Non-Urgent Ocular Conditions Flashcards
Describe the etiology of dacryocystitis
Infection of lacrimal sac d/t obstruction of nasolacrimal duct
Acute v chronic
MC staph & strep
RF: infants, ppl over 40
Describe the clinical presentation of dacryocystitis
Pain, tenderness, swelling, erythema, drainage of pus from tear punctum
Describe the treatment for dacryocystitis
abx followed by surgery to reopen the blocked area
Describe the etiology/RF for ptosis
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
Describe the etiology/RF of subconjunctival hemorrhage
Results from rupture of vessels in space between episclera & conjunctiva
Spontaneous, eye rubbing, vigorous coughing, vomiting, anticoags
Describe the clinical presentation of subconjunctival hemorrhage
Asymptomatic with a bright red bloody eye, painless, no vision loss
Describe the etiology of proptosis
Bulging of eye/s out of orbit/s anteriorly
Congenital, orbital cellulitis, glaucoma, hyperthyroidism, tumors
MC cause in adults: Grave’s Disease
Describe the clinical presentation of proptosis
unilateral/bilateral eye bulging, dryness, irritation, difficulty closing eye fully
Describe the diagnostic testing for proptosis
Clinical, exophthalmometer to measure position of eyes in orbits
Describe the etiology/RF for macular degeneration
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
Describe the clinical presentation of dry macular degeneration
gradual vision loss, typically bilateral, retinal atrophy, may notice scotomas with reading & driving, rely on brighter lights & magnifiers
Describe the clinical presentation of wet macular degeneration
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
Describe the diagnostic testing for macular degeneration
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
Describe the treatment for macular degeneration
Refer to ophtho for vision loss
Dry AMD: vit C, E, carotenoids, zinc can slow progression
Wet AMD: intraocular injections monthly
Describe the etiology/RF for diabetic retinopathy
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.
Describe the clinical presentation of proliferative diabetic retinopathy
neovascularization arising from disc/vessels leading to hemorrhage, fibrosis, retinal detachment
Describe the clinical presentation for non-proliferative diabetic retinopathy
nerve fiber infarcts (cotton wool spots), hemorrhages, hard exudates, microvascular changes (microaneurysm), macular edema leading to reduced vision
Describe the diagnostic testing for diabetic retinopathy
annual dilated fundoscopic exam
Describe the treatment for diabetic retinopathy
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
What is the leading cause of new blindness among adults age 20-65
diabetic retinopathy
Describe the etiology of hypertensive retinopathy
systemic HTN affecting circulation to retina and choroid
Describe the diagnostic testing for hypertensive retinopathy
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
Describe a complication of hypertensive retinopathy
reducing BP too quickly can worsen the damage
Can cause permanent damage
Describe the etiology/RF for optic neuritis
Subacute vision loss (typically unilateral & central)
Assoc. With demyelinating disease (MS), encephalomyelitis, sarcoidosis, viral infection, VZV, SLE, Sjogrens, biologic drugs
Describe the clinical presentation of optic neuritis
Pain behind eye, exacerbated by eye movement, loss of color vision, relatively afferent pupillary defect
Describe the treatment for optic neuritis
Urgent!
Vision improves in 2-3 weeks
Treat underlying cause (IV steroids x3 days and PO taper in MS) or prolonged steroids
Describe the etiology/RF for cataracts
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
Describe the clinical presentation of cataracts
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)
Describe the diagnostic testing for cataracts
Non-dilated fundoscopic exam: darkening or opacities of red reflex
Describe the treatment for cataracts
Surgery to remove lens and replace with prosthetic (when interfering with ADLs)
Prevent with multivitamin/mineral supplements and dietary antioxidants
Describe the complications of cataracts
risk of retinal detachment in pts with a history of cataract surgery
Describe this clinical sign
retinal drusen (macular degeneration)
Describe the clinical correlation
wet macular degeneration
Describe the clinical correlation
dry macular degeneration
what does this image show
neovascularization (proliferative diabetic retinopathy)
Describe what each color arrow is pointing to
green: hemorrhage
white: cotton wool spot
yellow: hard exudate
red: microaneurysm
Describe what is happening in the image on the right
AV nicking (HTN retinopathy)
What is the bright line in the bottom right corner
copper wire sign (HTN retinopathy)
Describe the etiology of herpes zoster keratitis
Inflammation of the cornea d/t Zoster or HSV-1
Describe the clinical presentation of herpes zoster keratitis
Photophobia, tearing, varying pain and irritation, redness, unilateral, vesicular rash in periocular area
Describe the diagnostic testing/PE of herpes zoster keratitis
Fluorescein exam may reveal dendritic corneal ulcer: hallmark of herpes infection
Describe the treatment for herpes zoster keratitis
oral acyclovir & referral to ophtho
Describe the etiology/RF for open angle glaucoma
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
Describe the clinical presentation of open angle glaucoma
Slow, insidious, bilateral loss of vision
Progresses from asymptomatic, scotoma, peripheral vision loss, blindness
Describe the diagnostic testing/PE for open angle glaucoma
Anterior structures look cloudy under oblique lighting
Fundoscope: optic disc cupping, large cup to disc ratio, splinter hemorrhages, visual field testing, tonometry
Describe the treatment for open angle glaucoma
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
Describe the etiology/RF for conjunctivitis
Bacterial, viral, allergic, systemic condition
MC staph aureus, strep pneum, h. Flu, moraxella catarrhalis (can be n. Gonorrhea, contact lens - pseudomonas)
Describe the clinical presentation of the different types of conjunctivitis
Bacterial: Copious exudates, itching
Allergic: stringy exudates, itching, redness, edema, cobblestoning
Viral: less goop, preauricular LAD
Describe the treatment for the different types of conjunctivitis
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
Describe the etiology of blepharitis
Irritation at oil glands of eyelids causing scaling, crusting
Describe the clinical presentation of blepharitis
Scaling, crusting around eyelids
Describe the treatment of blepharitis
Treat underlying condition, gentle scrubbing, mild soap
+/- steroid cream, nizoral antifungal cream, tacrolimus ointment
avoid abx
Describe the etiology/presentation of a chalazion
inflamed nodule within the eyelid at oil producing gland
Describe the etiology/presentation of a hordeolum
inflamed nodule in base of eyelid at hair follicle, usually the lower lid, tender & red
Describe the etiology/presentation of a pterygium
triangular growth from the inner canthus of the eye
Describe the etiology/presentation of a pinguecula
nodular growth on conjunctiva
Describe the treatment for chalazion & hordeolum
- Reassurance, hot/wet compresses with massage several times per day
- Refer to ophtho if no resolution (especially with chalazion - may need surgical resection)
Describe the treatment for pterygium & pinguecula
- No treatment unless it begins to encroach the pupil - surgical
Describe the presentation & treatment of episcleritis
localized erythema, irritation, swelling from inflamed episclera
spontaneously resolves in a few weeks, steroid drops in pts with recurrent attacks
Describe the etiology/RF for keratoconjunctivitis Sclera
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
Describe the presentation of keratoconjunctivitis sclera
Dry irritated eyes, redness, photophobia, gritty/scratchy, burning, foreign body sensation
Describe the treatment for keratoconjunctivitis sclera
Avoid causative meds, smoking cessation, humidifier, hot compress, eye massage
Mild: artificial tears
Mod-Severe: refer to ophtho for lubricants
Describe the eitology/RF for uveitis
Inflammation of uvea
Anterior (iritis) or posterior
Systemic, immune mediated
RF: sarcoidosis, juvenile RA, inflammatory bowel disease, psoriasis, RA, herpes, syphilis
Describe the presentation of uveitis
Iritis: redness, pain may be minimal, +/- vision loss, tearing, light sensitivity, floaters
Posterior uveitis: painless, blurred vision, floaters, usually no redness
Describe the diagnostic testing for uveitis
Slit lamp exam: presence of leukocytes in aqueous humor
Posterior: chorioretinal inflammation in addition to leukocytes
