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Flashcards in Eye Deck (99):
1

Define Blepharitis

-Chronic condition
-Inflammation of the eyelids
-Intermittent exacerbations

2

Anterior Blepharitis

-Infectious component: S.aureus
-Seborrheic component

3

Posterior Blepharitis

Meibomian gland dysfunction

4

What is the most likely dx of this clinical presentation:
-Red eye
-Gritty sensation
-Burning sensation
-Excessive tearing
-Crustiness in lashes
-Light sensitivity

Blepharitis

5

Physical exam findings in Blepharitis

1. Diffuse conjunctival injection
2. Inflamed and red eyelid margins
3. Crusting/matting of eyelashes
4. Plugged glands
5. Collarettes

6

Treatment of Blepharitis

1. Warm compresses
2. Topical abx: Erythromycin ointment

7

Causes of periorbital cellulitis

1. External sources
-Blepharitis
-Insect bites
-FB
2. Sinusitis

8

What is the most likely dx of this clinical presentation:
-Eye pain
-Eyelid swelling
-No vision change
-No fever
-No pain with eye movement

Periorbital cellulitis

9

Abx treatment if MRSA is NOT suspected in periorbital cellulitis

Oral Clindamycin OR
Amoxicillin-Clauvulanic acid

10

Abx treatment if MRSA IS suspected in periorbital cellulitis

Oral Trimethoprim-Sulfamethoxazole (Bactrim) +
Amoxicillin, AmoxClav

11

What is the most likely dx of this clinical presentation:
-Eye pain
-Eyelid swelling
-Vision changes
-Fever
-Pain with eye movement

Orbital cellulitis

12

Orbital cellulitis physical exam findings

1. Proptosis
2. Opthalmoplegia
3. Conjunctivitis
4. +/- discharge

13

What is the emergent complication we are trying to prevent in orbital cellulitis

-Optic nerve damage
-Spread of infection to cavernous sinus-->meninges or brain

14

Orbital cellulitis Treatment

1. Opthalmologist consult
2. IV abx- Broad spectrum= Vancomycin + Ceftriaxone

15

Define Orbital cellulitis

infection of the fat and muscle tissue surrounding globe

16

Etiology of Orbital cellulitis

extension of infection from the paranasal sinuses (ethmoid sinuses)

17

Define periorbital cellulitis

-Infection of the soft tissues around the eye
-Doe NOT extend into orbit

18

What is the most common eye disease?

Conjunctivitis

19

What virus is the most common cause of viral conjunctivitis?

Adenovirus

20

Signs and sx's of viral conjunctivitis

-Watery discharge
-Preauricular discharge
-Fever
-Malaise
-Pharyngitis

21

What are the most common organisms in bacterial conjunctivitis?

1. S.pneumoniae
2. H. influenza
3. Pseudomonas

22

What is a common symptom of bacterial conjunctivitis?

Copious discharge
-"Eyes matted shut"

23

bacterial conjunctivitis treatment

1. Erythromycin ointment
2. Fluroquinolone drops

24

Allergic conjunctivitis signs and sx's

-Usually bilateral
-Itchy eyes
-Conjunctival injections
-Chemosis (swelling)

25

Define dacrocystitis

infection in lacrimal sac

26

etiology of dacrocystitis

Usually secondary to nasolacrimal duct obstruction

27

dacrocystitis treatment

Clindamycin, IV vancomycin

28

Define entropion

inward turning of eyelids

29

Define ectropion

outward turning of eyelids

30

Define pingueculum

-Yellow, elevated nodule
-Commonly located on nasal side of conjunctiva

31

Define Pterygium

-Flesh, triangular growth of the conjunctiva
-Spreads

32

What is the main concern with Pterygium?

May threaten cornea and visual axis

33

Define hyphema

-Results from an injury (often blunt trauma) to the anterior chamber that disrupts the vasculature supporting the iris or ciliary body

34

Hyphema treatment

-Diuretics (Oral, Topical)
-Topical Cycloplegic

35

What signs are you going to look for in a perforated globe?

1. Loss of anterior chamber depth
2. Misshapen pupil
3. Vitreous leakage

36

Treatment for perforated globe

Emergent referral for surgical repair

37

Corneal abrasion treatment

1. Topical abx drops-Azithromycin
2. Topical lubricants

38

What should you NEVER send a patient home with if they have a corneal abrasion? Why?

Anesthetics
-->may cause anesthetic keratitis requiring a corneal transplant

39

What is the most common cause of corneal ulcers (keratitis)?

Infection
-Bacterial, viral, fungal or amebic

40

What are corneal ulcers (keratitis) commonly associated with?

Contact lens abuse

41

What eye disorder does this clinical presentation suggest?
-Cloudy, hazy opacity overlying cornea
-Conjunctival injection, esp. limbus
-Dendritic pattern seen on fluorescein staining
-+/- Hypopyon

Corneal ulcer-Keratitis

42

Corneal ulcer-Keratitis treatment for HSV

topical acyclovir

43

Corneal ulcer-Keratitis treatment for bacterial

Moxifloxacin

44

What does the urea consist of?

1. iris
2. ciliary body
3. choroid

45

What is uveitis/iritis most commonly caused by?

Immunologic:
-Ankylosing spondylitis
-Arthritis
-Inflammatory bowel dz

46

uveitis/iritis signs

1. Decreased vision
2. Ciliary flush/circumlimbal injection
3. Constricted pupil
4. Low or normal IOP
5. Cells and flares on SLE

47

uveitis/iritis treatment

1. Prompt ophthalmology referral
2. Topical steroids-Prednisone
3. Topical cycloplegics

48

Enopthalmos

Posterior displacement of the globe

49

What muscle is entrapped with blow-out fractures, restricting EOMs?

Inferior rectus muscle

50

What is the test of choice in blow-out fractures?

CT of the orbit

51

Treatment of blow-out fractures?

1. Emergency referral
2. Empiric abx during transport- Amoxicillin-clavulanate

52

What eye disorder does this clinical presentation suggest?
-Severe eye pain
-Blurred vision
-Photophobia
-HA
-N/V

Acute angle-closure glaucoma

53

Acute angle-closure glaucoma physical exam findings

1. Decreased vision
2. Red eye- Circumlimbal injection
3. Fixed, mid-dilated pupil
4. Crescent shadow
5. Increased IOP, >50 mmHg

54

Acute angle-closure glaucoma treatment

1. IV acetazolamide (Diamox) + oral dose
2. Topical timolol
3. Mitotic drop

55

Definitive treatment of Acute angle-closure glaucoma

Laser peripheral iridotomy

56

Define chronic open angle

decreased drainage through trabecular meshwork

57

Define chronic closed angle

obstruction of flow into anterior chamber

58

Who are fundoycopic exams recommended in?

1. Over the age of 40, every 2-5 yrs.
2. Positive family history or diabetic= annually

59

Diagnosis of chronic glaucoma

2 of the 3 abnormalities:
1. Optic disk-"cupping" or pallor
2. Visual field- constriction
3. IOP- increased

60

What is the leading cause of blindness in the world

Cataracts

61

What is the most common cause of cataracts

Age related- Senile cataracts

62

Signs of cataracts

1. Decreased visual acuity
2. Decrease in color vision
3. Opalescent changes to lens
4. Abnormal or absent red reflex
5. PAINLESS loss of vision

63

What is the most common type of nystagmus?

Jerk nystagmus

64

Possible treatment options for nystagmus

1. Medication- Gabapentin
2. Botulimun injections
3. Prism lenses
4. Kestenbaum muscle surgery

65

Define Amblyopia

Reduction of visual acuity of one or both eyes
-->caused by disuse or misuse during critical period of visual development

66

Types of Amblyopia

1. Strabismus
2. Anisometropic or refractive
3. Deprivational (congenital cataracts, ptosis, blocked visual axis)

67

What age does visual development occur up until?

6-8 y.o.

68

When would you use alternate cover test?

intermittent strabismus

69

Define optic neuritis

Inflammatory demyelinating condition that results in acute vision loss in ONE eye

70

Etiology of optic neuritis

-Strong associated with Multiple Sclerosis
-Viral infections: measles, mumps, influenza

71

Physical exam findings of optic neuritis

-loss of color vision
-Decreased visual acuity
-Relative afferent pupillary defect (APD)
-Optic nerve changes on exam

72

Optic Neuritis treatment

IV methylprednisone

73

Define papilledema

-Swelling of the optic nerve head
-Usually associated with increased intracranial pressure

74

Papilledema Physical Exam findings

1. Swollen optic disk with blurred margins
2. Obscured cup
3. Dilated and tortuous venules
4. Flame hemorrhages and infarctions ("cotton-wool spots")
5. Edema

75

What is the leading cause of adult blindness industrialized countries?

Age-related macular degeneration (AMD)

76

What type of vision loss occurs in AMD?

Central vision loss

77

Presenting sx's in AMD

1. Metamorphospsia
2. Central scotoma
3. Gradual or acute painless vision loss

78

Define Dry AMD

1. Drusen- yellow calcium deposits
2. Atrophy
*Better prognosis

79

Define Wet AMD

1. Subretinal neovascularization
2. Subretinal hemorrhage
*Majority (80-90%) cases of blindness due to AMD

80

What is the most common cause for retinal detachment?

Tear in retina

81

What is the most common site of a retinal detachment?

Superior temporal retinal area

82

What eye disorder does this clinical presentation suggest?
-Acute onset of monocular, decreased vision="curtain over their eye"
-Coudy/smoky vision
-Flashes of red
-No pain or redness

Retinal detachment

83

Retinal detachment physical exam findings

1. Afferent pupillary defect
2. Billowing or tent-like elevation of rugs retina
3. Elevated retina appears out-of-focus and gray
4. Vitreous hemorrhage

84

Retinal detachment Treatment

Cryosurgery or laser surgery

85

Define Amaurosis Fugax

-"Fleeting blindness"
-Usually caused by retinal emboli from ipsilateral carotid disease

86

Amaurosis Fugax Diagnostics

1. Duplex US and magnetic resonance angiography (MRA)
2. EKG and Echo if suspect cardiac source

87

What eye disease would a pale retina with "cherry red spot" at fovea suggest?

Central Retinal Artery Occlusion

88

What eye disease would "blood and thunder" fungus suggest?

Central Retinal Vein Occlusion

89

Central Retinal Vein Occlusion treatment

1. Urgent referral
2. ASA
3. Observation
4. Evaluate etiology

90

Which central retinal occlusion has a poor prognosis, artery or vein?

Artery

91

What is the #1 cause of blindness in the western world in pt's <50 y.o. ?

Diabetic retinopathy

92

What percentage of diabetics have retinopathy?

40%

93

Exam by an ophthalmologist is recommended when?

1. Type 1 Diabetes of 5+ yrs. duration
2. @ first dx in Type 2 Diabetes
2. IF ocular sx's develop or suspicious findings of retinopathy

94

Features of non-proliferative diabetic retinopathy

1. Microaneurysms
2. Dot-blot hemorrhages
3. Cotton-wool spots

95

Features of proliferative diabetic retinopathy

1. Neovascularization
2. Vitreous hemorrhage
3. Traction RD
+ all non-proliferative signs

96

Fundoscopic findings on diabetic macular edema

1. Retinal hemorrhage
2. Microaneurysms
3. Hard exudates

97

What is the daily glucose goal in treatment of diabetic retinopathy?

<120

98

What is the HbA1C goal in treatment of diabetic retinopathy?

<7

99

Keith-Wegener-Barker Classification

1. Arteriolar Narrowing= “Copper wiring”
2. Arteriolar Sclerosis=“Silver wiring”
3. "A:V Nicking"
4. Cotton-wool spots
5. Retinal hemorrhages
6. Retinal edema/exudates= macular star
7. Papilledema