Ophthalmology Flashcards
Blepharitis w/ intense itching, rubbing, rash or contact sensitivity; allergic rxn. Margins of eyelids are edematous and erythematous
Acute nonulcerative
Blepharitis that is crusty
Acute ulcerative: bacterial
Cause of spots or floaters
Benign vitreous opacities, posterior vitreous detachment w/risk of retinal damage, vitreous hemorrhage or posterior uveitis.
Diplopia
Double vision
Cause of Diplopia
Ocular misalignment: eye movement disorders (muscles) or cranial nerve palsies, orbital disease, orbital fracture.
Monocular diplopia- refractive error or lens opacities
Leading cause of blindness or vision loss
- Cataract
- Uncorrected refractive error
- Age related macular degeneration
Sx of Hordeolum
Redness of eyelid, swelling, pain, tearing, photophobia, foreign body
Types of Hordeolum
External; of the hair follicles
internal; of the meibomian gland
Pathophysiology of Hordeolum
Blocked sebaceous glands
Tx of Hordeolum
Warm compress for 5-10 min, 3-4 times daily. Drainage or Rx if does not respond to Tx
Difference between Hordeolum and Chalazion
Hordeolum: usually involves lashes and is painful
Chalazion: involves meibomian gland on lid, painless
What is a noninfectious obstruction of the meibomian gland?
Chalazion
Pathophysiology of Chalazion
Meibomian gland becomes blocked. Often chronic, usually painless, can follow internal hordeolum. Can be
Inflammation of the eyelid margins
Blepharitis: acute or chronic
Types of Blepharitis
Acute ulcerative (bacterial or virus), acute non ulcerative, chronic
Acute ulcerative: bacterial
Usually staphylococcal, affects eyelid margins at origins of lashes.
Chronic Blepharitis
Non-infectious inflammation of unknown cause. Often seen in patients with Rosacea , reoccurring hordeola or chalazia.
Itching and burning of eyelid margins, conjunctival irritation w/ lacrimation, photosensitivity, foreign body sensation. Dilated glands that may exude waxy, yellowish secretions. Can have greasy, but easily removed scales of eyelid margins.
Sx of Blepharitis
Dx of Blepharitis
Slit lamp exam
Tx of Blepharitis
Warm compress, cleaning w/ baby shampoo, gentle removal of scales.
Acute: antibiotic ointment
Causes of eye redness
- Hyperemia (excess of blood in vessels) of conjunctiva, ciliary, episcleral vessels
- Erythema of eyelids
- Subconjunctival hemorrhage
Causes of eye pain
- Trauma
- Infection
- Inflammation
- Increase in IOP
Causes of feeling of foreign body in eye
- Foreign body
- Eyelashes rubbing (trichiasis)
- Disturbance of corneal epithelium
Causes of photophobia
Usually: corneal inflammation or anterior uveitis
Rarely: albinism, aniridia, cone dystrophy, or fever associated with various systemic infections.
Causes of eye itching
Allergic eye disease
Causes of eye scratching or burning
- Lacrimal gland hypofunction, secondary to systemic disorders (eg, Sjögren disease)
- Drugs (eg, atropine-like agents)
- Ocular surface disease
- Dry environment.
Causes of eye watering
Inadequate tear drainage due to:
- obstruction of the lacrimal drainage system
- malposition of the lower lid
Disturbance or corneal epithelium will cause reflex tearing
Causes of “eyestrain” & headache
Refractive error: - presbyopia - inadequate illumination - latent ocular deviation Giant cell arteritis Acute angle closure glaucoma
Causes of conjunctival discharge
Bacterial infection of the conjunctiva, cornea, or lacrimal sac
Causes of visual loss
reduced visual acuity
Refractive error, corneal opacities, cataract, intraocular inflammation (uveitis), vitreous hemorrhage, retinal detachment involving the macula, diabetic retinopathy, central retinal vein occlusion, central retinal artery occlusion, macular degeneration, optic nerve disorders.
Cause of monocular visual loss
Disease of the retina or optic nerve
Better eye less than 20/60 but 20/400 or better
Low vision
Best corrected distant visual acuity in the better eye of less than 20/400 or widest diameter of the visual field of an angle less than 20 degrees
Blindness
Emergent vs urgent referring for diplopia
Emergent: recent onset isolated third nerve palsy, particularly if there is pupillary involvement or pain. (inter cranial aneurysm)
Urgent: any other recent onset of diplopia
Admit emergently: Giant cell arteritis
Causes of “Spots Before the Eyes” & “Flashing Lights”
Commonly benign vitreous opacities.
Together with flashing lights: refer urgently for possible retinal tear or detachment
Causes of a large, poorly reacting pupil
- Third nerve palsy
- Iris damage caused by acute glaucoma
- Acute tonic pupil (autonomic nervous sys disorder)
- Rx
Causes of a small pupil
- Horner syndrome
- inflammatory adhesions between iris and lens
- long-standing tonic pupil
- neurosyphilis (Argyll Robertson pupils)
Causes of pupillary light reaction
Optic nerve disease
When to refer to Ophthalmology emergently
Sudden vision loss due to:
- giant cell arteritis
- acute glaucoma
- corneal ulcer
- acute anterior uveitis
- orbital cellulitis
- gonococcal keratoconjunctivitis
- ocular trauma
- contact lens wearer with acute, painful red eye- bacterial keratitis
When to refer to Ophthalmology urgently
- Acute anterior uveitis
- Gradual loss of vision
Refractive errors
Myopia
Hyperopia
Presbyopia
Astigmatism
Farsightedness, eye too short and focus in behind retina
Hyperopia
Nearsightedness, eye too long and focus anterior to retina
Myopia
Uneven curvature of the cornea
Astigmatism
Presbyopia
Gradual loss of accommodation with age. Usually start to notice inability to focus at normal reading distance around age 45
Treatment for refractive errors
- Glasses/contacts lens
- Surgery
- Rx, rigid contacts worn at night, or soft lenses may reduce rate of progression
Risks for contact lens use
bacterial, amebic, or fungal corneal infection
Infection of the lacrimal sac
Dacryocystitis
Most common cause of viral conjunctivitis
Adenovirus
Rx to treat inflammation
Steroid
