Red eye and Emergencies Flashcards
Red-eye etiologies:
DUI IT!
D - Dry eye
U - Uveitis
I - IOP (above 21, 30-40 can be asymptomatic/vision loss with no red-eye)
I - Infections
T - Trauma (never put a pressure bandage)
Closed or narrow-angle glaucoma symptoms:
HyPHeN
H - Halos and blurry vision. y P - Pain H - Headache e N- N/V
Closed or narrow-angle glaucoma signs:
PI! CCAFA!!!
P - Pupil
I - IOP
C - Ciliary injection C - Cornea opaque A - Angle closed (Gonioscope) F - Flare A -Ant chamber is shallow
Glaucoma drugs - drugs that dec aqueous humor synthesis
B - beta bolckers (Timolol, betaxolol,carteolol)
A - alfa agonists (Epinephrine-a1, apraclonidine, brimonidine -a2)
D - Diuretics (Acetazolamide)
via vasoconstriction (Epinephrine)
via inhibition of carbonic anhydrase (Acetazolamide)
Glaucoma drugs - drugs that inc outflow of aqueous humor
Prostaglandins - uveoscleraI pathway (Bimatoprost, latanoprost -PGF2a)
Cholinomimetics, M3 - contraction of the ciliary muscle and opening of the trabecular meshwork
Cholinomimetics-Direct: pilocarpine, carbachol
Cholinomimetics-indirect: physostigmine, echothiophate
Definitive closed or narrow-angle glaucoma treatment:
Peripheral Iridotomy (Slit-lamp procedure if acute, Surgical if chronic- tough Iris)
Findings in Allergic\Viral\Bacterial conjunctivitis:
Allergic: Follicles - Papule
Viral: Follicles
Bacterial: Papule
Secretion color in Allergic\Viral\Bacterial conjunctivitis:
Allergic: watery
Viral: yellow
Bacterial: green
Papules vs Follicles structure:
Papules - central vasculature
Follicles - peripheral vasculature
Steroidal treatment in conjunctivitis when ___(2)___ are seen
P-P
Patches (sub-epithelial)
Pseudomembranes
Steroidal treatment icrease _______
IOP
Corneal Dendrites indicate______
Primary Herpes infection - Follicular Keratoconjunctivitis
Pseudo-Dendrites indicate______
Fungal infections
RF for HSV infection of the cornea:
Sweet TIC
Sweet - DM
T - Trauma
I - Immunodeficiency
C -Contact lens
Corneal Dendrites can be visualized with____(2)____.
Fluorescein or Rose-bengal
Follicular Keratoconjunctivitis treatment:
AAA:
A - Acyclovir 3% (local)
A - Acyclovir (systemic- for recurrent infection)
A - Antibiotics for superinfection coverage
NO Steroids! Only after the virus is gone and the patient is still in pain along with antiviral coverage and very carefully!
Stromal herpes treatment:
SALT with Plegia:
S - Steroids (at the beginning - we worry about immune system activation)
A - Acyclovir (local and systemic)
L - Lubrication
T - transplant (for optic axis)
C - Cycloplegics (Atropine/cyclopentolate ) for pain
Signs and symptoms of Herpes Zoster ophthalmicus:
Hutchinson DISCO is PG
Hutchinson - nose lesion (nasociliary nerve)
D - dendritic keratitis I - iridocyclitis S - scleritis or episcleritis C - chorioretinitis O - Optic neuropathy
P - paralisis of mucsles
G - Glaucoma
Herpes Zoster ophthalmicus treatment:
ASS!
Analgesics
Systemic Acyclovir
Steroids
RF for infectious Keratitis:
Sweet TIC
Sweet - DM
T - Trauma
I - Immunodeficiency
C -Contact lens
Subconjunctival hemorrhage mandates a ______
Fundus exam
Subconjunctival hemorrhage does not mandate ______, but _____
Anticoagulant therapy but monitor coumadin patients.
Dry eye signs:
MISFED Breakup
M - Minscus of tear decrease I - Irregularity of the corneal surface S - SPK F - Filaments E - Engored bulbar conjunctival vessels D - Dirty tears
Breakup - Breakup time of tears (dry spots appear at below 10 seconds - fluorescein test)
Dry eye etiologies:
FIRE ALARMS!
F - FB
I - infections/inflamations
R - RA
E - ExPosure (Proptosis, Palsy, PSP- Progressive Supranuclear Palsy)
A - vitamin A deficiency
L - Lash (entropion or trichiasis)
A - Aplasia of the lacrimal gland/Autonomic sysfuction
R - Rosecia
M - Meds (birth control, anticholinergics)/ Mucos membrane (OCP, chemicals, Erythema multiforme)
S -Sjogrens, Sarcoid, Spasm
Sever orbital cellulitis can present with______
RAPD (pressure on the ON)
Orbital cellulitis mandates_____(3)_____
ENT consult, CT scan, IV antibiotics
Orbital cellulitis usually develops from______
Sinusitis (through lamina papricia)
Pterygium is a result of _______, and treated with ________
Solar elastosis, Mitomycin C.
Perforation of the eye will manifest as_____
PIPS
P - Pupil abnormal shape
I - Iris abnormal shape
P - Pigmentory parts outside the eye
S - Smaller eye
Trauma - never put a______.
pressure bandage
Perforation of the eye mandates_____
CT scan, IV antibiotics
Ant vs Post perforation operation qualifications:
Ant - all eye surgeons
Post - Retina specialists
Lid margin cuts mandate_____
Surgery so lashes don’t turn inward
Hyphemia mandates_____
Pupil dilation and fundoscopy
Cycloplegia
Steroids
Hyphemia may lead to_______
Glaucoma.
Trauma may lead to _____
dislocation of the lens (Optic axis deviation-> need for high, +10, lens to see)
Retinal bleeding usually____
is absorbed
Retinal bleeding means we have to think about _____
abuse, shaken baby syndrome.
Optic nerve avulsion mandates_____
Steroids - ease of the edema may give back some sight capabilities.
Optic nerve avulsion will manifest as_____
White, pale disc, with APD (NLP - no light perception)
Chemical burns manifest as_____
Corneal damage seen with flurecin.
Chemical burns mandate_____
WISP
W - WASH!
I - Inspection of the limbus
S - Steroids
P - Pain control (drops/ointment)
Chemical burns - more than ______ of the______, will lead to significant vision loss
1/3 of the limbus.
Uveitis etiologies:
POSI!
P - Postoperative
O - Ocular disease
S - Systemic disease (JRA, Behecet)
I - Infection
Anterior Uveitis findings:
Anterior Uveitis loves KFC’S Nodules!
K - Keratopercipitants (on the endothlium)
F - Flare and cells
C - Ciliary injection
S - Synechea (posterior - flower pupil in kids)
Nodules - on the Iris (Sarcoidosis)
Anterior Uveitis findings - Ciliary injection not affected with
Phenylephrine. Ciliary injection manifested from deep vessels, and Phenylephrine superficial vessels.
Posterior Uveitis findings:
CV3R:
C - Choroid lesion (elevated lesions on the retina) V - Vasculitis V - Vitreous has cells V - Vitreous has snowballs R - Retinitis
Posterior Uveitis findings - Retinitis manifests as
Scotomas.
