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Clin Med Exam 2 (Lauren) > The Red Eye > Flashcards

The Red Eye Flashcards

1
Q

What kind of humor is in the anterior chamber

A

Aqueous humor

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2
Q

What kind of humor is in the posyerior chamber?

A

Vitreous humor

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3
Q

What is ophthalmology’s vital sign?

A

Visual acuity

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4
Q

What do you do if someone’s vision is worse than 20/400 and you can’t do a snellen chart?

A

Count fingers, hand motion, light perception

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5
Q

What intraocular pressure is an emergency?

A

Over 30

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6
Q

What is normal intraocular pressure

A

8-21

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7
Q

What is the more common device to measure intraocular pressure in primary care or ED

A

TonoPen

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8
Q

What causes blepharitis?

A

Meibomian gland dysfunction

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9
Q

What are the symptoms of blepharitis?

A

Chronic itching, burning, scratching

Worse in AM**

NO vision decrease

Erythema, scales, debris

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10
Q

How do you treat blepharitis?

A

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

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11
Q

Does blepharitis affect dry eyes?

A

Yes makes it worse. Remember blepharitis is a meibomian gland dysfunction

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12
Q

What ate the symptoms/signs of dry eye?

A

Chronic itching, burning and scratching

“Tired” eyes in PM

Vision may be worse

Poor tear film

Small erosions in cornea

+schirmer test

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13
Q

What is a schirmer test?

A

Little strips to measure tear production

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14
Q

What is the treatment for dry eye?

A

Artificial tears

Optho referral for cyclosporine, steroids, or punctual plugs

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15
Q

What causes hordeolum?

A

Infected eyelash root

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16
Q

What is the presentation of hordeolum?

A

PAINFUL

Swelling that may cover whole eyelid**

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17
Q

What causes a chalazion?

A

Clogged meibomian gland

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18
Q

What is the presentation of a chalazion?

A

NOT painful

Rarely causes whole eyelid to swell

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19
Q

What is the treatment for hordeolums and chalazions?

A

Warm compress

Abx if needed

Steroid injection

Surgical drainage

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20
Q

What is dacryoadenitis?

A

Inflammation of lacrimal gland

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21
Q

What causes dacryoadenitis?

A

Acute: viral or bacterial source: mumps, EBV, staph, gonococcal

Chronic: inflammatory disorders, thyroid dz,

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22
Q

How do you treat dacryoadenitis?

A

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

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23
Q

What usually causes periorbital cellulitis

A

Extension of sinus infection, ethmoid sinus most common

Also may come from dental/facial infection

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24
Q

What are some of the differences between the presentations of preseptal and orbital cellulitis?

A 
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
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25
Q

How do you diagnose periorbital cellulitis?

A

CT w contrast or MRI so you can figure out if it’s preseptal or orbital

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26
Q

Does orbital cellulitis need to be admitted to the hospital

A

Yes

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27
Q

What it the treatment for preseptal cellulitis?

A

Outpatient:
Clindamycin
Bactrim

Inpatient:
Vancomycin
Optho consult

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28
Q

What is the treatment for orbital cellulitis?

A 
IV cefotaxime
IV ceftriaxone
IV vancomycin
Hospital admission+optho consult
Surgery if abscessed or to decompress orbit
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29
Q

Name the conjunctivitis:

Bilateral

Severe injection

Watery discharge

Preauricular lymphadenopathy

+/- photophobia and foreign body sensation

Following URI

A

Viral conjunctivitis

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30
Q

What is the treatment for viral conjunctivitis?

A

Warm compress

Supportive

Self limiting 2-3 weeks

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31
Q

NAme that conjunctivitsL;
Acute

Unilateral or bilateral

Moderate injection

Thick, mucopurulent discharge

A

Bacterial

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32
Q

What bacteria usually cause bacterial conjunctivitis in adults?

A

S. Aureus

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33
Q

What bacteria usually cause bacterial conjunctivits in childern?

A

S. Pneumoniae

H. Influenzae

M. cattarrhalis

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34
Q

What is the treatment for bacterial conjunctivits?

A

Erythromycin

Trimethoprim-polymyxin B

Ciprofloxacin

Azithromycin

5-7 days

No contact wearing until infection resolved

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35
Q

How does conjunctivitis caused by c.trachomatis (chlamydia) present?

A

Bilateral

Marked follicular response

Non-tender preauricular lymphadenopathy

Associated keratitis

36
Q

How do you diagnose conjunctivitis caused by c. Trachomatis? (Chlamydia)

A

Giemsa stain

Culture

PCR

37
Q

How do you treat conjunctivits caused by c. Trachomatis?

A

Erythromycin

Azithromycin

38
Q

How does conjunctivitis caused by n.gonorrhea present?

A

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

39
Q

How do you manage conjunctivitis caused by n.gonorrhea?

A

Hospitalization-risk of vision loss

Topical erythromycin

IV ceftriaxone

Ophtho consult

40
Q

Name that conjunctivitis:
Bilateral

Mild injection

Chemosis

Stringy discharge

A

Allergic conjunctivitis

41
Q

What is the hallmark sign of allergic conjunctivitis ?

A

Itching

42
Q

How do you treat allergic conjunctivitis

A

Lubricating eye drops

Cool compress

OTC antihistamine

Antihistamine eye drops

43
Q

What kind of conjunctivitis has the longest duration?

A

Allergic- weeks to months

44
Q

How does subconjunctival hemorrhage present?

A

Sudden painless appearance of blood in the conjunctiva

“Loud bark, no bite”

45
Q

What is the difference between episcleritis and scleritis

A

Episcleritis:
No pain

Scleritis:
Severe pain and photophobia
Deep bluish hue
\+/- nodule
Potentially blinding!
46
Q

What are episcleritis and scleritis associated with?

A

Systemic autoimmune disease

47
Q

How do we treat episcleritis and scleritis?

A

Refer to ophthalmology for slit lamp exam

Topical lubricants

NSAIDS

Topical steroids

Immunosuppressive medications for scleritis only

48
Q

What are the symptoms of a corneal abrasion?

A

Acute onset of pain and foreign body sensation

Epiphora (lots of tears)

Vision may be affected

Epithelial defect

49
Q

How do we manage corneal abrasion?

A

Topical lubricants

Topical antibiotics

Oral pain meds

NEVER EVER topical anesthetics

50
Q

What can happen if you give anesthetic drops to someon with a corneal abrasion?

A

Anesthetic keratitis - eye gets covered in white corneal exudate. Very bad

51
Q

How do we manage chemical injury to the eye?

A

Irrigate

Irrigate

Morgan lens for irrigation

Topical lubricants and abx

Ophthalmology consult STAT

52
Q

What do you need to be aware of before you go trying to remove a corneal foreign body?

A

Figure out what got in there and beware of intraocular foreign body

53
Q

What is keratitis?

A

Infection of the cornea/ corneal ulcer

54
Q

What usually causes keratitis/corneal ulcer?

A

Sleeping in contact lenses

55
Q

Name it:

Acute onset of pain

Mucous discharge

Contact lens abuse

Vision decrease

White infiltrate seen without fluorescin stain

+/- hypopyon

A

Keratitis/ corneal ulcer

56
Q

How do you treat keratitis/corneal ulcer?

A

Intense topical antibiotics

Optho referral

57
Q

What should you think about if you see a “dendritic pattern” with fluorescin staining?

A

Herpes simplex virus causing keratitis

58
Q

How do you treat keratitis caused by herpes simplex?

A

Topical antivirals

refer to ophtho

NEVER use steroids

59
Q

What is hyphema?

A

Blood in the anterior chamber casiued by trauma to iris/pupil

60
Q

Name it:
Acute onset of pain

Photophobia

Nausea/vomiting

Layered heme

+/- vision decrease

A

Hyphema

61
Q

What should you think about if you see a “dendritic pattern” with fluorescin staining?

A

Herpes simplex virus causing keratitis

62
Q

How do you treat keratitis caused by herpes simplex?

A

Topical antivirals

refer to ophtho

NEVER use steroids

63
Q

What is hyphema?

A

Blood in the anterior chamber casiued by trauma to iris/pupil

64
Q

Name it:
Acute onset of pain

Photophobia

Nausea/vomiting

Layered heme

+/- vision decrease

A

Hyphema

65
Q

What do you need to be aware of before you go trying to remove a corneal foreign body?

A

Figure out what got in there and beware of intraocular foreign body

66
Q

What is keratitis?

A

Infection of the cornea/ corneal ulcer

67
Q

What usually causes keratitis/corneal ulcer?

A

Sleeping in contact lenses

68
Q

Name it:

Acute onset of pain

Mucous discharge

Contact lens abuse

Vision decrease

White infiltrate seen without fluorescin stain

+/- hypopyon

A

Keratitis/ corneal ulcer

69
Q

Name it:
Acute onset of pain

Photophobia

Nausea/vomiting

Layered heme

+/- vision decrease

A

Hyphema

70
Q

How fo you treat hyphema?

A

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
71
Q

As the grade of hyphema increases, what happens to their prognosis of regaining 20/50 vision?

A

Decreases

72
Q

When do we usually use eye patches and eye shield?

A

Trauma and post-op

*they can worsen infections

73
Q

What is uveitis/iritis?

A

Uveitis: inflammation of the uveal tissue

Iritis: inflammation of the anterior uveal tissue (the iris) most common presentation of uveitis

74
Q

What can cause uveitis/iritis?

A

Trauma

Infection

Autoimmune disease

75
Q

Name it:
Acute onset of photophobia

Eye pain/blurred vision

Ciliary flush (white around iris then lots of vasculature elsewhere)

+/- hypopyon

A

Uveitis/iritis

76
Q

How do you manage uveitis/iritis?

A

Refer to ophtho

Topical steroids/NSAIDS

Cycloplegics

Typically resolves in 6-8 weeks

77
Q

What are some complications of uveitis/iritis?

A

Irregular pupil due to scar tissue

Cataracts

Swelling

Increased IOP

78
Q

When do we use topical anesthetcis for eyes?

A

Only during exam. Never prescribe them. Only ophtho may prescribe it for hyphema

79
Q

Should YOU as a PA prescribe steroids for the eyes?

A

NO.

Can cause glaucoma and cataracts
Can worsen infections

80
Q

Should you ever use gentamicin in eyes?

A

NO

81
Q

What is your best friend when it comes to topical antibiotics for eyes

A

Erythromycin ointment

82
Q

WHen should you just refer to ophthalmology?

A

Vision/eye threatening

Infection worsening

Contact lens wearers

Rapidly progressing/severe disease

Chronic eye conditions

Uncertain diagnosis

worried patient

Worried PA

83
Q

What is hyphema?

A

Blood in the anterior chamber casiued by trauma to iris/pupil

84
Q

How do you treat keratitis caused by herpes simplex?

A

Topical antivirals

refer to ophtho

NEVER use steroids

85
Q

What should you think about if you see a “dendritic pattern” with fluorescin staining?

A

Herpes simplex virus causing keratitis

86
Q

How do you treat keratitis/corneal ulcer?

A

Intense topical antibiotics

Optho referral

Clin Med Exam 2 (Lauren) (6 decks)

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