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Eye Flashcards

1
Q

Chronic inflammation of the eyelid

A

blepharitis

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2
Q

Causes of blepharitis? Symptoms?

A

Causes: seborrhea, rosacea, staph, dysfunction of meibomian gland

Symptoms: no palpable lump… signs of inflammation - red, swollen, dandruff-like depositis (scurf) and fibrous scales (collarettes), pruritus, tearing, blurred vision

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3
Q

Treatment for blepharitis?

A

warm compress, irrigation, lid massage, lid scrubs, if suspect infection - topical abs

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4
Q

painless nodular lesion on eyelid….what is it? cause? and treatment?

A

Chalazion

Cause: obstruction of tear glands (meibomian or leis)

Treatment: warm compress… if doesn’t go away can refer for excision

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5
Q

Painful, purulent nodular lesion of eyelid…what is it? cause? and treatment?

A

Hordeolum (internal and external)

Cause: staph aureus (not contagious)

Treatment: warm compress several times a day for 48 hrs. if suspect secondary infection = topical abs

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6
Q

Define Ectropion?

A

Ectropion -
eyelid/lashes turns OUTWARD exposing the palpebral conjunctiva

secondary to age, trauma, infection, palsy of facial nerve

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7
Q

Define Entropion?

A

Entropion -
eyelid turns INWARD causing chronic conjunctival irritation

secondary to scar tissue or spasm of the orbicular coulee muscles

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8
Q

Treatment for ectropion? and entropion?

A

surgical repair

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9
Q

What is dacrostenosis?

A

duct does not open

  • common in newborns (first month of life)
  • resolves by 9 months
  • warm compress and massage
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10
Q

What is dacryoadenitis? What can this lead to?

A

inflammation of the nasolacrimal duct - due to obstruction or cyst

can lead to dacryocystitis and periorbital/orbital cellulitis

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11
Q

Treatment for dacryoadenitis?

A

cancellation of duct, dacryoplasty, stunting

if cystic = need surgery

if chronic = topical ABX

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12
Q

What is dacrycystitis? Symptoms? Treatment?

A

inflammation of the lacrimal gland caused by obstruction (staph aureus)

Symptoms: pain, swelling, tender, red, tearing, purulent discharge

Tx: warm compress and ABX

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13
Q

ptosis, eyelid edema, exophthalmos, purulent discharge

fever, decreased EOM, pain with eye movement

what should you order?

A

orbital cellulitis

CBC, blood culture, culture of any drainage

CT confirms intraorbital involvement

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14
Q

Cause of orbital cellulitis?

A

staph/strep

  • young kids (7-12 years old)
  • predisposing factors = paranasla sinusitis, eye surgery, orbital trauma, tooth infection
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15
Q

Treatment of orbital cellulitis?

A

EMERGENCY!
-IV ABX (broad spectrum)
Ex. nafcillin + metronidazole / clindamycin/ ceftriaxone / cefotaxime

Vance if MRSA

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16
Q

What are they 2 types of Glaucoma?

A
  1. open angle

2. angle-closure

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17
Q

What is glaucoma?

A

increased intraocular pressure with optic nerve damage

any impediment to the flow of aqueous flow = increases pressure in anterior chamber

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18
Q

increased intraocular pressure, asymptomatic, defect in peripheral vision

suspect findings on fundoscopy? on tonometry?

what test to confirm?

A

open angle

  • fundoscopy = increased cup to disk ratio
  • tonometry >21mmHg

confirmation: peripheral field testing

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19
Q

Treatment for open angle glaucoma?

A

need to decrease IOP

  • decrease aqueous production = BB, carbonic anhydrase inhibitors (acetazolamide)
  • increase outflow = prostaglandins (latanoprost, bimatoprost)
  • alpha agonists (brimonidine)
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20
Q

increased IOP, steamy/cloudy cornea, painful eye, fixed mid-dilated pupil, injected conjunctiva?

also n/v

A

angle closure glaucoma

=emergency

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21
Q

Treatment for angle closure glaucoma?

A

immediately refer

Start IV carbonic anhydrase inhibitor (acetazolamide, methazolamide)

topical BB

osmotic diuresis (mannitol)

optimal treatment = laser or surgical iridotomy

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22
Q

What is conjunctivitis?

A

inflammation of the conjunctiva

from = bacteria, virus, allergy, chemical, infiltration, or foreign body

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23
Q

purulent discharge from both eyes, mild discomfort, feel eyes are glued shut

cause?

A

bacterial conjunctivitis

cause = staph aureus, strep pneumo, h influ, m cat

rare = chlamydia, gonorrhea (sexual contact, vaginal delivery)

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24
Q

Diagnose bacterial conjunctivitis?

A

gram stain = polymorphonuclear (PMN) and predominant organism (NOT ROUTINELY DONE)

chlamydia = no organism seen

gonorrhea = gram - diplococci

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25
Treatment for bacterial conjunctivitis?
hygiene = hand washing, avoid contamination topical ABX - macrolide (erythromycin) - sulfa (sulfacetamide) - fluoroquinolone (cipro/ofloxacin) - polymixin (cortisporin/polytrim)
26
patient has very watery discharge, was swimming with a friend who had similar symptoms, started with one eye - now both eyes, cobblestoning of palpebral conjunctiva, does not itch what is it? cause? treatment?
Viral conjunctivitis cause = adenovirus treatment = self limiting - eye lavage - antihistamines - warm to cool compress
27
patient presents in the spring after visiting a friend with a dog and now has very watery eye discharge (non purulent), cobblestoning of palpebral conjunctiva, sneezing, itchy eyes What is it? Treatment?
allergic conjunctivitis Treatment: - topical (cromolyn, olopatadine) - oral anti-histamine (loratadine, cetirizine, fexofenadine, diphenyhydramine) - remove offending agent/environment
28
What is corneal abrasion?
disruption of the corneal surface - caused by trauma, foreign body, contact lens, fingernail
29
pain and sensation of foreign body, photophobia, tearing, injection, blepharospasm slit lamp/fluorescein stain = epithelial defect, clear cornea Treatment?
corneal abrasion - topical anesthetic (only used to confirm diagnosis - can retard healing) - saline irrigation, abx ointment (gentamicin, sulfacetamide) - tylenol for pain - PATCHING if large abrasion
30
What is corneal ulcer?
breakdown, necrosis or thinning of corneal surface - from inflammation or infection
31
patient presents with pain, photophobia, tearing, circumcorneal injection, discharge, uses contact lens fluorescein stain = dense corneal infiltrate, overlying epithelial defect seen on penlight exam too
corneal ulcer | -REFER TO ophthalmologist
32
fluorescein stain = dendritis lesion?
herpes keratitis
33
what do you use to identify a foreign body in the eye? remove foreign body?
slit lamp - irrigation, swab - refer if need instrument usage
34
What do you think of with a rust ring on the cornea?
metallic foreign body = need a burr to remove
35
what is a pterygium? When do you treat?
benign vascular corneal growth (slow growing thickening of the bulbar conjunctiva) triangle mass from nasal side to cornea Treatment = if interferes with vision (common recurrence)
36
What is pinguecula?
benign growth, yellowish, does NOT cross onto cornea, on nasal side no treatment necessary
37
opacity of the lens?
cataract (translucent, yellow discoloration of sense) decreases vision
38
cataract risk factors?
age, smoking, alcohol, steroid use, sunlight exposure, DM, congenital KIDS = TORCH (toxoplasmosis, syphilis, rubella, cytomegalovirus, herpes simplex)
39
Treatment of cataract?
lens replacement (good prognosis) -cataracts are leading cause of blindness!
40
What are some types of retinopathy?
hypertensive and diabetic (#1) -inflammatory = behcet, sarcoidosis, sle, giant cell arteritis, polyarteritis nods, wagerer's granulomatosis infectious = syphilis, herpes simplex, varicella zoster, TB, toxoplasmosis, CMV (HIV)
41
What are the 2 types of diabetic retinopathy? Treatment?
1. nonproliferative = venous dilation, microaneurysm, retinal hemorrhage, retinal edema, hard exudate 2. proliferative = NEOVASCULARIZATION, vitreous hemorrhage Treatment = control glucose, BP, laser photocoagulation, virectomy
42
patient with fib, sudden painless, marked unilateral vision loss fundoscopy = perifoveal atrophy (cherry red spot), pallor of retina, arteriolar narrowing, box-carding
retinal artery occlusion EMERGENCY
43
cause of retinal artery occlusion?
emboli, thrombotic phenomenon, vasculitides, a fib, endocarditis, sickle cell disease, hyper coagulable state amaurosis fugax
44
sudden, unilateral, painless vision loss exam: afferent pupillary defect, optic disc swelling, "blood and thunder retina", superficial retinal hemorrhage/edema/exudate
retinal vein occlusion | central vein = most common
45
risk factors of retinal vein occlusion?
age, HTN, DM, hyper coagulable state, glaucoma, smoking, obesity (secondary to thrombotic event)
46
Treat retinal vein occlusion?
ranibizumab, Intravitreal steroids, thrombolytics, surgery (vitrectomy)
47
painless, blurred vision, see floaters, flashing lights, curtain being drawn over eye ... progress to blindness Treatment?
retinal detachment Tx: - without tear = ophthalmology f/u - with tear = surgery - patient should remain supine with head turned to side of retinal detachment
48
age, central vision loss, drusen deposits (yellow retinal deposits)
macular degeneration | peripheral loss = glaucoma
49
causes of macular degeneration? Treatment?
age drugs (chloroquine, phenothiazine) Treatment = supportive, supplements
50
difficulty driving and reading (central vision loss)
macular degeneration Dry - macular atrophic changes Wet - macular changes due to exudative or vascular changes
51
patient with multiple sclerosis, has monocular vision loss, pain, sluggish pupillary response Diagnose? Treat?
optic neuritis (inflammation and demyelination of optic nerve) MRI confirm demyelination Treatment = IV steroid
52
blunt or penetrating trauma, now blood in anterior chamber, decreased visual acuity, enlarged or misshapen pupil Treatment
hyphema r/o blowout fracture, lens trauma, skull or cervical fracture Treatment = eye protection, rest with head of bed at 30 degrees, topical beta adrenergic blockers,
53
swelling, misalignment, movement of globe is restricted, not able to look up, double vision
blowout fracture (direct trauma) CT to see extent of damage refer to ophthalmologist, avoid sneezing, coughing
54
papilledema... confirm and treatment
from increased intracranial pressure (tumor/bleed, cerebral edema, CSF outflow obstruction, overproduction), results in swelling of optic disk confirm: imaging and lumbar puncture (increased opening pressure) Treatment = underlying intracranial disorder
55
transient visual loss?
transient ischemic attack (emboli - amaurosis fugal) or giant cell arteritisi
56
sudden visual loss?
central retinal vein or branch vein occlusion, optic neuropathy, papillitis, retrobulbar neuritis
57
gradual visual loss?
macular degeneration, tumor, cataract, glaucoma
58
icterus/jaundice?
yellowing of sclera | -retention of bilirubin
59
blue or cyanotic sclera
normal or seen in infants with osteogenesis imperfect
60
bitemporal heteronymous hemianopsia
lesion at optic chiasm (affect both eyes)
61
strabismus?
binocular fixation is not present -misalignment inward = esotropia outward = exotropia if not treated by age 2 = amblyopia will result
62
nystagmus?
involuntary eye movement
63
optic neuritis
multiple sclerosis

PANCE (16 decks)

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