Ophthalmology Flashcards
Clinical features of a corneal abrasion
Caused by minor trauma
pain and sensation of foreign body
+/- photophobia, tearing, injection
Corneal abrasion tx
Topical anesthetic (Proparacaine) ONLY to assist in dx
Saline irrigation
Abx e.g. gentamicin or sulfacetamide
Acetaminophen for analgesia
Patching for no longer than 24 hours
Daily follow-up
NEVER prescribe steroids
Corneal ulcer clinical features
pain, photophobia, tearing
circumcorneal injection and watery/purulent discharge
Fluorescein staining
- dense corneal infiltrate
- overlying epithelial defect
Corneal ulcer
topical anesthetic for eye ONLY used for exam purposes
Proparacaine
never leave in the room with patients
Herpes keratits
(Herpes Simplex Virus (HSV) of the eye)
Corneal ulcer tx
Refer to ophthalmologist
NEVER prescribe steroids
Herpes keratitis tx
Acyclovir 400 mg 5x daily
Valacyclovir 500 mg TID
Refer to ophthalmology
Patient reports painless acute blurred or loss of vision over several minutes to hours. She describes it as a curtain being drwn over the eye from top to bottom. What do you suspect?
Retinal detachment
Bilateral detachment occurs in 20% of cases
Retinal detachment tx
Emergency consult with ophthalmologist
Keep pt supine with head turned to the side of the retinal detachment
Leading cause of irreversible central vision loss
Macular degeneration
70 yo patient presents with sudden, painless, and marked unilateral loss of vision. PMH includes HTN, diabetes, and glaucoma. Funduscopy reveals pallor of the retina, retinal edema, and perifoveal atrophy (cherry red spot). What do you suspect and how are you going to treat the pt?
Central retinal artery occlusion
Emergency referral to ophthalmologist
Place pt in recumbent position
Patient presents with sudden, unilateral, painless blurred vision or complete visual loss. PMH includes diabetes, hyperlipidema, and glaucoma. Exam shoes afferent pupillary defect, optic disc swelling, and a “blood and thunder” retina (dilated veins, hemorrhages, edema, and exudates). What do you suspect?
Central retinal vein occlusion
Leading cause of blindness in adults in the US
diabetic retinopathy
Cataract
What is glaucoma and which form is most common?
An increase in IOP with optic nerve damage. Increased IOP is due to increase production or decreased flow of aqueous humor through the trabecular meshwork resulting in increase pressure in the anterior chamber
MC = Open-angle glaucoma
Risk factors for open-angle glaucoma
>40 years
African American
Family hx of glaucoma or diabetes
Patient presents with painful eye and loss of vision. PE reveals circumlimbal injection, fixed mid-dilated pupil, decreased VA. and tearing. Anterior chamber is narrowed and IOP is acutely elevated. Nausea, vomiting and diaphoresis are common.
Angle-closure glaucoma
Angle-closure glaucoma tx
Emergency referral to ophthalmologist
Meds
- IV carbonic anhydrase inhibitor (i.e. acetazolamide)
- topical ß-blocker
- osmotic diuresis
Chronic, asymptomatic, and potentially blinding disease that affects 2% of population.
Patient presents with:
- elevated IOP
- defects in peripheral vision
- increased cup:disc ratio
What do you suspect?
Open-angle glaucoma
Open-angle glaucoma tx
Referral to ophthalmologist
Decrease IOP by decr aqueous production
-
B-blocker
- Timolol
-
Carbonic anhydrase inhibitors
- Dorzolamide
- Brinzolamide
Increase outflow
-
Prostaglandin-like meds
- Latanoprost, Bimatoprost, Travoprost
-
Cholinergic agents
- Pilocarpine
Both
-
alpha-agonists
- brimonidine
Normal IOP
12-22 mmHg
Condition characterized by:
- red, irritated lid margins
- dry flaking to the eyelashes
- oily discharge
- dandruff-like depostis (scurf)
- fibrous scales (collarettes)
Blepharitis (seborrheic or staphylococcal)
Blepharitis tx
Warm compressses
Wash eyelids with baby shampoo
Artificial tears
