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Eye Emergencies > Ocular infections and inflammation > Flashcards

Ocular infections and inflammation Flashcards

1
Q

What is preseptal (periorbital) cellulitis, and what is the general treatment?

A
  • Infection of the eyelid and periocular tissues that is anterior to the orbital septum
  • PO abx and f/u
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2
Q

What is the treatment for postseptal (orbital) cellulitis?

A

Admit with IV abx and consult

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3
Q

What is endophthalmitis?

A

Infection of the globe

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4
Q

What is the only test that definitively distinguishes between periorbital and orbital cellulitis?

A

head CT

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5
Q

What is the ddx for preseptal and postseptal cellulitis? (8)

A
  • Preseptal/postseptalcellulitis
  • Subperiosteal/orbital
  • Cavernous sinus thrombosis
  • Dacryoadenitis/Dacryocystitis
  • Hordoleum
  • Bacterial/viral conjunctivitis
  • Contact dermatitis
  • Herpes zoster/Herpes simplex
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6
Q

What sort of infection is preseptal cellulitis usually associated with?

A

URI

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7
Q

What is epiphora?

A

Excessive tearing

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8
Q

What is the most common precipitating illness leading to postseptal cellulitis?

A

Sinusitis

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9
Q

What are the s/sx that are present in orbital cellulitis, that are not usually found with preseptal cellulitis?

A
  • Pain on EOMs
  • Decreased visual acuity
  • Chemosis
  • Proptosis
  • Abnormal pupillary response
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10
Q

Orbital cellulitis + CN palsy = ?

A

Cavernous sinus thrombosis

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11
Q

What is the treatment for emergently increased IOP in a patient with orbital cellulitis?

A

Lateral canthotomy

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12
Q

What is a stye (external hordeolum)? What does it look like?

A
  • Acute bacterial infection of the sebaceous glands along the eyelid
  • Appears as a pustule along the eyelid margi
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13
Q

What is an internal hordeolum?

A

Acute bacterial infection of the meibomian gland

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14
Q

What is the difference between a style (external hordeolum) and an internal hordeolum?

A

Internal occurs on the inner surface of the tarsal plate

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15
Q

What are the s/sx of a hordeolum?

A

pain
Edema
Erythema

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16
Q

What is the treatment for a hordeolum?

A

Erythromycin abx and warm compresses for 7-10 days.

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17
Q

What is a chalazion?

A

Acute/chronic inflammation of a Zeis oil gland in the tarsal plate

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18
Q

What is blepharitis?

A

Inflammation of the eyelash follicles along the edge of the eyelash 2/2 bacterial infx

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19
Q

What are the s/sx of blepharitis? When are symptoms usually their worst?

A

Burning sensation
photophobia
Blurred vision
Conjunctival injection

Worst in the mornings

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20
Q

What is the treatment for blepharitis?

A

Daily cleansing of eyelash edges

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21
Q

What are the two major diagnoses that need to be distinguished from viral conjunctivitis?

A

Herpes

serious bacterial infx

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22
Q

What is keratoconjunctivitis?

A

Conjunctivitis that includes corneal involvement

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23
Q

What is chemosis?

A

Edema of the conjunctiva

24
Q

What is the abx of choice for treating conjunctivitis in contact lens wearers?

A

Fluoroquinolone

25
Q

What is epidemic keratoconjunctivitis?

A

Severe adenovirus that usually causes epidemics. More severe s/sx, with associated URI s/sx

26
Q

Viral conjunctivitis is usually preceded by what sort of infection?

A

URI

27
Q

True or false: follicles in the inferior fornix are common in viral conjunctivitis

A

True

28
Q

What will fluorescein staining reveal with epidemic keratoconjunctivitis?

A

Punctate staining

29
Q

What is the treatment for viral conjunctivitis?

A

Symptomatic, with nasal decongestants and warm compresses

30
Q

How long can viral conjunctivitis last for?

A

1-3 weeks

31
Q

When should you consult an ophthalmologist regarding the use of ocular steroids?

A

Always

32
Q

Does herpetic conjunctivitis tend to be unilateral or bilateral?

A

Unilateral

33
Q

Which cause of conjunctivitis usually has palpable LAD?

A

herpetic

34
Q

What is the general treatment for herpes conjunctivitis?

A

Oral antivirals and topical antivirals

35
Q

What is herpes zoster ophthalmicus?

A

Shingles affecting the V1 (rarely V2, V3) distribution, and eventually the eye

36
Q

What is the treatment for herpes zoster ophthalmicus?

A

Admission and IV antivirals

37
Q

What causes a corneal ulcer?

A

breaks in the epithelial barrier allows infection of the underlying corneal stroma

38
Q

What is dacryocystitis?

A

Infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of the lacrimal sac

39
Q

What are the common causes of a corneal ulcer? (4)

A

Contact lenses
Trauma/surgery
Herpes
Bells palsy

40
Q

What are the s/sx of uveitis?

A
  • Irregular pupil
  • Scleral injection
  • Blurred vision
  • HA
  • Floaters
41
Q

What is synechia?

A

When iris adheres to the cornea, usually from trauma, iritis, or inflammation.

42
Q

What condition can synechia lead to?

A

Closed angle gluacoma

43
Q

What is the treatment for synechia?

A

Mydriatics/cycloplegic agents, to keep synechia from forming

44
Q

Why should you never patch an eye to treat a corneal ulcer?

A

Increases risk of Pseudomonas infection, which can cause rapid, aggressive ulceration with corneal melting and perforation

45
Q

What is the presentation of ultraviolet keratitis?

A

Slow onset of FB sensation and photophobia after UV exposure, progressing to severe pain

46
Q

What will slit lamp exam show with UV keratitis? Wood’s lamp?

A

Diffuse punctate corneal edema and corneal abrasions

47
Q

What is the treatment and prognosis of UV keratitis?

A
  • Pain control with topical cycloplegics/oral analgesic

- Healing occurs in 24-36 hours

48
Q

What causes the photophobia with uveitis?

A

Ciliary muscle spasm irritates CN V

49
Q

What can be seen on slit lamp exam with uveitis?

A

Flare and cells

50
Q

True or false: discharge is common with uveitis?

A

False

51
Q

What is the classic PE finding of iritis?

A

Consensual photophobia

52
Q

What is the most common cause of endophthalmitis?

A

Trauma or surgery to the globe

53
Q

What are the symptoms of endophthalmitis?

A
  • HA
  • Eye pain
  • Photophobia
  • Vision loss
54
Q

What are the signs of endophthalmitis?

A
  • Erythema and edema of lids
  • Conjunctival and scleral injection
  • Chemosis
  • Hypopyon
55
Q

What is the treatment for endophthalmitis?

A
  • Call ophtho
  • Intravitreal abx and steroids
  • Admit
56
Q

What is the most common cause of vitreous hemorrhage?

A

Diabetic retinopathy

57
Q

What are the symptoms of vitreous detachment/hemorrhage?

A

Sudden painless vision loss and sudden appearance of cobwebs or black spots

Eye Emergencies (5 decks)

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