Ophthalmology in Primary Care Lecture Powerpoint Flashcards
fuck
Corneal abrasion
Patient presents with pain, tearing, and photophobia second to corneal epithelium trauma, clinically diagnosed with fluorscein dye stain, treat with topical antibiotics because increased risk of infection, use topical erythromycin , most of time does not require patching unless large abrasion
Upon removal of foreign body from the eye need referral to ophthalmology to remove..
….residual rust ring
Morgan lens
Contact lens that is connected to IV tube that irrigates the lid and the corneal surface to flush out eyes after chemical burn until pH returns to normal
Numbness in cheeks and upper lip suggests ___ fracture, numbness in eyebrow and forehead suggests ___ fracture
floor, roof
Chalazion (stye)
Blocked meibomian gland or eyelash hair follicle? that presents with a wel defined, subcunaeous nodule within the eyelid
A Chalazion (stye) is NOT a ____
infectious process, don’t need antibiotics
Chalazion treatment (3)
- Warm compresses to eyelid
- doxy BID for its anti oil properties (like acne meds)
- intralesional injection of steroids
Dacryocystis treatment (4)
- oral antibiotics augmentin
- IV if severe
- warm compress
- referral for I&D
Preseptal cellulitis lacks these 4 things compared to orbital cellulitis
- no conjunctival redness
- no pain with eye movement
- no restriction of extraocular mobility
- Can treat outpatient instead of admit for IV antibiotics in hospital
Herpes zoster ophthalmicus affects what dermatome?
V1 (ophthalmic division of trigem)
Hutchinson’s sign
A rash that involves the nose that predicts herpes zoster ophthalmicus and other diseases associated from this
Typical treatment for bacterial conjunctivitis (2)
- moxifloxacin
- ofloxacin
“True” pink eye
Viral induced conjunctivitis, watery, droopy lid, pinkish coloration
Clinical sign: Inferior tarsal conjunctival follicles
Pale, dome shaped nodules tender upon palpation in the area around the eye indicative of viral conjunctivitis
Clinical sign: Upper tarsal conjunctival papillae
Small flattened nodules with a central vascular core see on the upper lid indicative of allergic conjunctivitis
3 topical mast cell stabilizers for allergic conjunctivitis
- zaditor
- alaway
- pataday
In patients with allergic conjunctivitis want to avoid ____ products because _____
“get the red out”, rebound hyperemia when stopped
Contact lens overwear can cause 2 possible conditions
- non infectious overwear can cause vascularity to grow in the cornea
- infectious leads to corneal ulcer
Most common cause of bacterial corneal ulcer
Improper contact lens wear/care
Clinical sign: Dendritic branching staining pattern on flurescin staining of eye
Herpes simplex virus
Elderly patient with “red eye” with nausea and vomiting likely indicates…
….high intraocular pressure
Definitive reatment for acute angle closure glaucoma
Laser peripheral iridotomy
Clinical sign: Leukocoria
When a white pupillary reflex is noted rather than normal on a fundoscopic exam which can indicate malignant lethal tumor called retinoblastoma, assume tumor until proven otherwise
Possible causes of leukocoria (4)
- Retinoblastoma
- Toxocariasis
- Coat’s disease
- Congenital cataracts
Congenital nasolacrimal ductobstruction
Persistent tearing, crusting of eyelashes
Clinical sign: wet looking eyes, reflex of mucopurulent material from punctum when pressure is applied over lacrimal sac
Indicates congenital nasolacrimal duct obstruction, different from conjunctivitis in that conjunctiva is not injected
How do differentiate between congenital nasolacrimal duct obstruction with congenital glaucoma which also causes tearing?
Enlarged globe and corneal diameter >12mm is indicative of glaucoma
Congenital nasolacrimal duct obstruction treatment (3)
- digital massage 2-4x a day over duct
- moxifloxacin drops or erythromycin ointment
- physical opening of tube
Amblyopia
An eye that does not see well due to abnormal visual development, develops during first decade of life and does not worsen later on
Clinical sign: poorer vision in an eye that cannot be improved with glasses
Amblyopia
Amblyopia origin (3)
- idiopathic (most common)
- anisometropia (major diff in refractive error between eyes, eye with worse refractive error sends blurred image to retina and visual pathways and visual cortex is not stimulated)
- strabismus (misalignment of eyes either esotropic or exotropic or hyper hypo tropic, if it is intermittent and alternates between two eyes, good vision can still develop but if constant in one eye amblyopia will likely occur
How strabismus can lead to amblyopia
When eyes are misaligned, 2 diff images sent to brain resulting in diplopia, during visual development brain shuts down to deviated eye to avoid diplopia, as reesult visual cortex is not stimulated properly causing poorer vision results in the nonfixating eye
How amblyopia can lead to strabismus
Good vision is an essential stimulus to keeping eyes straight, if one is amblyopic, stimulus is lost and eyes can become misaligned, disuse exotropia being most common mech of this
Adult who has good vision that then becomes double vision is likely due to…
…cranial nerve palsy
Cells in flare/cilliary flush is indicative of…
….iritis
High risk group for corneal ulceration
Contact lens wearers
Common cause of dendritic keratitis is ____, could also be herpes opthalmacus which presents with ____
Herpes simplex I viral infection often from contact lens use, associated vesicles near the eye
Epischleritis shows up only in ____ ulcerative colitis or IBS while iritis can show up in ______
active, active or not
