optometry and LP Flashcards
chalazion
- non-infectious
- inflammation of meibomian gland
- tx- hot compress
hordeolum
- infection of lash follicle and glands of zeis/moll
- tx- hot compress, topical abx, drain
preseptal cellulitis
- infection of tissue anterior to orbital septum
- tender, red, swollen
- eye exam normal*
- tx- abx for sinusitis
- refer w/ in 24 hours
orbital cellulitis
- infection of tissues ant/ post to orbital septum
- decreased visual acuity and EOM function
- proptosis
- STAT hospitalization
- tx- meningitis dose abx
slit lamp width
- narrow= slice through tissue
- wide= view gross structures
slit lamp height
- long= view in front of pupil
- short= view behind pupil and ant chamber angle
low mag on slit lamp
- 6-10 X
- lids/ lashes
- bulbar conjunctiva and sclera
- cornea
- tear film
med mag on slit lamp
- 16-25 X
- corneal epithelium
- stroma
- conjunctiva
high mag on slit lam
- 25-40 X
- corneal fine detail/ abnormalities
- stromal striae or folds
- endothelial cell changes
what is the cobalt blue filter used for on slit lam
- abrasions
- ulcers
- superficial punctate keratitis
- used with NaFl which will glow green
what types of conditions do contact lens wearers get
- neovascularization
- bacterial conjunctivitis
- microbial keratitis- pseudomonas esp, penetrates cornea in < 72 hours, requires intensive quinolone tx
what is the test used for leaking aqueous humor
- sidel test
- put fluorescein into conjunctiva
retinal detachment signs
- flashes then floaters
- veil or shade pulled over visual field
- requires same day consult
- high risk: assoc with trauma, high myopia, younger pt, recent ophthalmic surgery
posterior vitreous humor detachment signs
- flashes then floaters
- NO loss of vision or peripheral fields
- usu in pts > 50, normal in aging d/t vitreous fluid shrinking
migraine signs
- flashes that last 20 min
- +/- visual distortion
viral conjunctivitis
- most common*
- bilat, mild photophobia, tearing, injection
- usu assoc with URTI
- self limited 7-10 d
- supportive tx
epidemic keratoconjunctivitis
- highly contagious viral conjunctivitis
- treat with support +/- antivirals
- follows the rule of 8’s
rule of 8’s
- used for epidemic keratoconjunctivitis
- first 8 d: red eye with fine corneal staining
- second 8 d: lesions/ pseudomembranes
- third 8 d: infiltrates, highly contagious
what does leukocoria indicate
- retinoblastoma
- appears as white glow instead of red reflex on PE
what is the PE findings for congenital cataracts
- no red light reflex
corneal abrasions
- secondary to FB or poke
- use topical anesthetic to examine but DONT prescribe
- clean irregular edges from outside in
- requires borad spectrum abx QID
- eye consult within 24 hours
microbial keratitis
- aka corneal ulcers
- pain, photophobia, tearing, +/- mucopurulent d/c
- can be central or marginal
- decreased vision if on/near visual axis
- whitish infiltrate
- aggressive in contact lens wearers
uveitis
- red at edge of cornea- circumlimbal flush
herpes simplex keratitis
- similar to microbial but less pain d/t nerve damage
- dendritic lesions with terminal end bulbs on exam
- requires topical and PO antivirals
- refer for consult within 24 hours
emergent eye complaints
- refer within 1 hour
- chemical burns
- sudden painless vision loss
- acute trauma, penetrating eye injury
- severe eye pain with N/V and/or halos
urgent eye complaints
- requires care within 4-6 hours
- FB, corneal abrasions
- sudden onset double vision, flashes/ floaters
- sudden onset red eye +/- pain, vision changes
semi-urgent eye complaints
- requires care within 24 hours
- painful bump on eyelid
- itchy eyes
- mild eye pain with no change in vision over 2-3 days
anatomic land marks for LP
- from out to in:
- spinous process
- supraspinal ligaments
- interspinal ligaments
- ligamentum flavum (causes pop)
- epidural space
- dura mater
- arachnoid mater
how do you obtain an opening pressure
- lateral recumbent position
what is a normal opening pressure
- 18- 20 mmHg
WBCs on LP
- > 5 cells/UL suggests possible infection
- bacterial: increased neutrophils
- viral: increased lymphocytes
RBC on LP
- normal= < 10 cells/UL
- traumatic tap ruled out by xanthochromia
glucose on LP
- normal= 50-80 mg/DL
- low: bacterial meningitis, sarcoidosis, syphilis, SAH
- viral: variable
- serum hyperglycemia may mask depressed CSF glucose
protein on LP
- normal= 15-45 mg/DL
- elevated suggests infection
GN diplococci on LP
- n miningitidis
GN bacilli on LP
- h flu
GP bacterial on LP
- s pneumo
- other strep and staph spp
xanthochromia on LP
- d/t RBC lysis
- orange yellow discoloration of CSF
what does opening pressure > 30 indicate
- bacterial infection
- pseudotumor cerebri
diagnostic indications for LP
- CNS infection
- inflammatory processes
- suspected spontaneous SAH
- unexplained seizure
- certain malignancy or paraneoplastic syndrome
therapeutic indications for LP
- relieve sx from increased ICP
- deliver meds
absolute c/i for LP
- local skin infx
- intracranial or SC mass lesion
- elevated ICP - risk of herniation
- uncontrolled bleeding diathesis or coagulopathy
- coumadin
relative c/i for LP
- raised CIP with known cerebral herniation
- SC deformities
- body deformities at LP site
- suspected epidural abscess
- thrombocytopenia
- elevated INR
tube sequencing for LP
- 1: cell count and diff
- 2: glucose and protein
- 3: culture and gram stain
- 4: cell count and diff
how long does it take to regenerate CSF after LP
- one hour
how do you prevent post LP HA
- put pt in recumbent position for 1 hour
- hydrate and caffeine
what should you alway do before and after an LP
- neuro exam
subarachoid hemorrhage
- 2-10% not detected on CT
- stabilize pt first
- presents as worst HA of my life, thunderclap HA
what is the normal pH of the eye
- 7-7.3
what type of chemical burn is the worst
- alkali
why should you not prescribe anesthetics for the eye
- can cause cornea to melt -> permanent damage
parallelepiped
- mid width with narrow beam
- best for general exam of the eye
