Lecture 7 - Ophthalmology Flashcards
Visual Axis
The pathway of processing light (areas where light moves through the eye)
Corneal —> anterior and posterior chamber of the vitreous humor —> lens —> vitreous humor —> retina —-> optic nerve —-> brain
What are the two most common eye complaints in the ER?
Eye pain
Vision changes
Does conjunctivitis cause vision changes?
No
Think about the visual axis —-light does not go through the congunctiva
What does an urgent vs emergent ophthalmology referral mean?
Urgen - within 24 hours
Emergent - within 1-4 hours
What is blepharitis?
Inflammation of the eyelid margin
Can be caused by acute infection (staph), chronic inflammation, or lid gland dysfunction (meibomium gland)
Will see erythema at lid margin and brittle scaling in lashes
Tx: lid hygiene
Hordeolum
This is a stye
Basically just a pimple on the eyelid—caused by a clogged meibomian gland
Painful
Most go away on their own within a week
Tx: lid hygiene
Chalazion
Subacute sterile granulomatous nodule at lid margin
Similar to hordolium but is no longer infected
Might need referral for intralesional steroid injection if refractory
Tx: lid hygiene
How do you differentiate orbital cellulitis from periorbital cellulitis?
Pain with eye movement = orbital (aka septal) cellulitis
What is the septum in regards to eye anatomy?
Septal is the periostium tissue that covers the bones of the orbit
Periorbital cellulitis
This is just regular cellulitis that is on the face
We don’t like it because it is closer to the eye than we are comfortable with
What is a common cause of orbital cellulitis and why?
Ethmoid sinusitis because this sinus is only protected from the orbit by a paper thin bone
Pterygium
Fibrovascular conjunctival tissue growth with corneal surface involvement
Stopped on slide 12
Stopped on slide 12
Pinguecula
Fibrovascular conjunctival tissue growth without corneal surface involvement
Associated with UV exposure
PE: lateral peri limbus conjunctival growth
Tx: artificial tears
What is the PE and tx for pterygium?
PE: triangular tissue growth at medial limbus
Tx: surgery
Conjunctivitis
Acute inflammation of bulbar and palpebral conjunctiva
Can be viral (adenovirus - pink eye) Cab be atopy (seasonal allergies) Can be staph Can be pseudomonas (contact lens wearers) Can be gonococcus
Pus or discharge doesnt tell you the difference between viral and bacterial unless it is a lot a lot of pus then you should suspect gonococcus and admit them for iv ceftriaxone
What is the treatment for conjunctivitis?
If is atopy: antihistamines and vasoconstrictors
If is bacterial use fluoroquinolones because it covers both staph, strep, and psuedomonas
If gonococcal admit them and give topical fluoroquinolones and IV ceftriaxone
Corneal abrasion
Corneal epithelial defect from blunt globe trauma, without infection
Etiology:
Fingernails
Paper or plastic objects
Retained foreign bodies (e.g sand)
What will you see on PE for someone with corneal abrasion?
Corneal irregularity
Photophobia
Dx:
Flurorescein-assisted UV biomicroscopy
Lid eversion to identify retained foreign bodies
CT for ballistic foreign bodies
What is the management for corneal abrasion?
Foreign body removal
Topical NSAIDs and cycloplegics
Consider prophylatic topical antibacterials
Pseudomonal coverage is CL -related
Keratitis
Inflammation of the cornea, with or without ulceration
Etiology:
Viral (adenovirus, HSV, VZV)
Bacterial (staph, strep, pseudomonas)
Noninfectious (UV, chemical)
What will you see on PE for a pt with keratitis?
Corneal haze and opacities
Photophobia
Reactive conjunctivitis
What is the management for keratitis?
Topical NSAIDs and cycloplegics
Prophylactic topical antibacterials (viral)
Oral acyclovir (HSV, VZV)
Topical late-gen fluoroquinolone (bacterial)
Copious irrigation (Chemical)
Emergent referral
Angle closure glaucoma
Ocular ischemia or infarction from intraocular hypertension due to aqueous outflow obstruction
