Ophthalmic Flashcards
What is the cornea?
Transparent, anterior portion of the eye with NO blood vessels
Pain receptors present
What is the sclera?
Posterior aspect of the eye’s outer surface
White fibrous tissue (if inflamed white section becomes red)
What is the conjunctiva?
Membrane covering the sclera and inside the eyelids
Has blood vessel supply (allergies affect this)
When to refer for first aid scenarios?
2 days if no improvement
Symptoms and red flags of black eye
Changes in vision (esp. double vision)
NV, dizziness (concussion)
RF: swelling NOT receding after a few days
Treatment of black eye
Self-limiting: swelling gone in few days
Bruising gone within weeks
Ice packs and analgesics are great
Symptoms of a foreign body in the eye
Immediate increase in tearing, irritation, scratchy
Treatment for a foreign body
AVOID rubbing
Gentle rinsing with warm water
If cannot be removed -> cover eye + MD care
Close both eyes if possible
Treatment for chemical contact in eye
Flush eye, hold eyelids away from eye for 15 minutes
Remove contact lenses
Symptoms of radiant energy in eye (sun blindness/snow blindness)
Red eyes, itchy, foreign body sensation
Possible UV causes:
Skiers - reflection via water and snow
Not using goggles in suntan booth
Treatment for mild cases of radiant energy
Cool compresses
Non-medicated eye drops
Sunglasses for a few days
What are the non-medicated eye drops?
Murine (supplementary tears)
Visine (saline drops)
Systane (saline drops)
What is the DOC for dry eye syndrome?
Systane (artificial tears)
More of a lubricant that stays around longer
What are the three layers of the tear film?
Outer surface (layer) is oily
Middle layer is mainly aqueous
Inner layer is mucoidal
Etiology of dry eyes
Dryness occurs when the outer oily layer is gone so middle aqueous layer dries up faster
Changes to tear component, alteration in blink frequency and efficacy
Symptoms of dry eyes
Dry sensation, itchiness, redness
Sensitivity to light, difficulty blinking
Less tears produced
Factors affecting dry eyes
Age
Blepharitis
Medications
Sjorgrens syndrome (from contacts)
Menopause
Allergic conjunctivitis
Preserved treatment for dry eyes
Systane artificial tears
Starting point
Anything up to QID dosing
Unpreserved treatment of dry eyes
Refresh artificial tears
Single use
Has 1 less chemical for less irritation anything MORE than QID dosing
Liquid -> gel treatment for dry eyes
GenTeal
Starts as a liquid, becomes gel like in the eye (can give more relief)
Can cause bluriness (apply at home)
Ointments / gel treatment for dry eyes
GenTeal gel
More for overnight relief
HS dosing = the most bluriness caused
Other treatments for dry eyes
Humidifier
Lid margin hygiene
Plug the ducts
Cyclosporine drops
Omega 3 fatty acids
Heat at night
Presentation/etiology of a stye
Etiology: infected hair follicle
Swelling, tender, progresses to pimple-like
No changes to vision, redness
Treatment of stye
Self-limiting
NO squeezing
Warm compresses
Maybe ointment antibiotic if serious
Chalazion presentation and etiology
Etiology: obstruction of an oil gland
Generally painless and slow to develop
(Like stye)
Treatment of chalazion
Warm compresses
Massage (can help clear up obstruction of fat)
Presentation / etiology of conjunctival hyperaemia
Wont be able to tell a difference will just look red
Etiology of sub-conjunctival hemorrhage
Blood vessels in the area break
Refer to MD!
Treatment for sub-conjunctival hemorrhage
7-10 days to clear
Decongestant will NOT help
Etiology and presentation of hyperaemia
Etiology: many causes -
Dust, smoke, chlorine, low humidity, eye strain, contact lenses
Symptoms of ocular conditions (blepharitis, rosacea)
Treatment for hyperaemia
Flush out if possible
Murine is the DOC
Cool compresses can help
Etiology and presentation of blepharitis
Etiology: disorder of meibomian glands caused by two types - bacterial(kids) and seborrheic (older adults)
Every blink hurts
Sticky eyelids in morning
Inflammation of the eyelid margins
Scales
Treatment for bacterial blepharitis
Eyelid hygiene
Topical antibiotics
Polysporin or blephamide (rx)
Treatment for seborrheic blepharitis
Eyelid hygiene
Check / treat scalp with anti fungal
Warm compresses / massage
Treatment for 3 weeks up to months
Etiology / presentation of pink eye conjunctivitis
Most likely will be bacterial»_space; viral > allergic
MD referral paediatric»_space; adult
treatment of pink eye
Most are self-limiting over 2-3 days
Etiology / presentation of allergic conjunctivitis
Seasonal»_space; perennial
Other allergy symptoms (sneezing, itchy, runny nose)
BOTH eyes affected
Etiology / presentation of bacterial conjunctivitis
Exudate from eye / exudate from lid margin / blepharitis
Sticky eyelids is the main feature
Treatment for bacterial conjunctivitis
Wait and see for 3 days before starting antibiotics
Topical antibiotics - 1st choice
Polysporin good backup if MD visit not possible
Etiology / presentation of viral conjunctivitis
Starts in 1 eye -> 2nd involved in 1/3 of cases
Often follows a cold
Should be painless
Treatment for viral conjunctivitis
Symptomatic care: clean eyes, avoid towel sharing
NO antibiotics
Improvement in 2 days
Viral conjunctivitis treatment in kids
Symptomatic care
Bacterial conjunctivitis treatment in kids
Can refer or prescribe
Giving eye drops
Non-medical treatment for allergic conjunctivitis
Cool compresses / avoid allergen
Non-medicated drops
Drug treatments for allergic conjunctivitis
Topical antihistamines
Oral antihistamines
Topical chromolyn et el
Decongestants
Ocular steroids - DOC
Topical NSAID
OTC and rx topical antihistamine for allergic conjunctivitis
OTC: Naphcon A (skip, go to rx)
Rx: livestin, zaditor, emadine - can prescribe these
Oral antihistamine for allergic conjunctivitis
Naphcon A - 1st gen so not great
OTC and rx topical cromonlyn for allergic conjunctivitis
BETTER then antihistamine
OTC: opticrom (mast cell stabilizer)
Rx: patanol, alocril, alomide
Topical and oral decongestants for allergic conjunctivitis
Topical: visine, opcon-A (topical not that good)
Oral: no value for eyes only for nasal
Ocular steroids for allergic conjunctivitis
DOC but concern for increased IOP
Nasal is DOC with minimal AE
Optical NSAID for allergic conjunctivitis
Acular (ketorolac) - more for after surgeries
When to see optometrist for floaters in:
Older patient:
Quick onset:
Vision changes:
Older patient: 6 months
Quick onset: 2 months
Vision changes: 2 days
What is blepharospasm?
Benign twitches in eyelids
What happens with an obstructed tear duct?
Tears do not drain away - common in newborns
Causes of eye bags
Genetics!!
Aging
Maybe sleep
Presentation / etiology of AMD dry type
Fat deposits -> lead to damaged macula
There is early - intermediate - advanced
Treatment for AMD dry type
Secondary prevention is key
AREDs formula - slow progression
Presentation / etiology of wet type AMD
Advanced type only
