Red Eye Flashcards
1
Q
what are the 3 types/causes of Conjunctivitis
A
Bacterial
Viral
Allergic
2
Q
uni- or bilateral
copious purulent discharge; eyes can be “stuck shut” in the morning
transmitted via direct contact
A
bacterial conjunctivitis
3
Q
MC causative organism of conjunctivitis in adults
A
staph aureus (including MRSA)
4
Q
MC causative organism of conjunctivitis in children
A
- strep pneumo
- H. flu
5
Q
what is the MC causative organism to cause conjunctivitis with ppl who wear contacts
A
pseudomonas
6
Q
6 MC Causative Organisms of conjunctivitis
A
S. aureus (including MRSA)
S pneumonaie
H flu
M cat
Pseudomonas
Gonococcal/chlamydial
7
Q
tx for mild-moderate bacterial conjunctivitis
A
topical sulfonamide
Polytrim - polymyxin B/Trimethoprim
8
Q
tx for severe/pseudomonas conjunctivitis
A
- moxifloxacin (Vigamox or moxeza)
- ofloxacin ophthalmic (ocuflox/floxin)
- cipro ophthalmic
9
Q
tx for gonococcal conjunctivitis
A
- ceftriaxone (rocephin 1G IM single dose)
- Can add erythromycin or Bacitracin - Emergency - corneal involvement = perforation
10
Q
tx for chlamydial conjunctivitis
A
azithromycin PO single dose
11
Q
what is the MC infectious cause of blindness
A
trachoma/chlamydial
12
Q
usually bilateral
copious watery discharge
foreign body sensation
A
viral conjunctivitis
13
Q
MC of viral conjunctivitis
A
adenovirus
- clinics
- swimming pools
14
Q
viral conjunctivitis can last up to ?
A
10 days
15
Q
associated sx with viral conjunctivitis
A
- pharyngitis
- fever
- malaise
- preauricular adenopathy
16
Q
tx for viral conjunctivitis
A
- supportive
- cold compresses
17
Q
causes of allergic conjunctivits
A
- atopy - atopic asthma, dermatitis, allergic rhinitis
- seasonal - spring and summer
- hyperemia and chemosis
18
Q
itching, tearing, redness, stringy discharge, some photophobia/visual loss, cobblestone papillae
what could they have?
A
allergic conjunctivitis
19
Q
tx for mild to moderate allergic conjunctivitis
A
-
topical antihistamines
- ketotifen (alaway)
- olopatadine (patanol, pataday)
- bepotastine
- emedastine - topical NSAIDs
- diclofenac
- ketorolac - mast cell stabilizers - prophylaxis
- cromolyn
- lodoxamide
- nedocromil
- pemirolast - oral antihistamines
- Claritin, Zyrtec, Allegra
20
Q
tx for severe allergic conjunctivitis
A
topical corticosteroids - loteprednol
21
Q
topical corticosteroids are NOT given for who for allergic conjunctivitis?
A
pt with hx/suspected HSV
can exacerbate
22
Q
___ consists of the layer and structures of the eye beneath the sclera.
A
uvea
23
Q
3 parts of the uvea
A
(1) the iris (and pupil)
(2) the ciliary body (secretes the aqueous humor)
(3) the choroid, which is the layer of blood vessels and connective tissue between the sclera and the retina.
24
Q
anterior portion of the uvea
A
- iris
- ciliary body
25
posterior portion of the uvea
choriod
26
MC type of uveitis
acute nongranulomatous anterior uveitis
27
inflammation with no epithelial or giant cells
Predominant cell is the Polymorphonuclear Cells
what is the cause/type of the uveitis
nongranulomatous
28
inflammation noted with histiocytes, specifically macrophages, as predominate cell
what is the cause/type of the uveitis
granulomatous
29
which uveitis
PRESENTS ACUTELY
UNILATERAL PAIN
REDNESS
PHOTOPHOBIA
VISUAL LOSS
NON-GRANULOMATOUS
30
which uveitis
SLOW GROWING
BLURRED VISION
MILDLY INFLAMED EYE
RECURRENT
granulomatous
31
nongranulomatous anterior causes ?
1. **_acute = primarily immunologic_**
- _HLA-B27 related conditions_:
--- ankylosing spondylitis
--- reactive arthritis
--- psoriasis
--- ulcerative colitis
--- Crohn's disease
2. chronic occurs in juvenile idiopathic arthritis
32
GRANULOMATOUS ANTERIOR CAUSES: ?
1. SARCOIDOSIS
2. TOXOPLASMOSIS
3. TB
4. SYPHILIS
- “SALT AND PEPPER” FUNDUS
5. HERPES
6. OCULAR TRAUMA
33
swelling and inflammation in the colored ring around your eye's pupil
“inflammatory cells and flare” (proteins) within the aqueous
iritis
34
what makes the "inflammatory" and "flare" iritis?
cells are the individual inflammatory cells
flare is the foggy appearance given by protein that has leaked from the inflamed blood vessels
35
how do you diagnose iritis?
slit-lamp exam
36
pus in the anterior chamber is known as ?
hypopyon - severe
37
inflammatory cellular deposits seen on the corneal endothelium are what?
keratic precipitates (KP)
38
granulomatous iritis is what kind of KPs and what else could it include?
Large KPs, Iris nodules may be seen
nongranulomatous = smaller KPs, no iris nodules
39
inflammatory lesions present in the retina or choroid is known as ?
posterior uveitis
40
pt with posterior uveitis presents with
yellow lesions with indistinct margins
retinal hemorrhages
how would you categorize these lesions?
new lesions
41
pt with posterior uveitis presents with
lesions with distinct margins
pigmented lesions
how would you categorize these lesions?
old lesions
42
pt comes in with
gradual visual loss, describing it as slower
floaters
happening bilaterally
what could be the cause?
posterior uveitis
(slower onset may be due to vitreous haze and opacities)
43
causes of posterior uveitis
1. idiopathic
2. autoimmune retinal vasculitis
3. pars planitis: disease of the eye between the iris and choroid
4. same diseases that cause _granulomatous anterior uveitis_ tend to cause posterior as well
44
tx for anterior uveitis
1. **topical corticosteroids**
- may need periodcular corticosteroid injections and/or systemic corticosteroids
2. dilate pupil
- relieves discomfort
--- reduces spams of ciliary muscles
45
tx for posterior uveitis
1. systemic, periocular, or intravitreal corticosteroid therapy
2. pupil dilation not needed
46
red eye condition caused by inflammation of the cornea
keratitis
47
types of keratitis
1. bacterial
2. viral
- HSV
- VZV
3. acanthamoeba
4. fungal
48
common causes of bacterial keratitis
1. **contact lens wear** (esp overnight) - MC
2. corneal trauma
49
MC pathogens that cause bacterial keratitis
1. **pseudomonas**
2. moraxella
3. staph - including MRSA
4. strep
50
Pt comes in complaining of:
- FB sensation
- trouble keeping eye open
- cornea is hazy with ulcer and adjacent stromal abscess
- hypopyon
what could it be?
bacterial keratitis
51
how to diagnose bacterial keratitis
scrap ulcer for gram stain and cx
52
tx for bacterial keratitis
1. fluoroquinolone drops - empiric
- ofloxacin 0.3%, cipro 0.5%, vigamox, moxeza
- hourly for the first 48 hrs
(tx based on cx!)
53
what is the important cause of ocular morbidity?
HSV-1
54
After HSV-1 infection, how could it get progressively worse?
1. travels to sensory ganglia where latency develops
- thought to be viral replication
2. can colonize trigeminal ganglion
- leads to recurrences
55
how can viral involvement with the trigeminal ganglion may be precipitated by?
fever
sunlight exposure
immunodeficiency
56
pt comes in with a complaint of
red eye
photophobia
foreign body sensation
watery discharge
vesicles around eye adnexa
dendritic corneal ulcer via fluorescein stain
what do they have?
herpes simplex
57
tx for viral keratitis
1. **topical and/or oral antivirals** - tx until 1 wk after lesions heal
- acyclovir 5x QD
- acyclovir 3% ointment
2. _reduce recurrence_ - valacyclovir
58
how does herpes zoster ophthalmicus occur?
reactivation of varicella zoster
involves _ophthalmic division of the trigeminal nerve_
59
a pt with a hx of VZV comes in with:
malaise
fever
HA
vesicular, pustular and crusting rash
periorbital burning and itching
occurring within a day
what could it be?
herpes zoster opthalmicus
60
skin lesions of the tip of nose or the lid margins that predicts involvement of the eye
hutchinson sign
61
tx for herpes zoster ophthalmicus
_high dose oral antiviral_
- **acyclovir**
- **valacyclovir**
62
for viral keratitis you must avoid what?
- corticosteroids- worsens or prolongs infection
- if abruptly stopped = rebound inflammatory reaction
63
this red eye tends to occur after corneal injury with plant material or in agricultural setting, as well as trauma to eye
fungal keratitis
(fusarium, candida, aspergillis)
64
corneal infiltrate feathery edges with "satellite lesions" is commonly seen in what red eye?
fungal keratitis
little epithelial loss
65
how to diagnose fungal keratitis?
corneal scraping and cx for fungi
66
tx for fungal keratitis
**natamycin 5%, amphotericin 0.1-0.5%, voriconazole 1%**
- tx may last for 6 months
67
what is acanthamoeba keratitis? where could it be found/how could it happen?
1. caused by single celled acanthamoeba
2. found in rivers, lakes, streams, air, soil cooling systems, sewage systems, contact wearing lens
- swimming, sitting in hot tub, not washing hands before changing contacts
68
a pt comes in with
red eye, tearing, blurred vision, light sensitivity
severe pain in their eye
you see infiltrates in the corneal stroma
otherwise, they are a healthy person
what could it be?
acanthamoeba keratitis
can likely invade through corneal opening
69
how do you diagnose acanthamoeba keratitis?
cx using specialized media
70
tx for acnthamoeba keratitis
1. _topical biguanide - polyhexamethylene or CHG_
2. long-term tx - 6 months to 1 yr
- bc of encyst within corneal stroma
71
s/s of subconjunctival hemorrhage
1. well-circumscribed area of hemorrhage underneath conjunctiva
2. normal visual acuity
3. pupil response
72
causes for subconjunctival hemorrhage
1. valsalva, coughing, sneezing
2. systemic HTN
3. anticoagulant meds
73
tx for subconjunctival hemorrhage
1. **self-limiting**
- reabsorbs within 2 wks
2. tx for underlying cause - HTN, trauma
74
inflammation or infection w/n lacrimal gland
dacryoadenitis
(supratemporal region)
75
infection of the lacrimal sac/duct
usually due to obstruction of the nasolacrimal system
dacryocystitis
1. congenital or acquired
- infants
- > 40/yo
2. inframedical region
3. epiphora
76
pain, swelling, tenderness, and redness in tear sac area
some purulent material may be present
is what type of dacryocystitis presentation?
acute infection
77
tearing and discharge
possible mucus or pus
is what type of dacryocystitis presentation?
chronic infection
78
causes of dacryoadenitis
1. inflammatory
- autoimmune diseases - Sjogren
2. viral
- mumps
3. bacterial
79
MC organisms that can cause dacryocystitis
1. acute
- **staph aureus**
- strep
2. chronic
- **staph epidermidis**
- strep
- g- bacilli
80
tx for dacryoadenitis
1. autoimmune
- tx underlying cause/steroids
2. viral
- supportive
3. bacterial
- systemic abx
- I&D
81
tx for dacryocystitis
1. acute
- _lacrimal sac massage_
2. mucopurulent discharge *W/O* other signs of infection
- topical abx
--- _tobramycin sulfate_ 0.3%
--- _moxifloxacin_ 0.5%
3. purulent discharge *WITH* signs of infection
- systemic abx
--- _amoxicillin/clavulanic (augmentin)_
- surgery
4. chronic
- abx to keep latency
- _dacryocystorhinostomy_ - exploration of lacrimal sac and formation of fistula into nasal cavity
82
chronic inflammatory condition of the lid margins
blepharitis
83
blepharitis involving:
- eyelid skin
- eyelashes
- associated glands
is what type?
anterior
84
blepharitis involving the meibomian glands at the inner portion of the eyelid is what type?
posterior
85
what are the 2 different presentations of anterior blepharitis
1. ulcerative - staph
2. seborrheic
- involves scalp, brows, ears
- itchy rash with flaky scales
86
what can cause posterior blepharitis
1. bacterial infection - staph
2. primary glandular dysfunction
3. chronic skin infection
- rosacea
- psoriasis
- eczema
87
what are modified sebaceous glands that are responsible for eye lubrication, secreting oily layer for tears
meibomian glands
88
what is the purpose of the oil layer from meibomian glands?
reduce evaporation of tears
spreads tears
89
pt presenting with a "red-rimmed" and scales in lashes is mostly likely what red eye?
anterior blepharitis
90
lid margins are hyperemic with telangiectasia
inflamed meibomian glands
inward rolled lid margin
frothy/greasy tears
is what red eye?
posterior blepharitis
91
s/s of blepharitis
1. red, swollen, itchy eyelids
2. gritty/burning sensation
3. red eyes
4. excessive tearing (can be a sign of dry eye)
5. crusting/matting of eyelashes in the AM
6. flaking or scaling of eyelid skin
7. light sensitivity
8. blurred vision (improves after blinking)
92
ddx for blepharitis
conjunctivitis
hordeolum
chalazion
93
tx for anterior blepharitis
1. cleaning of lid margins, eyebrows, and scalp
2. remove scales with hot washcloth and baby shampoo
3. anti-staphylococcal ointment applied to lid margin
- **bacitracin**
- **erythromycin**
94
tx for mild posterior blepharitis
1. mild
- regular meibomian gland expression with hot wash cloth
- lid massage
95
tx for inflammation of conjunctiva and cornea
1. long-term low dose oral abx (2-4 wks)
- tetracycline/doxy/minocycline
2. short-term topical corticosteroids
- prednisolone
96
an acute **staph** abscess that is localized, red, swollen, tender on either upper/lower lid
hordeolum
97
what is an external hordeolum
stye
smaller and on the margin
98
what is an internal hordeolum
- meibomian gland abscess
- points onto the conjunctival surface of the lid
- internal hordeolum may lead to generalized cellulitis of the lid
99
tx for hordeolum
1. **warm compresses**
- 5-10min 2-5x a day
- massage and gentle wiping of eyelid after compress
- d/c makeup
2. I&D if not resolving within 48 hrs - 1 wk
3. (if indicated) bacitracin/erythromycin
100
what is a common granulomatous inflammation of a meibomian gland
chalazion
may follow internal hordeolum
101
describe a chalazion
hard, **_nontender_**, swelling
- painless, localized eyelid swelling
- nontender rubbery nodule on inner conjunctiva
- upper or lower lid
- redness and swelling of adjacent conjunctiva
102
tx for chalazion
1. self-limiting MC
2. supportive
- warm compress and massage
- lid scrubs - baby shampoo
3. refractory
- _Refer_
--- incision and curettage
--- corticosteroid injection
103
infection of the soft tissue and fat that hold the eye in its socket
orbit is surrounded by paranasal sinuses
part of the venous drainage is through the orbit
orbital cellulitis
104
for children, MC of orbital cellulitis arise from extension of ?
what pathogen causes it?
acute sinusitis through ethmoid bone
1. strep. pneumo
2. H. flu
3. staph aureus (including MRSA)
4. M. cat
105
for adolescents and adults, orbital cellulitis is often from what?
1. _chronic sinusitis_
- anaerobic organisms may be involved
2. hx of trauma or animal bite
- s. aureus
- GABHS
106
orbital cellulitis is MC in who?
younger children > older kids and adults
an uncommon complication of bacterial sinusitis
107
what is coexisting with orbital cellulitis that is present in up to 98% of cases
sinusitis
MC - ethmoid and pansinusitis
108
presentation of orbital cellulitis
1. fever
2. pain
3. eyelid swelling and erythema
4. decreased vision/diplopia
5. proptosis
6. ptosis
7. chemosis
8. pain with and limitation of extraocular movements
9. leukocytosis
CAN BE LIFE THREATENING
109
Pt with orbital cellulitis has sluggish pupillary reaction to light or a relative afferent pupillary defect indicates what?
optic nerve involvement
110
tx for orbital cellulitis
_IV abx Immediately_
1. prevents optic nerve damage and spreading to cavernous sinuses, meninges, and brain
2. _Empiric tx_
- **vancomycin + ceftriaxone/cefotaxime** IV
- MC for kids = vanc + ceftriaxone
3. anaerobic coverage
- add **metronidazole** or **clinda**
- **levofloxacin** - PCN allergy
4. trauma
- **cephalosporin** - cefazolin or ceftriaxone
5. Once improved
- **bactrim + augmentin**
- fluoroquinolone - PCN allergy
111
how do you diagnose orbital cellulitis
_clinically_
can order CT scanning of orbits and sinuses to confirm
**MUST** distinguish from preseptal and orbital cellulitis
112
a bacterial infection superficial to the orbital septum
infection of anterior portion of eyelid that does not involve the orbit or its contents/structures
preseptal cellulitis
usually mild conditions, rarely serious
113
preseptal cellulitis can be caused by a spread of infection arising within the eyelid, such as:
hordeolum
wound
animal bite
conjunctivitis
114
MC pathogen to cause preseptal cellulitis
staph. aureus
strep. pneumo
115
which cellulitis is more common
preseptal > orbital
116
presentation of preseptal cellulitis
1. eyelid swelling
2. erythema
_NO_: fever, proptosis, limitation or pain with extraocular movements, or vision impairments
117
how do you diagnose preseptal cellulitis
1. _clinically_
2. **MUST** distinguish from preseptal and orbital cellulitis
3. imaging *only* needed when:
- tx fails
- unsure of diagnosis
118
tx for preseptal cellulitis
1. oral abx
- **augmentin + bactrim**
- cefdinir - PCN allergy
- clinda - sulfa allergy
2. No improvement after 24-48 h?
- monitor closely to see if it develops orbital cellulitis
119
what functions as a protective barrier and as a "window" through which light rays pass to the retina?
cornea
120
ciliary flush is a pathognomonic for which condition
corneal ulcer
121
gray/yellow infiltrate at site of break in corneal epithelium
exudate that is bluish-green color
is caused by what pathogen for what condition?
pseudomonas
corneal ulcer
122
how do diagnose corneal ulcer
scraping from ulcer
_result_:
- pseudomonas: g- rods
- group A strep: g+ cocci in chains
123
tx for pseudomonas corneal ulcer
moxifloxacin, gatifloxacin, cipro, tobramycin, gentamicin
124
surrounding corneal stroma often inflitrated and edematous
moderately large hypopyon
what is the causative pathogen? what condition?
Group A strep
corneal ulcer
125
corneal ulcer with hypopyon and some surrounding corneal infiltration
often superficial
ulcer bed feels firm when scraped
is caused by what pathogen?
s. aureus/epidermidis
126
corneal ulcer that is
indolent
_gray infiltrate_ with irregular edges
marked inflammation of the globe
superficial ulceration
_satellite lesions_
is caused by what pathogen?
fungal
- candida, fusarium, aspergillus
127
tx for viral corneal ulcer
1. oral
- acyclovir
2. topical
- idoxuridine
- ganciclovir
128
tx for fungal corneal ulcer
- amphotericin B
- voriconazole
- posaconazole
129
tx for s. aureus/epidermidis corneal ulcer
moxifloxacin, gatifloxacin, vancomycin (MRSA)
130
tx for group A strep corneal ulcer
moxifloxacin, gatifloxacin, cefazolin
131
MC cause of corneal ulceration and corneal blindness
herpes simplex
132
which corneal ulcer causes
irritation, photophobia, tearing, reduced vision
dendritic ulcer in corneal epithelium
branching, linear pattern with feathery edges and terminal bulbs at its ends
HSV
