The Red Eye Flashcards
Evaluation of Orbital Cellulitis may include a CT with contrast if ?
- Limited eye movements
- Pain with eye movements
- Failure to improve within 24-48 hours of starting antibiotics
Hospital Management of Orbital cellulitis includes?
IV
- Ampicillin/Sulfbactam
Or
- Ceftriaxone plus metronidazole
Or
- Clindamycin
Or
Vancomycin plus one of the following drug
- Ceftriaxone
- Cefotaxime
- Ampicillin/sulfbactam
- Piperacillin tazobactam
T of F
Once you are seeing improvement (24 - 48hrs) in orbital cellulitis with a pt on IV, consider switching to oral abx
- True
T or F
Pinguecula affects the Conjunctival tissue BUT does not encroach on the cornea ?
- True
T or F
Pterygium affects the conjunctival tissue and IT DOES encroach on the cornea
- True
- Wing shaped
Pinguecula & Pterygium is caused by?
- Sunlight exposure
&
- Chronic eye irritation
Treatment of Pinguecula & Pterygium includes?
- Mild artificial tears
- Mild topical steroids
- Surgery if
- Pterygium threatens visual axis
- Excessive irritation
- Interfering with contact lens
T or F
Pinguecula & Pterygium can both become cancer?
- True
Conjunctivitis is a diagnosis of exclusion, what must you exclude ?
- Acute Angel Closure Glaucoma
- Keratitis
- Iritis
What are RED FLAGS for Conjunctivitis that could be signs of more serious condition’s like
- Acute Angel Closure Glaucoma
- Infectious Keratitis
- Infectious Iritis ?
- Decrease in visual acuity
- Cillary flush
- Photophobia
- Severe foreign body formation
- Corneal opacity
- Fixed pupil
- Severe headache with nausea
What is the Conjunctiva ?
- Mucus membrane that lines the globe up to the limbus
What does the Bulbar Conjunctiva cover?
- Globe
What does the Tarsal Conjunctiva cover?
- Inner Eye lids
T or F
Conjunctivitis “inflammation of the conjunctiva” is benign and self limiting, but must rule out other serous conditions ?
- True, must rule out
- Acute angle closure glaucoma
- Infectious Iritis
- Infectious keratitis
Bacterial acute conjunctivitis causes in kids?
- H. Influenza
Bacterial acute conjunctivitis in pt’s wearing contact lenses ?
- Pseudomonas
Other causes of bacterial acute conjunctivitis?
- Staph. aureus
- Staph. epidermidis
- Strep pneumonaie
- N. gonorrhoeae
- N. meningidis
- C. trachomatis
Viral causes of acute conjunctivitis?
- Adenovirus
- Herpes simplex
- Herpes zoster
- Flu
- Measles
- Mumps
Non infectious Allergic conjunctivitis causes?
- Seasonal allergies
- Atopy (Heighten immune response)
Non infectious Non allergic acute conjunctivitis causes?
- Topical medications
- Wind
- Uv light exposure
- Smoke
- Autoimmune
Bacterial Conjunctivitis Symptoms include?
- Affected eye stuck shut in the morning
- Copious purulent discharge that returns after wiping it away
- Mild pruritus
- Unilateral redness and discharge
- Injected bulbar conjunctiva
Bacterial Conjunctivitis initial treatment ?
- No contacts
- Clean eyes
- Cool compresses x 3 days
Bacterial Conjunctivitis treatment if unresolved after 3 days?
- Polymyxin B-bacitracin ophthalmic ointment
OR
- Polymyxin B-trimethoprim drops
OR
- Erythromycin ointment
OR
- Tobramycin ointment
OR
- Gentamicin drops
Hyperacute Bacterial Conjunctivitis is caused by?
- Gonococcal Neisseria infection
or
- Meningococcal infection
- Transmission from genitals to hands to eyes
T or F
Hyperacute Bacterial Conjunctivitis pt will have a concurrent urethitis?
- True
T or R
Hyperacute Bacterial Conjunctivitis is life threathening and requires emergency attention?
- True
Symptoms of a pt with hyperacute bacterial conjunctivitis include?
- Copious purulent discharge within 12 hours of exposure
- Tender pre-auricular lymphadenopathy
- Marked chemosis (swelling of conjunctiva)
- Redness
- Irritation
- Lid swelling
Treatment of hyperacute bacterial conjunctivitis?
- Ceftriaxone IM (1g)
plus
- Topical bacitracin ophthalmic ointment
- plus
- Azithromycin
Simple bacterial conjunctivitis
- Children
- H. Influenza or Staph
- Acute redness
- Discharge
Gonococcal bacterial conjunctivitis
- Neisseria Gonorrhea
- Hyperacute onset
- Severe copious purulent discharge
Follicular Conjunctivitis
- Acute follicular conjunctivitis is usually associated with viral infections
- Follicular Eruption on the Tarsal Conjunctiva
- Follicles can be seen in the inferior and superior tarsal conjunctiva
- Follicles appear as gray-white, round to oval elevations
Adult Inclusion Conjunctivitis
- Sexually transmitted
- Chlamydia trachomatis
- STI usually also present
Adult Inclusion Conjunctivitis symptoms include?
- Unilateral or occasionally bilateral
Follicular conjunctivitis - Last weeks to months
- Does not respond to antibiotic therapy
- Preauricular lymphadenopathy
Adult Inclusion Conjunctivitis Dx is done by?
- Giemsa stain
- Direct fluorescent antibody staining of conjunctival smear
- Cultures
Progression of Trachoma is the leading cause of ?
- Blindness in the world
Progression of Chlamydia trachomatis from Follicular conjunctivitis leads to ?
- Scaring and contraction of the conjunctiva
- Causes Eyelashes to scratch cornea
- More infection, More scaring
- Vision lost
Viral Conjunctivitis starts in one eye and then spreads to the other
T or F
- True
- Caused by Adenovirus Herpes Simplex Herpes Zoster Flu Measles Mumps
1 Pt affected by Viral Conjunctivitis ?
- Children
T or F
Viral Conjunctivitis may be accompanied viral prodrome ?
- True
- Adenopathy (preauricular)
- Fever
- Pharyngitis
- URI symptoms
Viral Conjunctivitis symptoms include?
- Watery discharge
- Second eye infected within 24-48hrs
- Mild Follicular eruption
(Tarsal conjunctiva) - Burning, sandy or gritty FB sensation
- Unilateral symptoms do not rule out a viral origin
T or F
Viral Conjunctivitis is self limited like the common cold ?
- True
- Worsening symptoms the first few days
- Resolves gradually
1-2 weeks
Viral Conjunctivitis treatment includes?
- Cool compresses
- Lubrication ointment
Allergic Conjunctivits is caused by?
- airborne allergens that contact the eye
Allergic Conjunctivits symptoms include?
- Bilateral redness
- Watery discharge
- Itching
Cardinal symptom - Help differentiate from viral conjunctivitis
- Chemosis
T or F
Allergic rhinitis symptoms are usually also present with allergic conjunctivitis ?
- True
Cardinal symptoms differentiating Allergic conjunctivitis from viral conjunctivitis ?
- Itching in Allergic Conjunctivitis
Allergic Conjunctivitis Treatment includes ?
- Topical antihistamine (Naphazoline)
- Olopatadine drops (antihistamine plus mast cell stabilizer)
T or F
Phone triage and treatment for conjunctivitis is a good idea?
- False
- Pt must be seen in person
T or F
Topical glucocorticoids have NO ROLE in the treatment of conjunctivitis?
- True
T or F
Must be on antibiotics for a minimum of 24 hours before returning to school or day care?
- True
- Problem is its Viral conjunctivitis
Hyphema definition?
- Blood in the front (anterior) chamber of the eye
- Appears as a small pool of blood at the bottom of the iris or in the cornea
Hyphema in the eyes is commonly caused by?
- Blunt or penetrating trauma
- Bleeding results from tears in the vessels of the cillary body or iris
T or F
A Hyphema can also occur spontaneously?
- True
- DM
- Clotting disorders
- Medications that inhibit platelet function
What are the signs and symptoms of a Hyphema?
- Photophobia
(Eye pain with Consensual constriction) - Decreased visual acuity
(Ophthalmologist ASAP) - Anisocoria
(Torn iris sphincter muscle = Miosis or Mydirasis) - Elevated intraocular pressure
(>21 tested with Tonopen) - Corneal blood staining
A traumatic hyphema can be an indication of other ocular injuries like ?
- Open globe
- Corneal abrasion
- Traumatic iritis
- Dislocated lens
T or F
Management of a Hyphema should include
Prompt evaluation by an ophthalmologist ?
- True
What are the PE’s included in a pt with a Hyphema?
- Visual acuity
- Pupillary response
- Extraocular movements
- Intraocular pressure
- Slit-lamp exam
- Fluoroscein stain
Corneal Abrasion refers to any defect in the corneal surface epithelium, what must you rule out?
- Penetrating trauma
- Infectious infiltrate (HSV)
- Ask about prolonged contact lens wear (Increases infection chances)
Corneal Abrasions requires a good eye exam, you may use anesthetic drops to facilitate eye?
T or F
- True
Corneal Abrasion eye exams include what to help with the Dx?
- Visual acuity
- Fluorescein examination
- Inspect Lids / lashes, Periorbital swelling
- EOMI / PERRLA
(Direct and consensual reaction) - Signs of Hyphema
Fluorescein examination is done with the woods lamp to help detect corneal abrasions?
- True
Corneal Abrasions heal fast if properly treated ?
T or F
- True
- 24 to 48 hours
Management of corneal abrasions should include?
- Update tetanus
- Topical antibiotics (ASAP)
Erythromycin
Ciprofloxacin
Tobramycin - Pain control
Tylenol
MAYBE Consideration of ophthalmic NSAIDS - CAREFUL
Why don’t you give pt’s topical steroids ?
- Pt’s tend to over use and can cause themselves Corneal Abrasions
When to refer a pt with a Corneal abrasion?
- Rust ring
- Chemical burn
- Cornealulcer or infiltrate
- Herpetic keratitis
- Failure to heal (3 to 4 days)
- Inability to remove a foreign body
- Increase size ofabrasionafter 24 hours
- Penetrating injury
- Hyphema (blood)
- Hypopyon (pus)
- Vision loss of >20/40
When should you follow up with a pt with a corneal abrasion?
- In 24 hours
What Corneal abrasion pt’s should be followed up with in 24hrs?
- Abrasion >4mm
- Contact lenses
- Decreased vision
Bacterial Keratitis in an infection involving what?
- Cornea
Bacterial Keratitis common pathogens include?
- S. aureus
- Pseudomonas
- S. Pneumoniae
- Polymicrobial
1 cause and risk factor of bacterial keratitis
- Improper contact lens wear
T or F
Bacterial Keratitis can lead to corneal abrasions if not treated correctly ?
- True
- Sleeping in them
- Improper cleaning
Bacterial Keratitis pt’s MUST be referred to Ophthalmology ?
- True
- ER ASAP
Symptoms of Bacterial Keratitis include?
- Photophobia Intense pain
- Foreign body sensation
- Cloudy cornea (WBC’s)
- Trouble keeping affected eye open
- Purulent discharge
Viral Keratitis is caused by ?
- HSV
Viral Keratitis S & S?
- Dendritic lesion (Fluorescein / woods lamp exam)
- Watery discharge
- Red eye
- Photophobia
- Foreign body sensation
Management of Viral Keratitis includes?
- Ophthalmologist referral
- Hospitalized for anti viral therapy IV
Iritis / Uveitis
- Inflammation of the anterior (Front) uveal tract
- Consists of three parts
1) Iris
2) Ciliary body
3) Choroid
If Ciliary body is involved in Iritis / Uveitis its called?
- Iridocyclitis
Iritis / Uveitis S & S include?
- Ciliary flush around Iris
- Pain
- Photophobia
- Blurred vision
- Pain with consensual pupillary reaction
- Pain in the affected eye when light is shined in the unaffected eye
Causes of Iritis include?
- Toxoplasmosis
- TB
- Sarcoid
- Syphilis
- Idiopathic (Autoimmune 60%, other)
What should you consider in a pt with repeated episodes of Iritis?
- Autoimmune 60%
or
- Infectious agent
Management of Iritis?
- Ophthamologist referral ASAP
- Typically treated with topical steroids
- Monitor side affects
- Treat cause
Acute Angle Closure Glaucoma
- Increases with age
- Narrowing or closure of the anterior chamber angle which allows aqueous humor drainage
Acute Angle Closure Glaucoma causes what?
- Inadequate drainage of aqueous humor
- Increase in IOP
- Damage to the optic nerve
What are the two types of Acute angle closure glaucoma?
1) Primary
2) Secondary
Acute angle closure glaucoma is an rare emergency?
- True
What is the second leading cause of blindness?
- Glaucoma
Risk factors of glaucoma include?
- Family history
- > 60y/o
- Female
- Hyperopia (Far Sightedness)
- Certain medications
Medications that increase the chances of acute angle closure glaucoma include?
- Alpha/beta adrenergic agonists
(Phenylephrine, Ephedrine) - Anticholinergic agents
(Atropin, Scopopamine) - Antihistamines
(Diphenhydramine) - Beta2 adrenergic agonists
(Abuterol) - Diuretics
(HTZ) - Psych drugs
(Tricyclic AD, SSRI’s) - Stimulants
Acute angle closure glaucoma S & S depend on the degree of IOP?
- Decreased vision
- Halo around lights
- Headache
- Eye pain
- Nausea / vomiting
What are the symptoms that suggest a rapid rise in IOP in acute angle closure glaucoma?
- Conjunctival redness
- Corneal edema or cloudiness
- Mild dilated pupil that reacts poorly to light
Acute angle closure glaucoma evaluation should include?
- Anterior chamber depth test
- VA
- Evaluation of the pupils
- Measure IOP (Tonomery pen)
- Slit lamp examination of the anterior
segments - Visual field testing
Acute angle closure glaucoma evaluation of the anterior chamber depth includes ?
- Light shined on one side of pt’s pupil
- Normal = Light shines on both sides of iris
- Abnormal = One side of the iris is darkened
Management of acute angle closure glaucoma if within 1 hour of S&S?
- Ophthalmologist ASAP if within 1 hour
Management of acute angle closure glaucoma if > 1 hour of S&S?
- 0.5% Timilol
Beta Blocker
Reduces the production of aqueous fluid - Apraclonidine
Alpha 2 agonist
Reduces the production of aqueous fluid
- Pilocarpine Stimulation of cholinergic receptors Results in contraction of the iris sphincter (miosis) Constriction of the ciliary muscle Lowering IOP
T or F
Pt receiving medication tx for acute angle closure glaucoma will need nausea and pain control ?
- True
- Keep Pt supine
Viral conjunctivitis
- Acute
- Bilateral, may be asymmetric
- Itching, burning, soreness
- Watery
- Preauricular lymphadenopathy
Bacterial conjunctivitis
- Acute
- Unilateral or bilateral
- Burning
- Heavy, mucopurulent
- Lids possibly adherent
Chlamydial conjunctivitis
- Subacute, chronic
- Usually unilateral
- Burning, irritation
- Scant, mucopurulent
- More often in young adults
Herpes simplex conjunctivitis
- Acute
- Unilateral
- Photophobia, irritation
- No discharge
- Dendritic ulcer on cornea vesicles on lid
Allergic conjunctivitis
- Chronic
- Bilateral
- Itching
- Stringy, mucoid
- Seasonal, atopic pts
Blepharitis
- Chronic
- Bilateral
- Itching, burning, foreign body sensation
- Usually no discharge
- Inflammation, crusting of lid margins
Dry eye
- Chronic
- Bilateral
- Foreign body sensation
- If severe case, mucoid
- Punctate fluorescein staining of cornea
