Quiz eye part 2 Flashcards
Recording visual acuity
cornea and conjunctiva examined to rule out FB, use fluorescien to examine with the light and the abrasian will be seen as a darker green area
ocular trauma tx
polymyxin- bacitracin opthalmic ointment, mydriatic and analgesiac
corneal abrasion
surface epithelium sloughed off and is stained with fluorescein
-caused by trauma, pain, tearing and red eye
corneal laceration
-significant ocular trauma
-metallic object
-fingernail scratch does not have enough force to lacerate the cornea
-intense pain
s and s corneal laceration
photophobia and profuse lacrimation with significant uvetis
-the anterior chamber will be shallow or flat in a full thickness laceration
-bubbles in the anterior chamber
-reduced visual acuity
-lens dislocation, iridodialysis and hyphema
is a hyphema visible when the pt is lying down
not always
hyphema tx (blood in front of the eye)
-refer, reduce manipulation, shield from the light, pain meds, xray and ct
bacterial causes of corneal ulcer
adnexal infection, lid malposition, dry eye, Clamydia
viral causes of corneal ulcer
hsv, h zoster oticus
-ramsey hunt and shingles
blow out fracture
large high velocity object causes intense swelling of the eye
-nose blowing may also be common
-sports related
s and s blow out fracture
-pain, local tenderness, double vision
-some pt ignore initially treating
-s and s may present after the inflammatory has subsided
relative enopthalmos and motility restriction with gazing up and a possible infraorbital hypoesthesia will be caused by
orbital blow out fracture
orbital blowout will be visible due to
edema, ecchymosis of the lid tissue, low motility and orbital crepitus (bone has air so it feels crunchy) and hypoesthesia of the ipsilateral cheek (entrapment of the infraorbital nerve), proptotic eye, enopthalmic and droopy
what is orbital blowout caused by
traumatic uveitis and or hyphema
managing orbital blowout fracture
if there is resultant crepitus or a motility restriction you need orbital imaging studie, ct is the choice procedure bc it is better at imaging the bony structures of the orbit than x ray or MRI
crepitus
cracking popping crunching
what if there is a floor fracture with associated herniation of the orbital contents
consider surgical intervention especially if there is unacceptable enophthalmos or diplopia
what is an orbital globe rupture
a medical emergency with a history of trauma, the eye must be covered
what is a cataract
an opacity of the lens, can be localized or diffuse causing problems with vision normally develops slowly, can be unilateral or bilateral
why do cataracts get worse with age
because the lens worsens with age
other causes of cataracts
congenital, traumatic, metabolic, toxic, secondary to another disorder
what can long term steroids cause
cataracts
early symp cataracts
loss of contract and glare, need more light to see, cant distinguish dark blue from black
later symptoms cataracts
progressive, painless blurring of vision, cataract can swell occluding drainage
-pain is rare
nuclear cataract
in central lens nucleus
-myopia may develop in the early stages and changes the refractive index of the lens so that a presbyopic patient may be temporarily able to read without glasses
Posterior subscapular cataract
-cataract beneath the posterior lens capsule
-reduces visual acuity more twhen the pupil constricts (bright light or reading)
-most likley to produce glare
-loss of contrast
cataract diagnosis
best with the pupil dilated
-well developed cataract will have gray or yellow opacities in the lens
-examination of the ref reflex through the dilated pupil discloses subtle opacities
small cataracts
stand out as dark defects in the red reflrex
-slit lamp examination provides more details about the character, location, and extent of the opacity
cataract prevention
UV coated eyeglasses or sunglasses
-reducing risk factors, polarized vision
something can indicate surgery intervention, vision prevents driving, reading etc
retinal detachment
posterior vitreous detachment with age, vitreous gel collapses and retina will detach
-vitreous fluid will seep into or underneath the retina
-web or veil in front of the eye
what causes the detachment
pigmented epithelium underneath
shower of floaters
thousands of blood cells being liberated from a tiny blood vessel which has been broken due to the tear
macular degeneration
loss of central vision bc the retina is damaged, leading cause irreversible blindness in the western world
-can be age related
can debris accumulate in the eye from ARMD
yes bc it will accumulate in the cells in the back of the eye
dry macular degeneration
thinning of the maculas layers and vision loss is typically gradual
wet macular deeneration
tiny fragile blood vessel develop underneath the macula, results from the blood vessels hemorrhage and destroy macular tissue
what happens if one bv is damages
vision loss can be rapid over months and weeks, if one is damages the others will compensate
earliest sx of macular degeneration
persistent blurred vision then the objects will become distorted (straight lines get crooked)
-after time a small blind spot will grow in size creating a “doughnut”
-cant recognize ppl face
visual loss not due to refrctive error
medical emergency especially if there is pain, redness, retinal artery occlusion, detachment or giant cell arthritis
emergencies:
-redness, vitreous hemorrhage, retinal detachment, branch retinal artery occlusion, diabetic maculopathy, ischemic optic neuropathy, optic neuritis, onset of macular degeneration, thyroid disease
