Flashcards in EENT-quiz Deck (168):
Each blink of the eye provides tears for what eye structure?
Skin over the eyelid is (thick/thin)
sphincter-like muscle that closes the eyelid
glands that secrete sebum onto the eyelid margin
Zeis glands, Moll's glands
2 types of glands that empty into the eyelash follicles
How many eyelashes are there on the upper eyelid?
How many eyelashes are there on the lower eyelid?
lifespan of an eyelash
How long does it take for an eyelash to be replaced?
bulbar, tarsal, fornical
3 parts of the conjunctiva
part of the conjunctiva that covers the globe
part of the conjunctiva that lines the eyelids
part of the conjunctiva in the inferior and superior cul-de-sacs
lymphatic drainage of the eyelid goes into what 2 nodes?
protect the eye, moisten cornea
function of the eyelid
CN VII, orbicularis muscle
What cranial nerve and muscle are responsible for closing the eye?
CN III, levator muscle
What cranial nerve and muscle are responsible for opening the eye?
small painful nodule within a gland in the upper or lower lid; acute inflammation
bacterial cause of hordeolum
external hordeolum (sty)
inflammation of the glands of Moll or Zeis on the lid margin; immediately adjacent to the edge of the palpebral margin
internal hordeolum (sty)
infection of a meibomian gland; deep from the palpebral margin; found inside eyelid
Hordeolums are contagious. (T/F)
external hordeolum (sty)
eye condition that presents with pain and edema of the involved lid; often there is a central area of purulence and surrounding erythema; the area is palpable and may point through the skin at the lash line
warm compress several times a day for 48 hrs
treatment for external hordeolum
treatment for an external hordeolum if there is a secondary infection or if drainage is present
treatment for external hordeolum if it does not resolve on its own
monitor external hordeolum for _____________
another name for an internal hordeolum
eye condition that involves the obstruction of the meibomian gland; focal inflammation within the eyelid tarsus; firm nodule that is located away from the lid margin
An internal hordeolum is (less/more) painful than an external hordeolum
treatment for chalazion
treatment for chalazion that should be considered if the sty is not resolving
refer for excision
treatment for chalazion if nodule is large or lasts more than 1 month
biopsied (risk of cancer)
Recurrent chalazion should be ___________
inflammation of lid margins
Blepharitis is common, esp. in (men/women)
anterior, allergic, posterior
3 type sof blepharitis
presents with irritation, burning, with red rims and eyelash adherence; dandruff-like deposits and fibrous scales may be seen; conjunctiva is clear to slightly red
blepharitis can be seen with what skin condition?
scrub lid margins with cotton-tip applicator and baby shampoo; topical antibiotics if infection is present or lid scrubs are ineffective
treatment for blepharitis
seborrhea, staph or strep, meibomian gland dysfunction
2 causes of blepharitis
eye condition that presents with itching of lid margins, usually bilateral; usually staph that colonized lash bases that secrete toxins causing red eye and corneal infiltrates; can lead to sty formation
hygiene, antibiotics if persistent
treatment for anterior blepharitis
eye condition caused by an ocular allergy; presents with itching, lid edema, mucoid discharge, conjunctival hyperemia, burning, lacrimation, and conjunctival edema
cool compresses, antihistamines, mast cell stabilizer, control of allergen
treatment for allergic blepharitis
infection on inside of lid; infection of oil secreting meibomian glands leads to obstruction and swelling causing a chalazion
treatment for posterior blepharitis
eye condition that causes eyelid swelling, can lead to blindness, cranial nerve palsies, or brain abscesses; life threatening condition
orbital cellulitis is more common in (children/adults)
sinuses, dental, facial, globe, eyelid, lacrimal
there are several causes of orbital cellulitis including infection of what things?
h, influenza, s. pneumoniae
causative organisms of orbital cellulitis in children <4 y/o
causative organism of orbital cellulitis in older people
molluscum contagiosum, warts, herpes
common viral infections of the eye
crabs, mites, fly larvae
3 parasitic infections of the eye that causes inflammation
condition of the eyelid being flipped in; irritates structures of eye (risk of corneal abrasion)
condition of the eyelid being flipped out; conjunctiva is exposed
droopy eyelid syndrome of upper lid
assess status of cornea to determine urgency, lubricate the eye, antibiotics for inflammation, warm compresses, surgery
treatment for eyelid/lash malpositions
Outer eye (cornea and sclera) and supporting structures are (more/less) sensitive than the inner eye (retina)
assessing severity and referring sight-threatening injuries
first priority when evaluating a traumatized eye
high velocity injury to the eye may lead to penetration of the ________
a blunt trauma injury may cause a ________ __________
an injury from a larger sized object will affect the _____ of the eye
an injury from a smaller sized object will affect the _______ of the eye
forms the lateral and inferior portion of the orbit
patients with a zygomatic fracture may have pain opening their mouth (T/F)
water;s view and jug-handle view x-rays, CT if suspected more than zygomatic fracture
diagnostic tests to determine a zygomatic fracture
entrapment of eye muscles
why may a patient with a zygotmatic fracture have gaze impairment?
treatment of zygomatic fracture
maxillary, palatine, zygomatic
what bones compose the orbital floor?
fracture that presents with misalignment and swelling; movement of globe is restricted; often inability to look upward; diplopia and exophthalmos
referral to ophthalmologist, avoid pressure increase, nasal decongestant, ice pack, antibiotics
treatment for blow-out fracture
eye condition caused spontaneously or by blunt trauma; bright red blood under conjunctiva; iris and pupil not involved
How long it the cornea across?
How thick is the cornea?
Bowman's, stroma, epithelium, Descemet's membrane, endothelium
5 layers of the cornea
The cornea has a blood supply (T/F)
check visual acuity, anesthetize, every lids, fluorescein, antibiotic drops/ointment, check daily
treatment for corneal abrasion
If a patient has a foreign body in their eye and they are experiencing blurred vision, it suggests what structure is involved?
If a patient has a foreign body in their eye and there is a penetrating injury, you should refer immediately and attempt to remove the body (T/F)
When a patient has a foreign body in their eye, you always need to test what?
slit lamp or hand held lamp
What should you use to look at foreign bodies in patients' eyes?
use irrigation or cotton tip applicator to remove, follow daily until resolved, patching (controversial)
treatment for foreign body in the eye
rust ring on cornea
indication of a metallic foreign body
removal with rotating burr or referral
treatment for a metallic foreign body in eye
welding without eyewear, snow blindness, indoor sunlamp
3 typical causes of acute UV radiation injury
acute UV radiation injury
eye condition characterized by pain, photophobia, excessive tearing, blurred vision; occurs 6-12 hours after exposure
acetamenophin (for pain), consider antibiotic 2-3 times a day, patching for 24 hours, re-evaluate next day
treatment for acute UV radiation injury
What should you do if a patient with an acute UV radiation injury does not improve after you re-evaluate the next day?
key in treatment for a chemical injury to the eye
water or normal saline, at least 30 min
What should you flush a chemical injury out with? for how long?
eye injury presenting with pain, blurred vision, and blepharospasm; ranges from mild to severe; cornea can be hazy to edematous and opaque, conjunctiva may be injected to white with a loss of vasculature
A patient with a chemical eye injury should be transported to the ER and referred to an ophthalmologist. (T/F)
Acid chemically injuries are generally worse than alkali. (T/F)
(acid/alkali) is precipitated and inactivated by tissue protein it destroys (for chemical injury)
(acid/alkali) soponifies collagen and damages underlying tissue (for chemical injury)
irrigation, test pH of tears, fluorescein stain to assess damage, daily exam to assess damage and follow healing, topical antibiotics or antibiotic/steroid combo considered
treatment for chemical injury
A chemical eye injury is an ophthalmic emergency. (T/F)
caused by exposure to heat; presents with pain, foreign body sensation, excessive tearing, decreased vision and visual acuity; conjunctiva is injected, cornea whitened
antibiotic drops, patching, referral
treatment for thermal injury
presents as eyelids shut with injected conjunctiva; foreign body sensation
warm compress, warm topical antibiotic ointment, artificial tears, gentle massage
treatment for glue injury
How long should you wait to refer to an ophthalmologist for a glue eye injury if it has not resolved?
has the thinnest skin of the body
if changes occur, bothersome
under what 2 conditions can you remove nevi on the eyelids?
eyelid neoplasm that resembles seborrheic keratosis
benign epithelial neoplasm that can occur on the eyelid
precancerous epithelial neoplasm that can occur on the eyelid
basal cell carcinoma
most common type of skin cancer; slow growing; noduloulcerative, pigmented, sclerosing, superficial
biopsy, excise, Moh's, radiation
treatment for BCC
squamous cell carcinoma
2nd most common type of skin cancer; fast growing; elevated, firm plaque or nodule, ulcerates, irregular borders; local spread and may metastasize to lymph nodes
biopsy, wide excision
treatment for SCC
carcinomas arising from meibomian gland
third most common malignancy of the eye
eyelid neoplasm whose presentation varies-appears like a chalazion as a small firm nodule, diffuse plaque-like tarsal thickening or papillomatous growth
treatment for sebaceous neoplasm
capillary hemangioma, nevus flammeus, pyogenic granuloma
3 vascular skin lesions of the eye
hidrocystoma, pilosebaceous cyst
2 cystic skin lesions of the eye
retention cyst of the apocrine or eccrine sweat glands
The lacrimal system secretes tears all of the time, including during sleep. (T/F)
Eyelids close lateral to medial. (T/F)
Eyelids close and milk tears toward what structure?
The lacrimal sac empties under the inferior turbinate into the nose through what structure?
The nasolacrimal duct's inferior end is not open at birth. (T/F)
supply nutrients, antibacterial substances, flushing microorganisms, and lubricates the eyes
meibomian sebaceous glands, lacrimal gland, conjunctival goblets
The lacrimal system has 3 layers: ___________ ___________ _________ in the outer layer, ___________ ________ in the middle layer, and _______________ _____________ in the inner layer.
tearing is stimulated by the first division of what cranial nerve?
dry eye syndrome; absence of tears
keratoconjunctivitis sicca (dry eye)
eye condition that is seen often from systemic disease (frequently connective tissue disease) or medications
eye condition that presents as complaints of gritty, foreign body sensation, burning, photophobia, and a decreased visual acuity
avoid irritants, artificial tears, lubricating ointment, steroid drops
initial treatment for keratoconjunctivitis sicca
2nd or 3rd line treatment for keratoconjunctivitis sicca
primary Sjogren's syndrome
keratoconjunctivitis sicca plus xerostomia is classified as what condition?
secondary Sjogren's syndrome
keratoconjunctivitis sicca pluse xerostomia and connective tissue disease is classified as what condition?
excessive tearing; overflow of tears onto the cheeks; "crocodile tears"
salivary and lacrimal
epiphoria is caused by an abnormal linkage of what 2 kinds of glands?
In epiphoria, _________ produces lacrimation
dacryocystorhinostomy or outpatient with local anesthetic
treatment for epiphoria
drainage hole in the lacrimal duct; a treatment for epiphoria
eye condition common in newborn after the first month of life; occurs when the lacrimal duct does not open
Dacryostenosis usually resolve within 9 months. (T/F)
warm compresses, surgical probe if no resolution
treatment for dacryostenosis
inflammation of the lacrimal gland caused by obstruction
staph aureus, hemolytic strep, staph epidermis, candida
4 common pathogens in dacryocystitis
eye condition that presents with revealing pain, swelling, tenderness, redness, and purulent discharge
warm compresses, antibiotics
treatment for dacroycystitis
Orbital structural defects, atrophies, degenerations, deposits, and tumors are uncommon and should be referred to an ophthalmologist. (T/F)
bony socket containing globe, EOM muscles (sensory, motor, autonomic nerves), blood vessels, and lacrimal gland, all packed in fat
orbital neoplasms typically occur (early/later) in life
Structural and degenerative disease prevalence of the orbit (increases/decreases) with age
condition that usually comes from the sinuses; threatens vision and life; can also come from face, teeth, meninges, ear, or eye; can spread causing cavernous sinus thrombosis, intracranial abscess, or temporal is fossa abscess; emergent
tissue of eyelids and periocular region anterior to the orbital septum
condition common in children; presents with pain, lid swelling, chemosis, and fever
strep, h, influenzae, s, aureus
causitive organisms in preseptal cellulitis
leukocytosis in preseptal, consider imaging if concern for orbital cellulitis
diagnostics for preseptal cellulitis
oral antibiotic, compresses
treatment for preseptal cellulitis
exophthalmos, decreased eye movement, lid swelling, and conjunctival injection is a presentation of ophthalmopathy associated with _______
thyroid associated ophthalmopathy
common cause of unilateral or bilateral proptosis; muscles of eye swell and push globe forward; possible tether of the levitator and rectus muscles and squeezing the optic nerve
support, treat thyroid condition, lubricants, surgery
treatment for thyroid associated ophthalmopathy
condition of metastatic orbital tumor in children (90% <5 y/o); often with bilateral proptosis, raccoon eye, lid ecchymosis; may have associated abdominal or thoracic mass
most common orbital metastasis in adults
condition of no globe-absent from birth or removed
symmetry with remaining eye, matching shape, color, and movement
goal of socket rehabilitation
ophthalmologist and ocularist
you should refer an anophthalmic socket to what 2 specialists?
There is usually a place for an artificial eye if a patient has congenital anophthalmic socket, because lid and socket are large. (T/F)
How often should a prosthetic eye be removed, irrigated, and cleaned by an ocualrist?