Eye Flashcards
Sign and Symptoms that suggest problems of the eyes
Halos around lights in surrounding darkness: cataracts and glaucoma
Loss of peripheral vision: glaucoma and retinal detachment
Pain: Glaucoma, foreign body and corneal abrasion
Sudden change in vision: retinal detachment, foreign
body, corneal abrasion, optic neuritis, temporal arteritis, migraine headaches, TIA or stroke, tumor, etc.
Common eye dz
Conjunctivitis
Corneal Abrasion
Retinal Detachment
Central and Branch Retinal Artery Obstruction
Hordeolum (Stye)
Chalazion
Cataract
Glaucoma
MAD
Conjustivitis
A common, acute, painful inflammation with or without infection of the conjunctiva, but involving the cornea or deeper structures of the eye
Most cases are acute, but can be chronic
May are infectious
Can be bilateral or unilateral
Redness, if pt touches face, can transfer to opposite eye
Etiology/predisposing factors pink eye
Spread by direct inoculation via fingers or droplets
Bacterial Conjunctivitis
Staphylococcus aureus
Pseudomonas
Haemophilus influenzae
Moraxella
Gonorrhea and chlamydia
Viral Conjunctivitis
Commonly adenovirus
Herpes virus (may be vision threatening)
Allergens (pollen, dust, contact lenses, dyes, eye drops, make up)
Trauma ( chemical and UV flash burns)
Dry Eye (Keratoconjunctivitis sicca)
Parasitic infection (pediculosis pubis)
Systemic disease
Medication adverse effects (e.g. antihistamines and
anticholinergics)
Environmental insults (wind, heat, sun, and smoke)
Pink eye sub and obj findings
Subjective
Redness or excessive tearing (sense of a foreign body in the eye)
Swelling or itching
History of allergy, infection, trauma
Discharge, edema of external eye or lid
Objective
Evert the upper lid by rolling it externally
Examine for foreign body or papillary changes
Drainage may be purulent or serous, obtain culture before drops or irrigation is instilled
Pink eye mgmt
Nonpharmacological
Cool Eye compresses for itching, irritation
Warm Eye compresses for crusting
Pharmacological
Bacterial
Topical antibiotic ophthalmic solutions or ointments
Gentamicin 3 mg/ml solution 1-2 drops q4hrs. for 5 days
Neomycin 1-2 drops q6hrs. Or ointment ½ inch ribbon q3-4hrs. for 7-10 days *
Polymyxin apply ointment q3-4hrs for 7-10 days
Ofloxacin 0.3% solution 1-2 drops into affected eye q6hrs depending on severity
- 15% risk for adverse reaction to neomycin products
Corneal abrasion
Disruption of the epithelium of the cornea (the clear, anterior covering of the eye
Usually associated with chemical, burn, or mechanical trauma
Result of outdoor activity, occupational hazards and lack of proper eye protection
Welding, painting, construction
Very common eye disorder
Always ask if patient wears contact lenses
corneal abrasion sub and obj findings
Subjective
Intense pain associated with sensory nerve supply of the eye
Sense of a foreign body in the eye
Report of redness or discharge of the conjunctiva
History of decreased visual acuity or vision
Complaint of tearing or photophobia
Decrease in visual acuity
Objective
Evert the lid and inspect for foreign body and signs of trauma
Fluorescein staining of the cornea -Appears as increased uptake of dye when the area is illuminated by a Wood lamp or UV light
Corneal abrasion mgmt
Refer to Ophthalmologist
Apply antibiotic ointment or solution
Gentamicin ophthalmic ointment 0.3%
Sulfacetamide solution 10%
Cycloplegic or mydriatic drops (do not use with angle closure conditions, glaucoma)
Apply a soft eye patch (removed by clinician in 24 hours)
Update tetanus immunization if indicated
Reevaluate in 24 hrs. at which time healing should be complete
Retinal detachment
Separation of the neural retina from the choroid after trauma, hemorrhage, increased intraocular pressure or transudation of fluid leaving the retina without oxygen and nourishment
Annually, 10 out of every 100,000 persons suffer a retinal detachment without a rhegmatogenous tear (tear with fluid between the retinal layers)
1-3% of patients undergoing cataract surgery suffer a retinal detachment
Following are associated with retinal detachment:
Diabetes Mellitus
Sickle cell anemia
Myopia and cataract extraction
RD sub and obj findings
Sudden onset of painless visual changes, floaters, blurred vision, light flashes
A “curtain” may obscure part or all of the visual field
Large detachments may produce a Marcus Gunn pupil (afferent pupil that reacts more consensually than directly)
Elevations of the retina related to tears
Exudative, bullous elevation without tears
RD mgmt
Immediate referral to ophthalmologist for evaluation and treatment:
Diathermy- technique to stimulate circulation through heat, electric current
Cryotherapy/cryopexy
Photocoagulation
Pneumatic retinopexy
Vitrectomy
If the detachment is a result of traumatic insult, patch the eye with a metal shield (Fox eye shield).
Central and Branch Retinal Artery Obstruction
An abrupt blockage of the central retinal artery or its branches, causing a sudden loss of visual fields
Permanent partial or complete visual loss may ensue without immediate intervention
Causes: thrombosis, embolism, arteritis of the central artery
Associated with:
Migraine
History of vasculitis
Atrial fibrillation
Diabetes
Hypertension
Inflammatory condition
Coagulopathies
Central and branch RAO sub and obj findings
Sudden, painless gross visual loss (monocular), or visual field loss
Ipsilateral, intermittent monocular blindness (Amaurosis fugax) is associated with ipsilateral carotid disorder and is sign of impending stroke
Intraocular hemorrhage can occur in patients on antiplatelet and anticoagulant therapy. Ask if this has happened before….
Visual loss may be central or peripheral
Partial dilatation of the pupil, which is sluggishly reactive to direct light may have a normal consensual response
Fundoscopic exam
May reveal a pale, opaque fundus and characteristic “cherry-red spot” at the forvea or bifurcation of the arteries where emboli is most likely to become lodged
Retina may be edematous
Arterial vessels may appear pale and bloodless
RAO labs and dx
Elevated Erythrocyte Sedimentation rate (ESR) associated with giant cell arteritis
Consider testing to evaluate for coagulopathies
CBC for anemia, polycythemia, and platelet disorders
Fasting blood sugar, Hgb A1c, cholesterol, triglycerides and lipid panel for atherosclerotic disease
Blood cultures for bacterial endocarditis and septic emboli
Fluorescein angiography
Visual acuity, visual field exam
