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Eye Diseases Lecture 3 Flashcards

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1
Q

Essentials of diagnosis for Blepharitis- Anterior

A

CHRONIC bilateral inflammatory conditions of the lid margins

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2
Q

Epidemiology of Blepharitis- Anterior

A

staph aureus or seborrheic

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3
Q

S&S of Blepharitis- Anterior

A

burning, itching, “red-rimmed” eyes with scales or granulation clinging to lashes “scruff” or collarette scales

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4
Q

Complications of Blepharitis- Anterior

A

Recurrent conjunctivitis, hordeolum, chalazion, abnormal lid or lash position

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5
Q

F/U for Blepharitis- Anterior

A

your nurse will call in 24hrs, F/U 1-3 weeks if improving, sooner w/ PCP if increased symptoms or no improvement after 3 days.

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6
Q

Pharm Tx for Blepharitis- Anterior

A

1st line: Erythromycin Ophthalmic 0.5% Ointment -or- bacitracin ophthalmic ointment applied daily to lid margins
2nd line:
Ophthalmic Fluoroquinolones solution (Levofloxacin 0.5% , or Moxifloxacin 0.5%, Gatifloxacin 0.3%)

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7
Q

Non-pharm Tx for Blepharitis- Anterior

A

warm compresses daily to soften encrustations, removal of scales daily with a warm washcloth, diluted baby shampoo twice daily

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8
Q

Pt Ed for Blepharitis- Anterior

A

clean eyes daily,

wash hands before instilling Rx, chronic condition not cured but controlled. no contacts

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9
Q

Essential of diagnosis for Blepharitis- Posterior

A

chronic bilateral inflammatory condition of the lid margins meibomian glands

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10
Q

Epidemiology of Blepharitis- Posterior

A

may have staphylococcus aureus

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11
Q

S&S of Blepharitis- Posterior

A

lid margins are hyperemic with telangiectasias, meibomian glands, are inflamed, lid margins- entropion, tears may be frothy or greasy

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12
Q

Complications of Blepharitis- Posterior

A

recurrent conjunctivitis, hordeolum, chalazion, abnormal lid or lash position

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13
Q

Tx for MILD Blepharitis- Posterior

A

Erythromycin Ophthalmic 0.5% ointment or Bacitracin ophthalmic ointment

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14
Q

F/U and referral for MILD Blepharitis- Posterior

A

routine to ophthalmologist
F/U: you/nurse call within 24 hours, F/U 1 week if Rx is improving condition; sooner with PCP if increased symptoms or no improvement in 3 days

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15
Q

Non- pharm tx for Blepharitis- Posterior

A

regular meibomian gland expression

warm compresses

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16
Q

referral and Tx for SEVERE Blepharitis- Posterior

A

urgent ophthalmologist referral
Tx 1st line:
long-term, low-dose abx:
Tetracycline 250 mg, one capsule PO BID (renal dosing)
OR
Doxycycline 100 mg, one capsule/tablet PO daily (renal dosing)
OR
Erythromycin 250 mg, one capsule/tablet PO TID

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17
Q

Pt Ed for Blepharitis- Posterior

A

prevent complications by regular meibomian expression, if female, no tetracycline during pregnancy, chronic condition cannot be cured, no contacts

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18
Q

Essentials of diagnosis for Chalazion

A

CHRONIC granulomatous inflammation of a meibomian gland, firm, hard non-tender swelling on the upper or lower eyelid with/without redness

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19
Q

Epidemiology of Chalazion

A

common, blockage of Zeis or meibomian gland

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20
Q

Tx and referral for Chalazion

A

routine consult to an ophthalmologist for inclusion and curettage

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21
Q

Pt ed for Chalazion

A

treat hordeolum quickly, resolved with surgery, but may re-occur, annual eye exam

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22
Q

Essential of diagnosis for Ectropion

A

advanced age, outward turning of the lower lid, dry eyes

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23
Q

Tx and referral for Ectropion

A

routine consult to ophthalmologist for surgery

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24
Q

Pt Ed for Ectropion

A

use artificial tears in the morning, no contacts, wear sunglasses

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25
Essentials of diagnosis for Entropian
Advanced age, FB sensation, inward turning of the lower eyelid
26
complications of Entropian
conjunctivitis
27
Tx and referral for Entropian
routine ophthalmology consult for surgery
28
Essentials of diagnosis for Hordeolum
acute, painful, redness
29
Risk factors for Hordeolum
Blepharitis, previous hordeolum, contact wearer, make-up, smoke, and dust exposure
30
Epidemiology of Hordeolum
staphylococcus aureus
31
S&S of Hordeolum
acute, painful, redness, pustule
32
F/U for Hordeolum
72 hours if not resolved- send to ophthalmologist for incision
33
Tx for Hordeolum
1st line: do NOT express it, warm compresses | 2nd line: may give erythromycin ophthalmic 0.5% ointment
34
Essentials of diagnosis for Xanthelasma
Yellow lesions on the eyelid
35
Risk factors for Xanthelasma
hyperlipidemia
36
Tx for Xanthelasma
ophthalmology can surgically remove if wanted control hyperlipidemia (PCP)
37
Essentials of diagnosis for Nystagmus
rhythmic regular oscillation of the eye (horizontal, vertical, circular)
38
Risk factors for Nystagmus
side effect of Rx, ETOH, infarct, demyelination, neoplasms, hydrocephalus
39
Epidemiology of Nystagmus
jerk = slow drift of eyes in one direction, repeatedly corrected with fast movement in the reverse direction, congenital or acquired
40
S&S of Nystagmus
eye movement, blurred vision
41
Diagnostic Studies for Nystagmus
MRI R/O mass, | Check serum B12 (low), magnesium (low), HIV
42
Tx and management for Nystagmus
consult neurosurgeon, tx varies based on the cause
43
Essentials of diagnosis for Optic Neuritis
UNILATERAL central vision loss, pain with eye movement
44
Risk factors for Optic Neuritis
presenting symptoms for multiple sclerosis; consider hypoparathyroidism
45
Epidemiology for Optic Neuritis
inflammation associated with demyelination
46
Disposition and referral for Optic Neuritis
inpatient, admit to hospital emergent consult to ophthalmologist/ neurologist (MS) or endocrinologist if hypoparathyroidism
47
Pharm tx for Optic Neuritis
IV Methylprednisolone x 3 days, then oral tapered dose (MS)
48
Essentials of diagnosis for Third Nerve Paralysis
Sudden dysfunction of muscles associated with CN III (oculomotor)
49
Epidemiology of Third Nerve Paralysis
subarachnoid hemorrhage, midbrain lesions, intracranial aneurysm, ischemia, trauma
50
S&S of Third Nerve Paralysis
diplopia, droopy eyelid (ptosis), HA (worst HA of my life = subarachnoid hemorrhage due to aneurysm)
51
Diagnostic studies for Third Nerve Paralysis
- MRI to r/o lesion - Contrast MRI with MRA angiogram) or CTA (CT angiogram) to r/o aneurysm - non-contrast CT & LP to r/o meningitis (HA, stiff neck & decreased LOC)
52
Disposition and referral for Third Nerve Paralysis
admit to hospital | emergent consult to neurosurgeon, tx based on cause
53
Essentials of diagnosis for Fourth Nerve Paralysis
Diplopia and lack of superior oblique m. (unilateral or bilateral), innervated by CN IV (trochlear)
54
Epidemiology of Fourth Nerve Paralysis
lesion
55
Diagnostic studies for Fourth Nerve Paralysis
MRI to r/o lesion
56
Tx and management of Fourth Nerve Paralysis
emergent consult neurosurgeon
57
Essentials of diagnosis for Sixth Nerve Paralysis
diplopia and lack of lateral rectus m. (unilateral or bilateral), innervated by CN VI (abducens)
58
Epidemiology for Sixth Nerve Paralysis
lesion
59
Diagnostic studies for Sixth Nerve Paralysis
MRI to r/o lesion
60
Tx and management of Sixth Nerve Paralysis
emergent consult to neurosurgeon
61
Essentials of Diagnosis for Papilledema
disc swelling, due to severe HTN or RX side effects or increased intracranial pressure (ICP), VF changes
62
Complications of Papilledema
vision loss
63
Tx and management of Papilledema
admit to hospital, control causative (BP, Rx, ICP)
64
Essentials of diagnosis for Periorbital Cellulitis
infection of the anterior portion of the eyelid, redness, pain, eyelid swelling
65
Other name for Periorbital Cellulitis
preseptal cellulitis
66
Epidemiology of Periorbital Cellulitis
common Staphylococcus aureus or Streptococcus pneumoniae
67
Diagnostic studies for Periorbital Cellulitis
contrast-enhanced CT
68
Pharm TX for Periorbital Cellulitis
PO Clindamycin 300 mg PO TID or Bactrim DS PO BID plus augmentin 875 mg PO BID; if not improved in 24 hr, admit to hospital for IV antibiotics
69
Essentials of diagnosis for Posterior Orbital Cellulitis
proptosis, swelling, pain with eye movement, redness
70
Risk factors for Posterior Orbital Cellulitis
bacterial rhinosinusitis, dacryocystitis, teeth infection, middle ear infection
71
Epidemiology of Posterior Orbital Cellulitis
S. pneumoniae, H. influenza, M. catarrhalis, Staphylococcus aureus
72
S&S of Posterior Orbital Cellulitis
proptosis, swelling, pain with eye movement, redness, edema, diplopia, vision loss
73
Diagnostic studies of Posterior Orbital Cellulitis
contrast-enhanced CT
74
Complications of Posterior Orbital Cellulitis
abscess and death if untreated
75
Pharm Tx and management of Posterior Orbital Cellulitis
admit to hospital emergent consult to ophthalmologist pharm: IV Vancomycin plus ceftriaxone; then discharge on clindamycin 300 mg PO TID or Bactrim DS PO BID plus augmentin PO BID for 2-3 weeks
76
Essential of diagnosis for Thyroid Eye Disease
BILATERAL proptosis (exophthalmos)
77
Risk factors for Thyroid Eye Disease
Graves disease- hyperthyroidism; Rx
78
Diagnostic studies for Thyroid Eye Disease
labs TSH, FT4
79
S&S of Thyroid Eye Disease
proptosis, lid lag, stare, +/- enlarged thyroid
80
Tx and management of Thyroid Eye Disease
treat thyroid disease, consult ophthalmologist, may have to consult an endocrinologist to control thyroid
81
Essentials of diagnosis for Arygyll Robertson Pupil
bilateral small pupils, constrict on accommodation but do not constrict when exposed to bright light (do not "react" to light)
82
Epidemiology of Arygyll Robertson Pupil`
Treponema pallidum; neurosyphilis | neurosyphilis can be asymptomatic to meningitis
83
Diagnostic studies for Arygyll Robertson Pupil
LP (lumbar puncture)- [Vernal disease research laboratory (VDRL) and Rapid plasma reagin (RPR) may be nonreactive]
84
Tx for Arygyll Robertson Pupil
if neurosyphilis: (report to public health) STD/STI work-up, treat partner Pharm: CDC algorithm (IV antibiotics for 10-14 days)

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