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Clinical Medicine I > The Red Eye > Flashcards

The Red Eye Flashcards

1
Q

OD

A

right eye

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2
Q

OS

A

left eye

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3
Q

What does tonometry measure?

A

inraocular pressure… normal IOP 8-21

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4
Q

A pt presents w/ eyelid inflammation of both eyes. She complains of burning and itching that is worse in the morning. There is no loss of visual acuity. You notice scales, erythema and debris on both lids. What is your presumptive dx?

A

Blepharitis.

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5
Q

How do you treat blepharitis

A
  1. warm compresses and baby shampoo scrubs
  2. bacitracin, erythromycin or azithromycin opthalmic ointment
  3. oral abx if topical ineffective
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6
Q

How does dry eye present?

A
  1. chronic itching, burning, scratching, especially in pm
  2. vision fluctuation
  3. positive schirmer test
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7
Q

A patient with a dry eye should be managed with…

A
  1. artificial tears

2. ophthalmology referral for topical cyclospirine, punctal plugs, glucocorticoids

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8
Q

Pt. presents w/ painful, warm swollen red lump on the eyelid. What is your dx and how do you treat it?

A
  1. Hordeolum

2. Tx w/ carm compress +/- abx. steroid injection if needed after 48 hrs.

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9
Q

Pt. complains of a mass on the interior eyelid. On inspection you see an erythematous, hard mass on the interior eyelid. Pt. does not complain of pain. What is your presumptive dx and tx?

A
  1. chalazion

2. warm compress, abx if needed, steroid injection, surgical I and D if needed.

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10
Q

Dacroadenitis presents as inflammation of the …

A

lacrimal gland

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11
Q

what pathogens can cause dacroadenitis?

A
  1. viral: mumps, EBV

2. Bacterial: staph, gonococcal

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12
Q

A patient presents with swelling of the upper eyelid. Inspection reveals erythema and increased tear production (epiphora). Pt. complains of pain. Exam reveals preauricular LAD. What is your presumptive dx?

A
  1. dacroadenitis

2. ask duration… chronic can mean orbital tumor

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13
Q

How do you confirm a diagnosis of dacryoadenitis?

A

CT w/ contrast, biopsy if tumor concern

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14
Q

What is the preferred tx for dacryoadenitis?

A
  1. warm compresses for viral.
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15
Q

How do you treat ectropion and endtropion?

A
  1. surgical repair indicated if excessive tearing, exposure keratitis, cosmetic distress, lash growth towards eye
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16
Q

What are the common causes of ectropion?

A
  1. advanced age, trauma, infection, palsy of CN VII
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17
Q

what is a key differentiator between pterygium and pingueculum?

A

pterygium will grow.

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18
Q

Pt. presents w/ eyelid pain, eye pain, erythema, and swelling of orbit. No proptosis (bulging), no loss of vision, no pain with EOMs. No chemosis. What is your presumptive dx?

A
  1. Preseptal cellulitis
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19
Q

What confirms a diagnosis of preseptal cellulitis?

A

CT w/ contrast or MRI

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20
Q

How do you manage preseptal cellulitis?

A
  1. Clindamycin, bactrim + augmentin or cefpodoime

2. refer to ophthalmology

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21
Q

Who requires inpatient tx for preseptal cellulitis?

A

consider under 2 yo, all under 1 yo.

inability to differentiate preseptal from orbital.

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22
Q

What is the inpatient tx for preseptal cellulitis or orbital cellulitis?

A

vanco plus ceftriaxone plus metronidazole

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23
Q

What differentiates orbital cellulitis from preseptal?

A

fever, proptosis, impaired EOMs, diplopia, chemosis, leukocytosis

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24
Q

A pt. is being seen after previous dx of URI. Pt. complains of bilateral watery discharge. Exam reveals severe injection (hyperemia) and preauricular LAD. What is your presumptive dx and treatment?

A
  1. viral conjunctivitis

2. warm compress, supportive care. educate on self-limiting 2-3 week course

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25
Q

What differentiates bacterial conjunctivitis from viral?

A
  1. acute onset
  2. can be unilateral
  3. moderate injection
  4. thick, mucopurulent discharge w/ crusting
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26
Q

How would you manage a pt. with bacterial conjunctivitis?

A

Abx:

  1. erythromycin ointment
  2. trimethoprim-polymyxin B solution
  3. cipro solution
  4. azithromycin solution

rest for 5-7 days, no contact use

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27
Q

Pt. presents w/ chronic, bilateral conjunctivitis. Exam revels non-tender preauricular LAD and keratitis. What pathogen do you suspect is responsible, how do you confirm, and what is the tx?

A
  1. c. trachomatis
  2. dx w/ culture, PCR
  3. Tx w/ erythromycin 500mg po qid x 7d, zithromax 1g po x 1
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28
Q

Pt. presents w/ unilateral profuse purulent discharge, chemosis, severe injection, and lid swelling. Exam notes preauricular LAD. Pt. notes onset was rapid. What pathogen is responsible, what should you be careful for, how do you dx and treat?

A
  1. N. gonorrhea infx
  2. this is vision threatening
  3. dx w/ giemsa stain, gram stain, culture on selective media.
  4. Hospitalization required w/ ophthalmology consult. Tx. w/ ceftriaxone 1gm IM x 1
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29
Q

What should you be on the look out for w/ a patient you suspect of allergic conjunctivitis?

A
  1. chronic sxs bilaterally
  2. mild injection
  3. chemosis (conjunctival swelling)
  4. stringy discharge
  5. itching!!!
  6. hx of atopy
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30
Q

Tx for allergic conjunctivitis?

A
  1. lubricating drops
  2. cool compress
  3. OTC antihistamine
  4. ophthalmic antihistamine drops
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31
Q

3 subtypes of scleritis w/ prevalence.

A
  1. Anterior diffuse (50%)
  2. Anterior Nodular (20-40%)
  3. Anteriornecrotizing (rare)
  4. Posterior scleritis (same subtypes)
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32
Q

Pt. presents w/ severe, constant eye pain that is worse in the morning. pain radiates to face and is increased w/ EOMs. Pt. complains of headache and epiphora (increased tears). You notice diffuse hyperemia. What is your presumptive dx?

A

Anterior diffuse scleritits.

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33
Q

How do you diagnose anterior scleritis vs. posterior scleritis?

A

Anterior:
violaceous redness of eye, pain w/ eyelid pressure, scleral edema on slit lamp.

Posterior:
orbit will appear normal, slit lamp shows inflammation, choroidal thickening.

34
Q

Tx for scleritis?

A
  1. ASAP referral to ophthalmology and rheumatology.
  2. slit lamp exam
  3. oral NSAIDs
  4. Oral glucocorditoids
35
Q

A woman complains of abrupt onset of eye redness, irritation, epiphora. Denies pain, denies change to visual acuity. What is the presumptive dx?

A

episcleritis

36
Q

How do you manage episcleritis?

A
  1. ophthalmology referral
  2. slit lamp exam
  3. topical lubricants
  4. topical/oral nsaids
  5. topical glucocorticoids
  6. assess for systemic disease
37
Q

How does corneal abrasion typically present?

A
  1. acute onset of pain, foreign body sensation
  2. epiphora
  3. vision may or may not be affected
  4. epithelial defect
38
Q

How do you treat a corneal abrasion?

A
  1. florescein stain to confirm
  2. topical lubricants and abx
  3. oral analgesics if severe
  4. NO PATCHING
  5. NO ANESTHETIC DROPS
39
Q

a chemical worker presents with acute pain and burning in the eye. The vision is decreased and blurred. How do you manage this apparant chemical injury?

A
  1. immediate irrigation
  2. morgan lens for prolonged irrigation
  3. topical lubricants/antibiotics
  4. urgent ophthalmology
40
Q

Pt. presents w/ acute onset of eye pain and mucous discharge. Vision is decreases and white infiltrate is visible.. Pt. states hasn’t changed contacts in a while. What is the presumptive dx and how do you treat it?

A

Keratitis, intensive topical abx and ophthalmology referral

41
Q

Pt. presents w/ sxs of keratitis with dendritic pattern of white infiltrate. What pathogen is responsible and how do you treat?

A
  1. HSV
  2. treat w/ topical antivirals.
  3. refer to ophthalmology
  4. NO STEROIDS
42
Q

How is hyphema treated?

A
  1. correct coagulopathy
  2. sx tx of pain and NV
  3. eye shield/bed rest
  4. elevate bed
  5. ophthalmology referral
43
Q

What are the common causes of uveitis?

A
  1. HSV, CMV, syphilis, TB, West Nile
44
Q

Pt. presents w/ pain x 7 days, photophobia, hypopyon, blurred vision and epiphora. You notice ciliary flush and increased IOP is noted. What is your presumptive dx?

A
  1. anterior uveitis
45
Q

How does posterior uveitis present and what is effected?

A
  1. painless, floaters and blurred vision.

2. affects the lens. leukocytes present in vitreous humor

46
Q

How do you dx uveitis

A

clinical, slit lamp exam

47
Q

Tx for uveitis?

A
  1. ophthalmology referral
  2. topical glucocorticoids/NSAIDs
  3. cyclopegic drops if increased IOP
48
Q

Three primary components to glaucoma…

A
  1. increased IOP (urgent if > 30mmHg)
  2. optic nerve damage
  3. visual field loss
49
Q

What causes angle closure glaucoma?

A
  1. primary: anatomic predisposition
50
Q

Test for angle-closure glaucoma?

A

penlight test to look for crescent shadow.

51
Q

A patient presents w/ severe eye pain, NV, headache, blurry vision, halos around lights and acute vision loss. The pupil reacts poorly to light and you can visualize a steamy, cloudy looking cornea. What is your presumptive tx?

A

Angle-closure glaucoma

52
Q

How do you manage angle-closure glaucoma?

A
  1. ophthalmologic emergency!
  2. dx w/ gonioscopy
  3. Tx w/ anti-hypertensive medications, oral/IV mannitol, laser peripheral iridotomy, surgical trabeculectomy
  4. DO NOT USE CYCLOPLEGICS
53
Q

Pt. complains of tunnel vision. Exam notes increased cup/disc ratio. What is the presumptive dx?

A

Open angle glaucoma

54
Q

How do you manage open-angle glaucoma?

A
  1. ophthalmology referral

2. topical ocular anti-hypertensives, laser trabeculoplasty, surgical trabeculectomy

55
Q

What are some risk factors for cataracts?

A
  1. smoking tobacco
  2. CS use
  3. UV exposure
  4. DM
  5. Aging
56
Q

Pt. complains of gradual loss of vision w/out pain. pt. stopped night driving due to glare from headlights. On exam, red reflex is absent and you notice a yellowing of the lens. What is the presumptive dx?

A

Cataracts

57
Q

How do yo umanage cataracts?

A
  1. rx glasses, surgery if ADLs impaired.
58
Q

What are the risk factors for age-related macular degeneration?

A
  1. over 50 yo
  2. smoking/etoh use
  3. fh
  4. hx of nitro, beta blockers, aspirin
59
Q

General presentation of ARMD?

A
  1. gradual or acutely blurred vision
  2. metamorphopsia
  3. central scotoma
  4. amsler grid distortion
60
Q

A patient presents w/ central scotoma, drusen deposits, loss of retinal pigment and geographic atrophy in macula. What type of ARMD do you suspect?

A

dry ARMD

61
Q

Patient presents with fibrosis and scarring, rapid vision distortion, metamorphopsia and central scotoma unilaterally. what type of ARMD do you suspect?

A
  1. wet ARMD due to fibrosis and scarring from subretinal neovascular degeneration.
62
Q

Treatments for ARMD?

A
  1. ophthalmology referral
  2. vitamins
  3. smoking cessation
  4. daily amsler grid
  5. low vision aids

WET:

  1. photocoagulation, photodynamic therapy
  2. intravitreal steroid/monoclonal antibodies
63
Q

Risk factors for retinal detachment:

A
  1. history of myopia
  2. cataract surgery
  3. current fluoroquinolone use
  4. fh
64
Q

Rhegmatogenous RD features`

A
  1. full thickness tear of retina

2. posterior vitreous detachment most common cause

65
Q

Nonrhegmatogenous RD features

A
  1. caused by vitreus traction pulling on retina, traction RD

2. associated w/ diabetes

66
Q

exudative RD features

A

caused by exudate beneath retina, no real tear. extremely rare

67
Q

Pt. presents w/ floaters, curtain like loss of vision. Exam reveals raised whitish retina. What is the presumptive dx?

A
  1. RD
68
Q

How do you treat RD?

A
  1. lack of tx progresses to involve whole retina
  2. urgent opthalmology referral
  3. small tear = laster photocoagulation
  4. surgery
69
Q

A patient presents to a well-exam with abnormal fundoscopic exam findings. you see copper wiring, silver wiring, AV nicking, cotton wool spot, hemorrhages and disc edema. What do you suspect?

A

hypertensive retinopathy

70
Q

How do you treat hypertensive retinopathy?

A

BP control and ophtho referral

71
Q

Pt. presents w/ blurred vision, retinal hemorrhage, retinal and macular edema, cotton wool spots, venous dilation and hard exudates on fundoscopic exam. What type of diabetic retinopathy do you suspect and why?

A
  1. non-proliferative due to absence of neovascularization, RD, and macular edema.
72
Q

Pt. presents with neovascularization, hemmorrhage and retinal detachment. What type diabetic retinopathy do you suspect?

A

Proliferative due to neovascularization, hemorrhage and RD

73
Q

How do you manage diabetic retinopathy>

A
  1. blood sugar control
  2. ophtho referral
  3. laster photocoagulation
  4. vitrectomy
74
Q

Risk factors for central retinal artery occlusion?

A
  1. over 40, male
  2. carotid artery artherosclerosis
  3. htn
  4. hyperlipidemia
  5. DM
75
Q

Is CRAO embolic or thrombotic

A

embolic. CRVO is thrombotic

76
Q

Risk factors for central retinal vein occlusion

A
  1. old age
  2. htn
  3. dm
  4. smoking
  5. obesity
  6. hypercoagulable state
  7. glaucoma
77
Q

patient presents with total, acute, painless loss of vision unilaterally. “no light perception”, afferent puillary defect. Exam notes ischemic retinal whitening and a cherry red spot at macula. What type of retinal occlusion is this?

A

CRAO

78
Q

pt. presents w/ acute, variable painless loss of vision in one eye. pt. coplains of scotoma w/ blurred vision. Exam notes blood and thunder appearance. What type of central retinal occlusion is this?

A

CRVO

79
Q

CRAO tx:

A

ophtho referral-emergent

poor prognosis

80
Q

CRVO tx

A

ophtho referral
aspirin
observation
tx for retinal edema/ischemia

81
Q

what causes optic neuritis?

A
  1. demyelination of optic nerve. 30% will develop MS
82
Q

pt. presents w/ central scotoma, painful EOMs, abnormal color vision, photopsias, optic disc edema and shrunken, pale optic nerve. What is the presumptive dx and how do you tx?

A

Optic neuritis.

Get MRI of brain and orbit w/ contrast.

start IV methylprednisolone for severe vision loss or 2 or more white matter brain lesions on MRI

Clinical Medicine I (25 decks)

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