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gen med 2: eent > Red Eye > Flashcards

Red Eye Flashcards

1
Q

red eye disease physiology

A

dilating blood vessels

1) ciliary injection= inflammation of the cornea, iris, or ciliary body
- -> see localized redness around lumbus

2) conjuctival injection= consistent with superficial injection of conjuctiva
- -> diffuse pattern of redness

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2
Q

who should not get an MRI

A

foreign METAL body in the eye

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3
Q

when testing visual acuity when do you need to do other strategies

A

if worse than 20/400, then count fingers, check for hand motion, or perception to light

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4
Q

consider gram stain/cultures for

A
  1. Immunocompromised
  2. newborns
  3. patients that do not respond to treatment
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5
Q

conjuctivitis

A

inflammation of conjuctiva secondary to something invading the eye

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6
Q

what is the most common non-traumatic eye complaint

A

conjuctivitis

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7
Q

what is conjuctiva

A

the loose connective tissue covering surface of the eye (bulbar and palpebral–> inside)

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8
Q

y do we get exudate in conjuctivitis

A

inflammatory cells move to the conjuctiva epithelium (trying to flush out)–> combines w mucus and fibrin and you get EXUDATE

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9
Q

allergic conjuctivitis presentation

A

assoc w seasonal allergies, allergic rhinitis, asthma

chronic sx
itching, watery eyes, sneezing, mild photophobia

–> see mild/moderate diffuse conjuctival injection BILATERALLY

chemosis: thick boggy conjuctiva
“allergic shiners” bruised under eye from inflammation

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10
Q

tx for allergic conjuctivitis

A
  1. cool compress
  2. topical decongestants/antihistamines= Vasocon-A or Naphacon-A drops (dont use long term: rebound vasodilation)
  3. nonsteroid drops= ketorlac
  4. oral antihistamines

refer to ES

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11
Q

viral conjuctivitis etiology

A

pink eye

adults= most of time its bacterial
kids= 50/50 bacterial and viral (kids rub eyes)

most commonly the adenovirus

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12
Q

where is viral conjuctivitis v common

A

winter and spring

very contagious –> school/daycare

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13
Q

________ sheds in tears for up to_______ weeks

A

viral conjuctivitis sheds in tears for up to two weeks

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14
Q

viral conjuctivitis clinical presentation

A

acute onset worse in first 3-5 days; bilaterally

itchy, burning, *feels like they have a foreign body

clear, watery discharge**
can also see URI sx

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15
Q

viral conjunctivitis PE findings

A
  • moderate conjuctival injection
  • water discharge

-follicular tarsal conjuctiva

possible to have a fever, preaurical adenopathy, rhinnorrhea

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16
Q

tx for viral conjuctivitis

A
  1. cool compress
  2. artificial tears
  3. consider abx (for kids to prevent secondary infxn) and antivirals (usually for herpes)
  4. contact precautions–> if in confined space, no school or work for 10 days= highly contagious; wash ur hands and don’t share washcloths
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17
Q

etiology for bacterial conjunctivitis

A

staph aureus
strep pneumoniae
(haemophilus influenzae)

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18
Q

clinical presentation bacterial conjuctivitis

A

acute onset
PURULENT discharge –> crusting along lid margins

  • mild irritations
  • moderate/severe conjuctival injection

can see some eyelid edema

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19
Q

what disease is usually unilateral but often then spreads to the other eye

A

bacterial conjuctivitis

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20
Q

which one has more redness; viral or bacterial conjuctivits

A

viral

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21
Q

bacterial conjunctivitis tx

A

culture if chronic infxn

cool (inflammation and irritation) v warm (loosen the discharge)

topical abx
1) erythro ointment, or polymyxin-trimethoprim drops, or sulfacetamide drops

(stick to 1st 3 usually unless chronic we can consider ofloxacin)

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22
Q

instructions for bacterial conjuctivits meds

A

infants and children–> ointments

night time use

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23
Q

bacterial conjunctivitis things to know precautions

A

wash hands before and after putting eye drops
dont let bottle touch eye
dont share towels

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24
Q

what is important about bacterial conjuctivitis

A

recheck if there is NO improvement within 48 hours

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25
Q

hyperacute bacterial conjuctivitis etiology

A

infxn w neirsseria gonorrhea

common w/ immunoC and newborns (use erythro as prophylaxis)

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26
Q

signs and sx for hyperacute bacterial conjuctivitis

A

LOTs of purulent drainage
injected conjunctiva

can be invasive and penetrate cornea

27
Q

workup for hyperacute bacterial conjuctivitis

A

IMMEDIATE optho referral

1) culture!! (gram - dipplo)

28
Q

tx for hyperacute bacterial conjuctivitis

A

1) hospitalization (topical AND systemic abx–> ceftriaxone)

2) IMMEDIATE optho referral

29
Q

what is the #1 cause of preventable blindness world wide and etiology

A

trachoma – > chlamydia trachomatis

30
Q

S/S trachoma

A

pruritus
moderate conjuctival injection
MINIMAL piain & discharge
inflammation and thickening of conjuctiva

  • *yellow follicles on upper tarsal conjuctiva
  • *Herbert’s pits –> the dots and pits near limbic margin

** remember its chronic and not really painful
(not ton of irritation on actual eye)

31
Q

tx for trachoma

A

SAFE –> by WHO

Surgical–> if bad enough bc of damage to conjuctiva and eyelids
Abx: azithromycin SINGLE = regional too
Facial cleanliness
Environmental improvements –> flies (warmer climates)

32
Q

what disease do we want to tx regional people like family unit and neighbors

A

trachoma

33
Q

what can trachoma lead to

A

cicatricial disease

34
Q

etiology of cicatricial disease

A

chronic or recurrent trachoma

35
Q

what happens bc of cicatricial disease

A

see chronic scarring –> can lead to entropion and trichiasis

increased risk of blindness** abrasions to cornea leading to opacities

36
Q

keratitis

A

nonsuppurative inflammation of the CORNEA

37
Q

keratitis etiology

A

bacterial= staph strep pseudo

viral= usually herpex

parasitic= acanthamoeba (contacts)

38
Q

what is the most common reason for corneal blindness in the US

A

Herpes simplex virus

39
Q

presentation for keratitis

A

pain
photophobia
decreased vision
maybe injected conjuctiva

40
Q

workup for keratitis

A

fluorescein stain

slit lamp exam

41
Q

tx for keratitis

A

DO NOT patch (warm enviro for growth)

topicals= antivirals, FQ, PHGB, lubricating ointment

consider culture is scraping lesion

42
Q

viral keratitis looks like

A

dendritic look

43
Q

pseudonomas keratitis loks like

A

this goopy circle in the middle

44
Q

bacterial presentation of keratinitis

A

this circle sitting on the cornea

45
Q

kertoconjunctivitis sicca etiology

A

dry eye syndrome

1) aqueous tear deficiency (Srojen’s, gland dysfunction or obstruction, secondary to systemic meds

2) evaporative
- screwed up meibomian gland, ectropion or lid disorders (cant shut all the way), contacts

46
Q

dx for kertoconjunctivitis sicca

A

1) clinical dx= presentation and questionnarires
or

2) tear breakup time = put fluorescein stain and see if ?????////

or
3) schrimer test (put anesthetic drops and filter paper in inner eye, close eyes for 5 mins and meausre)—> if there is less than 5 mm of wetting= abnormal

47
Q

tx for kertoconjunctivitis sicca

A

1) enviro changes
2) lubrication
3) topical cyclosporine= anti-inflammatory, increased tear production
4) oral omega 3 maybe –> greasier tears
5) surgical correction to fix eyelid if needed

48
Q

episcleritis

A

LOCALIZED conjuctival inflammation
(RA, TB, idiopathic)

resolves within 1-3 weeks
*want to rule out everything else; can look like subconjuctival hemorrhage but that goes away in a few days whereas this thing stays longer

refer to optho

49
Q

scleritis

A

chronic and painful inflammation

anterior= diffuse or nodular

posterior= may have proptosis

its more serious than episcleritis bc deep vessels effected

50
Q

pathophysiology of scleritis

A

thinning of sclera and choroid before it becomes visible –> bluish appearance

51
Q

scleritis workup

A

check all ur ANCA, ESR, ANA stuff , PPD

Imaging–> MRI/CT

52
Q

tx for scleritis

A

NSAIDS
Oral steroids
methotrexate
cyclophosphamide

53
Q

what disease impacts the middle layer or the vascular tunic

A

uveitis

54
Q

uveitis

A

inflammation of any part of the uveal tract (Iris, choroid, ciliary body)

there is anterior and posterior

55
Q

anterior uveitis vs posterior

A

anterior is more common

anterior= iritis!!

posterior= choroiditis (uncommon)–> also HIV and CMV retinitis-
^ in gen more concerned it is something more srs

56
Q

why do ppl get anteiror uveitis

A

exact patho unkown

trauma or systemic inflammatory disease (AI disorder like RA or lupus), infection related (herpes, syph, tb)

50% idiopathic

*its usually these pts that have high sed rate and you cannot figure it out

57
Q

how does anterior uveitis present

A

acute onset painful red eye

UNILATERAL
blurred vision, photophobia, tearing

58
Q

how does posterior uveitis present

A

onset of blurred vision
photophobia
FLOATERS
intermittent eye pain

can be uni or bilateral

59
Q

PE findings for uveitis

A

external eye is good

CILIARY flush around limbus
decreased visual acuity

photophobia on exam

w posterior= hazy fundus, blurred optic disc, hemorrhages

60
Q

uveitis dx

A

slit lamp exam

rule out corneal abrasions, ulcer, or FB

***hallmark or iritis= granulomatous keratitic precipitates (WBC on corneal epithelium)

look at anterior chamber for clarity (hazy flare–> iritis)

61
Q

hallmark of iritis

A

***hallmark or iritis= granulomatous keratitic precipitates

62
Q

tx for uveitis

A

1) optho within 24 hours

2) anterior (iritis)
- —–prednisolone solution
- —–scopolamaine OR
- —–cyclopentolate (dilate to relieve muscle spasm)

3) posterior
- ——-periocular or intraocular injection of glucocorticoids

4) systemic meds –> if resistant to topicals and still inflammed, oral glucocorticoids

63
Q

when siuld you refer to optho

A
  • acute change in vision
  • ciliary flush (deeper issue)
  • clouding of anterior chamber/corneal opacity
  • fixed pupil, globe penetrates, rust ring
  • tx response is inadequate
  • worried patient OR PA

gen med 2: eent (3 decks)

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