Ocular conditions Flashcards
subconjunctival hemorrhages
definition
common finding
bleeding between the conjunctiva and the sclera
cause of subconjunctival hemorrhage?
traumatic, spontaneous or secondary to a systemic illness
treatment of subconjunctival hemorrhage?
usu asx and don’t require tx
for mild irritation- artificial tears can be used
aspirin and NSAID use should be discouraged for recurrent cases
viral conjunctivitis
definition
infection of the mucus membrane of the surface of the eye
MC virus- adenovirus
SSX of viral conjunctivitis?
usu self limited last longer than bacterial infxn (2-4 weeks), less inflammation and without purulent d/c itching foreign body sensation tearing redness photophobia
tx of viral conjunctivitis?
chamomile tea bag artificial tears cold compresses good hand hygiene antiviral tx- for varicella-zoster and herpes infxn if all fails- opthalmic Abx or refer
SSX of bacterial conjunctivitis?
can be differentiated from viral by the purulent d/c
sexually active + urethritis- gonorrhea or CT
TX of bacterial conjunctivitis?
topical antibiotic tx
systemic Abx for gonorrhea or CT
Hordeolum
definition
outside the eyelid
infection of the glands of Zeis
aka Stye
SSX of hordeolum
pain
warm
swelling
edema
TX of hordeolum
usu self limiting eyelid hygiene warm compresses massage topical Abx systemic Abx- pre-septal cellulitis incision and drainage for large hordeolum
Chalazions
definition
deep within the lid
granulomatous inflammatory rxn of meibomian gland
MC on upper lid
SSX of chalazions
single, firm, nontender nodule
with the appearance of lots of floaters you should consider what condition?
retinal detachment
what can help to visualize corneal abrasions?
blue light, the abrasion will appear yellow green
TX of corneal abrasions?
self limited (typically heal within 24 hrs)
ice compresses
non-steroidal anti-inflammatory eye drops
prophylactic Abx
close follow up necessary bc of risk of developing a corneal ulcer
what’s a corneal ulcer?
full thickness epithelial loss
SSX of corneal ulcer?
pain
discomfort
blurry vision
may lead to loss of vision
DX of corneal ulcer?
appear as white or grey spots on the cornea
uptake of fluorescein dye
TX of corneal ulcer?
antibiotic drops
occasionally Abx injection or surgery
what’s a cataract?
clouding of the lens inside the eye which leads to decreased vision
fun fact about cataracts?
MC cause of blindness
SSX of cataracts?
difficulty with color vision and changes in contrast
difficulty with driving, reading, recognizing faces, glare from bright lights
what’s acute angle-closure glaucoma?
elevated intraocular pressure (IOP) due to obstruction of outflow from the anterior chamber
one of two types of glaucoma (chronic being the other) where the optic nerve is damaged
associated with farsighted patients
SSX of acute angle-closure glaucoma?
sudden onset of severe ocular pain h/a nausea and vomiting blurred vision with halos around lights loss of vision conjunctival injection corneal edema mid-dilated nonreactive pupil shallow anterior chamber IOP > 21 mmHg
TX of acute angle-closure glaucoma?
immediate reduction in IOP
suppression of inflammation
reversal of angle closure
SSX of temporal arteritis?
h/a
scalp tenderness
jaw claudication
reduced visual acuity in right eye
what’s retrobulbar hematoma?
results from trauma, a complication of orbital surgery, or retrobulbar injection
SSX of retrobulbar hematoma?
painful proptosis dec visual acuity scintillating scotoma lid ecchymosis chemosis mydriasis afferent pupillary defect increased IOP
TX of retrobulbar hematoma?
immediate opthalmologic consultation ice packs pain control bed rest IV acetazolamide, mannitol and steroids
What’s a hyphema?
injury to the anterior chamber that disrupts the vasculature supporting the iris or ciliary body
blood forms a characteristic meniscus
SSX of hyphema?
pain
photophobia
blurred vision
TX of hyphema?
head slightly elevated
eye shielded
pain meds without anti-platelet/anticoagulation activity
IOP measured
Classic finding for central retinal artery occlusion?
cherry-red spot
SSX of central retinal artery occlusion?
sudden, PAINLESS loss of vision
TX of central retinal artery occlusion?
dilation of the central retinal artery by rebreathing expired CO2, breathing carbogen, or sublingual nitroglycerin
Classic finding for central retinal vein occlusion?
retinal hemorrhages extending outward from the optic disk
“blood and thunder” appearance
SSX of central retinal vein occlusion?
asx or present with gradual vision loss that is more pronounced in the morning
what’s retinal detachment mean?
occurs from a break or tear in the neuronal layer with subsequent sub-retinal fluid accumulation
SSX of retinal detachment?
flashes of light floaters *a curtain or shadow moving over the field of vision* peripheral or central vision loss pain ABSENT
DX of retinal detachment?
direct and indirect ophthamoscopy
TX of retinal detachment?
lying down while transported
laser treatment to tack down retina
SSX of orbital cellulitis?
fever erythematous, swollen, tender eyelid recent Hx of sinusitis or URI proptosis tenderness pain with EOMs chemosis visual changes
TX of orbital cellulitis?
CT is mandatory
pts require hospitalization
broad spectrum antibiotics
opthalmologic and otolaryngology consultation is warranted
common finding of alkaline chemical injury to the eye?
stromal haze with opacification of the cornea
why are alkaline chemical agents so damaging to the eye?
they are both hydrophilic and lipophilic, allowing rapid penetration of cell membranes inducing saponification of cell membranes and cell death
