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Family Med EOR > Eye Disorders > Flashcards

Eye Disorders Flashcards

1
Q

What is blepharitis? Who is it common in?

A

Inflammation of both eyelids

Down syndrome & eczema

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2
Q

What causes anterior blepharitis (skin & base of eyelids)?

A
  1. Infectious: S. aureus or S. epidermis, viruses

2. Seborrheic

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3
Q

What causes posterior blepharitis?

A

Meibomian gland dysfunction (a/w rosacea & allergic dermatitis)

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4
Q

What are the s/s of blepharitis?

A

Eye irritation/itching

Eyelid: burning, erythema, crusting, scaling, red-rimming* & eyelash flaking

+/- entropion or ectropion

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5
Q

How do you treat anterior blepharitis?

A

Eyelid hygiene, warm compresses

Azithromycin sol or ointment

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6
Q

How do you treat posterior blepharitis?

A

Eyelid hygiene, regular massage/expression of the meibomian gland

If severe, unresponsive –> systemic tetracyclines or azithromycin

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7
Q

What is entropion? Who is it MC in?

A

Eyelid & lashes turned inward

MC in elderly

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8
Q

What causes entropion?

A

May be caused by spasms of the orbicularis oculi muscle

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9
Q

What does entropion look like?

A

Eyelashes may cause corneal abrasion/ulcerations, erythema, tearing, increased sensitivity

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10
Q

How do you treat entropion?

A

Surgical correction if needed

Lubricating eye drops

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11
Q

What is ectropion? Who is it MC in?

A

Eyelid & lashes turned outward (tends to be B/L)

MC in elderly, but can be congenital, infectious, CN 7 palsy

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12
Q

What causes ectropion?

A

Relaxation of the orbicularis oculi muscle

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13
Q

What is a chalazion?

A

Painless granuloma of the internal meibomian sebaceous gland –> focal eyelid swelling

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14
Q

What are s/s of a chalazion?

A

Nontender* eyelid swelling –> rubbery nodule

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15
Q

How do you treat a chalazion?

A

Eyelid hygiene, warm compress

If large & affecting vision –> Corticosteroid inj or incision + curettage

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16
Q

How can you tell the difference btwn a chalazion & a hordeola?

A

Chalazions are larger, firmer, slower growing & less painful

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17
Q

What is a hordeolum (stye)?

A

Local abscess of the eyelid margin

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18
Q

Describe an external hordeolum vs internal hordeolum

A

External: inf of eyelash follicle or external sebaceous glands near the lid margin

Internal: inflammation/inf of the meibomian gland

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19
Q

What are the s/s of a hordeolum?

A

painful, warm, swollen red lump on eyelid

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20
Q

How do you treat a hordeolum?

A

Warm compresses +/- topical abx

+/- I&D if no spontaneous drainage after 48hrs

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21
Q

What is a pterygium?

A

Elevated, SF, fleshy, triangular “growing” fibrovascular mass

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22
Q

What causes a pterygium? & where is it MC?

A

A/w increased UV exposure in sunny climates, sand, wind, & dust

MC in inner corner/nasal side of eye & extends laterally

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23
Q

How do you treat a pterygium?

A

Obs for most +/- artificial tears

Affecting vision –> remove

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24
Q

What is the MC cause of permanent legal blindness & visual loss in elderly?

A

Macular degeneration

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25
Q

What are RFs for macular degeneration?

A

> 50
Caucasians
Females
Smokers

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26
Q

Describe dry (atrophic) macular degeneration

A

Gradual breakdown of the macula –> gradual blurring of central vision

Drusen: small, round, yellow-white spots on the outer retina (scattered, diffuse)

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27
Q

Describe wet (neovascular or exudative) macular degeneration

A

new, abnormal vessels grow under the central retina, which leak & bleed –> scarring

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28
Q

What are the s/s of macular degeneration?

A

B/L blurred or loss of central vision (including detailed & colored vision)

Scotomas, metamorphopsia, micropsia

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29
Q

How do you diagnose wet macular degeneration?

A

Fluorescein angiography

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30
Q

How do you treat dry macular degeneration?

A

Amsler grid

Zinc, Vit A/C/E

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31
Q

How do you treat wet macular degeneration?

A

Intravitreal anti-angiogenics (Bevacizumab - inhibits blood vessel growth)

Laser photocoagulation

Optical tomography

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32
Q

What is the MC cause of new, permanent vision loss/blindness in 25-74yo?

A

Diabetic retinopathy

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33
Q

What causes diabetic retinopathy?

A

maculopathy

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34
Q

What is diabetic retinopathy?

A

Blood vessel damage –> ischemia, edema

Glycosylation –> capillary breakdown

35
Q

Describe nonproliferative diabetic retinopathy

A

Microaneurysms –> blot & dot, flame-shaped hemorrhages

Cotton wool spots, hard exudates

Not a/w vision loss

36
Q

How do you treat nonproliferative diabetic retinopathy?

A

Panlaser

Glucose control

37
Q

Describe proliferative diabetic retinopathy

A

Neovascularization: new, abnormal blood vessel growth, vitreous hemorrhage

38
Q

How do you treat proliferative diabetic retinopathy?

A

VEGF inhibitors (Bevacizumab)

Laser photocoagulation

Glucose control

39
Q

Describe maculopathy (type of diabetic retinopathy)

A

macular edema or exudates, blurred vision, central vision loss

40
Q

What causes maculopathy?

A

macular microaneurysm leakage

41
Q

How do you treat maculopathy?

A

Laser

42
Q

What is hypertensive retinopathy?

A

damage to retinal blood vessels from long-standing HTN

43
Q

Describe grade I of hypertensive retinopathy

A

Arterial narrowing, copper wiring moderate, silver wiring severe

44
Q

Describe grade II of hypertensive retinopathy

A

AV nicking

45
Q

Describe grade III of hypertensive retinopathy

A

Flame shaped hemorrhages, cotton wool spot

46
Q

Describe grade IV of hypertensive retinopathy

A

Papilledema (malignant HTN)

47
Q

What are s/s of a corneal abrasion?

A

FB sensation, tearing, red & painful

48
Q

How do you diagnose a corneal abrasion?

A

Fluorescein staining: “ice rink” / linear abrasions

49
Q

How do you treat a corneal abrasion?

A

If large –> patching (no longer than 24hrs)

DO NOT PATCH IN CONTACT LENS WEARERS OR PSEUDOMONAS - Place on FQ eye drops (cipro)

50
Q

What is the MC cause of viral conjunctivitis?

A

Adenovirus

Swimming pool MC source

MC in children

51
Q

What are the s/s of viral conjunctivitis?

A

FB sensation, erythema & itching

May be accompanied by viral sx

52
Q

What does viral conjunctivitis look like on PE?

A

Preauricular lymphadenopathy, copious watery discharge

Often B/L

May have punctate staining on slit lamp

53
Q

How do you treat viral conjunctivitis?

A

Supportive (cool compress, artificial tears)

+/- antihistamines (olapatadine)

54
Q

What are s/s of allergic conjunctivitis?

A

Erythema

May have allergic sx

55
Q

What does allergic conjunctivitis look like on PE?

A

Cobblestone mucosa to the inner/upper eyelid

Itching, tearing, redness, stringy discharge

Usually B/L +/- chemosis

56
Q

How do you treat allergic conjunctivitis?

A

Topical antihistamines (H1 blockers): Olopatadine, pheniramine/naphazoline

Topical NSAID: ketorolac

Topical corticosteroids

57
Q

What is the MC cause of bacterial conjunctivitis?

A

S. aureus, Strep penumo

58
Q

What are s/s of bacterial conjunctivitis?

A

Purulent discharge, lid crusting

59
Q

How do you treat bacterial conjunctivitis?

A

Topical erythromycin, FQ, sulfas, aminoglycosides

If contact wearer –> cover pseudomonas w/ FQ or aminoglycoside

60
Q

What causes orbital cellulitis?

A

Secondary to sinus infections (ethmoid 90%)

S. aureus, S. pneumo, GABHS, H. flu

May be caused by dental/facial inf or bacteremia

61
Q

What are s/s of orbital cellulitis?

A

Decreased vision, pain w/ ocular movement, proptosis

62
Q

How do you diagnose orbital cellulitis?

A

High resolution CT/MRI

63
Q

How do you treat orbital cellulitis?

A

IV vanco, clinda, cefotaxime, ampicillin, amox

64
Q

What is the cause of iritis?

A

Systemic inflammatory disease: a/w HLA-B27 spondyloarthropathies, sarcoid, Behcet’s

Infectious: CMV, toxoplasmosis, syphilis, TB

Trauma

65
Q

What are s/s of anterior iritis?

A

unilateral ocular pain/redness/photophobia

Excessive tearing

Usually occurs after blunt trauma

66
Q

What are s/s of posterior iritis?

A

blurred/decreased vision, floaters

67
Q

What does iritis look like on PE?

A

Ciliary injection (limbic flush), consensual photophobia

Inflammatory cells & flare within the aqueous humor

68
Q

How do you treat anterior iritis?

A

Topical steroids, scopolamine, topical cycloplegics

69
Q

How do you treat posterior iritis?

A

system corticosteroids

70
Q

What do cataracts look like on PE?

A

absent red reflex, opaque lens

71
Q

What causes retinal artery occlusion?

A

MC 50-80y w/ atherosclerotic disease

72
Q

What are the s/s of retinal artery occlusion?

A

Acute, sudden monocular vision loss

Often preceded by amaurosis fugax

73
Q

How do you diagnose retinal artery occlusion?

A

Funduscopy:

  1. Pale retina w/ cherry-red macula
  2. Box car appearance of retinal vessels
74
Q

How do you treat retinal artery occlusion?

A

Decrease IOP (acetazolamide)

Revascularization (orbital massage to dislodge clot)

75
Q

What are the s/s of acute angle closure glaucoma?

A

severe, sudden onset of unilateral ocular pain

+/- N/V, HA

Vision changes: halo around lights, peripheral vision loss

76
Q

What does acute angle closure glaucoma look like on PE?

A

Erythema, “steamy” cornea

Mid-dilated, fixed, nonreactive pupil, eye feels hard to palpation

77
Q

How do you diagnose acute angle closure glaucoma?

A

Increased IOP by tonometry

“Cupping” of optic nerve on funduscopy

78
Q

How do you treat acute angle closure glaucoma?

A
  1. Acetazolamide = 1st line (decreases aqueous humor production)
  2. Topical BB (Timolol)
  3. Miotics/cholinergics (pilocarpine, carbachol)
  4. Alpha 2 agonists
  5. Peripheral iridotomy = definitive tx

AVOID ANTICHOLINERGICS, SYMPATHOMIMETICS

79
Q

What are the s/s of chronic open angle glaucoma?

A

Gradual B/L painless peripheral vision loss

80
Q

What does chronic open angle glaucoma look like on PE?

A

Cupping of optic discs

81
Q

How do you treat chronic open angle glaucoma?

A

Prostaglandin analogs 1st line (Lantanoprost)

BB, alpha2agonists, acetazolamide

Laser

Surgery = last line

82
Q

How do you diagnose a foreign body or corneal abrasion?

A

Pain relieved w/ analgesic drops

Fluorescein staining: corneal abrasion = “ice rink”/linear abrasions

83
Q

How do you treat an ocular foreign body?

A

Check visual acuity 1st

Remove w/ sterile irrigation or moistened sterile cotton swab

Abx drops (topical erythromycin, polymyxin/trimethoprim, sulfacetamide, cipro)

24hr ophtho follow up

Family Med EOR (15 decks)

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