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EENT Exam 1 > Ocular Disorders: Anterior > Flashcards

Ocular Disorders: Anterior Flashcards

1
Q

Indications for Topical Ophthalmic Steroids

A
  • Inflammatory condiSons of the anterior segment of the globe
  • Ex// allergic conjuncSviSs, uveiSs, episcleriSs, scleriSs, phlyctenulosis,
    superficial punctate keraSSs, intersSSal keraSSs, vernal conjuncSviSs, & post-
    op inflammaSon
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2
Q

Contraindications for Topical Ophthalmic Steroids

A
  • HypersensiSvity reacSons
  • Microbial (bacterial/viral/fungal) keraSSs
  • Ocular hypertension
  • Glaucoma
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3
Q

T/F Topical Ophthalmic Steroids Should be managed by Ophthalmology

A

T

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4
Q

Topical Ophthalmic Steroids
Serious Adverse Effects

A
  • Cataracts (prolonged use)
  • Corneal perforation
  • Exacerbation of viral infections (herpes simplex)
  • Glaucoma
  • Immunosuppression
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5
Q

Corneal Abrasion
Clinical Presentation

A
  • Unilateral symptoms
  • Foreign body sensation
  • Eye pain
  • Inability to open eye
  • Photophobia
  • Excessive tearing
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6
Q

Corneal Abrasion
Diagnosis

A
  • No obvious laceration on initial exam
  • Assess visual acuity
  • Instill topical anesthetic
  • Fluorescein & Wood’s lamp
  • Slit lamp examination if no obvious abrasion
  • If penetrating injury suspected , CT or MRI
  • If ulcer suspected, obtain cultures prior to antibiotics
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7
Q

Corneal Abrasion
Management - prophylaxis

A
  • Prophylaxis
  • Topical antibiotics until patient is
    asymptomatic
  • Ciprofloxacin, tobramycin,
    trimethoprim/polymyxin B
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8
Q

Corneal Abrasion management

A
  • Small abrasions can be managed outpatient
  • Ice compresses for 24-48 hrs to reduce edema
  • Warm compresses
  • Eye rest
  • Close follow-up until healed
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9
Q

Abrasions from contact lenses Tx

A
  • Prophylactic topical antibiotics
  • Pseudomonas aeruginosa
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10
Q

Abrasions from vegetable matter Tx

A

Fungal
* Natamycin – topical ophthalmic antifungal

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11
Q

Corneal Ulcer

A
  • Ophthalmologic emergency
  • ~20,000 cases per year in US
  • Viral occur on a previously intact corneal epithelium
  • Bacterial generally follow a traumatic break in the
    corneal epithelium
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12
Q

Corneal Ulcer Tx

A

Topical ophthalmic corticosteroid = funga

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13
Q

Corneal Ulcer presentation

A
  • Redness
  • Severe pain
  • Foreign body sensation
  • Tearing
  • Discharge
  • Blurred vision
  • Photophobia
  • Swelling of the eyelids
  • A white spot on the cornea
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14
Q

What pattern will a corneal abrasion take if it is HSV?

A

Dendritic pattern if HSV

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15
Q

Corneal Foreign Body
Presentation

A
  • Red eye
  • Pain
  • Foreign body sensaSon
  • Photophobia
  • Tearing
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16
Q

Corneal Foreign Body diagnosis

A

Dilated examination by ophthalmology
* InfecSous corneal infiltrates/ulcers generally
require scrapings for smears & cultures
* Exclude intraocular foreign body
* Orbital CT
* B-scan ultrasound
* Ultrasound biomicroscopy (UBM)
* If metallic object suspected, consider
x-ray as initial study

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17
Q

Do NOT patch a corneal foreign body if:

A
  • A chance of a perforation of the globe exists
  • A corneal infiltrate is present
  • A chance of a retained intraocular foreign
    body is possible
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18
Q

Keratitis

A

Infection/Inflammation of the cornea

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19
Q

Keratitis
Epidemiology/Etiology

A
  • Emergent Condition
  • 25,000 cases in US/year
  • Complication of contact lens use
    & refractive corneal surgery
  • Bacterial
  • Streptococcus, Pseudomonas,
    Enterobacteriaceae, Staphylococcus
    Infection/Inflammation of the cornea
    Corneal leukoma
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20
Q

Keratitis Pathogenesis

A
  • Corneal ulceration, stromal abscess
    formation, surrounding corneal edema,
    anterior segment inflammation
  • Corneal destruction complete in 24-48 hrs!
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21
Q

hypopyon

A

Leukocytic exudate
- can happen with keratitis when Outpouring of inflammatory cells into the
anterior chamber

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22
Q

Keratitis Clinical Presentation

A
  • Reduced vision
  • Sudden eye pain, severe
  • Increased light sensitivity
  • Tearing
  • Excessive discharge from the eye
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23
Q

Keratitis
Diagnosis

A
  • Cultures
  • Scrapings
  • Corneal biopsy
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24
Q

Keratitis management

A
  • Antimicrobials
  • Cycloplegic drops
  • IV antibiotics
  • Surgery
  • Vitreoretinal specialist
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25
Q

Keratitis
Complications

A
  • Corneal leukoma: Scar tissue formation with the presence of corneal vascularization necessitating corneal
  • Irregular astigmatism: Uneven healing of the stroma → irregular astigmatism
  • Corneal perforation: Most feared complication may result in endophthalmitis & eye loss, Corneal destruction complete in 24-48 hours
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26
Q

Most feared complication of keratitis

A

Corneal perforation

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27
Q

Ultraviolet (UV) Keratitis

A

Ultraviolet radiation injury to the eye

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28
Q

Ultraviolet (UV) Keratitis
Epidemiology/Etiology

A
  • Most common cause of radiation injury to the eye
  • Cornea absorbs most UV radiation
  • Similar to a sunburn on dermal epithelium
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29
Q

Ultraviolet (UV) Keratitis Clinical Presentation (6 - 12 hours later)

A
  • Foreign-body sensation
  • Irritation
  • Pain
  • ↓ visual acuity
  • Photophobia
  • Tearing
  • Blepharospasm
30
Q

Exam findings in Ultraviolet (UV) Keratitis

A
  • Varying lid edema & conjunctival hyperemia
  • Diffuse corneal haze in severe cases
31
Q

Ultraviolet (UV) Keratitis
Diagnosis

A

Fluorescein
* Superficial punctate epithelial surface irregularities
* Small pinpoint defects

32
Q

Ultraviolet (UV) Keratitis
Treatment

A

Short-acting cycloplegic (paralysis of ciliary muscle)
drops
* Cyclopentolate 1% (Cyclogyl®)
* Mydriasis (dilation of the pupil)
* ↓ the pain of reflex ciliary spasm

33
Q

Ultraviolet (UV) Keratitis Treatment

A
  • Topical Anesthetics?
  • Yes, 24 hours only → relief is immediate
  • Don’t allow the patient to take the bottle
  • Frequent topical anesthetic use slows epithelial
    healing & → corneal ulcer formation
34
Q

Chemical Keratitis epidemiology

A
  • True ocular emergency
  • 10-20% ocular traumas
  • Men > women
  • Industrial accidents, usually alkali chemicals
  • building materials & cleaning agents
35
Q

4 important pieces of information in chemical keratitis

A
  1. Toxicity of chemical (Type? acid v. alkali)
  2. Duration of contact
    * When
    * How long until rinsed? Time rinsing?
  3. Depth of penetration (Pressurized?)
  4. Area of involvemen
36
Q

Chemical Keratitis
Exam

A
  1. Check pH first*
    * If not in physiologic range
    * Irrigate to bring the pH to an appropriate range (7 - 7.2)
  2. After irrigation: Assess the extent & depth of injury
  3. Fluorescein
  4. Intraocular pressure
37
Q

What should you not do with chemical keratitis?

A

Do not neutralize acid with an alkali or vice versa
* Heat → damage
* Morgan lens with normal saline or lactated Ringer’s solution to a pH of 7

38
Q

Elemental metals to be aware of in chemical Keratitis

A

Na+・K+・Mg2+・P–・Li+・Cs+・TiCl4

39
Q

Iritis

A

Anterior Uveitis - Inflammation of iris & ciliary body

40
Q

Iritis
Clinical Presentation

A
  • Unilateral eye symptoms
  • Eye pain
  • Photophobia
  • Redness
  • Watering
41
Q

Iritis Exam

A
  • Pain/photophobia early signs
  • Ocular findings
  • Red & watering eyes
  • MioSc pupil
  • Pupil may have irregular shape
  • Pupil may be sluggish to react
  • ↓ accommodation due to pain
  • S/S consistent w/ ankylosing spondylitis
42
Q

Synechiae in iritis

A
  • Iris adheres to cornea or lens
  • Pupil has an irregular shape due to
    posterior synechiae which have
    bound the iris posteriorly to the
    lens
43
Q

What is this

A

Synechiae

44
Q

Features that warrant further investigation in Iritis

A
  • Bilateral inflammation
  • Recurrent, moderate/severe inflammation
    with granulomatous features
  • Systemic symptoms or signs suggesting
    underlying medical condition
45
Q

Iritis
Diagnosis

A
  • Visual acuity with “pinhole test”
  • Tonometry (↓ IOP)**
  • Gonioscopy
  • Sacroiliac & spine x-ray
  • HLA-B27 typing
46
Q

Iritis Tx

A
  • Initiate cycloplegic agents
  • Pain, synechiae prevention
  • Ophthalmology
47
Q

Iritis complications

A
  • Macular edema
  • Vision loss (permanent or temporary)
  • Retinal detachment
48
Q

Preseptal Cellulitis

A

Infection of the dermis anterior to the orbital septum

49
Q

Most common organisms in Preseptal Cellulitis

A

S. Aureus, S. Epidermidis, Streptococcus

50
Q

What to consider if Preseptal Cellulitis Pain disproportionate to clinical findings?

A

periorbital necrotizing fasciitis

51
Q

Preseptal Cellulitis exam findings

A
  • Typically, unilateral
  • Involves the lid
  • Erythema
  • Swelling
  • Induration
  • Tenderness
  • Warmth
  • Fever & leukocytosis
  • Often absent 2° trauma
52
Q

ophthalmic signs in preseptal cellulitis, should make you think ___

A

orbital cellulitis

** Painful and/or limited eye movement
* Afferent Pupillary defect
* Increases resistance to globe retropulsion

53
Q

What is this

A

Preseptal Cellulitis

54
Q

Preseptal Cellulitis Tx

A
  • No data establishing a standard
    treatment
  • Treat empirically for S. Aureus &
    Streptococci
  • Penicillins or Cephalosporins
  • If you are thinking MRSA
  • Clindamycin
  • TMP-SMX
55
Q

What is this

A

Orbital Cellulitis

56
Q

Risk Factors or orbital cellulitis

A
  • Recent facial trauma, surgery, dental work
  • Hematogenous spread
    *Note: Incidence of periorbital cellulitis has ↓ with H. influenzae vaccination
57
Q

Orbital Cellulitis
Clinical Presentation

A
  • Fever, malaise, & Hx of recent sinusitis or URI
  • Conjunctival chemosis
  • Decreased vision
  • Pain on eye movement
  • Headache
  • Lid edema
  • Rhinorrhea
58
Q

Orbital Cellulitis
Diagnosis

A
  • CBC c/ diff
  • Blood cultures prior to antibiotics
  • Eye discharge culture
    Imaging
  • High-resolution contrast CT scan of the orbit with axial & coronal views
  • R/O peridural & parenchymal brain abscess
  • MRI
  • Lumbar puncture if cerebral or meningeal signs develop
59
Q

Orbital Cellulitis
Management

A
  • Inpatient care until afebrile x 48 hours & clearly improved
  • Broad-spectrum IV antibiotics should be started immediately
  • Ophthalmology, ENT, infectious disease consults
  • Continually monitor vision
  • Repeat CT if symptoms worsen
60
Q

Orbital cellulitis Tx

A
  • IV antibiotic therapy for 1-2 weeks
  • Oral antibiotics for an additional 2-3 weeks
  • Amoxicillin clavulanate, ampicillin, cefpodoxime, cefuroxime, cefprozil
  • Fungal infection requires IV antifungal therapy along with surgical debridement
61
Q

Orbital Compartment Syndrome Tx

A
  • Canthotomy
  • lengthen palpebral fissure
  • Cantholysis
  • canthotomy + incision of inferior
    branch of lateral
    canthal tendon
62
Q

Hyphema

A

Post-injury accumula=on of blood in the anterior chamber

63
Q

What is this

A

Hyphema

64
Q

Hyphema
Epidemiology/Etiology

A
  • Incidence = 17-20 per 100,000
  • Blunt trauma to the eye
  • balls, rocks, projectile toys, air gun pellets,
    BB gun pellets, car airbag, hockey puck..
65
Q

Hyphema management

A
  • Ophthalmology
  • Consider open globe injury
  • Surgical intervention is rarely indicated for hyphemas that occupy < ½ of the ant. chamber
  • Resolves spontaneously
66
Q

Hyphema complications

A

synechiae, corneal bloodstaining, opSc atrophy, secondary glaucoma

67
Q

What is this

A

Orbital Blowout Fracture

68
Q

Orbital Blowout Fracture Leads to entrapment of the ____ muscle

A

inferior rectus

69
Q

½ orbital fractures involve _____

A

inferior wall/floor of the orbit

70
Q

What is this

A

Corneal ulcer

71
Q

What is this

A

Chemical Keratitis

EENT Exam 1 (5 decks)

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