Eyes MDT Flashcards
(159 cards)
1
Q
What is blepharitis?
A
Common chronic inflammatory condition of the lid margins
2
Q
What structures are involved in Anterior blepharitis?
A
Lid skin, eyelashes and associated glands
3
Q
What are the common causes of anterior blepharitis?
A
Ulcerative, staphloccoci, sebborheic
4
Q
What structures are involved with posterior blepharitis?
A
Meibomian glands
5
Q
What are common causes of posterior blepharitis?
A
Staphylococci, glandular dysfunction, strong association with acne rosacea
6
Q
Physical findings of anterior blepharitis
A
Eyes are redrimmed and scales or granulations can be seen on lashes
7
Q
Physical findings of posterior blepharitis
A
Margins are hyperemic with telangiectasia and the Meibomian glands and their orifices are inflamed
8
Q
Treatment of blepharitis
A
- Scrub eyelids twice a day with commercial eyelid scrub, baby shampoo
- warm compresses
- lid massage
9
Q
What is hordeolum caused by?
A
Acute infection usually involving staphylococcus
10
Q
Where is external Hordeolum located?
A
Smaller, on the margin “stye”
11
Q
What gland are external hordeolums on?
A
Gland of Zeis
12
Q
Where is internal hordeolum located?
A
Points onto conjunctival surface of lid
13
Q
What gland is internal hordeolums located?
A
Meibomian gland
14
Q
What is chalazion secondary to?
A
Hordeolum
15
Q
Physical findings of hordeolum
A
- well defined nodule on eyelid
- pointing purulent material
16
Q
Physical findings of chalazion
A
- hard and non-tender
- normally further back on eyelid than hordeolum
17
Q
Treatment of hordeolum/chalazion
A
- warm compresses
- massage
- do not pop
- can use bacitracin
18
Q
What is conjunctivitis?
A
Inflammation of conjunctive
19
Q
What is common cause of viral conjunctivitis?
A
Adenovirus
20
Q
Where viral conjunctivitis is easily spread?
A
Clinics and contaminated pools
21
Q
What causes allergic conjunctivitis?
A
Allergens
22
Q
What causes bacterial conjunctivitis (nongonoccocal)
A
- Staph
-HiB - Strep
23
Q
What causes gonococcal conjunctivitis?
A
Take a wild fucking guess
24
Q
Sx of viral conjunctivitis
A
- watery discharge
- hx of recent URI
25
Sx of allergic conjunctivitis
- watery, itchy eyes
- hx of allergy
26
Sx of bacterial conjunctivitis
- purulent discharge
- usually unilateral
27
Sx of gonococcal conjunctivitis
- infected w/genital secretions
- Emergency can lead to perforation
- severe purulent discharge
- hyper acute onset
28
Which conjunctivitis requires gram stain, cultures and sensitivities?
Gonococcal and non-gonococcal bacterial conjunctivitis
29
Treatment of viral conjunctivitis
- Artificial tears
Opthalmic Antihistamine
- Epinastine .005% 1 drop BID
Opthalmic corticosteroid (MED ADVICE PRIOR)
- Loteprednol 0.5% 1-2 drops QID
- Prednisolone 1% 1-2 drops BID-QID
- Fluormetholone 0.1% 1-2 drops BID
- Dexamethasone 0.1% 1-2 drops q4-6hrs
30
Treatment of allergic conjunctivitis
- Artificial tears
Opthalmic Antihistamine
- Patanol 0.1% BID
- Epinastine .05% QID
***Topical antihistamines are more effective than oral therapies
31
Treatment of bacterial conjunctivitis non gonococcal for non-contact users
- Erythromycin ophthalmic ointment QID 5-7days
- Bacitracin
- Polytrim
32
Treatment of bacterial conjunctivitis non gonococcal for contact users
Fluoroquinolone
- Ciprofloxacin or Ofloxacin 0.3% 1-2 drops QID for 5-7 days
If associated with dacryocystitis
- Augmentin 875/125 BID or 500/125TID
33
Treatment of gonococcal conjunctivitis
Cephalosporin
- Ceftriaxone 2g IV q12hrs
Macrolide
- Azithromycin 500mg PO then 250mg daily for next 4 days
34
Who else do you treat in addition to your patient with gonococcal conjunctivitis?
Patient's partners
35
What is conjunctival hemorrhage?
Rupture of the fragile conjunctiva vessels
36
What causes conjunctival hemorrhage?
Trauma, HTN, bleeding disorder, antiplatelet or anticoagulant medication
37
Sx of conjunctival hemorrhage
- red eye, foreign body sensation
- usually asymptomatic
38
Treatment for conjunctival hemorrhage
- none, usually clears within 2-3 weeks
39
What is pterygium
Degeneration of fibro vascular, deep conjunctival layers resulting in vascular tissue proliferation, which extends onto the cornea
40
What could cause pterygium?
Sunlight exposure, chronic inflammation and oxidative stress
41
Signs of pterygium
Wing shaped folds of fibrovascular tissue arising from interpalpebral conjunctiva and extending into the cornea, usually starting medial
42
What might the lesion of a pterygium be?
Highly vascularized and injected
43
What equipment should be used to exam pterygium?
Slit lamp exam
44
Treatment of pterygium
- Protect eyes from sun, dust, wind
- Artificial tears
Opthalmic Corticosteroids
45
When is surgical removal of pterygium indicated?
- threaten visual axis or induces astigmatism
- excessive irritation
- interference w/ contact lens wear
- prior to cataract or refractive surgery
46
How often should asymptomatic pterygium be re-evaluated?
1-2 years
47
When should pterygia be measured?
Every 3-12 months
48
What should you be checking if patient is on topical steroid?
IOP
49
What is ocular foreign body?
Foreign body superficially or partially embedded on the cornea or conjunctiva
50
What is most indicative of ocular foreign body?
Hx of trauma
51
What is a critical sign of ocular foreign body?
Foreign body with or without rust ring
52
What radiologic study should be avoided if possible metallic foreign body?
MRI
53
What should be done prior to treatment of ocular foreign body?
Visual acuity
54
Medications for ocular foreign body?
Opthalmic anesthetic
- Proparacaine 0.5% 1-2 drops
Non Contact lens wearers
- Erythromycin TID-QID
Contact Lens wearers
- Ciprofloxacin 0.3%
55
What conservative treatment should be done for ocular foreign body?
Irrigation
56
Should an attempt be made to remove foreign body with needle?
No
57
How long is recovery for corneal abrasion?
24-48 hours
58
What is the difference between an intact corneal epithelium and damaged epithelium?
Intact=resistant to infection
Damaged=portal of entry for bacteria, viruses and fungi
59
Sx of corneal abrasion
- pain, tearing
- photophobia
- hx of eye trauma involving foreign object
60
What should be used to identify a corneal abrasion?
Slit lamp
61
Medications for corneal abrasion
Non Contact lens wearer
- erythromycin, bacitracin, polymyxin
Contact Lens wearer
- ciprofloxacin, ofloxacin
62
How would you debride a corneal abrasion?
- CTA soaked in topical anesthetic
63
When may contact wearers resume contact lens wear?
One week after sx resolve
64
What is infectious keratitis?
Serious infection involving multiple layers of the cornea
65
What is the biggest risk factor for corneal ulcer?
Improper contact lens use
66
Bacterial causes of corneal ulcer
Pseudomonas aeruginosa, streptococcus pneumonia, staphylococcus, Moraxella
67
Viral causes of corneal ulcer
Herpes, varicella
68
Fungal causes of corneal ulcer
Candia, aspergillus, penicillium, cepjalosporium
69
Sx of corneal ulcer
- changes in visual acuity
- round or irregular opacity or infiltrate on cornea
- white hazy base due to WBC infilitration
70
Medications for corneal ulcer
- Ciproflocacin
- Fluoroquinolone
71
When should a patient with corneal ulcer be seen by an ophthalmologist?
12-24hrs
72
Should you patch a corneal ulcer?
No, risks pseudomonas infection
73
What is hyphema?
Accumulation of red blood cells within the anterior chamber
74
Where does hyphema occur?
Between the cornea and the iris
75
Physical exam findings of hyphema
- blood or clot or both in anterior chamber
- visible w/o slit lamp
- hx of blunt trauma
76
What exam should be done with hyphema?
Visual exam
77
What radiologic study should be done with hyphema?
CT
78
Treatment of hyphema
- referral to optometry/ophthalmology
- bed rest with elevation of head
- no strenuous activity
- rigid eye shield
79
What medication should hyphema patients avoid?
Antiplatelet medications
80
After initial f/u, what cycloplegic agent should be used with hyphema patients?
Atropine 1%
81
What is uveitis/iritis?
Inflammation of anterior segment of uveal tract
82
What are infectious etiologies of uveitis/iritis?
Herpes virus, cytomegalovirus, toxplasmosis, syphilis, west nile
83
What are systemic inflammatory disease etiologies of uveitis/iritis?
Spondyloarthritis, sarcoidosis, SLE, multiple sclerosis
84
Acute non granulomatous anterior uveitis sx?
Pain, redness, photophobia and visual loss
85
Granulomatous anterior uveitis sx?
Blurred vision in mildly inflamed eye
86
Medications for uveitis/irits
**ONLY STARTED BY OPHTHALMOLOGIST**
Cycloplegic
- Cyclopentolate 1% tid
- Atropine 1% bid-qid
Topical Steroid
- Prednisolone 1% q1-6hrs
87
What structures are involved with periorbital cellulitis?
- soft tissues anterior to the orbital septum
- arise from external sockets
88
What structures are involved with orbital cellulitis?
- eye socket, eye and eyelid
- arise from paranasal sinuses
89
What organisms cause cellulitis?
Adult: staph, strep
Children: HiB
90
Significant sx of orbital cellulitis
- periorobital swelling
- pain w/ eye movement
- sinus HA/pressure/congestion
- tooth pain
91
What might a CT show in patient with orbital cellulitis?
Adjacent sinusitis
92
What labs should be done for orbital cellulitis?
CBC, blood cultures, gram stain and culture drainage
93
Treatment of orbital cellulitis
Amoxcillin/Clavulanate (Augmentin) 875mg PO Bid
Ceftriaxone 2g IM
94
How often should you re-evaluate orbital cellulitis?
Twice daily in hospital for first 48 hours
95
How long will clinical improvement of orbital cellulitis take?
24-36hrs
96
What is an orbital fracture?
Break in one of the bones surrounding the eyeball (orbit or eye socket)
97
What is the main cause of orbital fracture?
Blunt force trauma
98
What is an orbital rim fracture?
Fracture of bony outer edges of the orbit
99
What is the common cause of orbital rim fracture?
Car accidents, needs lots of force due to thick bone
100
What is a blowout orbital fracture?
Affects inner walls or floor of the orbit
101
What can occur due to the thin bone that makes up the walls of the orbit?
Pinch muscles or other structures
102
What is a common cause of blowout orbital fracture?
Hit with a baseball or fist
103
What can orbital floor fracture cause the bones of the eye to do?
Buckle downwards
104
Sx of orbital fracture
- pain on attempted eye movement and local tenderness
- crepitus
- binocular diplopia
105
Critical sx of orbital fracture
- restricted eye movement (upward, lateral or both)
- air pockets
106
Treatment of orbital fractures
Prophylactic antibiotics
- Amoxicillin/Clavulante (500mg/125mg tid or 875/125mg PO BID)
- Azithromycin
If PCN Allergy
- Doxycycline 100mg bid
Nasal Decongestant
¬ - Afrin
Corticosteroid
- Prednisone
107
What conservative treatment should be given to patients w/ orbital fractures?
- instruct pt not to blow their nose
- Ice packs
108
What is the timeframe of Transient Visual Loss?
Within 24 hours, usually within 1 hour
109
What causes Transient Visual loss for a few seconds?
Acute BP change
110
What causes Transient Visual Loss for a few minutes?
TIA or vertebrobasilar artery insufficiency
111
What causes Transient Visual Loss for 10-60 minutes?
Migraines
112
What is a common reason for sudden, painless Visual Loss lasting >24 hours?
- Retinal Detachment
113
What conditions could cause gradual, painless vision loss?
- Cataract
- Glaucoma (Open/Chronic Angle)
114
What are some causes for painful visual loss?
- Optic neuritis (pain with eye movement)
- uveitis
115
If concerned for a traumatic globe rupture, what should you use?
Eye shield
116
Who should be consulted for acute vision loss?
- MO
- Optometry
- Ophthalmology
117
What are the 3 types of retinal detachment?
- Rhegmatogenous retinal detachment (most common)
- Exudative/serous retinal detachment
- Tractional Retinal Detachment
118
What is rhegmatogenous retinal detachment?
- One or more peripheral retinal tears holes
- Holes allow fluid to separate retina from RPE
119
What age population does rhegmatogenous retinal detachment normally affect?
- 50 years of age
- usually due to degenerative changes
120
What are the most common predisposing conditions that cause rhegmatogenous retinal detachment?
- Nearsightedness
- Cataract Extraction
- Penetrating or Blunt Ocular Trauma
121
What is Exudative/Serous Retinal Detachment?
Accumulation of sub retinal fluid due to macular degeneration or choroidal tumor
122
What is Tractional Retinal Detachment?
- Pre-retinal fibrosis, due to retinopathy or retinal vein occlusion
- Can also be a complication of rhegmatogenous retinal detachment
123
Flashes of light, floaters, a curtain or shadow moving over the visual field are sx of what?
Rhegmatogenous retinal detachment
124
For rhegmatogenous retinal detachment, what physical findings will there be?
- Retina will be hanging in the vitreous like a gray cloud
- one or more retinal tears of holes
125
Which retinal detachment may have minimal or severe loss of vision or visual field defect but may vary with head position?
Exudative/Serous Retinal Detachment
126
What are some signs of Exudative/Serous Retinal Detachment?
Retina is dome-shaped and the subretinal fluid shifts with changes in posture
127
Which retinal detachment may be asymptomatic?
Traction retinal detachment
128
What are some signs of Traction retinal detachment?
- Retina appears concave with smooth surface
129
What treatment is needed for retinal detachment?
Urgent Ocular surgery
130
What position should retinal detachment patient be transported in?
Positioned so the detached portion of the retina will fall back
131
Visual prognosis of retinal detachment is worsened by what conditions?
- Macula detached
- Detachment is of long duration
132
What is another name for flash burns?
Ultraviolet Keratopathy
133
Common causes of flash burns?
- Sun lamp w/o eye protection
- Exposure to welding arc
- "Snow blindness"
134
What is significant for diagnosing flash burns?
- History of welding or inadequate eye protection
- Sx worsen 6-12 hours exposure, usually bilateral
135
What should be used to examine the eye?
- Fluorescein stain
136
How should you treat flash burns?
- Mild oral opioids
- Oxycodone 5mg q4-6hrs prn
- Antibiotic Ointment
- Erythromycin or Polytrim 4-8x per day
137
How long does it take patients to recover from flash burns?
- 24-48hours
- If bandage soft contact lens was placed, 1-2days
138
What causes chemical burns on the eyes?
- Improper PPE use
- Job Exposure
- CS gas, mechanics cement workers
139
What will severe alkali burns have?
Opacified cornea and scleral blanching
140
How do you manage alkali burns?
- Irrigate eyes w/water or saline
- Reach neutral PH
- Normalization takes 30-60 minutes
- Test pH with litmus paper
141
What medications can be used to treat chemical burns of the eye?
Topical ophthalmic
- Erythromycin 0.5% q1-2hrs
142
What is a penetrating eye wound?
- Anything that has potential to penetrate the eye
143
Lid lacerations require what?
Examination, especially if it involves both eyelids
144
How do you determine if it’s a penetrating eye wound?
- Hx of trauma, fall or sharp object entering the globe
145
What equipment do you use when examining for penetrating eye wound?
- Penlight
- Ophthalmoscope
- Slit lamp (very carefully)
146
What should be used to protect the eye with penetrating eye wound?
- Shield (metal or paper cup)
147
How should you position the patient with penetrating eye wound?
45 degrees
148
What medications should be given for penetrating eye wound
Cephalosporin
- Cefazolin 1g IV q8hrs for 7 days
Glycopeptide
- Vancomycin 1gram IV BID for 7 days
Fluoroquinolone
- Ciprofloxacin 750mg BID for 4-8weeks
Antiemetic
- Ondansetron 4mg PO/IV q8hrs prn
149
Which vaccination should be up to date for penetrating eye wounds
Tetanus, re-vaccinate if >5 years since last
150
Which vaccination should be up to date for penetrating eye wounds
Tetanus, re-vaccinate if >5 years since last
151
What should be considered if admitting patient for surgery with penetrating eye wound?
NPO
Avoid strenuous activities, bending and Valsalva
152
What causes herpetic lesions of the eye?
Herpes simplex
153
Where does the virus colonize in herpectic lesions of the eye?
Trigeminal ganglion
154
What is significant hx for dx of herpectic lesions of the eye?
Hx of oral or genital herpes
155
What are signs of herpetic lesions?
- Ulcers
- Eyelids may have vesicular eruptions
- Palpable preauricular node
156
What medications should be given to patients with herpetic lesions of the eye?
Topical antiviral
- Ganciclovir 0.15% opathalmic gel 5x per day
- Trifluridine 1% drops 9x per day
- Vidarabine 3% ointment 5x per day
Oral Antiviral Agents
- Acyclovir 400mg PO 5x per day
- Valacyclovir 500mg PO TID
- Famiclovir 250mg PO TID for 7-10 days
157
What is the difference in chronicity when giving Acyclovir vs Valacyclovir for herpetic lesions?
- Acyclovir (acute)
- Valacyclovir (chronic)
158
Which medications should not prescribe for herpetic lesions?
Topical Steroids
159
Who should patient with herpetic lesions be referred to?
Ophthalmologist
