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Integrative Analysis > Red Eye > Flashcards

Red Eye Flashcards

1
Q

problematic diagnoses

A
  • acute angle closure
  • cavernous sinus fistula/thrombosis
  • orbital cellulitis
  • endophthalmitis
  • scleritis
  • dacryocystitis/canaliculitis
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2
Q

acute angle closure

A

Questions:

  • hx of nausea, vomiting, HA, orbital pain, blurred vision, haloes around lights, recurrent
  • realize different forms of ACG (primary vs secondary)

Diagnostic testing:

  • acuity, pupils (mid-dilated)
  • SL exam (cornea, van Herrick, cataract?)
  • GAT
  • gonioscopy, including iris configuration
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3
Q

cavernous sinus fistula/thrombosis

A

Questions:
-recent head trauma (75% of all cases), “wooshing” noise in the head, ptosis, facial pain, EOM restriction/diplopia, systemic HTN or DM, sinusitis, HA

Diagnostic testing:

  • acuity, pupils (3rd nerve)
  • EOM (6th nerve most common due to location, other nerves at sinus wall)
  • hypo-/hyperesthesia on V2 and V2 dermatome
  • SL exam (corneal edema, chemosis, AC rxn, cataract, NVI, proptosis)
  • IOP (increased 2’ to orbital congestion and elevated episcleral venous pressure)
  • fundoscopy (ONH edema, venous dilation, hemes)
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4
Q

orbital cellulitis

A

Questions:

  • hx of hordeolum, pain/tenderness/warmth on palpation, pain on EOM movement, fever/HA, blurred vision, discharge, sinus conditions, facial surgery/trauma, diplopia, diabetic (mucormycosis)
  • lid edema, proptosis, conjunctival chemosis (finding suggestive of acute orbital disease, among others)- also found in uveitis
  • fever, malaise- can be helpful in differentiating from pre-septal cellulitis

Diagnostic testing:

  • acuity, pupils
  • EOM (generalized restriction)
  • SL exam (gross lid exam and palpation, conjunctival discharge)
  • fundoscopy (ONH edema, venous tortuosity)
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5
Q

endophthalmitis

A

Questions:
-hx of ophthalmic surgery, pain, photophobia, recent systemic infections (including fungal/sepsis), IV drug use, immunocompromised

Diagnostic testing:

  • acuity
  • SL exam and fundoscopy (lid edema, corneal edema, chemosis, AC rxn, ant/post vitreous cells, hypopyon, retinal edema/infiltrates/hemes)
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6
Q

scleritis

A

Questions:
-pain (esp radiating to temple, brow, or jaw), blurred vision (maybe), recurrence, suspicious systemic diagnoses

Diagnostic testing:

  • acuity
  • SL exam (AC rxn, blanching w/ phenyl, nodules/color changes 2’ to thinning)
  • fundoscopy (ONH edema, choroidal folds, macular edema, detachments, exudates, posterior vitritis/retinitis)
  • differentiate from epislceritis
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7
Q

dacryocystitis/canaliculitis

A

Questions:
-associated lid tenderness/swelling, excessive tearing

Diagnostic testing:
-SL exam (medial canthal evaluation, expression of punctum, tear film and nasolacrimal duct evaluation)

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8
Q

corneal problems

A

Questions:
-hx of recurrence, DES questioning, associated systemic conditions/adnexa, CL wear, FB, timing, associated “family” illness, discharge

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9
Q

adnexal causes of red eye

A

trichiasis, distichiasis, floppy eyelid syndrome, entropion/ectropion, lagophthalmos, blepharitis, and rosacea

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10
Q

conjunctival causes of red eye

A

conjunctivitis, subconjunctival hemorrhage, pinguecula, SLK, GPC, FB, cicatricial pemphigoid, Stevens Johnson syndrome, neoplasia

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11
Q

corneal causes of red eye

A

infectious/inflammatory keratitis, RCE, pterygium, neurotrophic keratopathy, UV keratitis

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12
Q

fundus causes of red eye

A

inflammatory disease

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13
Q

systemic causes of red eye

A

thyroid, RA, etc.

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14
Q

follicles vs papillae

A

Follicles:

  • focal infiltration of lymphocytes
  • dome-shaped
  • pale at surface, red at base
  • toxic, viral, atypical bacteria, lymphoma

Papillae:

  • focal infiltration of inflammatory cells
  • flattened nodules
  • vascular core
  • red at surface, pale at base
  • allergic immune response, foreign body, bacterial
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15
Q

allergic conjunctivitis

A

-treatment options: vasoconstrictors/decongestants (“get the red out”), H1-specific receptor blockers, mast cell stabilizers, combination, steroid

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16
Q

viral conjunctivitis

A
  • +PAN suggestive of viral, some forms of bacterial, and some forms of lymphoma
  • expected findings- infiltrates approx 7 days after initial systemic symptoms, patient feels worst first 4-7 days, then gradually gets better
  • treatment options: palliative (artificial tears and cool compresses; standard of care*), steroid if infiltrates potentially scar and affect central acuity or cause moderate to severe symptoms, Zirgan (off-label), betadine wash
  • educate pt on contagious nature of disease (usually during 1 week of onset, but can be up to 14 days)
17
Q

adenoplus testing system

A

picks out adenoviral particles with a 90% sensitivity and a 96% specificity

18
Q

bacterial conjunctivitis

A
  • cautious approach to treatment (central vs. peripheral lesion of cornea associated); rule out CL wear
  • treatment options: typically 4th gen fluoroquinolones, however simple medications such as neosporin and polytrim have their place due to emergence of MRSA and bacterial resistance
  • not as common as you may think
19
Q

subconjunctival hemorrhage

A
  • rule out HIV- Kaposi’s sarcoma
  • ensure patient education on non-threatening nature
  • always ask about aspirin use and/or blood thinners as these will slow resolution
  • recurrence- PTT, CBC, protein C and S (vitamin K-dependent), internist consult
20
Q

herpes simplex keratitis

A
  • corneal sensitivity testing
  • assess recurrence, as this may dictate future/current treatment
  • treatment options: antibiotic ung for skin lesions, Viroptic (no more than 14 days due to corneal toxicity), Zirgan, Acyclovir
  • AC rxn may indicate need for cycloplegic
  • avoid steroid**
  • potential for debridement
21
Q

herpes zoster

A
  • gross dermatome exam, immunodeficiency
  • avoid individuals not infected with chickenpox, esp pregnant females
  • become very suspicious in individuals under 40- suspect immunodeficiency and order appropriate testing
  • treatment options: usually within 72 hours of first signs if possible; Acyclovir, valacyclovir, famciclovir, antibiotic to skin involvement, cool compresses to any adnexal swelling, steroids for corneal disease with infiltrates and AC rxn, Capsaicin OTC ung for painful skin lesions, PCP for oral analgesics
22
Q

HEDS II study showed that oral acyclovir in a prophylactic dose of 400 mg bid reduced the rate of recurrence of any form of ocular herpes in the following year by ____

A

41%

Integrative Analysis (5 decks)

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