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EENT/ID > Non-Urgent Ocular Conditions > Flashcards

Non-Urgent Ocular Conditions Flashcards

1
Q

Describe the etiology of dacryocystitis

A

Infection of lacrimal sac d/t obstruction of nasolacrimal duct

Acute v chronic

MC staph & strep

RF: infants, ppl over 40

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2
Q

Describe the clinical presentation of dacryocystitis

A

Pain, tenderness, swelling, erythema, drainage of pus from tear punctum

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3
Q

Describe the treatment for dacryocystitis

A

abx followed by surgery to reopen the blocked area

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4
Q

Describe the etiology/RF for ptosis

A

Drooping of upper eyelid

Congenital or acquired abnormality of the muscles that lift the eyelid (levators) or secondary to neuro condition

RF: aging, injury, previous eye surgery

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5
Q

Describe the etiology/RF of subconjunctival hemorrhage

A

Results from rupture of vessels in space between episclera & conjunctiva

Spontaneous, eye rubbing, vigorous coughing, vomiting, anticoags

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6
Q

Describe the clinical presentation of subconjunctival hemorrhage

A

Asymptomatic with a bright red bloody eye, painless, no vision loss

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7
Q

Describe the etiology of proptosis

A

Bulging of eye/s out of orbit/s anteriorly

Congenital, orbital cellulitis, glaucoma, hyperthyroidism, tumors

MC cause in adults: Grave’s Disease

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8
Q

Describe the clinical presentation of proptosis

A

unilateral/bilateral eye bulging, dryness, irritation, difficulty closing eye fully

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9
Q

Describe the diagnostic testing for proptosis

A

Clinical, exophthalmometer to measure position of eyes in orbits

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10
Q

Describe the etiology/RF for macular degeneration

A

Degenerative disease of central portion of retina/macula resulting in central vision loss

Dry AMD (MC) vs Wet AMD

RF: age, fam hx, smoking, CV disease, european origin, F>M, light iris color, farsightedness

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11
Q

Describe the clinical presentation of dry macular degeneration

A

gradual vision loss, typically bilateral, retinal atrophy, may notice scotomas with reading & driving, rely on brighter lights & magnifiers

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12
Q

Describe the clinical presentation of wet macular degeneration

A

acute distortion of vision, typically unilateral, new vessels growing/leaking and causing scarring, loss of central vision, more rapid and severe onset, distortion of straight lines

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13
Q

Describe the diagnostic testing for macular degeneration

A

Precursor finding: retinal drusen
- hard: discrete yellow subretinal deposits
- soft: larger, paler, less distinct

Dilated slit lamp exam, fluorescein angiography, optical coherence tomography for wet AMD

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14
Q

Describe the treatment for macular degeneration

A

Refer to ophtho for vision loss

Dry AMD: vit C, E, carotenoids, zinc can slow progression

Wet AMD: intraocular injections monthly

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15
Q

Describe the etiology/RF for diabetic retinopathy

A

Damage to small blood vessels in retina resulting from chronically elevated BG levels

33% of all DM pts and 20% with T2DM at time of diagnosis

90% pts T1 and 60% pts T2 will develop this

RF: prolonged or poorly controlled DM

Proliferative v. nonprolif.

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16
Q

Describe the clinical presentation of proliferative diabetic retinopathy

A

neovascularization arising from disc/vessels leading to hemorrhage, fibrosis, retinal detachment

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17
Q

Describe the clinical presentation for non-proliferative diabetic retinopathy

A

nerve fiber infarcts (cotton wool spots), hemorrhages, hard exudates, microvascular changes (microaneurysm), macular edema leading to reduced vision

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18
Q

Describe the diagnostic testing for diabetic retinopathy

A

annual dilated fundoscopic exam

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19
Q

Describe the treatment for diabetic retinopathy

A

Control blood sugars, HTN, cholesterol, kidney function

Proliferative: VEGF inhibitors, laser photocoag, surgery if severe and T1DM

Non-prolif: observation for mild-mod, laser photocoag for severe

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20
Q

What is the leading cause of new blindness among adults age 20-65

A

diabetic retinopathy

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21
Q

Describe the etiology of hypertensive retinopathy

A

systemic HTN affecting circulation to retina and choroid

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22
Q

Describe the diagnostic testing for hypertensive retinopathy

A

Fundoscopic exam
- retinal arterioles more tortuous & narrow
- copper wiring: abnormal light reflexes or retinal arterioles
- arteriovenous nicking: increased venous compression at AV crossings
- flame hemorrhages
- cotton wool spots
- retinal edema/exudates

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23
Q

Describe a complication of hypertensive retinopathy

A

reducing BP too quickly can worsen the damage

Can cause permanent damage

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24
Q

Describe the etiology/RF for optic neuritis

A

Subacute vision loss (typically unilateral & central)

Assoc. With demyelinating disease (MS), encephalomyelitis, sarcoidosis, viral infection, VZV, SLE, Sjogrens, biologic drugs

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25
Q

Describe the clinical presentation of optic neuritis

A

Pain behind eye, exacerbated by eye movement, loss of color vision, relatively afferent pupillary defect

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26
Q

Describe the treatment for optic neuritis

A

Urgent!

Vision improves in 2-3 weeks

Treat underlying cause (IV steroids x3 days and PO taper in MS) or prolonged steroids

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27
Q

Describe the etiology/RF for cataracts

A

Clouding of the lens leading to vision loss, degeneration of proteins in lens

RF: aging, smoking, UV light, DM, steroid use, eye trauma, rarely congenital

Leading cause of blindness worldwide

28
Q

Describe the clinical presentation of cataracts

A

Painless progressive decline in vision/blurring, typically bilateral, difficulty with fine print, glare in bright light or night driving, increased myopia, diplopia possible

Lens opacity may be grossly visible (can be normal with aging)

29
Q

Describe the diagnostic testing for cataracts

A

Non-dilated fundoscopic exam: darkening or opacities of red reflex

30
Q

Describe the treatment for cataracts

A

Surgery to remove lens and replace with prosthetic (when interfering with ADLs)

Prevent with multivitamin/mineral supplements and dietary antioxidants

31
Q

Describe the complications of cataracts

A

risk of retinal detachment in pts with a history of cataract surgery

32
Q

Describe this clinical sign

A

retinal drusen (macular degeneration)

33
Q

Describe the clinical correlation

A

wet macular degeneration

34
Q

Describe the clinical correlation

A

dry macular degeneration

35
Q

what does this image show

A

neovascularization (proliferative diabetic retinopathy)

36
Q

Describe what each color arrow is pointing to

A

green: hemorrhage
white: cotton wool spot
yellow: hard exudate
red: microaneurysm

37
Q

Describe what is happening in the image on the right

A

AV nicking (HTN retinopathy)

38
Q

What is the bright line in the bottom right corner

A

copper wire sign (HTN retinopathy)

39
Q

Describe the etiology of herpes zoster keratitis

A

Inflammation of the cornea d/t Zoster or HSV-1

40
Q

Describe the clinical presentation of herpes zoster keratitis

A

Photophobia, tearing, varying pain and irritation, redness, unilateral, vesicular rash in periocular area

41
Q

Describe the diagnostic testing/PE of herpes zoster keratitis

A

Fluorescein exam may reveal dendritic corneal ulcer: hallmark of herpes infection

42
Q

Describe the treatment for herpes zoster keratitis

A

oral acyclovir & referral to ophtho

43
Q

Describe the etiology/RF for open angle glaucoma

A

Chronic progressive optic neuropathy, acquired atrophy of optic nerve, loss to retinal ganglion cells, associated with increased IOP

RF: african/hispanic descent, fam hx, age, thin central cornea, T2DM, myopia

44
Q

Describe the clinical presentation of open angle glaucoma

A

Slow, insidious, bilateral loss of vision

Progresses from asymptomatic, scotoma, peripheral vision loss, blindness

45
Q

Describe the diagnostic testing/PE for open angle glaucoma

A

Anterior structures look cloudy under oblique lighting

Fundoscope: optic disc cupping, large cup to disc ratio, splinter hemorrhages, visual field testing, tonometry

46
Q

Describe the treatment for open angle glaucoma

A

Annual screening 65+

Keep IOP in target range by decreasing production/inflow of aqueous humor
- prostaglandin analogs, beta blockers, a-2 adrenergic agonists, parasympathomimetics, topical/oral carbonic anhydrase inhibitors

47
Q

Describe the etiology/RF for conjunctivitis

A

Bacterial, viral, allergic, systemic condition

MC staph aureus, strep pneum, h. Flu, moraxella catarrhalis (can be n. Gonorrhea, contact lens - pseudomonas)

48
Q

Describe the clinical presentation of the different types of conjunctivitis

A

Bacterial: Copious exudates, itching

Allergic: stringy exudates, itching, redness, edema, cobblestoning

Viral: less goop, preauricular LAD

49
Q

Describe the treatment for the different types of conjunctivitis

A

Bacterial: Mostly self limited, decrease spread, tailor abx to cause

Allergic:
1. Artificial tears
2. antihistamine/decongestant
3. Ophtho NSAIDs
4. Mast-cell stabilizer prophylaxis

Viral: self limited (2 weeks), cold compress, infection control

50
Q

Describe the etiology of blepharitis

A

Irritation at oil glands of eyelids causing scaling, crusting

51
Q

Describe the clinical presentation of blepharitis

A

Scaling, crusting around eyelids

52
Q

Describe the treatment of blepharitis

A

Treat underlying condition, gentle scrubbing, mild soap

+/- steroid cream, nizoral antifungal cream, tacrolimus ointment

avoid abx

53
Q

Describe the etiology/presentation of a chalazion

A

inflamed nodule within the eyelid at oil producing gland

54
Q

Describe the etiology/presentation of a hordeolum

A

inflamed nodule in base of eyelid at hair follicle, usually the lower lid, tender & red

55
Q

Describe the etiology/presentation of a pterygium

A

triangular growth from the inner canthus of the eye

56
Q

Describe the etiology/presentation of a pinguecula

A

nodular growth on conjunctiva

57
Q

Describe the treatment for chalazion & hordeolum

A
  • Reassurance, hot/wet compresses with massage several times per day
  • Refer to ophtho if no resolution (especially with chalazion - may need surgical resection)
58
Q

Describe the treatment for pterygium & pinguecula

A
  • No treatment unless it begins to encroach the pupil - surgical
59
Q

Describe the presentation & treatment of episcleritis

A

localized erythema, irritation, swelling from inflamed episclera

spontaneously resolves in a few weeks, steroid drops in pts with recurrent attacks

60
Q

Describe the etiology/RF for keratoconjunctivitis Sclera

A

Aka dry eyes, very common

Meds, sjogren’s, sarcoidosis, radiation therapy, lesions affecting CN 5 or 7 (Bell’s Palsy), incomplete eye closure, forced air heat

61
Q

Describe the presentation of keratoconjunctivitis sclera

A

Dry irritated eyes, redness, photophobia, gritty/scratchy, burning, foreign body sensation

62
Q

Describe the treatment for keratoconjunctivitis sclera

A

Avoid causative meds, smoking cessation, humidifier, hot compress, eye massage

Mild: artificial tears
Mod-Severe: refer to ophtho for lubricants

63
Q

Describe the eitology/RF for uveitis

A

Inflammation of uvea

Anterior (iritis) or posterior

Systemic, immune mediated

RF: sarcoidosis, juvenile RA, inflammatory bowel disease, psoriasis, RA, herpes, syphilis

64
Q

Describe the presentation of uveitis

A

Iritis: redness, pain may be minimal, +/- vision loss, tearing, light sensitivity, floaters

Posterior uveitis: painless, blurred vision, floaters, usually no redness

65
Q

Describe the diagnostic testing for uveitis

A

Slit lamp exam: presence of leukocytes in aqueous humor

Posterior: chorioretinal inflammation in addition to leukocytes

EENT/ID (15 decks)

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