The Red Eye Flashcards
What kind of humor is in the anterior chamber
Aqueous humor
What kind of humor is in the posyerior chamber?
Vitreous humor
What is ophthalmology’s vital sign?
Visual acuity
What do you do if someone’s vision is worse than 20/400 and you can’t do a snellen chart?
Count fingers, hand motion, light perception
What intraocular pressure is an emergency?
Over 30
What is normal intraocular pressure
8-21
What is the more common device to measure intraocular pressure in primary care or ED
TonoPen
What causes blepharitis?
Meibomian gland dysfunction
What are the symptoms of blepharitis?
Chronic itching, burning, scratching
Worse in AM**
NO vision decrease
Erythema, scales, debris
How do you treat blepharitis?
Warm compress
Baby shampoo lid scrubs
Topical antibiotics:
Bacitracin, erythromycin, azithromycin
Oral antibiotics
Ophthalmology refer if not improving. They can prescribe steroid drops. YOU should never mess with them
Does blepharitis affect dry eyes?
Yes makes it worse. Remember blepharitis is a meibomian gland dysfunction
What ate the symptoms/signs of dry eye?
Chronic itching, burning and scratching
“Tired” eyes in PM
Vision may be worse
Poor tear film
Small erosions in cornea
+schirmer test
What is a schirmer test?
Little strips to measure tear production
What is the treatment for dry eye?
Artificial tears
Optho referral for cyclosporine, steroids, or punctual plugs
What causes hordeolum?
Infected eyelash root
What is the presentation of hordeolum?
PAINFUL
Swelling that may cover whole eyelid**
What causes a chalazion?
Clogged meibomian gland
What is the presentation of a chalazion?
NOT painful
Rarely causes whole eyelid to swell
What is the treatment for hordeolums and chalazions?
Warm compress
Abx if needed
Steroid injection
Surgical drainage
What is dacryoadenitis?
Inflammation of lacrimal gland
What causes dacryoadenitis?
Acute: viral or bacterial source: mumps, EBV, staph, gonococcal
Chronic: inflammatory disorders, thyroid dz,
How do you treat dacryoadenitis?
CT w/ contrast if you don’t know what it is
Biopsy if you think its a tumor
Viral cause- warm compress
Other- treat underlying cause
What usually causes periorbital cellulitis
Extension of sinus infection, ethmoid sinus most common
Also may come from dental/facial infection
What are some of the differences between the presentations of preseptal and orbital cellulitis?
Preseptal: No proptosis No vision impairment No pain with ocular movement Chemosis rare (conjunctival swelling)
Orbital: Fever common Proptosis common Impaired and painful ocular movement Diplopia may be present Chemosis may be present
How do you diagnose periorbital cellulitis?
CT w contrast or MRI so you can figure out if it’s preseptal or orbital
Does orbital cellulitis need to be admitted to the hospital
Yes
What it the treatment for preseptal cellulitis?
Outpatient:
Clindamycin
Bactrim
Inpatient:
Vancomycin
Optho consult
What is the treatment for orbital cellulitis?
IV cefotaxime IV ceftriaxone IV vancomycin Hospital admission+optho consult Surgery if abscessed or to decompress orbit
Name the conjunctivitis:
Bilateral
Severe injection
Watery discharge
Preauricular lymphadenopathy
+/- photophobia and foreign body sensation
Following URI
Viral conjunctivitis
What is the treatment for viral conjunctivitis?
Warm compress
Supportive
Self limiting 2-3 weeks
NAme that conjunctivitsL;
Acute
Unilateral or bilateral
Moderate injection
Thick, mucopurulent discharge
Bacterial
What bacteria usually cause bacterial conjunctivitis in adults?
S. Aureus
What bacteria usually cause bacterial conjunctivits in childern?
S. Pneumoniae
H. Influenzae
M. cattarrhalis
What is the treatment for bacterial conjunctivits?
Erythromycin
Trimethoprim-polymyxin B
Ciprofloxacin
Azithromycin
5-7 days
No contact wearing until infection resolved
How does conjunctivitis caused by c.trachomatis (chlamydia) present?
Bilateral
Marked follicular response
Non-tender preauricular lymphadenopathy
Associated keratitis
How do you diagnose conjunctivitis caused by c. Trachomatis? (Chlamydia)
Giemsa stain
Culture
PCR
How do you treat conjunctivits caused by c. Trachomatis?
Erythromycin
Azithromycin
How does conjunctivitis caused by n.gonorrhea present?
Unilateral or bilateral
TONS of purulent discharge
Chemosis (conjunctival swelling)
Moderate to severe injection
Irritation and tenderness lid swelling
Preauricular lymphadenopathy
Severe and sight threatening
HYPERACUTE onset within 12 hours
How do you manage conjunctivitis caused by n.gonorrhea?
Hospitalization-risk of vision loss
Topical erythromycin
IV ceftriaxone
Ophtho consult
Name that conjunctivitis:
Bilateral
Mild injection
Chemosis
Stringy discharge
Allergic conjunctivitis
What is the hallmark sign of allergic conjunctivitis ?
Itching
How do you treat allergic conjunctivitis
Lubricating eye drops
Cool compress
OTC antihistamine
Antihistamine eye drops
What kind of conjunctivitis has the longest duration?
Allergic- weeks to months
How does subconjunctival hemorrhage present?
Sudden painless appearance of blood in the conjunctiva
“Loud bark, no bite”
What is the difference between episcleritis and scleritis
Episcleritis:
No pain
Scleritis: Severe pain and photophobia Deep bluish hue \+/- nodule Potentially blinding!
What are episcleritis and scleritis associated with?
Systemic autoimmune disease
How do we treat episcleritis and scleritis?
Refer to ophthalmology for slit lamp exam
Topical lubricants
NSAIDS
Topical steroids
Immunosuppressive medications for scleritis only
What are the symptoms of a corneal abrasion?
Acute onset of pain and foreign body sensation
Epiphora (lots of tears)
Vision may be affected
Epithelial defect
How do we manage corneal abrasion?
Topical lubricants
Topical antibiotics
Oral pain meds
NEVER EVER topical anesthetics
What can happen if you give anesthetic drops to someon with a corneal abrasion?
Anesthetic keratitis - eye gets covered in white corneal exudate. Very bad
How do we manage chemical injury to the eye?
Irrigate
Irrigate
Morgan lens for irrigation
Topical lubricants and abx
Ophthalmology consult STAT
What do you need to be aware of before you go trying to remove a corneal foreign body?
Figure out what got in there and beware of intraocular foreign body
What is keratitis?
Infection of the cornea/ corneal ulcer
What usually causes keratitis/corneal ulcer?
Sleeping in contact lenses
Name it:
Acute onset of pain
Mucous discharge
Contact lens abuse
Vision decrease
White infiltrate seen without fluorescin stain
+/- hypopyon
Keratitis/ corneal ulcer
How do you treat keratitis/corneal ulcer?
Intense topical antibiotics
Optho referral
What should you think about if you see a “dendritic pattern” with fluorescin staining?
Herpes simplex virus causing keratitis
How do you treat keratitis caused by herpes simplex?
Topical antivirals
refer to ophtho
NEVER use steroids
What is hyphema?
Blood in the anterior chamber casiued by trauma to iris/pupil
Name it:
Acute onset of pain
Photophobia
Nausea/vomiting
Layered heme
+/- vision decrease
Hyphema
What should you think about if you see a “dendritic pattern” with fluorescin staining?
Herpes simplex virus causing keratitis
How do you treat keratitis caused by herpes simplex?
Topical antivirals
refer to ophtho
NEVER use steroids
What is hyphema?
Blood in the anterior chamber casiued by trauma to iris/pupil
Name it:
Acute onset of pain
Photophobia
Nausea/vomiting
Layered heme
+/- vision decrease
Hyphema
What do you need to be aware of before you go trying to remove a corneal foreign body?
Figure out what got in there and beware of intraocular foreign body
What is keratitis?
Infection of the cornea/ corneal ulcer
What usually causes keratitis/corneal ulcer?
Sleeping in contact lenses
Name it:
Acute onset of pain
Mucous discharge
Contact lens abuse
Vision decrease
White infiltrate seen without fluorescin stain
+/- hypopyon
Keratitis/ corneal ulcer
Name it:
Acute onset of pain
Photophobia
Nausea/vomiting
Layered heme
+/- vision decrease
Hyphema
How fo you treat hyphema?
Correct any underlying coagulopathy
Treat pain
Treat nausea/vomiting (vomiting increases IOP)
Elevate head of bed (drain eye)
Refer to ophtho- sight threatening! Ophtho will do these: Control IOP Cycloplegics to dilate eye Steroids Short-term topical anesthetic drops
As the grade of hyphema increases, what happens to their prognosis of regaining 20/50 vision?
Decreases
When do we usually use eye patches and eye shield?
Trauma and post-op
*they can worsen infections
What is uveitis/iritis?
Uveitis: inflammation of the uveal tissue
Iritis: inflammation of the anterior uveal tissue (the iris) most common presentation of uveitis
What can cause uveitis/iritis?
Trauma
Infection
Autoimmune disease
Name it:
Acute onset of photophobia
Eye pain/blurred vision
Ciliary flush (white around iris then lots of vasculature elsewhere)
+/- hypopyon
Uveitis/iritis
How do you manage uveitis/iritis?
Refer to ophtho
Topical steroids/NSAIDS
Cycloplegics
Typically resolves in 6-8 weeks
What are some complications of uveitis/iritis?
Irregular pupil due to scar tissue
Cataracts
Swelling
Increased IOP
When do we use topical anesthetcis for eyes?
Only during exam. Never prescribe them. Only ophtho may prescribe it for hyphema
Should YOU as a PA prescribe steroids for the eyes?
NO.
Can cause glaucoma and cataracts
Can worsen infections
Should you ever use gentamicin in eyes?
NO
What is your best friend when it comes to topical antibiotics for eyes
Erythromycin ointment
WHen should you just refer to ophthalmology?
Vision/eye threatening
Infection worsening
Contact lens wearers
Rapidly progressing/severe disease
Chronic eye conditions
Uncertain diagnosis
worried patient
Worried PA
What is hyphema?
Blood in the anterior chamber casiued by trauma to iris/pupil
How do you treat keratitis caused by herpes simplex?
Topical antivirals
refer to ophtho
NEVER use steroids
What should you think about if you see a “dendritic pattern” with fluorescin staining?
Herpes simplex virus causing keratitis
How do you treat keratitis/corneal ulcer?
Intense topical antibiotics
Optho referral
