corneal disorders

Question 1

transparent outermost layer of the eye that covers the pupil and iris and allows light to enter the eye

Answer 1

cornea

Question 2

opacities of the lens – usually bilateral

cloudy

leading cause of blindness worldwide

Answer 2

cataracts

Question 3

cataracts MC cause

Answer 3

age related

Question 4

cataracts other causes

Answer 4

congenital (from intrauterine infections such as rubella) (errors of metabolism)

topical, systemic, or inhaled corticosteroid treatment

radiation exposure

Question 5

cataracts risk factors

Answer 5

> 60 years of age
cigarette smoking

Question 6

progressive blurring of vision

glare (especially in bright light or with night driving)

change of focusing (development of nearsightedness)

can be seen on exam with dilated pupil even when it is small

as it progresses the funds loses its reflex and pupil appears white

Answer 6

cataracts clinical findings

Question 7

cataracts treatment

Answer 7

refer to ophthalmology (not emergent)

lens replacement*

Question 8

scratch or injury to the surface of the cornea

Answer 8

corneal abrasion

Question 9

corneal abrasion causes

Answer 9

trauma
foreign bodies
contact lens (over worn, improperly fitting, improperly cleaned)

Question 10

corneal abrasion presentation

Answer 10

severe pain
photophobia
foreign body sensation

Question 11

what to do first on a corneal abrasion exam

Answer 11

check visual acuity before tetracaine or fluorescein

Question 12

corneal abrasion: patient will be in severe pain. what to use to anesthetize

Answer 12

tetracaine

Question 13

what exam to do with corneal abrasion

Answer 13

lid inversion with q tip to r/o foreign body

Question 14

why should you be cautious with tetracaine

Answer 14

toxic to epithelium and can slow healing which increases risk of corneal infection and scarring

Question 15

what exam to do with corneal abrasion if you are not certain

Answer 15

fluorescein stain
(defect will light up green)

Question 16

corneal abrasion treatment

Answer 16

bacitracin- polymyxin/erythromycin ophthalmic ointment (antibiotic and lubricant)

oral NSAIDS/topical NSAIDS

Question 17

corneal abrasion treatment for contact lenses (pseudomonas)

Answer 17

don’t wear contacts for 1 week

ciprofloxacin or other fluoroquinolone eye drops

Question 18

what should you not use with corneal abrasion

Answer 18

antibiotic drops with steroids

reduce host resistance to superinfection and may make missed diagnosis of HSV, epithelial keratitis, or microbial keratitis worse

Question 19

what should you not send the patient home with in corneal abrasion that they may ask for

Answer 19

tetracaine

causes delayed healing

Question 20

treatment for large corneal abrasions > 50%

Answer 20

cycloplegic drops
(dilate eye to reduce pain)

patching

Question 21

defect in the corneal epithelium
crater, open sore

Answer 21

corneal ulcer

Question 22

corneal ulcer usually due to

Answer 22

infection
long term contact lens use

can be due to conditions that lead to persistent eye irritation

Question 23

corneal ulcer delay/ failure to treat can lead to

Answer 23

scarring or intraocular infection

Question 24

what can you expect to see with corneal ulcer

Answer 24

irregular border and hazy
pain
photophobia
tearing
reduced vision
corneal injection
may have discharge
corneal abnormality

Question 25

corneal ulcer treatment

Answer 25

refer emergently to ophthalmology most likely will have you initiate antibiotics with close follow up

Question 26

what to do with foreign body on cornea

Answer 26

check vision * remove with sterile wet cotton tipped applicator or with 25G needle bacitracin-polymyxin/erythromycin opthalmic ointment

Question 27

what to do if foreign body cornea cannot be removed or corneal infection is suspected

Answer 27

send to ophthalmology right away

Question 28

foreign body intraocular usually affects those who

Answer 28

work with metal high speed injury

Question 28

if no corneal FB is seen but there appears to be a wound if there is visual loss or media opacity deeper than cornea

Answer 28

foreign body intraocular

Question 29

what to do with foreign body intraocular

Answer 29

emergent referral to ophthalmology

Question 30

keratitis bacterial MC pathogens

Answer 30

staphylococci streptococci pseudomonas aeruginosa moraxella species

Question 30

infection of the cornea corneal opacity or infiltrate with red eye, photophobia, and foreign body sensation agressive often have purulent discharge

Answer 30

keratitis bacterial

Question 31

keratitis bacterial affects who

Answer 31

usually contact lens wearers overnight use sometimes after trauma

Question 32

how to make keratitis bacterial diagnosis

Answer 32

seeing the opacity (usually it is > 0.5 mm) with the other symptoms - red eye - photophobia - foreign body sensation hypopyon*

Question 33

keratitis bacterial treatment

Answer 33

needs to see ophthalmology emergently topical antibiotic usually under direction of ophthalmology, usually fluoroquinolone given hourly

Question 34

what to avoid in keratitis bacterial

Answer 34

NO steroid drops stop wearing contacts

Question 35

herpes simplex (HSV) red eye, photophobia, foreign body sensation, and watery discharge primary infection may affect lid, conjunctiva, and cornea dendritic lesion is characteristic manifestation (seen with fluorescein)

Answer 35

keratitis viral

Question 36

keratitis viral treatment

Answer 36

self limited antivirals and topical corticosteroids (to reduce duration of treatment) refer to ophthalmologist

Question 37

the virus in keratitis viral recurrence can colonize the __________ and recur

Answer 37

trigeminal ganglion - fever - exposure to sunlight - immunodeficiency

Question 38

keratitis viral recurrence can be stroll risk for

Answer 38

corneal scarring

Question 39

occurs after corneal injury involving plant material or in an agricultural setting occurs in eyes with chronic ocular surface disease and in contact lens wearers corneal infiltrate may have feathery edges and multiple "satellite" lesions

Answer 39

keratitis fungal

Question 40

does pinguecula get larger

Answer 40

rarely, but may get pingueculitis

Question 40

keratitis viral diagnosis often ________ and treatment _________

Answer 40

delayed, difficult

Question 41

degenerative and benign lesion yellow nodule on the conjunctiva, usually on nasal side (contain fat, protein, calcium) common over the age of 35 usually bilateral

Answer 41

pinguecula

Question 42

pinguecula treatment

Answer 42

no treatment is required but artificial tears may help topical anti-inflammatories may be needed

Question 43

fleshy triangular conjunctival tissue that grows on to the cornea, the nasal side usually bilateral

Answer 43

pterygium

Question 44

what is pterygium associated with

Answer 44

long term exposure to wind, sun, sand, dust

Question 45

what do you have to watch for with pterygium

Answer 45

may get larger and/or inflamed

Question 46

pterygium treatment

Answer 46

artificial tears or topical NSAIDS sometimes they are excised (growth that threatens vision, astigmatism, severe irritation)