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diseases 1 > Normal and Abnormal S/Sx > Flashcards

Normal and Abnormal S/Sx Flashcards

1
Q

lid opening

A

levator (CN3), muller’s muscle (symp. innervation)

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2
Q

lid closure

A

via orbicularis oculi, CN7

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3
Q

paranasal sinuses

A

frontal, ethmoidal, sphenoid, maxillary

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4
Q

orbital septum importance

A

important in terms of spread of disease

hard barrier preventing infection spreading

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5
Q

signs of orbital disease

A 
soft tissue involvement
orbital displacement (proptosis, enophthalmos, dystopia)
EOM restrictions
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6
Q

proptosis

A

abnormal protrusion of the globe

lesion WITHIN muscle cone – axial proptosis
lesion OUTSIDE muscle cone – combined proptosis and dystopia

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7
Q

exphthalmometry

A

measured distance from lateral orbit rim to corneal apex

>20mm indicates proptosis

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8
Q

pseudoproptosis

A

false impression of proptosis

facial asymm., enlargement of globe (high myopia or buphthalmos), lid retraction or contralateral enophthalmos

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9
Q

enophthalmos

A

opp. of proptosis

recession of the globe within the orbit

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10
Q

dystopia

A

displacement of the globe in the coronal plane
ie. lateral or vertical displacement

caused by extraconal orbital mass (ie. lacrimal gland tumour)

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11
Q

meibomian gland

A

modified sebaceous glands; ~30 upper and lower lids

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12
Q

glands of zeis

A

modified sebaceous glands at base of eyelash folllicle

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13
Q

glands of moll

A

modified sweat glands, lash follicle

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14
Q

krause & wolfring

A

accessory lacrimal glands

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15
Q

trichiasis

A

abnormal, misdirected growth of lashes

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16
Q

distichiasis

A

rare, extra row of lashes arising from meibomian gland orifices; associated with trichiasis

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17
Q

madarosis

A

loss of lashes/brows - can be partial or complete

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18
Q

poliosis

A

premature localised whitening of hair which may involve lash/brows
(loss of pigmentation bc body is attacking melanin producing cells)

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19
Q

entropion/ectropion

A

inward/outward tuning of eyelid

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20
Q

trichomegaly

A

increased length, thickness or curliness of lashes

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21
Q

lacrimal system

A

responsible for tear production - primarily the aqueous part of tear film
responsible for tear film exchange

note: 1st refractive surface is actually the tears (not cornea)

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22
Q

examination of punctum

A

punctal stenosis, ectropion causing malposition, punctal obstruction (eyelash), large caruncle displacement etc.

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23
Q

examination of lacrimal sac

A

palpation and compression for punctal reflux, pain, swelling, stone, tumour.
note: avoid compression in dacryocystitis - severely painful!

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24
Q

examination of marginal tear strip

A

evaluate before touching lids or using drops

px may show high marginal tear strip on affected side

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25
Q

fluorescein retention test

A

dye should drain within 3-5 mins –> indicates proper tear turnover

prolonged retention indicates poor drainage

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26
Q

S/Sx of lacrimal disease

A

lumps, bumps, swelling in areas of puncta, canaliculi and lacrima sac

excessively high/low tear meniscuc

excessive tearing/watery eye/epiphora

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27
Q

excessive lacrimation (hypersecretion)

A

due to overproduction of tears from lacrimal gland

  • reflex secondary to inflammation or ocular surface disease
  • usually due to inflammation / dry eye
28
Q

epiphora (defective drainage)

A

problem with lacrimal drainage system
- obstruction of the drainage system (puncta to nasolacrimal duct)
- malposition of puncta
lacrimal pump failure

29
Q

primary jones test aka jones test 1

A

indicates when partial obstruction of drainage system is suspected
(ddx: partial obstruction of lacrimal passages from primary hypersecretion of tears)

30
Q

secondary jones test aka jones test 2

A

identifies the probable site of partial obstruction

31
Q

dilation and irrigation

A

test for obstruction of the lacrimal system
- local anaesthetic instilled into conjunctival sac
lower punctum is dilated
- saline-filled syringe is inserted into the lower punctum
- saline is released to check for obstructions

this is done after neg. jones test 2, which is repeated again

positive result = NaFl entered lacrimal sac, so blockage likely nasolacrimal duct

negative result = NaFl did not enter the lacrimal sac, so blockage likely in puncta, canaliculi, or common canaliculus (ie. somewhere further up)

32
Q

signs of conjunctival disease

A

discharge, hyperemia, chemosis, xerosis (drying), follicles, papillae, membranes

33
Q

haemorrhage

A

blood outside of blood vessels

idiopathic, traumatic, viral infections (petechial), bacterial infections (rare; larger, diffuse)

34
Q

chemosis

A

inflammatory response of the conj.
swelling due to severe inflammation
- acute = allergy / hypersensitivity, severe infection
- chronic - orbital outflow constriction, chronic allergy, thyroid eye disease, surgery, trauma, systemic disease

35
Q

follicles

A

foci of hyperplastic lymphoid tissue
- multiple, discrete elevated lesions
(like translucent grains of rice, circled by small blood vessels at base)
- suggest viral or chlamydial infection

36
Q

papillae

A

d: hyperplastic epithelial growth within central vessels
s: multiple, discrete elevated lesions
- usually in palpebral conj or at limbus

37
Q

infiltration

A

cellular recruitment to the site of chronic inflammation

- loss of detail of normal conj vessels

38
Q

pseudomembranes vs true membranes

A

pseudo: coagulated exudate adheres to conj
- can be peeled away and won’t bleed by not actually attached to conj

true: infiltration of superficial layers of conj
- tear skin when you try to peel bc u are actually tearing the epithelial layer of the conj

39
Q

xerosis

A

areas of conjunctival dryness

  • areas of dehydration of the conj
  • conj keratinises, becoming more like the skin of our body
40
Q

layers of the cornea

A 
epithelium
bowmans layer
stroma 
(dua layer)
descemets membrane
endothelium
41
Q

punctate epithelial keratitis

A

hallmark of viral disease
granular, opalescent, swollen epithelial cells
(visible with/without stain)

42
Q

subepithelial infiltrates

A

tiny foci of non-staining inflammatory infiltrates

cause: often severe, or prolonged infection or inflammation

43
Q

epithelial oedema

A

epithelial layer becomes swollen
sign of endothelial decompensation, acute elevation of IOP
(so much fluid on cornea, that even the epi layer starts to swell)

mild cases: tiny epithelial vesicles - loss of normal cornea lustre
moderate-severe: bullae

44
Q

filaments

A

specific sign for severe dry eye
Eye has become so dry that the mucus is unable to stay wet, thus builds up on each other → becomes stuck onto cornea and conjunctiva

  • small comma-shaped mucus strands lined with epithelium
45
Q

vascularisation

A

feature of chronic ocular surface irritation or hypoxia

  • contact lens wear
  • small superficial blood vessels grow from limbus towards the corneal centre
  • pannus - Degenerative (or inflammatory) subepithelial ingrowth of fibrovascular tissue from the limbus + superficial vascularization
46
Q

infiltrates

A

focal areas of active stromal inflammation

  • composed of accumulation of inflammatory cells and cellular debris
  • yellow/grey/white opacities in ant. stroma –> associtaed w limbal or conj. hyperaemia
47
Q

PEDAL

A 
P ain
E pithelial defect
D ischarge
A nterior chamber
L ocation
48
Q

stromal oedema

A

increased corneal thickness + loss of clarity

- caused by keratoconus, Fuchs dystrophy etc

49
Q

Descemet’s membrane folds

A

corneal oedema exceeding the capacity of the endothelium

50
Q

Descemet’s membrane breaks

A

corneal enlargement

  • birth trauma, keratoconus
  • may result in acute aqueous influx into cornea = corneal hydrops
51
Q

descemetocele

A

Bubble-like herniation of Descemet membrane into the cornea

52
Q

ulceration

A

tissue excavation associated w inflammation and defect

53
Q

Seidel test

A

demonstrates aqueous leakage.
Fluorescein is instilled → watch for dilution from aqueous fluid

Seidel test tries to create situations where it can be apparent that it is some liquid that doesn’t have fluorescein thats going to be on the surface of the eye
Eg. putting a bunch of fluorescein on the area where you think the wound is
Observing that area , you will see that the colour will go from reddish-orange to green → suggestive of a positive seidel

Another method: placing NaFl over entire tear film - Any area that gets diluted/might be leaking, might be an area where there is no green at all
This method might be harder to interpret

54
Q

iris atrophy

A

atrophy of part or all of iris structures

signs: light leakage through iris on retroillumination

55
Q

synechiae

A

adhesions between iris and some other structure

  • w posterior cornea = ant. synechiae
  • w anterior lens = posterior synechiae
56
Q

hyphema

A

blood in the anterior chamber

- blood settles on the bottom due to gravity

57
Q

hypopyon

A

purulent exudate composed of inflammatory cells that settle in the anterior chamber
(similar to hyphema but inflammatory cells built up within the ant. chamber)

sigbs: pus/white exudate at bottom of ant. chamber

58
Q

cells and flare

A

breakdown of blood-aq. barrier - allows cells and protein and immune cells into ant. chamber

59
Q

mydriasis

A

pupil dilation

  • excite symp
  • inhibit parasymp
60
Q

miosis

A

pupil contriction

  • excite parasymp
  • inhibit symp
61
Q

corectopia

A

irregular pupil shape, off centre

62
Q

polycoria

A

more than one pupil opening; multiple openings within the iris

63
Q

colobomas

A

incomplete pupil; ‘keyhole’ pupils

- failure of the optic fissure to close during development

64
Q

hypoplasia; aniridia

A

no/little iris

65
Q

scleral nodule

A

focal area of scleral oedema

- raised area of sclera/episclera

66
Q

scleral thinning

A

thinning of scleral tissue due to inflammation

diseases 1 (4 decks)

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