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HEENT > ophthalmic lecture > Flashcards

ophthalmic lecture Flashcards

1
Q

anterior segment contains

A

orbits, lids/lashes, cornea, conjunctiva,sclera, anterior chamber/aqueous humor, iris, pupil

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2
Q

posterior segment

A

posterior vitreous, optic nerve, macula/fovea, peripheral retina, vessels (arteries and veins)

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3
Q

segment b

A

lens and ciliary body

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4
Q

LR6 +SO4+EE3

A

lateral rectus CN6 (abducens)
superior oblique CN 4 (trochlear)
everything else CN3 (oculomotor)

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5
Q

meibomian glands purpose

A

secrete the oil layer to our tear film, oil prevents tears from evaporating

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6
Q

the cornea is filled with

A

thousands of tiny nerve endings that make the cornea extremely sensitive to pain.

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7
Q

The pathway for the outflow of aqueous humor.

A

Aqueous humor produced by ciliary body -> flows through the pupil into the anterior chamber -> flows out through the trabecular meshwork into the canal of schlemm -> absorbed into the episcleral veins via the collector channels.

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8
Q

macula is in charge of our

A

central vision

also contains pigmented cells called cones

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9
Q

optic nerve is in charge of

A

our peripheral vision

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10
Q

periorbital (preseptal) cellulitis
define
s/s
tx

A
  • Bacterial infection of eyelid anterior to orbital septum that occurs 2° to sinusitis, trauma, ocular Sx, hordeolum, etc.
  • s/s = eyelid tenderness, erythema, and edema; (-) proptosis, (-) pain on EOMs, (-) vision changes
  • Tx = Mild = PO Abx (amoxicillin, Bactrim); moderate - severe = hospital admission + IV Abx (vancomycin, clindamycin, cefotaxime)
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11
Q

orbital (septal) cellulitis
define
s/s
tx

A
  • Bacterial infection that occurs Most commonly 2° to sinusitis
  • s/s = eyelid tenderness, erythema, and edema; (+) proptosis (bulging), (+) pain on EOMs, (+) decreased vision
  • Tests = assess EOMs, CT scan (infection of the orbital fat and EOMs), CBC with diff
  • Tx = hospital admission + broad spectrum IV abx
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12
Q

dacrocytitis

A

bacterial infection of the lacrimal sac

most common is staph aureus

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13
Q

dacrocytitis s/s

A

pain, erythema and edema over lacrimal sac/medial canthus (nasal side of the lower lid)

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14
Q

orbital blowout fractures

A

the force from a direct traumatic blow to the eye, - a fracture of thin bones of the orbital floor

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15
Q

orbital blowout fracture complications

A

the contents of the orbit EOM, fat ect, can get entrapped which leads to the following :
decreased visual acuity, diplopia (especially upward gaze if there is inferior rectus entrapment), restricted eye movement, ptosis

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16
Q

orbital blowout fracture s/s

A

pain, tenderness, orbital emphysema (eyelid swelling after blowing nose), ecchymosis

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17
Q

ectropion

A

eyelid turned outwards

most common in elderly and aging

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18
Q

ectropion s/s & tx

A
  • irritation, tearing (epiphora), foreign body sensation

- artificial tears, blepharoplasty

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19
Q

entropion

A

eyelid turned inward

most common in elderly and aging

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20
Q

entropion s/s & tx

A

irritation, tearing (epiphora) foreign body sensation, corneal abrasions- leads to pain and vision changes
tx: artificial tears and blepharoplasty

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21
Q

hordeolum-internal

A

inflammation/bacterial infection of a meibomian gland

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22
Q

hordeolum-external

A

inflammation/bacterial infection of the glands of zeis

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23
Q

horeolum s/s &tx

A

pain, tender, warm, erythematous, swollen, soft, lump on eyelid
-hot compress, topical abx (erythormycin or bacitracin)

24
Q

chalazion

A

caused by chronically blocked meibomian gland

-untreated horeolum is a chalazion

25
Q

chalazion s/s &tx

A

nonpainful, nontender, swollen hard lump on eyelid

hot compress, eye hygein and if not resolving IND

26
Q

blepharitis

A

inflammation of both eyelids involving the skin, lashes and meibomian glands

27
Q

blepharitis s/s and tx

A

crusting on lashes, red-rimming/erythema of the eyelid, burning irritation, tearing, foreign body sensation
tx: hot compress, eyelid/lashes scrubbing, baby shampoo, messaging of meibomian gland

28
Q

viral conjunctivitis

A

most common pathogen- adenovirus- thus typically occurs with a URI
source: swimming pool
most common seen in kids

29
Q

viral conjunctivitis
s/s
tx

A

foreign body sensation, watery discharge, bilateral, no vision changes, preauricular lymphadenopathy, conjunctival injection
tx: supportive

30
Q

bacterial conjunctivitis

A

most common pathogen staph aureus, strep pneumoniae

31
Q

bacterial conjunctivitis
s/s
tx

A

purulent discharge, a lot less conjunctival injection, crusting on lashes, no vision changes, unilateral eye matted shut in the morning
tx: abx drops
if contact lens wearer cover pseudomonas w/ FQ (ofloxacin)

32
Q

allergic conjunctivtis

A

h/o seasonal allergies
s/s cobblestone mucosa to the inner eyelids, itching, bilateral
tx antihistamine drops ketotifen, olopatadine

33
Q

pingurcula

A

yellow elevated conjunctival nodule nasally
*does not grow but can get inflamed/cause irritation
no vision changes

34
Q

subconjunctival hemorrhage

A

subconjunctival bleeding due to broken vessels

most commonly from heavy lifting, sneezing, valsalva

35
Q

pyerygium

A

elevated fleshy vascular triangular shaped mass extending onto the cornea
can be nasal and temporal in origin but most commonly nasal
-tx: artificial tears, sunglasses and surgery if grown into visual axis

36
Q

corneal abrasion

A

scratched eye, foreign body

s/s blurred/decreased vision, pain, tearing, photophobia, foreign body sensation

37
Q

corneal abrasion pain relief with

A

propericaine drops

**do NOT rx

38
Q

corneal abrasion tx

A

abx drops that cover pseudomonas in contact lens wearers, bandage contact lens

39
Q

bacterial corneal ulcer

A

causes pseudomonas (in CL wearers) and acanthamoeba

40
Q

bacterial corneal ulcer
s/s
tx

A

pain, photophobia, reduced visual acuity, tearing, hazy cornea, +/-hypopyon, ulceration on fluorescein, discharge conjunctival injection, ciliary injection
tx- FQ abx drops- ofloxacin, moxifloxacin DO not place on a BCL

41
Q

viral corneal ulcer

A 
cause: HSV
h/o cold sores or previous HSV keratitis
s/s pain photophobia, tearing & decreased visual acutiy
slit lamp: dendritic
tx: PO acyclovir
42
Q

herpes zoser ophthalmicus

A

causes: herpes zoster (shingles)
s/s painful vesicular rash along CN V dermatome, eye pain, decreased visal acuity, hutchingson’s sing (lesion on nose=ocular involvment)

43
Q

Uveitis anterior

A

inflammation of the iris or ciliary body

-unilateral ocular pain, injuection, photophobia and decreased vision

44
Q

uveitis posterior

A

inflammation of the choroid (a pigmented vascular layer between the retina and sclera)
-blurred/decreased vision, floaters, no pain

45
Q

uveitis causes

A

a) granulomatous uveitis seen in: sarcoidosis, tuberculosis, syphilis, leprosy
b) non-granulomatous uveitis seen in: ankylosing spondylitis, reactive arthritis, rheumatoid arthritis, lyme disease

46
Q

uveitis tx

A

refer, topical steroids, topical cycloplegic, PO steroids, glaucoma drops due to steroids causing elevated IOP

47
Q

cataract description

A

Inside our eyes our natural lens made up of water and protein helps us see. As we age, the proteins break down causing the lens to become cloudy. This is called a cataract.
-Usually cataracts mature bilaterally

48
Q

3 main types of cataracts

A
  1. nuclear sclerotic – slow maturation, starts in 50s
  2. cortical – moderate maturation, causes myopic shift
  3. posterior subcapsular cataract (PSC) – fast maturation, common with steroid use or after vitrectomy
49
Q

ddx of cataract should include

A

retinoblastoma due to absent of red reflex (White pupil)

50
Q

cataract risk factors

A

aging, smoking cigarettes, steroid use, diabetes, sun exposure, congenital ToRCH syndrome (Toxoplasmosis, Rubella, CMV, HSV)

51
Q

macular degeration is ..

A

MCC of permanent legal blindness and visual loss in the elderly

52
Q

two types of macular degeneration

A

dry and wet

53
Q

dry macular degeneration

A

(non-exudative) exam findings
drusen = round yellow spots (lumpy-bumpy) drusen are waste products from the RPE layer
Geographic atrophy, pigmentary changes

54
Q

wet macular degeneration

A

(exudative)
Exam findings
Drusen, geographic atrophy, pigmentary changes + choriodal neovacularization
Choroidal neovascularization = new abnormal vessels that leak and bleed -> hemorrhaging, intraretinal fluid, subretinal fluid. These bad vessels secrete vascular endothelial growth factor (VEGF)

55
Q

tx for wet and dry

A 
Dry = amsler grid monitoring, eye vitamins such as PreserVision AREDS2 (zinc, A, C, E)
-Wet = intravitreal injections of Anti-VEGF inhibitors, laser photocoagulation
56
Q

s/s for macular degeneration

A 
oBilateral loss or blurring of central vision
oCentral Scotomas (black spots in central vision where atrophy or hemorrhaging is) 
oMetamorphopsia = straight lines appear bent (amsler grid)

HEENT (6 decks)

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