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EENT > Red Eye > Flashcards

Red Eye Flashcards

1
Q

what are the 3 types/causes of Conjunctivitis

A

Bacterial
Viral
Allergic

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2
Q

uni- or bilateral
copious purulent discharge; eyes can be “stuck shut” in the morning
transmitted via direct contact

A

bacterial conjunctivitis

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3
Q

MC causative organism of conjunctivitis in adults

A

staph aureus (including MRSA)

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4
Q

MC causative organism of conjunctivitis in children

A
  1. strep pneumo
  2. H. flu
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5
Q

what is the MC causative organism to cause conjunctivitis with ppl who wear contacts

A

pseudomonas

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6
Q

6 MC Causative Organisms of conjunctivitis

A

S. aureus (including MRSA)
S pneumonaie
H flu
M cat
Pseudomonas
Gonococcal/chlamydial

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7
Q

tx for mild-moderate bacterial conjunctivitis

A

topical sulfonamide
Polytrim - polymyxin B/Trimethoprim

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8
Q

tx for severe/pseudomonas conjunctivitis

A
  1. moxifloxacin (Vigamox or moxeza)
  2. ofloxacin ophthalmic (ocuflox/floxin)
  3. cipro ophthalmic
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9
Q

tx for gonococcal conjunctivitis

A
  1. ceftriaxone (rocephin 1G IM single dose)
    - Can add erythromycin or Bacitracin
  2. Emergency - corneal involvement = perforation
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10
Q

tx for chlamydial conjunctivitis

A

azithromycin PO single dose

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11
Q

what is the MC infectious cause of blindness

A

trachoma/chlamydial

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12
Q

usually bilateral
copious watery discharge
foreign body sensation

A

viral conjunctivitis

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13
Q

MC of viral conjunctivitis

A

adenovirus
- clinics
- swimming pools

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14
Q

viral conjunctivitis can last up to ?

A

10 days

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15
Q

associated sx with viral conjunctivitis

A
  1. pharyngitis
  2. fever
  3. malaise
  4. preauricular adenopathy
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16
Q

tx for viral conjunctivitis

A
  1. supportive
  2. cold compresses
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17
Q

causes of allergic conjunctivits

A
  1. atopy - atopic asthma, dermatitis, allergic rhinitis
  2. seasonal - spring and summer
  3. hyperemia and chemosis
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18
Q

itching, tearing, redness, stringy discharge, some photophobia/visual loss, cobblestone papillae
what could they have?

A

allergic conjunctivitis

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19
Q

tx for mild to moderate allergic conjunctivitis

A
  1. topical antihistamines
    - ketotifen (alaway)
    - olopatadine (patanol, pataday)
    - bepotastine
    - emedastine
  2. topical NSAIDs
    - diclofenac
    - ketorolac
  3. mast cell stabilizers - prophylaxis
    - cromolyn
    - lodoxamide
    - nedocromil
    - pemirolast
  4. oral antihistamines
    - Claritin, Zyrtec, Allegra
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20
Q

tx for severe allergic conjunctivitis

A

topical corticosteroids - loteprednol

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21
Q

topical corticosteroids are NOT given for who for allergic conjunctivitis?

A

pt with hx/suspected HSV
can exacerbate

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22
Q

___ consists of the layer and structures of the eye beneath the sclera.

A

uvea

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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.

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24
Q

anterior portion of the uvea

A
  1. iris
  2. ciliary body
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25
Q

posterior portion of the uvea

A

choriod

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26
Q

MC type of uveitis

A

acute nongranulomatous anterior uveitis

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27
Q

inflammation with no epithelial or giant cells
Predominant cell is the Polymorphonuclear Cells
what is the cause/type of the uveitis

A

nongranulomatous

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28
Q

inflammation noted with histiocytes, specifically macrophages, as predominate cell
what is the cause/type of the uveitis

A

granulomatous

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29
Q

which uveitis
PRESENTS ACUTELY
UNILATERAL PAIN
REDNESS
PHOTOPHOBIA
VISUAL LOSS

A

NON-GRANULOMATOUS

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30
Q

which uveitis
SLOW GROWING
BLURRED VISION
MILDLY INFLAMED EYE
RECURRENT

A

granulomatous

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31
Q

nongranulomatous anterior causes ?

A
  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
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32
Q

GRANULOMATOUS ANTERIOR CAUSES: ?

A
  1. SARCOIDOSIS
  2. TOXOPLASMOSIS
  3. TB
  4. SYPHILIS
    - “SALT AND PEPPER” FUNDUS
  5. HERPES
  6. OCULAR TRAUMA
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33
Q

swelling and inflammation in the colored ring around your eye’s pupil
“inflammatory cells and flare” (proteins) within the aqueous

A

iritis

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34
Q

what makes the “inflammatory” and “flare” iritis?

A

cells are the individual inflammatory cells
flare is the foggy appearance given by protein that has leaked from the inflamed blood vessels

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35
Q

how do you diagnose iritis?

A

slit-lamp exam

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36
Q

pus in the anterior chamber is known as ?

A

hypopyon - severe

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37
Q

inflammatory cellular deposits seen on the corneal endothelium are what?

A

keratic precipitates (KP)

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38
Q

granulomatous iritis is what kind of KPs and what else could it include?

A

Large KPs, Iris nodules may be seen
nongranulomatous = smaller KPs, no iris nodules

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39
Q

inflammatory lesions present in the retina or choroid is known as ?

A

posterior uveitis

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40
Q

pt with posterior uveitis presents with
yellow lesions with indistinct margins
retinal hemorrhages
how would you categorize these lesions?

A

new lesions

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41
Q

pt with posterior uveitis presents with
lesions with distinct margins
pigmented lesions
how would you categorize these lesions?

A

old lesions

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42
Q

pt comes in with
gradual visual loss, describing it as slower
floaters
happening bilaterally
what could be the cause?

A

posterior uveitis
(slower onset may be due to vitreous haze and opacities)

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43
Q

causes of posterior uveitis

A
  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
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44
Q

tx for anterior uveitis

A
  1. topical corticosteroids
    - may need periodcular corticosteroid injections and/or systemic corticosteroids
  2. dilate pupil
    - relieves discomfort
    — reduces spams of ciliary muscles
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45
Q

tx for posterior uveitis

A
  1. systemic, periocular, or intravitreal corticosteroid therapy
  2. pupil dilation not needed
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46
Q

red eye condition caused by inflammation of the cornea

A

keratitis

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47
Q

types of keratitis

A
  1. bacterial
  2. viral
    - HSV
    - VZV
  3. acanthamoeba
  4. fungal
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48
Q

common causes of bacterial keratitis

A
  1. contact lens wear (esp overnight) - MC
  2. corneal trauma
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49
Q

MC pathogens that cause bacterial keratitis

A
  1. pseudomonas
  2. moraxella
  3. staph - including MRSA
  4. strep
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50
Q

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?

A

bacterial keratitis

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51
Q

how to diagnose bacterial keratitis

A

scrap ulcer for gram stain and cx

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52
Q

tx for bacterial keratitis

A
  1. fluoroquinolone drops - empiric
    - ofloxacin 0.3%, cipro 0.5%, vigamox, moxeza
    - hourly for the first 48 hrs

(tx based on cx!)

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53
Q

what is the important cause of ocular morbidity?

A

HSV-1

54
Q

After HSV-1 infection, how could it get progressively worse?

A
  1. travels to sensory ganglia where latency develops
    - thought to be viral replication
  2. can colonize trigeminal ganglion
    - leads to recurrences
55
Q

how can viral involvement with the trigeminal ganglion may be precipitated by?

A

fever
sunlight exposure
immunodeficiency

56
Q

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?

A

herpes simplex

57
Q

tx for viral keratitis

A
  1. topical and/or oral antivirals - tx until 1 wk after lesions heal
    - acyclovir 5x QD
    - acyclovir 3% ointment
  2. reduce recurrence - valacyclovir
58
Q

how does herpes zoster ophthalmicus occur?

A

reactivation of varicella zoster
involves ophthalmic division of the trigeminal nerve

59
Q

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?

A

herpes zoster opthalmicus

60
Q

skin lesions of the tip of nose or the lid margins that predicts involvement of the eye

A

hutchinson sign

61
Q

tx for herpes zoster ophthalmicus

A

high dose oral antiviral
- acyclovir
- valacyclovir

62
Q

for viral keratitis you must avoid what?

A
  • corticosteroids- worsens or prolongs infection
  • if abruptly stopped = rebound inflammatory reaction
63
Q

this red eye tends to occur after corneal injury with plant material or in agricultural setting, as well as trauma to eye

A

fungal keratitis
(fusarium, candida, aspergillis)

64
Q

corneal infiltrate feathery edges with “satellite lesions” is commonly seen in what red eye?

A

fungal keratitis
little epithelial loss

65
Q

how to diagnose fungal keratitis?

A

corneal scraping and cx for fungi

66
Q

tx for fungal keratitis

A

natamycin 5%, amphotericin 0.1-0.5%, voriconazole 1%
- tx may last for 6 months

67
Q

what is acanthamoeba keratitis? where could it be found/how could it happen?

A
  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
Q

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?

A

acanthamoeba keratitis
can likely invade through corneal opening

69
Q

how do you diagnose acanthamoeba keratitis?

A

cx using specialized media

70
Q

tx for acnthamoeba keratitis

A
  1. topical biguanide - polyhexamethylene or CHG
  2. long-term tx - 6 months to 1 yr
    - bc of encyst within corneal stroma
71
Q

s/s of subconjunctival hemorrhage

A
  1. well-circumscribed area of hemorrhage underneath conjunctiva
  2. normal visual acuity
  3. pupil response
72
Q

causes for subconjunctival hemorrhage

A
  1. valsalva, coughing, sneezing
  2. systemic HTN
  3. anticoagulant meds
73
Q

tx for subconjunctival hemorrhage

A
  1. self-limiting
    - reabsorbs within 2 wks
  2. tx for underlying cause - HTN, trauma
74
Q

inflammation or infection w/n lacrimal gland

A

dacryoadenitis
(supratemporal region)

75
Q

infection of the lacrimal sac/duct
usually due to obstruction of the nasolacrimal system

A

dacryocystitis
1. congenital or acquired
- infants
- > 40/yo
2. inframedical region
3. epiphora

76
Q

pain, swelling, tenderness, and redness in tear sac area
some purulent material may be present
is what type of dacryocystitis presentation?

A

acute infection

77
Q

tearing and discharge
possible mucus or pus
is what type of dacryocystitis presentation?

A

chronic infection

78
Q

causes of dacryoadenitis

A
  1. inflammatory
    - autoimmune diseases - Sjogren
  2. viral
    - mumps
  3. bacterial
79
Q

MC organisms that can cause dacryocystitis

A
  1. acute
    - staph aureus
    - strep
  2. chronic
    - staph epidermidis
    - strep
    - g- bacilli
80
Q

tx for dacryoadenitis

A
  1. autoimmune
    - tx underlying cause/steroids
  2. viral
    - supportive
  3. bacterial
    - systemic abx
    - I&D
81
Q

tx for dacryocystitis

A
  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
Q

chronic inflammatory condition of the lid margins

A

blepharitis

83
Q

blepharitis involving:
- eyelid skin
- eyelashes
- associated glands
is what type?

A

anterior

84
Q

blepharitis involving the meibomian glands at the inner portion of the eyelid is what type?

A

posterior

85
Q

what are the 2 different presentations of anterior blepharitis

A
  1. ulcerative - staph
  2. seborrheic
    - involves scalp, brows, ears
    - itchy rash with flaky scales
86
Q

what can cause posterior blepharitis

A
  1. bacterial infection - staph
  2. primary glandular dysfunction
  3. chronic skin infection
    - rosacea
    - psoriasis
    - eczema
87
Q

what are modified sebaceous glands that are responsible for eye lubrication, secreting oily layer for tears

A

meibomian glands

88
Q

what is the purpose of the oil layer from meibomian glands?

A

reduce evaporation of tears
spreads tears

89
Q

pt presenting with a “red-rimmed” and scales in lashes is mostly likely what red eye?

A

anterior blepharitis

90
Q

lid margins are hyperemic with telangiectasia
inflamed meibomian glands
inward rolled lid margin
frothy/greasy tears
is what red eye?

A

posterior blepharitis

91
Q

s/s of blepharitis

A
  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
Q

ddx for blepharitis

A

conjunctivitis
hordeolum
chalazion

93
Q

tx for anterior blepharitis

A
  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
Q

tx for mild posterior blepharitis

A
  1. mild
    - regular meibomian gland expression with hot wash cloth
    - lid massage
95
Q

tx for inflammation of conjunctiva and cornea

A
  1. long-term low dose oral abx (2-4 wks)
    - tetracycline/doxy/minocycline
  2. short-term topical corticosteroids
    - prednisolone
96
Q

an acute staph abscess that is localized, red, swollen, tender on either upper/lower lid

A

hordeolum

97
Q

what is an external hordeolum

A

stye
smaller and on the margin

98
Q

what is an internal hordeolum

A
  • meibomian gland abscess
  • points onto the conjunctival surface of the lid
  • internal hordeolum may lead to generalized cellulitis of the lid
99
Q

tx for hordeolum

A
  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
Q

what is a common granulomatous inflammation of a meibomian gland

A

chalazion
may follow internal hordeolum

101
Q

describe a chalazion

A

hard, nontender, swelling
- painless, localized eyelid swelling
- nontender rubbery nodule on inner conjunctiva
- upper or lower lid
- redness and swelling of adjacent conjunctiva

102
Q

tx for chalazion

A
  1. self-limiting MC
  2. supportive
    - warm compress and massage
    - lid scrubs - baby shampoo
  3. refractory
    - Refer
    — incision and curettage
    — corticosteroid injection
103
Q

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

A

orbital cellulitis

104
Q

for children, MC of orbital cellulitis arise from extension of ?
what pathogen causes it?

A

acute sinusitis through ethmoid bone
1. strep. pneumo
2. H. flu
3. staph aureus (including MRSA)
4. M. cat

105
Q

for adolescents and adults, orbital cellulitis is often from what?

A
  1. chronic sinusitis
    - anaerobic organisms may be involved
  2. hx of trauma or animal bite
    - s. aureus
    - GABHS
106
Q

orbital cellulitis is MC in who?

A

younger children > older kids and adults
an uncommon complication of bacterial sinusitis

107
Q

what is coexisting with orbital cellulitis that is present in up to 98% of cases

A

sinusitis
MC - ethmoid and pansinusitis

108
Q

presentation of orbital cellulitis

A
  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
Q

Pt with orbital cellulitis has sluggish pupillary reaction to light or a relative afferent pupillary defect indicates what?

A

optic nerve involvement

110
Q

tx for orbital cellulitis

A

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
Q

how do you diagnose orbital cellulitis

A

clinically
can order CT scanning of orbits and sinuses to confirm
MUST distinguish from preseptal and orbital cellulitis

112
Q

a bacterial infection superficial to the orbital septum
infection of anterior portion of eyelid that does not involve the orbit or its contents/structures

A

preseptal cellulitis
usually mild conditions, rarely serious

113
Q

preseptal cellulitis can be caused by a spread of infection arising within the eyelid, such as:

A

hordeolum
wound
animal bite
conjunctivitis

114
Q

MC pathogen to cause preseptal cellulitis

A

staph. aureus
strep. pneumo

115
Q

which cellulitis is more common

A

preseptal > orbital

116
Q

presentation of preseptal cellulitis

A
  1. eyelid swelling
  2. erythema

NO: fever, proptosis, limitation or pain with extraocular movements, or vision impairments

117
Q

how do you diagnose preseptal cellulitis

A
  1. clinically
  2. MUST distinguish from preseptal and orbital cellulitis
  3. imaging only needed when:
    - tx fails
    - unsure of diagnosis
118
Q

tx for preseptal cellulitis

A
  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
Q

what functions as a protective barrier and as a “window” through which light rays pass to the retina?

A

cornea

120
Q

ciliary flush is a pathognomonic for which condition

A

corneal ulcer

121
Q

gray/yellow infiltrate at site of break in corneal epithelium
exudate that is bluish-green color
is caused by what pathogen for what condition?

A

pseudomonas
corneal ulcer

122
Q

how do diagnose corneal ulcer

A

scraping from ulcer
result:
- pseudomonas: g- rods
- group A strep: g+ cocci in chains

123
Q

tx for pseudomonas corneal ulcer

A

moxifloxacin, gatifloxacin, cipro, tobramycin, gentamicin

124
Q

surrounding corneal stroma often inflitrated and edematous
moderately large hypopyon
what is the causative pathogen? what condition?

A

Group A strep
corneal ulcer

125
Q

corneal ulcer with hypopyon and some surrounding corneal infiltration
often superficial
ulcer bed feels firm when scraped
is caused by what pathogen?

A

s. aureus/epidermidis

126
Q

corneal ulcer that is
indolent
gray infiltrate with irregular edges
marked inflammation of the globe
superficial ulceration
satellite lesions
is caused by what pathogen?

A

fungal
- candida, fusarium, aspergillus

127
Q

tx for viral corneal ulcer

A
  1. oral
    - acyclovir
  2. topical
    - idoxuridine
    - ganciclovir
128
Q

tx for fungal corneal ulcer

A
  • amphotericin B
  • voriconazole
  • posaconazole
129
Q

tx for s. aureus/epidermidis corneal ulcer

A

moxifloxacin, gatifloxacin, vancomycin (MRSA)

130
Q

tx for group A strep corneal ulcer

A

moxifloxacin, gatifloxacin, cefazolin

131
Q

MC cause of corneal ulceration and corneal blindness

A

herpes simplex

132
Q

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

A

HSV

EENT (11 decks)

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