Red eye X2 Flashcards
Posterior chamber
the area behind the irs on the sides of the lens
- the fluid drains out of the trabecular meshwork
Limbus
Where the sclera meets the iris
- usually a dark circle around the aris
Chemosis
swelling of the conjuctiva
Hypopyon
leukocyte exudate in the anterior chamber of th eye
Clilliary flush
dialated conjunctival and episcleral vessals adjacent and curcumferential to the corneal
Tonometry
tool that measures of intraocular pressure
normal is 8-21
Blepharitis Present
Eyelid indlammation due to meibomian gland disfunction - chronic itching or bruning, scratching - worse in the morning - not vision decrease erythema, scales, debris
Blepharitis tx
Warm ompress and baby shampoo lid scribs
Abx:
- Bacitracin opthalmic ointment
-Erythromycin or Azithromycin ointment
Dry Eye present
* can be caused by blephritis, autoimm, hormonal changes, ectropian, meds Pres: chronic itching burning scratching tired eyes especially in the PM - Vision fluctuation! -poor tear film - punctate epithelial erosions \+ schirmer test (>10cm)
Dry Eye Managment
-artificl tears/oinments
- opthamology referal
- topical cyclosporing
+/- topical glucocorticoids
punctal plugs
Hordeolum
Caused by infected eyelash root
Painful swelling
Tx: warm compress, abx if needed, steroid inection or surgery (refer)!
Chalazion
Presetn: clogged meiobian gland
usually not painfull
usually doesnt make the entire lid well
Tx: warm compress, abx, steroid or surgery
Dacryoadenitis
Pres: inlfamation of lacrimal gland
- pain in area of swelling, epiphoria
acute: viral or bacterial source
Chronic: non infectious inflmmatory disorders or orbitaltumor,
Pinguecula
clear thin tissue that covers part of the sclera
- can be assoaiated with aging usually do not cause vision loss
Tx: lubricating drops and sunglass use and possible surgery
Pterygium
thickening of the bulbar conjuctiva which grows slowly but can progess across cornea
Preseptal Cellulitis
Present: eyelid pain and they may or may not have erythema but will have swelling - no proptosis -no imparement of vison - not pain with oular movement - chemosis is rare Dx: CT with contrast or MRI
Preseptal Cellulitis Tx
Outpatient
Tx: clindamycin or Trimethoprim/sulfamethoxazole
and sugmentin or
cefpodoxamine
*refer to opth
Inpatient: for people under two years of age, inability to differentate presebtal from orbital cellulitis > vancomycin+ceftriaxone+metronidazole
Oribital Cellulitis
Presentation: eyelid swelling, erythema, fever common, propotosis common, impaired and painful *occular movement, optic nerve involvment
+/- impared vision, chemosis, leukocytosis
Oribital cellulitis Dx/Tx
Dx- CT with contrast or MRI
Tx: vancomycin and cetriaxone and metrinidozol
opthalmology consult, hospital admin, surgery if abscees forms or needs to be decompressed
Conjunctivitis
inlfmation of the conjuctive
etiology: viral, allergic, or bacterial, vision usally unaffected
Viral Conjunctiva present
Present: acute following a URI often
- severe injection, watery discharge, preauricular lymphadenopthy
- may feel like they have something in their eye
Viral conjuctiva managment
Warm compress, supportive, self limiting 2-3 wks, opth consult if think its herpes or immunocomp
Bacteril COnjunctiva pres
s. aureus
Presentation: usually unilateral, moderate injection, thick mucopurulent discarge
Bacterial conjuctivitis tx
Topical abx
- erythromycin
- trimethoprim-polymyxin B
- ciprofloxacin
- azithromycin
- no contact use*
Conjunctivitis
c. tachomatis
Rare- adults by direct contact and peds neonatally
Present: can develope chronic conjunctivitis- weeks to months
- may be ass with keratitis and non tender preauricular adenopathy
Dx: culture and PCR
Tx: erythromycin 500mg qid 7d
azithromycin 1g po x 1
N. Gonorrhea bacterial conjunctivitis
Present: Unilateral or bilateral sever profuse, purulent discharge -chemosis - lid swelling - moderate to severe injection *severe and sight threatening - sx occur within 12 hrs of inoculation
Gonorrhea conjuctiva Dx/Tx
Dx: giemsa stain, gram stain,
Tx: admit to hosp, ceftiazone 1gm IM x 1
opthalmology consult
allergic conjuctivits
Pres: chronic sx, bilateral, mild injection, stingy discharge, itching
Tx: lubricating drops, cool compress, OTC antihistamines, antihistaine drops
Subconjunctival Hemorrhage
Sx: acute, spontaneous, asymptomatic
blood in the conjunctiva
Signs: visions usually not affectuve
Tx: reassurance
Scleritis cause
inflam or autoimm dis or the sclera particularly vasculitis
- can be acute or chronic > potentially blinding !
Anterior Scleritis pre/dx
Present:
- severe constant eye pain, worse in am
- pain radiates to face and periorbital region
- pain increase with EOMs
- HA
-epiphoria
- hyperemia
Types: diffuse (most common), nodular, necroizing
Dx: violaceous redness, pain with pressure, scleral edema (c slit lamp)
Posterior scleritis pres/dx
no hyperemia unless associated with anterior scleritis
- milder sx
- slid light exam can show disk edema
Dx: orbit may appear normal, slit lamp will show inflammation
Scleritis tx
refer to opth and rheum
- slit lamp exam
- tral NSAIDs, oral gluccocorticoids
Episcleritis present
Abrupt, F>M Pres: bright red epirscleral discoloration irritation epiphora vision not affected pain typically not pain -normal sclera on slit exam
Episcleritis Dx/ Tx
Dx: clinical and normal appearing underlyign sclera
Tx: Refer, slit lamp exam, top lubricants, topical or oral NSAIDs, topical glucocorticoids, assess for other disease
Corneal Abraisons pres
Acute onset of pain, foreign body sensation, epihora +/ vision affected
Corneal abrasion tx
fluorecien stain, topical lub, top abx, oral pain meds, NO patching
** do not give topical anesthetic drops**
Chemical Injury presentation
Caustic Chemical exposure
- acute pain/ burning/ blurred vision/ vision decreased
+/- coneal abrasion
Chemical Injury Tx
Immediate irrigate
Morgans lens for prolonged irrigation
topical lubricants/antibiotics
Get opthalmology
Corneal Foreign Body
Pres: acute onset of foreign body sensation usually with associated event
-vision usually unaffected with visual foregin body
COrneal Foregin body Managemt
determien mechanism of injury
Remove> irrigation> cotton tipped applicator > specialized fb removal tool
lubricant/antibiotic drops
Keratitsis/corneal ulcer
Present: acute onset of pain, mucous discharge, contact lense abuse, vision usually decreased, white infiltrate
+/-hypopyon
Tx: intensive topical antobiotics, opthamology referall
Keratitis- HSV
- will have a dendritic pattern
when stained - refer an treat with topical antivirals
Hyphema
Blood in naterior chamber
Present: acute onset of pain, photohobia, nausea/vomitin
+/- vision decrease
Hyphema managment
- correct underlying coagulopathy
- treat pain N/V
- evalate head of bed
- refer to opthal
control intracoular pressure, cycloplegics, glucocorticoids, short term topical anesthetic
Uveitis
inflammation of the uveal tissue
- anterior or posterior chroid can be affected
- can occur as an isolated process, immune mediated response of drug resonse
Ant: inflamamtion of the iris and cilliary body
Post: inflammation posterior to the lens
Panuveitis: inlfammation in the anterior/posterior
Uveitis Presentation
Ant: pain, cilliary flsuh (white circle around), photophobia, hypopyon, blurred vision, increased tearing
Post: painless, floaters, blurred vision
Uveitis dx/tx
ds: clinical and slit lanp
Tx: opthalmology referal, topical glucocoriticoids/NSAIDs, cycloplegic grios if IOP
Comp: cataracts, irregular pupil due to scar tissue, swelling and increased eye pressure
