Midterm - external eye exam conditions Flashcards
Grayish White opacity from old injury or inflammation of cornea (termed keratitis)
Corneal scarring
Golden to red-brown ring in the periphery of cornea Caused by copper deposition > suggests Wilson’s disease
Kaiser-Fleisher Ring
-often very painful and may be visible on initial inspection - can be subtle… patient may report foreign body sensation/pain but nothing seen - may also have redness, photophobia
Corneal abrasion
Once suspected the Next step is urgent referral to PCP/urgent care for fluorscein dye test. Looking for a localized area of green fluorescence.
Corneal abrasion
If you suspect foreign body retained in the eye you should
Refer to opthalmogist
Acute corneal opacity with pain, redness, photophobia
Corneal infection
Corneal infection is more likely if (3 things)
- Discharge also present 2. Contact lens wearer 3. H/o herpes Simplex Virus (HSV)
If corneal infection is suspected, patient needs ___________ because it can become __________
- emergency referral to opthalmologist - ulcer and lead to permanent vision loss
Causes of corneal ulcer include (4 things)
Viral, bacterial, fungal, or parasitic
What is an exam for corneal ulcer and what would you find on the exam?
- slit lamp exam - dendritic lesions = herpes simplex keratitis
What are the symptoms and next step for acute iritis/ anteriro uveitis?
- symptoms: pain/ redness, photophobia and changes in vision. Acute onset, unilateral blurry vision. Affected pupil is small and won’t dilate in the dark (miosis) - requires urgent optho referral for pupil dilation and topical glucocorticoids
Inflammation of the iris and/or anterior uveal tract
Acute iritis/ anterior uveitis
Acute iritis/ anterior uveitis possible complication is _________
Synechia = inflamed iris adheres to the cornea
What is Increased intraocular pressure?
Glaucoma
What is a sudden increase in intraocular pressure in the anterior chamber of the eye when aqueous humor drainage is blocked
Acute angle closure glaucoma/ narrow angle glaucoma
Which condition can present with a crescent shadow over the medial iris when shining a light from the temporal side and looking from the front of the patient
Acute angle closure glaucoma/ narrow angle glaucoma
Narrow angle glaucoma is more common in patients of ____ decent or in patient with short eyeballs
Asian decent
Symptoms of acute angle closure glaucoma
Severe, deep, aching pain in the eye (usually unilateral) - possible redness, blurry vision, dilated pupil (mydriasis), headache, nausea and vomiting
Acute iritis pupil tends to be ___________ whereas acute angle closure glaucoma the pupil tends to be _________ Acute iritis redness pattern is typically ___________ whereas acute angle closure glaucoma tends to have a __________ redness pattern
- constricted (miosis), dilated (mydriasis) - ciliary injection (around limbus), ciliary and/or mixed injection (diffuse redness)
What is the treatment of angle-closure glaucoma?
Opthomologist will give medication to cause miosis and decrease production of aqueous humor. They can also perform laser surgery to make a hole in the iris and relieve the blockage
An absence or defect or iris tissue (could be acquired due to removal of malignant melanoma of the iris and ciliary body)
Coloboma
What is dyscoria?
And abnormal pupil shape
What is anisocoria?
Unequal pupil size. Physiologic in ~20% of population. Size difference is usually <10%
What are pathological causes of anisocoria?
Large (abnormally dilated) pupil - addie’s tonic pupil - CN 3 palsy Smaller (abnormally constricted) pupil - Horner’s syndrome
Adie’s tonic pupil is due to _________, is more common in _______ and patients may report _______
- parasympathetic nerve degeneration - females - blurry vision, photophobia
Patients with CN 3 palsy will present with (3 things)
Large pupil (fixed), ptosis, EOM weakness
Patients with Horner’s syndrome may present with (3 things)
Small constricted pupil (miosis), ptosis, facial anhidrosis - the pupil can still react to light and accommodation because the sympathetic innervation is decreased but the parasympathetic is intact
Patients with Argyll-Robertson pupils will present with (2 things) and pupil (will or will not) react to light and (will or will not) accomodate
Bilaterally small, irregularly shaped pupils Pupils will not react to light but will accomodate
What is the lacrimal apparatus?
The tear duct system
What is dacryoadenitis?
A lacrimal gland problem. Can be acute (infection) or chronic (inflammation)
What is dacryocystitis?
Inflammation/infection of the lacrimal drainage system - duct obstruction). It’s painful and leads to excess tearing
What is keratoconjuctivitis sicca? How is it treated?
Insufficient tear production (dry eyes) Treated with artificial tears
What are the causes of keratoconjuctivitis sicca?
Medications, Sarcoidosis & Sjögren Syndrome, idiopathic
When the margin of the lower lid is turned outward
Ectropion
When the lower lashes become invisible because they face inward and can lead to conjunctive and keratitis. This is known as ___________
Entropion
What is blepharitis?
Red, inflamed lid margins (but no turning in or out of the eyelid margin) Can be anterior blepharitis (seborrheic dermatitis) or severe anterior blepharitis (staphylococcal infection)
Anterior blepharitis is due to _____________ and severe anterior blepharitis is due to ______________
Seborrheic dermatitis Staphylococcal infection
What is an external hordeolum and what usually causes it?
- A painful infection of a superficial gland in the eyelid margin - Usually staphylococcal
What is an internal hordeolum and how is it treated?
- a posterior blepharitis - a painful infection of the meibomian gland (oil secreting glands within the tarsal plate of the eyelid) - treated with a warm, moist compress with a saline rinse afterwards. May require antibiotics if severe or chronic
What is a chalazion? How is it treated?
- a posterior blepharitis - patient presents with a firm painless pea-sized nodule with the eyelid - 50% respond to conservative treatment: moist compresses. Others require I&D or injection with glucocorticoids
If a patient has an eyelid lesion that is non-healing and/or ulcerative you should suspect
Cancer
What is xanthelasma and what is it associated with?
-slightly raised, yellowish, well circumscribed plaques due to subcutaneous fat deposition. - associated with lipid disorders in ~50% of cases
Ptosis is _______ and proptosis is ________
- abnormal lip drooping in which the eyelid covers the top of the iris - eye bulging in which you can see sclera above the superior iris
Bilateral proptosis indicates ________ but unilateral indicate ____________
- bilateral: Graves disease - unilateral: brain tumor or trauma
The junction between the sclera and the cornea is called the ________
Limbus
The thin layer of connective tissue between the sclera and conjunctiva is called _______
Episclera
The thin, transparent mucous membrane that covers the sclera and inner surfaces of the lids is called ________. The part the covers the lids is called _________ and the part that covers the sclera is called ___________
Conjunctiva, Palpebral, bulbar
What is episcleritis?
- localized inflammation of episcleral tissue. Can be idiopathic or due to systematic inflammatory diseases
What causes jaundice?
Liver disease and abnormalities in hemoglobin breakdown. Excess bilirubin deposition in the conjunctiva appears as yellowing of the eyes
What are the different presentations of allergic, viral and bacterial conjuctivitis?
- Allergic = itchy, bilateral, no fever Also possible chemosis (edema of bulbar conjunctiva) and possible lymphoid follicular response of palpebral conjunctiva - viral = “pink eye”, mild itchy, fever, usually starts in one eye and spreads to the other in 1-2 days. Patient often has pre-auricular lymphadenopathy. Most common. Adenovirus is moist common infectious agents. Highly infectious. - bacterial - mucopurulent discharge, matting of lashes in the morning, starts unilaterally but progresses to the other eye in 2-5 days. More likely to have eyelid edema.
Viral conjuctivitis is commonly caused by __________ Bacterial conjuctivitis is commonly caused by _____________
- adenovirus - staph, strep or Haemophilus infection
Bacterial conjuctivitis usually resolves in ________ without treatment, _________ with antibiotic treatment, unless it is __________, a clinical emergency
1-2 weeks 48-72 hours Gonococcal conjuctivitis - requires urgent visit to eye doctor
What is pinguecula?
Yellowish nodule of bulbar conjunctiva. More common with age. Typically harmless
What is a pterygium?
Triangular thickening of bulbar conjunctiva that grows across the outer surface of the cornea. Roughened, “wing-like” tissue that slowly encroaches on the cornea. Typically harmless
What is the difference between pinguecula and episcleritis?
Pinguecula is yellow and asymptomatic Episcleritis is red and uncomfortable
