosis?

A

Swelling of the conjunctiva

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13
Q

What is hypopyon?

A

Leukocytic exudate in anterior chamber of the eye

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14
Q

What is ciliary flush?

A

Dilated conjunctival and episcleral vessels adjacent and circumferential to the corneal limbus

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15
Q

What is hyperemia?

A

Dilated conjunctival vessels

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16
Q

What is keratitis?

A

Inflammatory condition of the cornea

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17
Q

What is proptosis?

A

Protrusion of the eye

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18
Q

If the patients vision is worse than 20/400 and they cannot read the snellen chart, what tests can you do?

A
  • Count fingers at a given distance
  • Hand motion
  • Light perception
  • No light perception
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19
Q

What does tonometry test?

A

Intraocular pressure (IOP)

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20
Q

What is normal intraocular pressure (IOP)?

A

8-21

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21
Q

What is the presentation of Blepharitis?

A
  • Eyelid inflammation due to Meibomian gland dysfunction
  • Iching, burning, scratching
  • No vision decrease
  • Erythema, scales, and debris
  • Worse in morning
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22
Q

What is the treatment for blepharitis?

A
  • Bacitracin ophthalmic ointment
  • Erythromycin or azithromycin ophthalmic ointment (Oral antibiotics if these are not effective)
  • Warm compresses
  • Baby shampoo lid scrubs
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23
Q

What condition does Blepharitis contribute to?

A

Dry eye syndrome

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24
Q

Other than blepharitis, what are other causes of dry eye syndrome?

A

Autoimmune disease, hormone changes, ectropion, contact lenses, medications, refractive eye surgery

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25
Q

What is dry eye syndrome?

A

Deficient aqueous tear production

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26
Q

What is the presentation of dry eye syndrome?

A
  • Chronic itching, burning, and scratching.
  • Tired eyes, worse in PM
  • Vision fluctuation
  • Punctate epithelial erosions on slit lamp exam
  • Positive shirmer test
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27
Q

What is the shirmer exam?

A

determines whether the eye produces enough tears to keep it moist.

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28
Q

What is the treatment of dry eye syndrome?

A
  • Artificial tears
  • Ophthalmology referral
  • Topical cyclosporine increase production of tears
  • Topical glucocorticoids
  • Punctal plugs
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29
Q

What is the cause of Hordeolum?

A

Infected Eyelash root

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30
Q

What is the presentation of Hordeolum?

A

Painful, swelling, and may affect entire eyelid

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31
Q

What is the treatment for Hordeolum?

A

Warm compresses, antibiotics if needed, steroid injection, and possible surgical drainage

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32
Q

What is the cause of Chalazion?

A

Clogged oil glands

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33
Q

What is the presentation of Chalazion?

A

Typically painless swelling of eyelid, unless it is very large. Does not make the entire eye lid swell

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34
Q

What is the treatment for Chalazion?

A

Warm compresses, antibiotics if needed, steroid injection, and possible surgical drainage

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35
Q

What is the presentation of Dacryoadentitis?

A
  • Swelling of the outer upper lid with pain and erythema.
  • Epiphora
  • Preauricular lymphadenopathy
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36
Q

What is Dacryoadentitis?

A

Inflammation of the lacrimal gland

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37
Q

What causes Acute Dacryoadenitis?

A

Viral or bacterial source - Mumps EBV, staphylococcal, gonococcal

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38
Q

What causes chronic Dacryoadentitis?

A

Noninfectious inflammatory disorders and orbital tumors

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39
Q

What is ectropion?

What causes it?

A

Edge of the eyelid is everted.

Caused by advanced age, trauma, infection, and palsy of facial nerve

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40
Q

What is entropion?

What causes it?

A

Eyelid and lashes are inverted inwards towards the eye.

Caused by scar tissue or spasm of orbicularis oculi.

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41
Q

What is the treatment for entropion and ectropion?

A

Surgical repair if there is excessive tearing, exposure keratitis, cosmetic distress, or the lashes are growing toward or into the eye

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42
Q

What is a pinguelcula?

A

Clear, thin tissue that covers part of the sclera

  • Unknown cause, but possibly from long term sun exposure and aging
  • Usually does not cause vision loss
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43
Q

What is a pterygium?

A

Thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea.

  • May interfere with vision as it encroaches on the pupil.
  • Usually on the nasal side.
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44
Q

What is the treatment for a pinguecula or a pterygium?

A

Lubricating drops, sunglasses use, possible surgery for cosmetic change or vision changes

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45
Q

What is preseptal and periorbital cellulitis most often caused by?

What are other possible causes?

A
  • Extension of a sinus infection; ethmoid sinus is most common
  • Can also be and extension from a dental infection, URI, or middle ear infection
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46
Q

What bacteria most often cause cellulitis?

A

S. Pneumonia, S. Aureus, S pyrogenes, and H Influenza

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47
Q

What is the presentation of Preseptal cellulitis?

A

Eyelid pain, eye pain, erythema, swelling, and fever.

  • No proptosis or impairment of vision
  • No pain with ocular movement
  • Chemosis is rare
48
Q

How is preseptal cellulitis diagnosed?

A

CT with contrast or MRI

49
Q

What is the outpatient treatment for preseptal cellulitis?

A
  • Clindamycin OR trimpethoprim/sulfamethoxazole (Bactrim)
  • PLUS Augmentin OR Cefpodoxime
  • Referral to Opthamologist
50
Q

What is the inpatient treatment for preseptal cellulitis?

A
  • Vancomycin PLUS ceftriaxone PLUS Metronidazole

- Ophthalmologist consult

51
Q

What is the presentation of Orbital cellulitis?

A
  • Eyelid swelling, erythema
  • Fever
  • Impaired and painful ocular movement
  • Proptosis is common, may be subtle.
  • Possible chemosis and leukocytosis
52
Q

How do you diagnose orbital cellulitis?

A

CT with contrast or MRI

53
Q

What is the treatment for orbital cellulitis?

A
  • Vancomycin PLUS ceftriaxone PLUS metronidazole
  • Ophthamology consult
  • Hospital admission
  • Surgery if abscess or to decompress orbit
54
Q

What is conjunctivitis?

What is the etiology?

A

Inflammation of the conjunctiva.

Viral, bacterial, or allergic

55
Q

What is the presentation of viral conjunctivitis?

A
  • Acute, often following URI with respiratory symptoms (Most often adenovirus or enterovirus)
  • Typically bilateral with severe injection
  • Watery discharge
  • Preauricular lymphadenopathy
  • Photophobia and foreign body sensation (severe cases)
56
Q

What is the management of viral conjunctivitis?

A
  • Warm compresses
  • Supportive
  • Self limiting
  • Ophthalmology referral with possible antivirals
57
Q

What is the most common cause of Bacterial Conjunctivitis in adults?

A

Staph aureus

58
Q

What is the most common cause of bacterial conjunctivitis in children?

A

S. Pneumoniae, H influenza, and M catarrhalis

59
Q

What is the presentation of Bacterial conjunctivitis?

A
  • Acute onset of symptoms
  • Moderate injection
  • Thick, mucopurulent discharge
60
Q

What is the treatment for bacterial conjunctivitis?

A
  • Erythromycin ophthalmic ointment
  • Trimethoprim-polymyxin B ophthalmic solution
  • Ciprofloxacin ophthalmic solution
  • Azithryomycin ophthalmic solution

Treat for 5-7 days and no contact use until infection has resolved

61
Q

What are the rare forms of bacterial conjunctivitis?

A

C. trachomatis and N. gonorrhea

  • Transmitted via direct contact in adults
  • Transmitted to neonate via vaginal delivery in children
62
Q

What is the presentation of bacterial conjunctivitis caused by C. trachomatis?

A
  • Bilateral and may be associated with keratitis
  • Nontender preauricular adenopathy common
  • Chronic conjunctivitis may develop
63
Q

How do you diagnosed bacterial conjunctivitis caused by C trachomatis?

A

Culture and PCR

64
Q

How do you treat bacterial conjunctivitis caused by C. Trachomatis?

A
  • Erythrymycin

- Azithromycin

65
Q

How do you treat bacterial conjunctivitis caused by N. Gonorrhea?

A
  • Hospitalization
  • Ceftriazone (Rocephin)
  • Ophthamology consult
66
Q

What is presentation of bacterial conjunctivitis cased by N. Gonorrhea?

A
  • Profuse, purulent discharge, striking in quantity
  • Chemosis
  • Moderate to severe injection
  • Irritation and tenderness, lid swelling
  • Preauricular adenopathy
  • Severe and sight threatening
  • Hyperacute onset within 12 hours of inoculation
67
Q

How do you diagnose bacterial conjunctivitis caused by G. Gonorrhea?

A

Giemsa stain, gram stain, culture on selective media

68
Q

What is the presentation of allergic conjunctivitis?

A
  • Chronic/Bilateral
  • Itching (hallmark sign)
  • Mild injection
  • Chemosis
  • Stringy discharge
  • History of atopy/seasonal allergies
69
Q

What is the treatment for allergic conjuntivitis?

A
  • Lubricating eye drops
  • Cool compresses
  • OTC antihistamine
  • Ophthalmic anti-histamine drops
70
Q

What is a subconjuntival hemorrhage?

A

Blood in the conjunctiva, harmless.

  • Typically spontaneous with no known injury but can result from trauma
  • Asymptomatic
71
Q

What are the signs of a subconjuntival hemorrhage?

A
  • Vision unaffected

- Diffuse red patch (not vascular engorgement)

72
Q

What is the treatment for subconjunctival hemorrhage?

A

Reassurance

73
Q

What is scleritis?

A

Inflammatory and autoimmune disorder of the sclera particularly vasculitis

  • Can occur as an isolated incident OR 50% of the time it is associated with underlying systemic disease
  • Potentially blinding!
74
Q

What are the 3 subtypes of Anterior scleritis?

A
  • Diffuse (most common)
  • Nodular (highest recurrence rate)
  • Necrotizing (rare)
75
Q

Is anterior or posterior scleritis more common?

A

Anterior

76
Q

What are the subtypes of posterior scleritis?

A

Diffuse, nodular, and necrotizing

-Same subtypes of anterior scleritis, but often delayed diagnosis due to location

77
Q

What is the presentation of anterior scleritis?

A
  • Severe constant eye pain that is worse in the morning
  • Pain radiates to face and periorbital region
  • Pain with EOMs and activity
  • Headache and Epiphora
  • Diffuse hyperemia
  • Possible photophobia
78
Q

What is the presentation of posterior scleritis?

A
  • No hyperemia unless associated with anterior scleritis
  • Milder symptoms than that anterior scleritis
  • Slit light exam can show optic disc edema
79
Q

How is anterior scleritis diagnosed?

A
  • Violaceous redness of the eye
  • Pain with pressure on the eyelid
  • Scleral edema on slit lamp exam
80
Q

How is posterior scleritis diagnosed?

A
  • If isolated, orbit will appear normal

- Slit lamp exam shows inflammation, choroidal thickening

81
Q

What is the treatment for both posterior and anterior scleritis?

A
  • Referral to ophthalmologist and rheumatology ASAP
  • Oral NSAIDS
  • Oral glucocorticoids
  • Immunosuppresive medications if severe
82
Q

What is episcleritis?

A

Abrupt onset of inflammation of episclera in one or both eyes

83
Q

What are the two types of episcleritis?

A

Nodular and diffuse

84
Q

What is presentation of episcleritis?

A
  • Bright red episcleral discoloration
  • Irritation
  • Epiphora
  • Vision NOT affected
  • Typically no pain
  • Normal sclera on slit lamp exam
85
Q

How is episcleritis diagnosed?

A

Clinical, normal appearing underlying sclera

86
Q

What is the treatment for episcleritis?

A
  • Referral to ophthalmologist
  • Topical lubricants
  • Topical and/or oral NSAIDs
  • Topical glucocorticoids
  • Assess for systemic disease
87
Q

What is the presentation of Corneal Abrasion?

A
  • Acute onset of pain, foreign body sensation
  • Epiphora
  • Possible affected vision
  • Epithelial defect
88
Q

What is the treatment for a corneal abrasion?

A
  • Fluorescein stain
  • Topical lubricants
  • Topical antibiotics
  • Oral pain meds
  • No patching!
  • Do not give topical anesthetic eye drop prescription!
89
Q

Why should you not prescribe anesthetic drops to a patient?

A

It can cause corneal toxicity

90
Q

What is the presentation of a chemical injury to the eye?

A
  • Acute pain, burning
  • Blurred vision
  • Vision decreased
  • Possible corneal abrasion
91
Q

What is the management of a chemical injury to the eye?

A
  • Irrigate immediately
  • Morgan lens for prolonged irrigation
  • Topical lubricants/antibiotics
  • Ophthalmology referral
92
Q

What is the presentation of a corneal foreign body?

A
  • Acute onset of foreign body sensation usually with an associated event.
  • Vision is usually unaffected
  • Visible foreign body
93
Q

What is the treatment for a corneal foreign body?

A
  • Determine mechanism of injury (beware of intraocular foreign body)
  • Remove with irrigation, cotton tipped applicator, specialized removal tool
  • Lubricant/antibiotic drops
  • Possible referral to ophthalmology
94
Q

What is keratitis/corneal ulcer?

A

Infection or inflammation of the cornea

95
Q

What is the presentation of a corneal ulcer?

A
  • Acute onset of pain
  • Mucous discharge
  • Contact lens abuse
  • Vision usually decreased
  • White infiltrate
  • Possible hypopyon
96
Q

How is a corneal ulcer treated?

A
  • Intensive topical antibiotics

- Ophthalmology referral

97
Q

If you see a dendritic pattern in the eye, what should you be concerned about?

A

HSV

98
Q

How do you treat keratitis caused by HSV?

A
  • Topical antivirals.
  • Do not use steroids!
  • Referral to ophthalmology
99
Q

What is Hyphema?

A

Blood in the anterior chamber, typically from trauma to iris and/or pupil

100
Q

What is the presentation of hyphema?

A
  • Acute onset of pain
  • Photophobia
  • Nausea and vomiting
  • Possible vision decrease
  • Layered heme
101
Q

If a patient has microhyphema, what are the chances that patients vision could return with 20/50 or better?

A

90%

102
Q

What are the changes of vision returning to 20/50 or better with a grade 4 hyphema?

A

50%

103
Q

What is the treatment for Hyphema?

A
  • Correct any underlying coagulopathy
  • Treat pain, nausea, and vomiting (want to control IOP)
  • Eye shield and bed rest
  • Elevate head of bed
  • Referral to ophthalmology because this can result in permanent vision loss
104
Q

What are the pros and cons of using an eye patch?

A

Pros: minimize cornea and eyelid rubbing, prevent corneal exposure, and good for post surgery

Cons: Can worsen infection

105
Q

What does an eye shield do?

A

Prevents external pressure on the eye, good for post-trauma and post op

106
Q

What is uveitis?

A
  • Inflammation of the uveal tissue.

- Can occur as an isolated process or as a result of immune-mediated response, drug response, or infection

107
Q

What is anterior uveitis also known as?

A

Iritis

108
Q

What is anterior uveitis?

A

Inflammation of the iris and ciliary body.

-Leukocytes in the anterior chamber of the eye

109
Q

What is posterior uveitis?

A
  • Inflammation posterior to the lens (choroid body)

- Leukocytes in the vitreous humor

110
Q

What is panuveitis?

A

Inflammation of the anterior and posterior uvea

111
Q

What type of uveitis is most common?

A

Anterior uveitis

112
Q

What is the presentation of anterior uveitis?

A
  • Pain
  • Ciliary flush
  • Photophobia
  • Hypopyon
  • Blurred vision
  • Increased tearing
  • Increased IOP
113
Q

What is the presentation of posterior uveitis?

A

Painless, floaters, and blurred vision

114
Q

How is uveitis diagnosed?

A

Clinically and slit lamp exam

115
Q

What is the treatment for uveitis?

A
  • Ophthamology referral
  • Topical glucocorticoids and NSAIDs
  • Consider oral if bilateral and no response to topical
  • Cycloplegic (dilating gtts) drops if increased IOP
  • Typically resolves in 6-8 weeks
116
Q

What are the complications of uveitis?

A
  • Cataracts
  • Irregular pupil due to scar tissue
  • Swelling and increased eye pressure

Clinical Med I (24 decks)

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