Week 3 'Eyes' Flashcards
Acute Allergic Conjunctivis
SSxs:
PE:
Lab:
Allergic conjunctivitis:
a. acute allergic - also called vernal (seasonal) conjunctivitis
recurs in spring and lasts through summer (with hay fever)
Signs & Sxs: sudden, mild to moderate to bilateral severe swelling of conjunctiva & lids
not painful, but pruritus is extremely common
clear, watery discharge is typical
PE:Palpebral conjunctiva appears pale; conjunctival injection is moderate
preauricular adenopathy is absent; chemosis (thickened, boggy conjunctiva) is common.
discharge amount is usually sparse; discharge quality is clear, thin, stringy
Lab: Wright stain of discharge shows eosinophils
Chronic Allergic Conjuctivitis
SSxs:
Chronic allergic – non-seasonal, on/off throughout year
little evidence of inflammation but itching, burning and photophobia may be present
eyelid eversion may show velvety projections on palpebral conjunctiva
Giant Papillary Conjunctivitis
Etiology:
SSxs:
PE:
giant papillary conjunctivitis – allergy to soft contact lenses; may be slow to develop
etiology: autoimmune response to pt’s own proteins or to the “trauma” of the lens wear
Signs & Sxs: excessive pruritus, mucous production, increasing intolerance to contact use.
PE: inflamed conjunctiva – red, itchy, and irritated
may have a thick discharge, worse in morning
eyelid eversion: see giant papillae usu on upper palpebral conjuctitva (cobblestone granulations)
Viral Conjunctivitis
What is it most commonly caused by?
SSxs:
PE:
Viral conjunctivitis: !adenovirus!, common, lasts 1 – 2 wks
Signs & Sxs: pruritus, minimal pain; clear, thin, watery discharge is typical.
occasionally severe photophobia and foreign-body sensation occurs, usually caused by adenovirus when associated with keratitis (inflammation of cornea) (epidemic keratoconjunctivitis [EKC])
common concomitants: sore throat, nasal discharge (rhinitis)
PE:pre-auricular adenopathy is common in EKC and herpes; chemosis is variable.
discharge: amount—moderate or sparse; quality—thin, seropurulent
conjunctival injection is moderate to marked
Herpes simplex virus (viral conjunctivitis)
SSxs:
-early:
-late:
Herpes Simplex virus conjuctivitis HSV (less common than adenovirus)
affects one eye, most often occurs on the cornea which results in herpes keratitis
recurrences usu take form of dendritic keratitis, with a characteristic raised lesion of the cornea “veins of a leaf”; nodules at terminal end of each “branch”
Signs & Sxs:
early: foreign body sensation lacrimation
photophobiaconjunctival injection
late: anesthesia of cornea & dendritic keratitis lesion diagnostic
ulceration and permanent scarring of cornea may result (loss of vision)
Triggers fever, stress, sunlight, trauma
associated with oral herpes, genital herpes
immune compromised pts (HIV, DM)
zoster (shingles) on the tip of the nose moving to cornea, resulting in uveitis and glaucoma
Bacterial Conjunctivitis:
Etiology: What are the most common pathogens? (2)
SSxs:
PE:
Bacterial conjunctivitis:
Etio: Staph and Strep are most common pathogens
Signs & Sxs:
acute onset, minimal pain, occasional pruritus
PE: preauricular adenopathy; chemosis is common.
Discharge: copious; thick and purulent
conjunctival injection is moderate to marked
acute infx - gram stain or culture to identify
chronic may produce little or no d/c except for crusting of eyelashes in AM, no itching
Neisseria gonorrhea (bacterial conjunctivitis)
Adult ssxs:
Neonate ssxs:
Neisseria gonorrhea
i) adult - rare, 12-48 hr incubation period
severe, purulent discharge, usu unilateral, lids swollen
complications: corneal ulceration, abscess, blindness
ii) neonate- purulent discharge, 2-5 days after birth, may be severe lid edema
Chlamydia trachomatis
i) adults
ii) neonates
Chlamydia trachomatis
i) adult inclusion conjunctivitis
“swimming pool conjunctivitis”- infected genital secretions
other exposures from sharing eye make-up, etc
tends to be chronic with exacerbation and remission
pre-auricular adenopathy is occasional
discharge: scant; seropurulent
conjunctival injection is moderate
ii) neonatal inclusion conjunctivitis (inclusion blennorrhea—exposure from cervix)
5-14 day incubation, sx may be mild to severe
chemosis, mucopurulent d/c, often bilateral, no corneal damage occurs
Trachoma (granular conjunctivitis) Caused by \_\_\_\_\_\_\_\_\_\_\_. Endemic in what countries? Most common in what ages? SSxs: PE:
Trachoma (Granular conjunctivitis) chronic infection of cornea and conj. caused by chlamydia
Endemic in Africa, Asia, Middle East, Latin America, Pacific Islands, and aboriginal
communities in Australia
active disease most common in preschool children
Signs & Sxs: Often asymptomatic incubation of 7 days, most contagious in early stages usu. bilateral mucopurulent keratoconjunctivitis photophobia, lacrimation, pain PE: conjunctival surface of the upper eyelid shows a follicular/ inflammatory response (yellow- gray granules eyelid edema, may be corneal ulceration cornea may have limbal follicles, superior neovascularization (pannus), and punctate keratitis.
Pinguecula
SSxs:
Pinguecula: (pin gwek u la)
harmless slightly raised bumps, fatty deposits (yellow-white material) under conjunctiva (nasal side)
no tendency to grow onto the cornea, may become inflamed and red
Pterygium
SSxs:
Pterygium: (ter ij e um)
conjunctival thickening from chronic inflammation from wind, dust
often distinct triangular lesion which may grow over cornea & affect vision
Corneal Trauma
Etiology:
SSxs:
PE:
Corneal trauma
Etiology: foreign body and/or abrasion
Signs & Sxs: pain, photophobia, blepharospasm (spasm of lid, treated with botulism toxin to paralyze lid), may be blurred vision
PE: evert lid to inspect for foreign body, Check cornea for foreign material or hemorrhage
fluorescein stain picked up by blue lens
Check PERRLA
Ophthalmoscopic exam for retinal or vitreous hemorrhages or retinal detachment.
Corneal Ulcer
Etiology:
SSxs:
Corneal ulcer:
Etiology: HSV most common cause contact lenses (particularly soft lenses)
traumatic corneal injury chronic topical steroid use
varicella-zoster virus (VZV)—shingles in ophthalmic branch of trigeminal N
{Hutchinson’s sign: The nasocilliary branch of CN V enervates tip of nose and cornea
leads to loss of corneal sensation, may lead to blindness}
Bacterial infections - staphylococcal spp, P aeruginosa, Streptococcus pneumoniae, and Moraxella spp
Signs & Sxs:
erythema of eyelid and conjunctivamucopurulent discharge
foreign body sensationblurred vision
photophobiapain
Band Keratopathy
Band keratopathy:
hard, white calcified plaques (bands) at 2, 5, 7, 10 o’clock of limbus
may be hypercalcemia, secondary to kidney disease
Arcus Senilis (corneal arcus)
What is it?
Age:
May be related to _____________.
Arcus senilis (corneal arcus):
whitish deposits around limbus; usu in elderly
may be related to hyperlipoproteinemia
UV keratitis
Etiology:
SSxs:
PE:
UV keratitis:
Etiology: exposure to UV lights, welding arcs, “snow blindness”
Radiation damage to the corneal epithelium is cumulative
Signs & Sxs: onset of foreign-body sensation, irritation, pain, photophobia, tearing,
blepharospasm
PE: decreased visual acuity 6-12 hours after the exposure diffuse staining with fluorescein dye (loss of epithelium) lid edema, conjunctival hyperemia variable
List some of the main questions to ask for the eye during Hx:
ask about vision changes, eye pain, discharges, etc
Eye exam should include
EYE EXAM—see CPD lab notes Inspection of structures Visual acuity—central, peripheral, color PERRLA: Extra ocular movements: Fundoscopic exam
If someone reports vision loss, what questions should you ask?
DDX:
Vision Loss
Ask rate of onset, pain or no, central or peripheral, uni- or bilateral?
DDX: Vision Loss
Errors of refraction; Define
i. Hyperopia:
ii. Myopia:
iii. Astigmatism:
iv. Presbyopia:
Errors of Refraction
i. Hyperopia (far-sightedness) - most common; distant objects are clear, and close-up objects blurry.
ii. Myopia (near-sightedness) - faraway objects will appear blurry
iii. Astigmatism - the cornea or the lens has a slightly different surface curvature. Often present at birth and may occur in combination with nearsightedness or farsightedness.
iv. Presbyopia - a slow loss of ability to see close objects or small print. With age, the lens becomes less pliable and eventually cannot accommodate in response to the action of the ciliary muscles
