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X Clin Med Exam 2 > L13 The Red Eye > Flashcards

L13 The Red Eye Flashcards

1
Q

What are the possible mechanisms for a red eye?

A

Infection, inflammation or trauma

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2
Q

Conjunctiva

A

Clear, mucous membrane with blood supply and immune system and response, sits on top of the sclera

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3
Q

Sclera

A

Fibrous connective tissue with structural rigidity

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4
Q

When the eye is red what does it mean?

A

Blood (somewhere in the eye)

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5
Q

What does Meibomian gland produce?

A

Tears to help lubricate the eye

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6
Q

Posterior chamber

A

Between ciliary body and lens

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7
Q

What does ciliary body do?

A

Causes accommodation

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8
Q

What parts of the eye exam are important for the red eye?

A

Visual acuity, tonometry and slit lamp (pen light) exam

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9
Q

What lines the cornea?

A

Epithelial cells

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10
Q

Ophthalmology’s vital sign

A

Test visual acuity one eye at a time (OD right, OS left or OU both)

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11
Q

If someone is worse than 20/400 how do you test?

A 
Count fingers (CF) at given distance
Hand motion (HM)
Light perception (LP)
No light perception (NLP)
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12
Q

Presbyopia

A

Age related focus dysfunction where you lose near vision over time

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13
Q

Tonometry

A

Measurement of intraocular pressure (IOP)

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14
Q

What is the normal IOP?

A

8-21 (usually not an emergency less than 30), tests up to 80+ mmHg

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15
Q

6 things to test in slit lamp/pen light exam

A

Lids/lashes, conjunctiva/sclera, cornea, anterior chamber, iris, lens

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16
Q

Presentation of blepharitis

A 
Eyelid inflammation due to meibomian gland dysfunction (MGD)
Chronic itching, burning, scratching
Worse in AM
NO vision decrease
Erythema, scales, debris
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17
Q

Management of blepharitis

A

Warm compresses or baby shampoo lid scrubs

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18
Q

Antibiotics for blepharitis

A

Bacitracin ophthalmic ointment, erythromycin ophthalmic ointment (EES), azithromycin ophthalmic solution, oral antibiotics if topical not work, topical corticosteroid drops

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19
Q

What can blepharitis contribute too?

A

Dry eye syndrome

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20
Q

Dry eye syndrome

A

Deficient aqueous tear production

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21
Q

Symptoms of dry eye

A

Chronic itching, burning, scratchy
Tired eyes, esp in PM
Vision fluctuation, poor tear film, punctuate epithelial erosions (slit lamp), + Schirmer test

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22
Q

Tx for dry eye

A

Aritifical tears/ ointments
Topical cyclosporine
Topical steroids
Punctal plugs (block ducks so that tears can’t drain so that eye can heal)

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23
Q

Presentation of hordeolum

A

Caused by infected eyelash root, painful, swelling may affect whole eye lid

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24
Q

Tx of hordeolum

A

Warm compresses, antibiotics if needed, steroid injection, might need surgical drainage

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25
Q

Presentation of chalazion

A

Caused by clogged oil gland (MGD), not painful unless very large, rarely involves whole eyelid

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26
Q

Tx of chalazion

A

Warm compresses, antibiotics if needed, steroid injection, might need surgical drainage

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27
Q

Presentation of dacryoadenitis

A 
Inflammation of lacrimal gland
Swelling of outer upper lid
Pain in area of swelling, erythema
Epiphora (excessive tears)
Preauricular LAD
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28
Q

Acute dacryoadenitis

A

Viral or bacterial source (mumps, EBV, staph, gonococcal)

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29
Q

Chronic dacryoadenitis

A

Noninfectious inflammatory disorders, thryoid diseased, orbital pseudotumor

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30
Q

Dacryoadenitis management

A

CT if etiology unclear, biopsy if tumor concern
Viral-warm compress
Other- treat underlying cause

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31
Q

Pinguecula

A

Clear, thin tissue that covers part of the sclera
Cause unknown
Possible eye irritation/long term sun exposure
Can be associated with aging
Usually not any vision loss
Can progressive to pterygium

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32
Q

Tx for pinguecula

A

Lubricating drops, sunglass use, surgery cosmetic or vision changes

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33
Q

Pterygium

A

Thickening of bulbar conjunctiva
Grows slowly across outer surface of cornea, usually on nasal side
May interfere with vision as gets closer to pupil

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34
Q

Tx for pterygium

A

Lubricating drops, surgery if vision changes

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35
Q

Etiology of cellulitis

A

Infection of periorbital tissues
Often caused by extension from sinus infection (usually ethmoid)
Can be extension from dental infection/facial
Most common bacteria: s. pneumoniae, s aureus, s pyogenes, h influenzae

36
Q

Presentation of preseptal cellulitis

A

Eyelid/eye pain, possible eye pain and erythema, swelling, +/- fever
No proptosis (abnormal protrusion)
No impairment of vision
No impairment or pain with ocular movement
Chemosis is rare

37
Q

How to diagnose preseptal or orbital cellulitis?

A

CT with contrast or MRI

38
Q

Outpatient treatment for preseptal cellulitis

A

Clindamycin (Cleocin) or Trimethorpim/sulfamethoxazole (Bactrim DS)

39
Q

Inpatient treatment for preseptal cellulitis

A

Add vancomycin to the regimen to cover for MRSA

40
Q

Presentation of orbital cellulitis

A

Eyelid swelling and erythema, fever, proptosis, impaired and painful ocular movement
May have impaired vision, chemosis or leukocytosis

41
Q

Tx for orbital cellulitis

A

Always admit to hospital
IV cefotaxime (Claforen) or ceftriaxone (Rocephin), maybe vancomycin
Surgery if abscess or to decompress orbit

42
Q

Etiology ot conjunctivitis

A

Infectious: viral or bacterial

Allergic

43
Q

Presentation of viral conjunctivitis

A

Acute, often after URI with respiratory symptoms
Adenovirus or enterovirus mostly
Typically bilateral, severe injection, watery discharge, preauricular LAD
May have photophobia or foreign body sensation in severe cases

44
Q

Tx for viral conjunctivitis

A

Warm compresses

Self-limiting 2-3 weeks, supportive

45
Q

Presentation of bacterial conjunctivitis

A

Acute, unilateral mostly, moderate injection, thick/mucopurulent discharge
Adults-s aureus
Children- s pneumoniae, h influenza, m catarrhalis

46
Q

Antibiotics for bacterial conjunctivitis

A

Topical eye drops/ointments:
Erythromycin ophthalmic ointment
Trimethoprim-polymyxin B ophthalmic solution
Ciprofloxacin ophthalmic solution
Azitrhomycin ophthalmic solution
*Usually 5-7 days
*No contact use until infection is resolved

47
Q

How can adults get bacterial conjunctivitis due to C. trachomatis or N. gonorrhea?

A

Direct contact

48
Q

How can peds get bacterial conjunctivitis due to C. trachomatis or N. gonorrhea?

A

Transmitted to neonate during vaginal delivery

49
Q

Presentation of bacterial conjunctivitis due to C. trachomatis

A

Can be chronic for weeks to months
Bilateral
May have keratitis (inflammation of cornea), marked follicular response (telangectasia)
Non-tender preauricular LAD

50
Q

How to diagnose bacterial conjunctivitis due to C. trachomatis

A

Giemsa stain, culture, PCR

51
Q

Tx of bacterial conjunctivitis due to C. trachomatis

A

Erythromycin ophthalmic ointment, azithromycrin ophthalmic solution

52
Q

Presentation of bacterial conjunctivitis due to N. gonorrhea

A

Unilateral or bilateral
Profuse, purulent discharge (striking in quantity), chemosis, moderate to severe injection, irritation and tenderness and lid swelling
Preauricular LAD
Very severe and sight threatening
Hyperacute onset within 12 hours of inoculation

53
Q

How to diagnose bacterial conjunctivitis due to N. gonorrhea

A

Giemsa stain, gram stain

54
Q

Tx for bacterial conjunctivitis due to N. gonorrhea

A

Admit because of risk of vision loss

Systemic and topical therapy: topical EES ointment + ceftriaxone (Rocephin) IV/IM

55
Q

Presentation of allergic conjunctivitis

A

CHRONIC, itching (hallmark sign), bilateral, mild injection, chemosis, stringy discharge
History of stopy, season allergy or specific allergy

56
Q

Tx for allergic conjunctivitis

A

Lubricating eye drops, cool compresses, OTC antihistamine, ophthalmic anti-histamine drops (gtts)

57
Q

Subconjunctival hemorrhage

A

Blood in the conjunctiva usually from spontaneous rupture of a blood vessel
Acute, asymptomatic, can be from trauma
Vision unaffected
Diffuse red patch (not vascular engorgement)

58
Q

Symptoms of episcleritis

A

Inflammation of episcleral tissue
Typically no pain
Vision usually unaffected, focal injection

59
Q

Symptoms of scleritis

A

Inflammation of scleral tissue
Severe pain, photophobia
Vision usually unaffected, focal injection with diffuse redness
Deep, bluish hue and may have nodule

60
Q

Tx for episcleritis

A

Slit lamp exam, topical lubricants, topical and/or oral NSAIDs, topical corticosteroids

61
Q

Tx for scleritis

A

Potentially blinding!!
Slit lamp exam, topical lubricants, topical and/oral NSAIDS, topical corticosteroids, immunosuppressive medications if severe (Cyclosporin)

62
Q

Corneal abrasion

A

Corneal epithelial defect
Acute onset of pain, foreign body sensation, epiphora (excessive tearing)
Vision affected depending on size and location

63
Q

Tx for corneal abrasion

A

Topical lubricants, topical antibiotics, oral pain meds

NO TOPICAL ANESTHETIC DROPS

64
Q

Why do you not want to prescribe topical anesthetic drops to patient?

A

It can cause anesthetic keratitis (large ulcer in the cornea)

65
Q

Presentation of chemical injury

A

Caustic chemical exposure and acute pain/burning with blurred/decreased vision, sometimes corneal abrasion

66
Q

Tx for chemical injury to eye

A

IRRIGATE
Morgan lens for prolonged irrigation, topical lubricants/abx
Refer

67
Q

Symptoms of corneal foreign body

A

“Speck in my eye”

Acute onset of foreign body sensation and vision usually unaffected

68
Q

Management of corneal foreign body

A

Determine mechanism of injury in order to remove
Might need Xray or CT if intraocular foreign body
Remove with irrigation, cotton-tipped applicator or specialized fb removal tool
Lubricant/antibiotic eye drops

69
Q

Presentation of keratitis/corneal ulcer

A

Infection of cornea (can be due to contact lens abuse)

Acute onset of pain, mucous discharge, vision usually decreased, white infiltrate, may have hypopyon

70
Q

Management of keratitis

A

Intensive topical antibiotics

71
Q

Presentation of keratitis due to HSV

A

“Dendritic pattern”
Treat with topical antivirals (no steroids!!)
Corneal clouding means it is advanced

72
Q

Presentation of hyphema

A

Blood in anterior chamber with trauma to iris/pupil
Acute onset of pain, photophobia, maybe nausea/vomiting
Vision decreased and layered heme
Increased intraocular pressure

73
Q

Management of hyphema

A

Correct underlying coagulopathy
Treat pain and n/v
Eye shield/bed rest with elevated head

74
Q

What can resulting to ophthamology do for a hyphema?

A

Control intraocular pressure, cycloplegics, corticosteroids, short-term topical anesthetic drops

75
Q

Cycloplegics

A

Dilate eye to lift iris and relieve pressure

76
Q

4 grades of hyphema

A

I: prognosis for 20/50 vision is 90%
II: prognosis for 20/50 vision is 70%
III and IV: prognosis for 20/50 vision is 50%
Grade IV might see new blood and clotting blood

77
Q

Benefits of eye shield

A

Prevents external pressure on eye, good for post trauma and post op (lots of swelling)

78
Q

Eye patch

A

Minimize cornea/eyelid rubbing, prevents corneal exposure, good for post-op
Can worsen infections

79
Q

Most common type of uveitis

A

Anterior uveitis (iritis), inflamamtion of uveal tissue

80
Q

Presentation of iritis

A

Acute onset, one or both eyes
Due to trauma, infection or autoimmune dz
Acute onset photophobia with eye pain/blurred vision
Ciliary flush (increased vasculature going out from iris)
May see hypopyon

81
Q

What is the uvea made of?

A

Ciliary body, choroid, iris

82
Q

Management of iritis

A

Refer
Topical corticosteroids/NSAIDs, cycloplegics
Usually resolves in 6-8 wks

83
Q

Complications of iritis

A

Cataracts, irregular pupil due to scar tissue, swelling and increased eye pressure

84
Q

What are the risks of prolonged steroid use?

A

Glaucoma or cataracts

Can worsen infections (HSV or fungal)

85
Q

What topical abx is notorious for toxicity?

A

Gentamicin

X Clin Med Exam 2 (6 decks)

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