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gen med 2: eent > Red Eye > Flashcards

Red Eye Flashcards

(63 cards)

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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
hyperacute bacterial conjuctivitis etiology
infxn w neirsseria gonorrhea | common w/ immunoC and newborns (use erythro as prophylaxis)
26
signs and sx for hyperacute bacterial conjuctivitis
LOTs of purulent drainage injected conjunctiva can be invasive and penetrate cornea
27
workup for hyperacute bacterial conjuctivitis
IMMEDIATE optho referral 1) culture!! (gram - dipplo)
28
tx for hyperacute bacterial conjuctivitis
1) hospitalization (topical AND systemic abx--> ceftriaxone) | 2) IMMEDIATE optho referral
29
what is the #1 cause of preventable blindness world wide and etiology
trachoma -- > chlamydia trachomatis
30
S/S trachoma
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
tx for trachoma
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
what disease do we want to tx regional people like family unit and neighbors
trachoma
33
what can trachoma lead to
cicatricial disease
34
etiology of cicatricial disease
chronic or recurrent trachoma
35
what happens bc of cicatricial disease
see chronic scarring --> can lead to entropion and trichiasis increased risk of blindness**** abrasions to cornea leading to opacities
36
keratitis
nonsuppurative inflammation of the CORNEA
37
keratitis etiology
bacterial= staph strep pseudo viral= usually herpex parasitic= acanthamoeba (contacts)
38
what is the most common reason for corneal blindness in the US
Herpes simplex virus
39
presentation for keratitis
pain photophobia decreased vision maybe injected conjuctiva
40
workup for keratitis
fluorescein stain | slit lamp exam
41
tx for keratitis
DO NOT patch (warm enviro for growth) topicals= antivirals, FQ, PHGB, lubricating ointment consider culture is scraping lesion
42
viral keratitis looks like
dendritic look
43
pseudonomas keratitis loks like
this goopy circle in the middle
44
bacterial presentation of keratinitis
this circle sitting on the cornea
45
kertoconjunctivitis sicca etiology
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
dx for kertoconjunctivitis sicca
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
tx for kertoconjunctivitis sicca
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
episcleritis
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
scleritis
chronic and painful inflammation anterior= diffuse or nodular posterior= may have proptosis its more serious than episcleritis bc deep vessels effected
50
pathophysiology of scleritis
thinning of sclera and choroid before it becomes visible --> bluish appearance
51
scleritis workup
check all ur ANCA, ESR, ANA stuff , PPD Imaging--> MRI/CT
52
tx for scleritis
NSAIDS Oral steroids methotrexate cyclophosphamide
53
what disease impacts the middle layer or the vascular tunic
uveitis
54
uveitis
inflammation of any part of the uveal tract (Iris, choroid, ciliary body) there is anterior and posterior
55
anterior uveitis vs posterior
anterior is more common anterior= iritis!! posterior= choroiditis (uncommon)--> also HIV and CMV retinitis- ^ in gen more concerned it is something more srs
56
why do ppl get anteiror uveitis
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
how does anterior uveitis present
acute onset painful red eye UNILATERAL blurred vision, photophobia, tearing
58
how does posterior uveitis present
onset of blurred vision photophobia FLOATERS intermittent eye pain can be uni or bilateral
59
PE findings for uveitis
external eye is good CILIARY flush around limbus decreased visual acuity photophobia on exam w posterior= hazy fundus, blurred optic disc, hemorrhages
60
uveitis dx
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
hallmark of iritis
***hallmark or iritis= granulomatous keratitic precipitates
62
tx for uveitis
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
when siuld you refer to optho
- 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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