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PANCE Review > Eyes > Flashcards

Eyes Flashcards

1
Q

retinal detachment - definition, tx

A

usually spontaneous or traumatic

  • flashers, floaters, “curtain” closing
  • results in acute vision loss

tx: refer to ophthalmology

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2
Q

retinal artery occlusion

A

acute, PAINLESS, loss of vision (unilateral)

  • emergency!
  • # 1 cause is carotid atherosclerosis (emboli occludes)
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3
Q

retinal vein occlusion

A

subacute, unilateral blurriness

  • “blood and thunder” fundus - leaking due to blockage and back-up of blood
  • may resolve on own
  • w/u for underlying cause
  • risks: elderly, HTN, glaucoma, DM
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4
Q

optic neuritis - definition, causes, sxs, tx

A

sudden inflammation of nervous tissue of eye; can destroy myelin

  • unilateral vision loss
  • loss of pupillary rx to light
  • pain with EOEM

causes: infection, autoimmune dz (SLE, sarcoid), multiple sclerosis

tx:

  • treat underlying cause
  • may resolve on own
  • corticosteroids, IV
  • prognosis good unless MS or SLE
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5
Q

causes of acute vision loss

A

retinal detachment
retinal artery occlusion
optic neuritis

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6
Q

causes of chronic vision loss

A

glaucoma
cataract
macular degeneration
retinopathy

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7
Q

glaucoma - definition, risks

A

increased intraocular pressure (IOP) and optic nerve damage

  • visual field loss leading to blindness
  • PREVENTABLE

risks: DM, HTN, hypothyroid, FH, African American

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8
Q

glaucoma - two types

A

open angle: asymptomatic rise in IOP

  • central vision spared
  • most common / less severe

angle closure:

  • ocular emergency!
  • sudden, complete occlusion of aqueous humor flow
  • pain, blurred vision, photophobia
  • hazy cornea w/ fixed pupil
  • N/V, sweating
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9
Q

glaucoma - screening (3 things to check)

A
  1. anterior chamber angle (bowing of iris)
  2. optic nerve exam
    - cup: disc ratio (>0.5 = abnormal)
  3. IOP>21 mmHg
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10
Q

angle closure glaucoma - tx

A

TRUE ocular emergency

  • immediate referral
  • decrease IOP: carbonic anhydrase inhibitor (IV), osmotic agent (mannitol), pilocarpine drops (contract ciliary muscles and facilitate flow)
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11
Q

glaucoma - general tx

A

promote drainage:
- cholinergic agents (pilocarpine)

decrease production:
- beta blockers

both
- alpha agonists

Can get surgical tx if not responding to meds

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12
Q

cataract - definition, sxs, tx

A

opacity of lens (brown to yellow discoloration)

  • white in pupil; appears dark against red reflex w/ otoscope
  • slow, progressive loss of vision
  • VERY common

tx:
- early: magnifying glasses
- later: surgical removal

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13
Q

macular degeneration (age-related) - definition, sxs

A

yellowish, hyaline nodules that deposit in Bruch’s membrane and limit nutritional and metabolic support of macula

  • sxs: gradual blurry vision, wavy or distorted vision, central bid spot
  • PE: dec. acuity, drusen mottling, macular scarring
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14
Q

retinopathy - definition, 2 major causes in US, tx

A

ischemic injury to retinal vasculature

causes: diabetes and HTN
tx: treat underlying DM and HTN

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15
Q

blepharitis - definition, sxs, tx

A

inflammation or infection of eyelid
- “dandruff of eyelid”

sxs: irritation, burning, FB sensation, tearing, photophobia
tx: topical ABX (erythromycin), warm compress

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16
Q

dacryocystitis

A

inflammation of lacrimal gland +/- duct

sxs: pain, swelling, tearing, drainage
- unilateral

tx:

  • warm or cool compress
  • oral ABX if infectious
  • abscess: I&D
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17
Q

hordeolum (stye)

A

infection of sebaceous gland (staph aureus)

  • mildly painful nodule or pustule on lid
  • can be internal (under lid) or external (facing outside)
  • red, tender, comes to point

tx:

  • warm compress (2-3 days)
  • topical ABX if needed
18
Q

chalazion

A

chronic granulomatous inflammation of meibomian gland

  • may arise post-stye
  • PAINLESS

tx: warm compress

19
Q

ectropion - definition, tx

A

lid turns outward
- usually age-related

tx: botox (temporary); surgery

20
Q

entropion - definition, tx

A

lid turns inward

  • usually age-related
  • cause cause foreign body sensation

tx: botox (temporary); surgery

21
Q

orbital cellulitis - cause, sxs, dx, tx

A

cause: URI, sinusitis, lid trauma (kids)
- systemic dz

sxs: pain, erythema, fever, dec. vision

PE: erythema of lid and surrounding skin; RESTRICTED motility

dx: inc. WBC, CT: infiltration of orbital fat

tx:
- ADMIT: broad spectrum ABX (IV than PO 2-3 weeks)
Preferred: amoxicillan-clavulanate (augmentin)
PEN allergy or hx of MRSA: doxycycline

22
Q

viral conjunctivitis (pink eye) - sxs and tx

A

sxs: redness, mild discomfort, watery d/c
- tender preauricular nodes
- rapidly bilateral

tx:
- self limiting, cold to warm compress
- artificial teams, antihistamine drops

23
Q

bacterial conjunctivitis - sxs and tx

A

sxs: redness, irritated, purulent d/c, adhesions
- often bilateral
- often contact lens wearers

tx: ABX drops
- fluoroquinolone, polymixin, sulfa

24
Q

chlamydial conjunctivitis - sxs and tx

A

sexually transmitted

sxs: unilateral, scant purulent d/c

tx:

  • systemic tetracycline or erythromycin
  • topical ABX ointment
25
Q

allergic conjunctivitis - sxs and tx

A

seasonal, people w/ atopic hx

sxs: mild injection, edema, cobblestoning
- stringy d/c, edema

tx:
- remove allergen
- systemic antihistamines
- topical antihistamine

26
Q

pterygium

A

triangular wedge-shaped fleshy growth in eye that fold over into cornea

  • interferes with vision
  • localized inflammatory process

tx: surgical excision, artificial tears, topcial NSAIDS or steroids

27
Q

herpes simplex keratitis - sxs, dx, tx

A

sxs:

  • unilateral, recurrent
  • HSV-1&raquo_space; HSV-2
  • irritation, light sensitivity, redness

dx: dendritic lesion (fluorescein stain)

tx: REFER!!
- topical anti-viral
- NO STEROID - will cause tissue loss, ocular perforation

28
Q

herpes zoster ophthamicus - definition, sxs, tx, prevention

A

latent varicella virus that stays dormant on trigeminal ganglion

sxs: pain, H/A, photophobia, malaise, fever
- often w/ vesicular, pustular rash in dermatomal dist.

Hutchinson’s sign: lesions on tip of nose = ocular involvment

tx: REFER
- oral or IV antivirals (protect site)

prevent: vaccine (Zostavax)

29
Q

corneal ulcer - definition, sxs, tx

A

infection and inflammation of cornea
- history of trauma, contact lens use

sxs: pain, photophobia, tearing
dx: dense corneal infiltrate seen with fluorescein stain

tx: REFER
- avoid contact lens use

30
Q

corneal abrasion - definition, sxs, tx

A

small cut due to mild trauma

sxs: conjunctival injection, photophobia, tearing
- foreign body sensation

dx: epithelial defect (fluorescein stain)
- R/O ulcer

tx: ABX ointment
- F/U daily until resolves
- If does not resolve in 1 day, refer for ulcer

31
Q

foreign bodies

A

tearing, red, irritated, painful

evert lids for exploration

remove under topical anesthesia

  • irrigate, forceps or q-tip
  • apply ABX ointment after removal
32
Q

subconjunctival hemorrhage - sxs and tx

A 
spontaneous bleedings (confined to sclera)
 - usually following valsalva

tx:
- reassurance
- 2-3 wks to clear

33
Q

orbital fracture (“blow out”) - cause, sxs, tx

A

fracture of tiny bones of orbit due to trauma (fist, ball)
- bones “blow out” into maxillary sinus

sxs: restricted, painful vertical eye movement
- double vision, edema

tx: REFER
- CT to assess extent of damage and tx (likely surgery)

34
Q

hyphema

A

blood in anterior chamber
- typically caused by trauma (think shaken baby if infant)

sxs: pain, blurry vision, red eye, sluggish pupil, watery appearance

tx: REFER
- admit and monitor closely

35
Q

chemical burns

A

irrigate, irrigate, irrigate

36
Q

papilledema

A

increased pressure in or around the brain causes the part of the optic nerve inside the eye to swell
- see on opthomascopic exam

Sxs: fleeting disturbances in vision, headache, vomiting

37
Q

what test to you do to confirm refractory error (e.g. near sighted / far sighted)

A

pinhole test: vision will improve if due to refractory error

38
Q

amblyopia

A

loss of visual acuity (NOT correctable by glasses) in otherwise healthy eye

  • “lazy eye”
  • normal eye that is prohibited from developing
  • MOST OFTEN due to untreated strabismus

tx:
- treat underlying problem (strabismus or refractive error) b/f age of 6

39
Q

strabismus

A

unequal alignment of eyes - misalignment of eye axis due to unequal straight of eye muscles

  • can interfere w/ proper formation of visual cortex
  • hypotropia: downward
  • hypertropia: upward
  • exotropia: outward
  • esotropia: inward

tx:

  • patch good eye
  • surgery (severe cases)
40
Q

myopia

A

nearsightedness

41
Q

hyperopia

A

farsightedness

PANCE Review (16 decks)

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