Ophthalmic Disorders Flashcards
COMMON EYE COMPLAINTS
Redness
Pain
Foreign body sensation
Photophobia
Dryness
Watery eyes
Decreased visual acuity
Loss of vision
Double vision
Conjunctival discharge
“Spots,” “floaters,” “flashing lights”
Eye redness diseases
Acute conjunctivitis
Acute Anterior Uveitis (iritis)
Acute Angle-Closure Glaucoma
Corneal Trauma or Infection
what can cause ocular discomfort?
Pain (trauma, infxn, rapid increase in IOP)
Dry eye (lacrimal gland hypofunc. related to systemic disorders or drugs)
Watery eyes (inadequate tear drainage related to obstruction of lacrimal drainage sys or malposition of lower lid, reflex tearing due to disturbance of corneal epithelium)
Photophobia (keratitis, iritis, albinism, aniridia, cone dystrophy, fever due to systemic infection)
Strabismus
Ocular misalignment
Only one eye fixates on an object
Present in ~4% of children
“Ocular instability of infancy” - unsteady ocular alignment often present in normal newborns during first few months of life, typically goes away after 4-6 months
Risk factors = family history, preterm/low birth weight, other ocular conditions, certain neuromuscular conditions
Can also be acquired due to cranial nerve palsies or orbital mass, fracture, or thyroid eye disease
Prefix describes
direction of eye deviation
Eso
inward
Exo
outward
Hyper
upward
Hypo
downward
Suffix describes
conditions under which it is present
Phoria (latent strabismus)
strabismus that is present only when binocular fusion is disrupted (i.e. when one is covered)
Tropia (manifest strabismus)
strabismus that is present when there is no disruption of binocular fusion
Most common causes - Strabismus
Esodeviations =
DASIA
accommodative esotropia, idiopathic infantile esotropia, Duane syndrome, abducens palsy, sensory esotropia
Most common causes - Strabismus
Exodeviations =
intermittent exotropia
Most common causes - Strabismus
Hyperdeviations =
trochlear nerve palsy
Most common causes - Strabismus
Hypodeviations =
fracture of orbital floor or wall, thyroid-related ophthalmopathy, Brown syndrome, oculomotor palsy, trochlear nerve palsy, congenital fibrosis of extraocular muscles
Strabismus test
Corneal light reflex (Hirschberg test)
Cover test (detects tropia) - looking at uncovered eye
cover/uncover test (detects phoria)
cover test
Detects tropia (manifest strabismus)
In this test, the child is asked to visually fixate on a target at distance or near. The examiner briefly covers one eye while observing the opposite eye for movement
No movement is detected when covering either eye if the child has normal ocular alignment (orthotropia).
Manifest strabismus (tropia) is present if the eye that is not occluded with the cover test shifts to refixate on the target when the fellow previously fixating eye is covered
repeat on each eye
Cover/uncover test
Detects phoria (latent strabismus)
Do not have to do if cover test reveals tropia
the child is asked to visually fixate on a target at distance or near. A cover is placed over one eye for a few seconds, and then it is rapidly removed. The eye that was under the cover is observed for refixation movement
If a phoria is present, this previously covered eye will shift back into the orthotropic (straight-ahead) position to reestablish sensory fusion with the other eye
Strabismus complications
amblyopia (in up to half of younger children with strabismus)
Diplopia (in acquired strabismus in patients > 8 years old
Secondary contracture of extraocular muscles
Adverse psychosocial and vocational consequences
when to refer (strabismus)
Constant strabismus at any age
Intermittent manifest strabismus after 4-6 months of age
Persistent esodeviations after 4 months of age
Abnormal corneal light reflex test or cover test
Deviation that changes depending on position of gaze
Diplopia or asthenopia
Parental concern about ocular alignment
Corneal light reflex (Hirschberg test)
shining a light onto the child’s eyes from a distance and observing the reflection of the light on the cornea with respect to the pupil. The location of the reflection from both eyes should appear symmetric and generally slightly nasal to the center of the pupil
Treatment (strabismus)
Non-surgical = glasses, contacts, occlusion therapy, visual training exercises
Surgical = recession, resection and transposition of extraocular muscles
Amblyopia - what it is
Functional reduction in visual acuity caused by abnormal visual development early in life
50% of cases related to strabismus
predominately unilateral (defined as as ≥ 2 line difference in visual acuity between eyes)
Amblyopia risk factors
prematurity,
small for gestational age,
first-degree relative with amblyopia,
neurodevelopmental delay
Amblyopia MCC of
ped visual impairment (1-4% children)
One of the reasons we assess vision in preschool-age children!
Vision screening at age 3, 4, and 5
Refer to ophthalmology/optometry if suspected
Leukocoria
White pupillary reflex
Leukocoria common causes
Retinoblastoma!
Cataract, coats dz, persistent fetal vasculature, vitreous hemorrhage, ocular toxocariasis, Hereditary retinal dysplasia
Retinal detachment, Coloboma, Astrocytic hamartoma
Retinoblastoma
Most common primary intraocular malignancy of childhood
accounts for 10-15% cancers that occur w/i first year of life
median age at dx = 18-20 months
typically presents at leukocoria in a child <3 years
Retinoblastoma other S/S
Strabismus!
Nystagmus; red, inflamed eye; decreased vision; FH
Retinoblastoma Treatment
deadly if untreated, tx is very successful (>95% 5-year survival rate)
multidisciplinary approach
- chemo
- surgery
- cryotherapy
- laser photoablation
Retinitis Pigmentosa
Causes progressive loss of night and peripheral vision
Retinitis Pigmentosa
group of inherited dystrophies = progressive degeneration and dysfunction of retina
Primarily affects photoreceptor and retinal pigment epithelial function
May occur alone or as part of a syndrome
May be inherited or occur sporadically
Retinitis Pigmentosa - Ophtho findings
Attenuation of retinal blood vessels
Waxy pallor of optic disc
Intraretinal pigmentation in a bone-spicule pattern
Retinitis Pigmentosa - Treatment
no great tx currently
Conjunctivitis
Inflammation of the mucous membrane that lines the surface of the eyeball and inner eyelids
Conjunctivitis - 3 types
Viral
Bacterial
Allergic
Conjunctivitis - Mode of transmission:
direct contact of contaminated fingers or objects to other eye or other persons
Conjunctivitis - symptoms
foreign body sensation
scratching/burning
itching
photophobia
sensation of fullness around eyes
Viral conjunctivitis
MCC = adenovrius
May or may not be part of viral prodrome followed by adenopathy, fever, pharyngitis, URI
Viral conjunctivitis usually sequential
bilateral dz
spreads easily
Viral conjunctivitis presentation
Conjunctival injection with WATERY or mucoserous discharge
Burning, sandy, gritty feeing in one eye
May have crusting in the morning and scant mucus throughout the day
May see small amount of mucoid discharge when pulling down lower lid on exam, but usually profuse tearing
+/- follicular appearance of tarsal conjunctiva
Viral conjunctivitis management
no specific tx
lasts up to 2 weeks; may get worse before better (consult pts on this)
Artificial tears and cold compresses may help discomfort
Viral conjunctivitis made up story
Adens kid FOLLed 2 weeks ago at the Sandy shore. His kids EYES (both eyes watery) filled with water because it he just had a viral infection. I told that kid it may get worse before it gets better. It was COLD that day anyway.
Bacterial Conjunctivitis MC organisms
Staph aureus, Strep pneumo, Haemphilus species, Pseudomonas (contact lens wearers), Moraxella
“Some Say Hairy People that wear contacts Make bacterial conjunctivitis)”
other causes gonococcal conjunc. and chlamydial conjun.
“they have gonorrhea and chlaymdia and are very contagious”
Bacterial Conjunctivitis other factors
usually unilateral
highly contagious
Bacterial Conjunctivitis clinical presentation
Purulent eye discharge
Eyelid matting
Mild discomfort
Mild blurring of vision
Bacterial Conjunctivitis - management
Usually self-limited
Lasts 10-14 days if untreated
Topical antibiotics may hasten remission
May consider depending on back-to-school considerations
Erthryo ointment or Bactrim (TMX-SMP) drops
Contact lens wearers must always be treated!
(fluoroquinolones drop such as ofloxacin or ciprofloxacin)
Made up story Bact. Conjunc.
Some Say Hairy People that wear contact lens Make bacterial conjunctivitis in one eye. They have Gonorrhea and Chlamydia so they are very Contagious. They discharge constantly and pray on a Mat that is goes away. Luckily is doesn’t hurt too bad and they just have mild blurry vision, this should be a Self lesson. Maybe a 2 week lesson. I they are in school they can have antibiotic topicals because we don’t want them to come BACk with red eyes (erythromycin) and if they do wear contact lens they should be treated with eye drops Of Course (ofloxacin and ciprofloxacin). She needs new makeup anyway and forget about them contacts until the discharge is gone for another 24.
Contact users for Bact. Conjunc.
ciprofloxacin vs ofloxacin
Don’t wear contacts until no longer red and no discharge 24 hours after taking meds; change makeup esp. things like eyeliner
Gonococcal Conjunctivitis
usually acquires thru genital secretions
ophthalmic emergency!
Gonococcal Conjunctivitis - clinical presentation
Copious purulent discharge
Gonococcal Conjunctivitis - Diagnosis
confirm with stained smear and culture of discharge
Gonococcal Conjunctivitis - Management
Single dose ceftriaxone IM
May add topical erythro/bacitracin
Also treat for chlamydia (doxy)
Consider other STIs
Chlamydial Conjunctivitis
Trachoma = chronic keratoconjunctivitis caused by recurrent infection with Chlamydia trachomatis
Chlamydial Conjunctivitis
MC in
children
Typically asymptomatic
May have eye redness, discomfort, light sensitivity, and mucopurulent discharge
Recurrent episodes cause bilateral follicular conjunctivitis, epithelial keratitis, corneal vascularization, scarring of tarsal conjunctiva
Scarring of tarsal conjunctiva leads to entropion and trichiasis
Chlamydial Conjunctivitis -
Adult inclusion conjunctivitis
Chronic, indolent conjunctivitis caused by certain serotypes of C. trachomatis
Concurrent asymptomatic urogenital infection typically present
Usually unilateral follicular conjunctivitis lasting weeks-months that has not responded to topical antibiotics
Chlamydial Conjunctivitis - Diagnosis
Giemsa or DFA stain of conjunctival smears or culture of swabbed specimen
Chlamydial Conjunctivitis - Treatment
Single dose of azithromycin PO
surgery to correct lid deformities
Allergic Conjunctivitis
Usually associated with atopy:
Eczema, asthma, allergic rhinitis
May be seasonal (hay fever); usually in spring/summer
Bilateral
Allergic Conjunctivitis - Clinical Presentation
Itching
Conjunctival hyperemia and edema (chemosis)
Watery discharge
Cobblestoning of upper tarsal conjunctiva
Itching
Allergic Conjunctivitis - Management
Avoid known allergens
Avoid rubbing
Cool compresses
Artificial tears
Avoid contact lenses
Topical therapy (see next slide)
Oral H1 antihistamines
Examples of antihistamines for Allergic Conjunc.
Olopatadine (OTC) - usually 1st line + oral antihistamine
Vasoconstrictor/antihistamine combo (allergic conjunc)
Usually not recommended b/c after using can make eyes red
Naphazoline and pheniramine (OTC)
Mast cell stabilizers (allergic conjunc)
can be used if initial antihistamine not effective enough
Rx only
Cromolyn sodium
Nedocromil
Big Picture - Bacterial Conjunc.
unilateral or bilateral
Discharge most prominent symptom
Eye often “stuck shut” in morning
No other symptoms
“red eye”
Big Picture - Viral Conjunc.
Unilateral or bilateral
Sensation of grittiness, burning, or irritation
Crusting on lid margin in morning
May be part of viral URI w/ associated nasal congestion or pharyngitis
“red eye”
Big Picture - Allergic Conjunc.
Typically bilateral
Itching
Sensation of grittiness, burning, or irritation
Crusting on lid margin in morning
May have other allergic symptoms, such as nasal congestion, sneezing, cough, wheezing
“red eye”
Bacterial Conjuctivits - Tx
self limited
topical abx may shorten symptom duration and required for contact lens wearers
Viral Conjunctivitis - Tx
Self limited
topical antihistamines and/or topical decongestants
warm or cool compresses
Allergic Conjunctivits - Tx
minimizing exposure to allergen
topical lubricants
cool compresses
topical or systemic antihistamines
Dacryocystitis
Infection of lacrimal sac secondary to obstruction of nasolacrimal duct
Thought to be related to chronic inflammation resulting in fibrosis within the duct
uncommon
Dacryocystitis Pathogens
S aureus, S epidermis, Pseudomonas aeruginosa or anaerobic organisms
Dacryocystitis - Clinical Presentation
Tearing/discharge
Inflammation, pain, swelling, tenderness beneath medial canthal tendon in area of lacrimal sac
May be able to express purulent drainage through lacrimal puncta by applying pressure to sac
Dacryocystitis - Diagnosis
Gram stain/culture of drainage
Dacryocystitis - Treatment
Antibiotics based on gram stain/culture results
Surgical correction
Keratoconjunctivitis Sicca
AKA Dry eye disease
Multifactorial
loss of hemostasis of tear film
Can have significant impact on visual acuity, social/physical functioning, and workplace productivity
Keratoconjunctivitis Sicca- Risk factors
Advanced age
Female sex
Hormonal changes
Systemic diseases (DM, Parkinson’s, Sjogren’s)
Contact lens wear
Systemic/ocular medications
Nutritional deficiencies (vitamin A)
Decreased corneal sensation
Ophthalmic surgery
Low-humidity environments
Keratoconjunctivitis Sicca - Management
Artificial tears
Discontinue offending medications if possible
Warm compresses
Made up story - KCS
Keep Congress Stupid - they cant see what’s going on , no social life, and especially no workplace productivity. They are just so DRY. Most are old, some women with hormone changes (yikes), some had eye surgery and have to wear contacts and take medication for. They just need to have WARMer hearts or DISCONTINUE working. Cry me a river (of artificial tears)
HSV Keratitis
Ability of virus to colonize trigeminal ganglion leads to recurrences that may be precipitated by fever, excessive exposure to sunlight or immunodeficiency
Typically unilateral
HSV Keratitis - Clinical Presentation
Dendritic (branching) corneal ulcer!!!
Lid, conjunctival or corneal ulceration
HSV Keratitis - Diagnosis
Fluorescein stain and examination with cobalt blue light
HSV Keratitis - Treatment
Topical or oral antivirals
- Trifluridine drops, ganciclovir gel, acyclovir ointment (10-14 days)
- Acyclovir, valacyclovir PO
Avoid topical corticosteriods (leave to ophtho) - CS can promote viral replication
Bacterial Keratitis MC pathogens
staph, strep, Pseudomonas aeruginosa, Moraxella species, other gram neg bacilli
Bacterial Keratitis - risk factors
Contact lens wear (especially overnight)
Corneal trauma
Bacterial Keratitis - Clinical presentation
Foreign body sensation
Difficulty keeping eye open!!
Central corneal ulcer
+/- hypopyon (WBC in anterior chamber and fall to bottom = emergency!)
Mucopurulent discharge
Bacterial Keratitis - Treatment
Urgent ophtho referral
Topical fluoroquinolones applied hourly for first 48 hours
Herpes Zoster Ophthalmicus
freq involves ophthalmic division of trigeminal nerve
Involvement of tip of nose or lid margin predicts involvement of the eye
Potentially sight-threatening
Herpes Zoster Ophthalmicus - Clinical Presentation
Periorbital burning/itching
Vesicular rash that becomes pustular, then crusts
Conjunctivitis, keratitis, episcleritis, anterior uveitis
+/- elevated IOP
Herpes Zoster Ophthalmicus - Tx
Urgent ophtho referral
High dose oral antivirals
(Acyclovir, valacyclovir, famciclovir x 7-10 days)
Periorbital Cellulitis
AKA preseptal cellulitis
Infection of soft tissues anterior to orbital septum
Does not involve orbit or other ocular structures
May be confused with orbital cellulitis
Generally mild, rarely leads to serious complications
May arise from sinusitis or local trauma
Periorbital Cellulitis - Pathogens
If related to sinuses or nasopharynx = S pneumo, Moraxella, H influenzae
If arising from trauma or other skin infection = Staph aureus, Strep pyogenes
Periorbital Cellulitis - Clinical Presentation
Unilateral ocular pain
Eyelid swelling and erythema
Does NOT affect visual acuity or extraocular movements
Periorbital Cellulitis - Treatment
Empiric abx
Amoxicillin/clavulanate
Consider admission in children < 1 year old, severely ill, or unsure if orbit is involved
Orbital Cellulitis
Infection involving contents of orbit (fat and extraocular muscles)
Can be vision/life-threatening
MC in children
Typically caused by infection of paranasal sinuses
Orbital Cellulitis - Clinical presentation
Fever
Proptosis
Restriction of extraocular movements
Pain/swelling with redness of lids
Decreased visual acuity
Orbital Cellulitis - Diagnosis
CT/MRI
Culture if purulent drainage on exam
Orbital Cellulitis - Treatment
Urgent IV abx to prevent optic nerve damage and spread of infection
Antibiotic choice depends upon pathogen
Empiric = vancomycin + ceftriaxone
+/- surgical drainage of paranasal sinuses/orbital abscess
Orbital Cellulitis - Complications
Cavernous sinus thrombosis
Intracranial extension
Vision loss
Death
Big picture - Preseptal Cellulitis
Eyelid swelling w/ or w/o erythema
Eye pain/tenderness may be present
chemosis rarely present
Fever and leukocytosis may be present
Big Picture - Orbital Cellulitis
Eyelid swelling w/ or w/o erythema
Eye pain/tenderness
Pain w/ eye movements
Proptosis usually but may be subtle
Ophthalmoplegia +/- diplopia may be present
vision impairment may be present
Chemosis and leukocytosis may be present
Fever usually present
Blepharitis
Chronic bilateral inflammatory condition of lid margins
- Anterior = involves lid skin, eyelashes and associated glands
- Posterior = results from inflammation of meibomian glands
Common cause of recurrent conjunctivitis
Blepharitis - Clin Pres
Irritation, burning, itching
Anterior = “red-rimmed” eyes with scales clinging to lashes
Posterior = hyperemic lid margins with telangiectasias, inflamed meibomian glands
Blepharitis - Tx
Anterior = warm compresses, eyelid cleansing with baby shampoo, antibiotic ointment for acute exacerbations
Posterior = Regular meibomian gland expression, warm compresses
Chalazion
Common granulomatous inflammation of a meibomian gland that may follow an internal hordeolum
Chalazion - Clin Pres
Hard, NONTENDER swelling on upper or lower lid
Redness and swelling of adjacent conjunctiva
Chalazion - TX
Warm compresses
Incision and curettage if not resolved in 2-3 weeks
Corticosteroid injection may be effective
Typically improve over several months- refer to ophtho for IL corticosteriod injection or surgical removal
Hordeolum (stye)
Acute infection/abscess of either meibomian gland (internal) or gland of Zeis or Moll (external)
MC due to staph aureus
Hordeolum - Clin Presentation
Localized red, swollen, TENDER area of upper or lower lid
Hordeolum - Tx
Warm compressions
Incision if not resolved in 48 hours
Topical antibiotic ointment applied every 3 hours during acute stage
Generally improves w/i 1-2 weeks
Hordeolum - complications
Internal hordeolum may lead to generalized cellulitis of lid
Chalazion - risk factors
Rosacea, posterior blepharitis
Hordeolum - risk factors
Rosacea, seborrhiec dermatitis, use of eye make-up
Cataracts
Opacities of crystalline lens
Usually bilateral
Leading cause of blindness worldwide
MCC = age
Cataracts - other causes
Congenital
Traumatic
Systemic disease (DM)
Topical, systemic, or inhaled corticosteroid treatment
Uveitis
Radiation exposure
Cataracts - risk factor
smoking cigarettes
Cataracts - clinical presentation
Progressive blurring of vision
Flare in bright lights or night driving
Cataracts - Tx
Surgery (improves visual acuity in 95% of cases)
Topical eye drops to dissolve or prevent cataracts are being experimented
Cataracts - Prevention
Multivitamin/mineral supplement
High dietary antioxidants
Chronic Glaucoma
Gradually progressive excavation (“cupping”) of optic disk with progressive loss of vision (slight visual field loss to complete blindness)
3 types of Chronic glaucoma
Open- angle (Elevated IOP due to reduced drainage of aqueous fluid through trabecular meshwork)
Angle-closure (Obstruction of flow of aqueous fluid into anterior chamber)
Normal-tension (Normal IOP but same pattern of optic nerve damage)
Chronic Glaucoma
Dx requires consistent and reproducible abnormalities in at least 2/3 parameters:
Often first suspected at routine eye test
- Optic disk cupping = an increase or asymmetry between the two eyes of the ratio of diameter of optic cup to diameter of whole optic disk (ratio > 0.5 or asymmetry > 0.2)
- Visual field abnormalities (central vision remains good until late in disease)
- Intraocular pressure = Normal range 10-21 mmHg
Chronic Glaucoma - Screening targeted
Affected first-degree relative
Diabetes mellitus
Older individuals with African or Hispanic ancestry
Long-term use of corticosteroids
Chronic Glaucoma - Tx
Prostaglandin analog eye drops
- Latanoprost, bimatoprost
Alpha-2-agonist, topical carbonic anhydrase inhibitors can be used in addition
- Brimonidine, brinzolamide
Laser therapy/surgery
Open-angle glaucoma = trabeculectomy
Angle-closure glaucoma = iridotomy/iridectomy
Acute Angle-closure Glaucoma (Primary)
Results from a closure of preexisting narrow anterior chamber angle
Closure of angle precipitated by pupillary dilation
Acute Angle-closure Glaucoma (Secondary)
Does not require preexisting narrow angle
May occur with anterior uveitis, dislocation of lens, hemodialysis, or various drugs
Acute Angle-closure Glaucoma - Clin Pres
Same symptoms but diff management
Extreme pain
Blurred vision
Halos around lights
+/- nausea, abdominal pain
Red eye, cloudy cornea, moderate dilated pupil that is nonreactive to light
IOP > 50 mm Hg
Hard eye on palpation
Acute Angle-closure Glaucoma - Tx
Initial treatment is reduction of IOP with IV acetazolamide + topical medications
Acute Angle-closure Glaucoma - Tx
Primary
Topical 4% pilocarpine q 15 mins x 1 hour, then four times a day
Cataract extraction (definitive; sometimes done first-line)
Laser peripheral iridotomy
Consider prophylactic laser peripheral iridotomy to unaffected eye
Acute Angle-closure Glaucoma - Tx
Secondary
Treat underlying cause
Acute Angle-closure Glaucoma - Prognosis
Results in permanent visual loss within 2-5 days if not treated
Macular Degeneration
Age-related is leading permanent visual loss in older population
Prevalence progressively increases over age 50
Slight female predominance
Macular Degeneration - Risk factors
Family history
HTN
Hyperlipidemia
CVD
Farsightedness
Light iris color
Cigarette smoking
Macular Degeneration - 2 types
Wet
Dry
Macular Degeneration - Clin Pres
Drusen
Hard drusen = discrete yellow subretinal deposits
Soft drusen = paler and less distinct
Central vision loss
“Dry” = gradually progressive bilateral visual loss
“Wet” = more rapid and severe onset of visual loss
Macular Degeneration - Tx
Dry = no specific treatment
Wet = rehabilitation including low-vision aids; VEGF inhibitors
(Ranibizumab, bevacizumab, aflibercept, brolucizumab)
Stop smoking
Vitamin supplements can reduce progression = vitamins C and E, zinc, copper, carotenoids
Retinal Detachment 3 types
Rhegmatogenous (most common)
Tractional
Exudative
Retinal detachment - Rhegmatogenous
One or more peripheral retinal tears or holes
Usually results from posterior vitreous detachment related to degenerative changes in vitreous
Can also be caused by penetrating or blunt trauma
Often occurs in people > 50 years of age
Retinal detachment - Tractional
preretinal fibrosis (as in proliferative retinopathy due to diabetic retinopathy or retinal vein occlusion)
OR
complication of rhegmatogenous retinal detachment
Retinal detachment - Exudative
accumulation of subretinal fluid
, (neovascular age-related macular degeneration or secondary to choroidal tumor
Retinal Detachment - Clin Pres
Rapidly progressive visual field loss
Floaters
Photopsias
Retina may be seen elevated in vitreous cavity with an irregular surface on ophthalmoscopic exam
Retinal Detachment - Tx
Laser photocoagulation
Pneumatic retinopexy = (expansile gas injected into vitreous cavity and patient’s head is positioned to facilitate apposition between gas and the hole, which permits reattachment of retina
Vitrectomy, direct manipulation of retina, internal tamponade of retina with air, expansile gas, or silicone oil
Corneal Abrasion
Defect in epithelial surface of the cornea - mechanical trauma
Can be traumatic (related to foreign body or contact lens) or spontaneous
Corneal Abrasion - Clin Pres
Severe eye pain
Photophobia
Foreign body sensation preventing opening of eye
Corneal Abrasion - Dx
Clinical
Can be confirmed on fluorescein stain
Evert eyelid to assess for presence of retained foreign body
Corneal Abrasion - Management
Removal of foreign body
Topical antibiotics
Cycloplegics for large abrasions (inhibit miotic response to light)
Oral/topical NSAIDs
Globe Rupture
Occurs following blunt eye injury
Globe Rupture - Clin Pres
Decreased visual acuity
Relative afferent pupillary defect
Eccentric or teardrop pupil
Increased or decreased anterior chamber depth
Extrusion of vitreous
External prolapse of uvea
Tenting of cornea or sclera at site of injury
Low IOP
Globe Rupture - Management
Emergent ophtho consult!
Pain control, IV abx
Surgical repair
Subconjunctival Hemorrhage
May occur spontaneously or with Valsalva associated with coughing, sneezing, straining, or vomiting
Generally asymptomatic
Subconjunctival Hemorrhage - Dx
confirmed by normal visual acuity and absence of S/S
Subconjunctival Hemorrhage - Prognosis
Blood generally resorbs over 1-2 weeks (may seem to increase on second day)
No specific treatment
Hyphema
Blood in the anterior chamber
Common complication of blunt or penetrating eye injury
Can result in permanent vision loss
Hyphema- Clin Pres
Vision loss
Eye pain
Photophobia
Anisocoria
N/V if elevated IOP
Often accompanied by corneal abrasion
Hyphema _ Dx
Clinical
Must exclude open globe
Hyphema - Management
Eye shield
Bed rest/dim lighting
Elevate HOB to 30 degrees
Topical pain control
Close monitoring by ophtho
Pterygium
Fleshy, triangular encroachment of conjunctiva onto the cornea
Usually associated with prolonged exposure to wind, sun, sand, and dust
Often bilateral
Occurs more frequently on nasal side of the conjunctiva
May become inflamed and may grow
Pterygium - Tx
rarely required
indicated when growth threatens vision
Pinguecula
Yellowish, elevated conjunctival nodule in area of palpebral fissure
Common in people > age 35 years
Often bilateral
Occurs more frequently on nasal side of the conjunctiva
Rarely grows but may become inflamed
Pinguecula - Tx
rarely required
artificial tears beneficial
Entropion
inward turning of eyelid
Entropion Occurs occasionally in
older people as result of degeneration of lid fascia
May follow extensive scarring of conjunctiva and tarsus
Entropion - Tx
surgery if lashes rub cornea;
botulinum toxin injections may help
Ectropion
outward turning of eyelid
Common with advanced age
Ectropion - tx
surgery if excessive tearing, exposure keratitis, or cosmetic problem
