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Non-Urgent Ocular Conditions Flashcards

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1
Q

Describe the etiology of dacryocystitis

A

Infection of lacrimal sac d/t obstruction of nasolacrimal duct

Acute v chronic

MC staph & strep

RF: infants, ppl over 40

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2
Q

Describe the clinical presentation of dacryocystitis

A

Pain, tenderness, swelling, erythema, drainage of pus from tear punctum

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3
Q

Describe the treatment for dacryocystitis

A

abx followed by surgery to reopen the blocked area

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4
Q

Describe the etiology/RF for ptosis

A

Drooping of upper eyelid

Congenital or acquired abnormality of the muscles that lift the eyelid (levators) or secondary to neuro condition

RF: aging, injury, previous eye surgery

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5
Q

Describe the etiology/RF of subconjunctival hemorrhage

A

Results from rupture of vessels in space between episclera & conjunctiva

Spontaneous, eye rubbing, vigorous coughing, vomiting, anticoags

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6
Q

Describe the clinical presentation of subconjunctival hemorrhage

A

Asymptomatic with a bright red bloody eye, painless, no vision loss

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7
Q

Describe the etiology of proptosis

A

Bulging of eye/s out of orbit/s anteriorly

Congenital, orbital cellulitis, glaucoma, hyperthyroidism, tumors

MC cause in adults: Grave’s Disease

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8
Q

Describe the clinical presentation of proptosis

A

unilateral/bilateral eye bulging, dryness, irritation, difficulty closing eye fully

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9
Q

Describe the diagnostic testing for proptosis

A

Clinical, exophthalmometer to measure position of eyes in orbits

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10
Q

Describe the etiology/RF for macular degeneration

A

Degenerative disease of central portion of retina/macula resulting in central vision loss

Dry AMD (MC) vs Wet AMD

RF: age, fam hx, smoking, CV disease, european origin, F>M, light iris color, farsightedness

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11
Q

Describe the clinical presentation of dry macular degeneration

A

gradual vision loss, typically bilateral, retinal atrophy, may notice scotomas with reading & driving, rely on brighter lights & magnifiers

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12
Q

Describe the clinical presentation of wet macular degeneration

A

acute distortion of vision, typically unilateral, new vessels growing/leaking and causing scarring, loss of central vision, more rapid and severe onset, distortion of straight lines

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13
Q

Describe the diagnostic testing for macular degeneration

A

Precursor finding: retinal drusen
- hard: discrete yellow subretinal deposits
- soft: larger, paler, less distinct

Dilated slit lamp exam, fluorescein angiography, optical coherence tomography for wet AMD

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14
Q

Describe the treatment for macular degeneration

A

Refer to ophtho for vision loss

Dry AMD: vit C, E, carotenoids, zinc can slow progression

Wet AMD: intraocular injections monthly

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15
Q

Describe the etiology/RF for diabetic retinopathy

A

Damage to small blood vessels in retina resulting from chronically elevated BG levels

33% of all DM pts and 20% with T2DM at time of diagnosis

90% pts T1 and 60% pts T2 will develop this

RF: prolonged or poorly controlled DM

Proliferative v. nonprolif.

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16
Q

Describe the clinical presentation of proliferative diabetic retinopathy

A

neovascularization arising from disc/vessels leading to hemorrhage, fibrosis, retinal detachment

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17
Q

Describe the clinical presentation for non-proliferative diabetic retinopathy

A

nerve fiber infarcts (cotton wool spots), hemorrhages, hard exudates, microvascular changes (microaneurysm), macular edema leading to reduced vision

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18
Q

Describe the diagnostic testing for diabetic retinopathy

A

annual dilated fundoscopic exam

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19
Q

Describe the treatment for diabetic retinopathy

A

Control blood sugars, HTN, cholesterol, kidney function

Proliferative: VEGF inhibitors, laser photocoag, surgery if severe and T1DM

Non-prolif: observation for mild-mod, laser photocoag for severe

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20
Q

What is the leading cause of new blindness among adults age 20-65

A

diabetic retinopathy

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21
Q

Describe the etiology of hypertensive retinopathy

A

systemic HTN affecting circulation to retina and choroid

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22
Q

Describe the diagnostic testing for hypertensive retinopathy

A

Fundoscopic exam
- retinal arterioles more tortuous & narrow
- copper wiring: abnormal light reflexes or retinal arterioles
- arteriovenous nicking: increased venous compression at AV crossings
- flame hemorrhages
- cotton wool spots
- retinal edema/exudates

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23
Q

Describe a complication of hypertensive retinopathy

A

reducing BP too quickly can worsen the damage

Can cause permanent damage

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24
Q

Describe the etiology/RF for optic neuritis

A

Subacute vision loss (typically unilateral & central)

Assoc. With demyelinating disease (MS), encephalomyelitis, sarcoidosis, viral infection, VZV, SLE, Sjogrens, biologic drugs

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25
Describe the clinical presentation of optic neuritis
Pain behind eye, exacerbated by eye movement, loss of color vision, relatively afferent pupillary defect
26
Describe the treatment for optic neuritis
Urgent! Vision improves in 2-3 weeks Treat underlying cause (IV steroids x3 days and PO taper in MS) or prolonged steroids
27
Describe the etiology/RF for cataracts
Clouding of the lens leading to vision loss, degeneration of proteins in lens RF: aging, smoking, UV light, DM, steroid use, eye trauma, rarely congenital Leading cause of blindness worldwide
28
Describe the clinical presentation of cataracts
Painless progressive decline in vision/blurring, typically bilateral, difficulty with fine print, glare in bright light or night driving, increased myopia, diplopia possible Lens opacity may be grossly visible (can be normal with aging)
29
Describe the diagnostic testing for cataracts
Non-dilated fundoscopic exam: darkening or opacities of red reflex
30
Describe the treatment for cataracts
Surgery to remove lens and replace with prosthetic (when interfering with ADLs) Prevent with multivitamin/mineral supplements and dietary antioxidants
31
Describe the complications of cataracts
risk of retinal detachment in pts with a history of cataract surgery
32
Describe this clinical sign
retinal drusen (macular degeneration)
33
Describe the clinical correlation
wet macular degeneration
34
Describe the clinical correlation
dry macular degeneration
35
what does this image show
neovascularization (proliferative diabetic retinopathy)
36
Describe what each color arrow is pointing to
green: hemorrhage white: cotton wool spot yellow: hard exudate red: microaneurysm
37
Describe what is happening in the image on the right
AV nicking (HTN retinopathy)
38
What is the bright line in the bottom right corner
copper wire sign (HTN retinopathy)
39
Describe the etiology of herpes zoster keratitis
Inflammation of the cornea d/t Zoster or HSV-1
40
Describe the clinical presentation of herpes zoster keratitis
Photophobia, tearing, varying pain and irritation, redness, unilateral, vesicular rash in periocular area
41
Describe the diagnostic testing/PE of herpes zoster keratitis
Fluorescein exam may reveal dendritic corneal ulcer: hallmark of herpes infection
42
Describe the treatment for herpes zoster keratitis
oral acyclovir & referral to ophtho
43
Describe the etiology/RF for open angle glaucoma
Chronic progressive optic neuropathy, acquired atrophy of optic nerve, loss to retinal ganglion cells, associated with increased IOP RF: african/hispanic descent, fam hx, age, thin central cornea, T2DM, myopia
44
Describe the clinical presentation of open angle glaucoma
Slow, insidious, bilateral loss of vision Progresses from asymptomatic, scotoma, peripheral vision loss, blindness
45
Describe the diagnostic testing/PE for open angle glaucoma
Anterior structures look cloudy under oblique lighting Fundoscope: optic disc cupping, large cup to disc ratio, splinter hemorrhages, visual field testing, tonometry
46
Describe the treatment for open angle glaucoma
Annual screening 65+ Keep IOP in target range by decreasing production/inflow of aqueous humor - prostaglandin analogs, beta blockers, a-2 adrenergic agonists, parasympathomimetics, topical/oral carbonic anhydrase inhibitors
47
Describe the etiology/RF for conjunctivitis
Bacterial, viral, allergic, systemic condition MC staph aureus, strep pneum, h. Flu, moraxella catarrhalis (can be n. Gonorrhea, contact lens - pseudomonas)
48
Describe the clinical presentation of the different types of conjunctivitis
Bacterial: Copious exudates, itching Allergic: stringy exudates, itching, redness, edema, cobblestoning Viral: less goop, preauricular LAD
49
Describe the treatment for the different types of conjunctivitis
Bacterial: Mostly self limited, decrease spread, tailor abx to cause Allergic: 1. Artificial tears 2. antihistamine/decongestant 3. Ophtho NSAIDs 4. Mast-cell stabilizer prophylaxis Viral: self limited (2 weeks), cold compress, infection control
50
Describe the etiology of blepharitis
Irritation at oil glands of eyelids causing scaling, crusting
51
Describe the clinical presentation of blepharitis
Scaling, crusting around eyelids
52
Describe the treatment of blepharitis
Treat underlying condition, gentle scrubbing, mild soap +/- steroid cream, nizoral antifungal cream, tacrolimus ointment avoid abx
53
Describe the etiology/presentation of a chalazion
inflamed nodule within the eyelid at oil producing gland
54
Describe the etiology/presentation of a hordeolum
inflamed nodule in base of eyelid at hair follicle, usually the lower lid, tender & red
55
Describe the etiology/presentation of a pterygium
triangular growth from the inner canthus of the eye
56
Describe the etiology/presentation of a pinguecula
nodular growth on conjunctiva
57
Describe the treatment for chalazion & hordeolum
- Reassurance, hot/wet compresses with massage several times per day - Refer to ophtho if no resolution (especially with chalazion - may need surgical resection)
58
Describe the treatment for pterygium & pinguecula
- No treatment unless it begins to encroach the pupil - surgical
59
Describe the presentation & treatment of episcleritis
localized erythema, irritation, swelling from inflamed episclera spontaneously resolves in a few weeks, steroid drops in pts with recurrent attacks
60
Describe the etiology/RF for keratoconjunctivitis Sclera
Aka dry eyes, very common Meds, sjogren’s, sarcoidosis, radiation therapy, lesions affecting CN 5 or 7 (Bell’s Palsy), incomplete eye closure, forced air heat
61
Describe the presentation of keratoconjunctivitis sclera
Dry irritated eyes, redness, photophobia, gritty/scratchy, burning, foreign body sensation
62
Describe the treatment for keratoconjunctivitis sclera
Avoid causative meds, smoking cessation, humidifier, hot compress, eye massage Mild: artificial tears Mod-Severe: refer to ophtho for lubricants
63
Describe the eitology/RF for uveitis
Inflammation of uvea Anterior (iritis) or posterior Systemic, immune mediated RF: sarcoidosis, juvenile RA, inflammatory bowel disease, psoriasis, RA, herpes, syphilis
64
Describe the presentation of uveitis
Iritis: redness, pain may be minimal, +/- vision loss, tearing, light sensitivity, floaters Posterior uveitis: painless, blurred vision, floaters, usually no redness
65
Describe the diagnostic testing for uveitis
Slit lamp exam: presence of leukocytes in aqueous humor Posterior: chorioretinal inflammation in addition to leukocytes

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