Week 2: Opthalmology Flashcards
What is the clinical presentation & management plan for retinal detachment?
Photopsia, visual field defect, floaters
Emergent ophthalmology consult
What is the clinical presentation & management plan for optic neuritis?
Preceding viral infection, pain with eye movement, dyschromotopsia, vision loss with exercise/heat, objects appear curved
Pupil light reflex decreased, decreased visual acuity, abnormal color vision, central scotoma, swollen optic disc
Emergent ophthalmology consult
What is the clinical presentation & management plan for amaurosis fugax?
Transient monocular loss of vision d/t ischemia of the retina/choroid/optic nerve
Monocular Gray curtain from periphery, transient (2-30 minutes)
Send to ER for stroke workup
How can you distinguish between viral and bacterial conjunctivitis?
Viral may have water discharge, bacterial will have thick purulent dc, sticky eyes
What is the clinical presentation & management plan of allergic conjunctivitis?
Non-painful red eye
Bilateral, pruritis, clear/white stringy discharge; allergic shiners and boggy conjunctiva
resolve allergens present, oral antihistamine (loratadine, fexofenadine); ocular mast cell stabilizers; artificial tears, cool compresses, removal of contact lenses
What is the clinical presentation & management plan of atopic/vernal conjunctivitis?
Non-painful red eye
Severe itching, burning and tearing
Ocular mast cell stabilizers
What is the clinical presentation & management plan of chemical conjunctivitis?
Non-painful red eye
redness and irritation
Flush eyes
What is the management plan of viral conjunctivitis?
artificial tears and cool compresses
this is highly contagious
What is the management plan of bacterial conjunctivitis?
What timeframe should patients start to see improvement once starting on treatment?
empiric use of topical abx if no improvement in sx (gentamicin, cipro, azithromycin, erythromycin, sulfacetamide, trimethoprim/polymyxin B)
For peds:
Younger children - start empiric treatment
Older children: can utilize conservative options first
Should see improvement in sx within 3 days on tx
What would you treat bacterial conjunctivitis with if it is also present w/ otitis media?
Augmentin
What is the clinical presentation & management plan of uveitis?
Painful red eye
Acute pain, photophobia, pupil constriction, blurred vision, epiphora; ciliary flush
Management: same day referral to ophthalmology
What is the clinical presentation & management plan of keratitis?
Painful red eye
Defect of the corneal epithelium – severe pain, redness, photophobia, discharge; green stain w/ fluorescein stain
Prompt referral to ophthalmology
What is the clinical presentation & management plan of herpes zoster opthalmicus?
Painful red eye
malaise and Hutchinson’s sign; vesicular lesions along trigeminal nerve dermatome, foreign body sensation, tearing, blurred vision, photophobia
Oral antivirals, corticosteroids; urgent referral to ophthalmology
What is the clinical presentation & management plan of scleritis?
Painful red eye
Severe eye pain, eye tenderness, blurred vision, inflamed sclera, tearing, photophobia
Urgent referral to ophthalmology
What condition do these symptoms describe and how would you manage it?
Pain, redness, blurred vision, HA, N/V
Difference in pupillary diameter on the affected side
Acute Angle Closure Glaucoma - ER referral
What condition do these symptoms describe and how would you manage it?
Yellow scales/swelling at the eyelid margin
burning, foreign body sensation, tearing, itching, discharge
Blepharitis
Lid hygiene, warm compresses
Doxycyline if severe
What is the most common causative agent of blepharitis and hordeolums?
staph aureus
What condition do these symptoms describe and how would you manage it?
Painful nodule on eyelid margin
Hordeolum
Lid hygiene, warm compresses
What can a hordeolum progress to?
Chalazion
What is the most common causative agent of periorbital and orbital cellulitis?
strep, staph
What is the presentation of periorbital (preseptal) vs. orbital cellulitis?
Preseptal: eyelid edema, warmth and erythema extends beyond eyebrow; no actual “eye” symptoms
Orbital: conjunctival chemosis and injection, pain or restriction with eye movement, centered in the middle of the eye
How do you manage periorbital vs. orbital cellulitis?
periorbital can be managed outpatient for those 2+ w/ dicloxacillin or cephalexin, clindamycin if suspected MRSA
Orbital cellulitis and periorbital less than 2yo needs hospitalization
What is the presentation of nasolacrimal duct obstruction vs. dacryocystitis?
Nasolacrimal duct obstruction: ○ Chronic tearing, mucoid ocular dc, eyelash crusting, eyelid inflammation
Dacryocystitis: focal swelling, fluctuance, erythema or tenderness of the medial canthus
How do you manage nasolacrimal duct obstruction vs. dacryocystitis?
Nasolacrimal: crigler massage (downward pressure on the lacrimal sac, warm compresses; topical abx if infection suspected
Dacryo: need referral to ENT - may need IV abx (Keflex, augmentin, erythromycin)
What are the general categories of patho of dry eye syndrome?
autoimmune (aqueous) or evaporative
What is the presentation of dry eye syndrome?
Dryness, foreign body sensation, burning or stinging pain, itching or ocular fatigue
What test can be done for dry eye syndrome?
Schirmer test - test for aqueous production
- abnormal = <5mm w/o anesthesia, 10mm w/ anesthesia
How can you manage dry eye syndrome?
avoid exacerbating enviro or tasks
artificial tears
refer to ophthalmology if moderate to severe sx or persistent/poorly controlled
What is subconjunctival hemorrhage?
Is this something that should be worrisome?
bleeding between conjunctiva and sclera
No - should resolve on its own w/in 2 weeks
What is the presentation and management of episcleritis?
non-painful localized scleral injection
artificial tears PRN
