Red Eye

Question 1

what is considered chronic conjunctivitis?

Answer 1

when it is lasting > 3 weeks

Question 2

in a red eye, a miotic pupil may suggest

Answer 2

iritis

Question 3

in a red eye, a fixed mid dilated pupil may suggest

Answer 3

angle closure

Question 4

in a red eye, an irregular pupil/ fixed may suggest

Answer 4

posterior synechiae

Question 5

in a red eye, an APD may suggest

Answer 5

orbital cellulitis, endopthalmitis

Question 6

in a red eye, a blown pupil may suggest

Answer 6

trauma

Question 7

in a red eye, if you found restrictions on EOMS, what would be some DDxs

Answer 7

graves, orbital cellulitis, trauma

Question 8

upper lid and lateral canthus drain into which node?

Answer 8

pre-auricular nodes

Question 9

lower lid and medial canthus drain in which node?

Answer 9

submandibular node

Question 10

lymph nodes with EKC (epidemic keratoconjunctivitis) are:

Answer 10

• palpable

- tender

Question 11

lymph nodes with PCF (pharngyeal conjunctival, fever) are:

Answer 11

-palpable
-non-tender
(may be tender as well)

Question 12

lymph nodes with Herpes Simplex or Herpes Zoster are:

Answer 12

• palpable

- tender

Question 13

lymph nodes with inclusion conjunctivitis (caused by chlamydia) are:

Answer 13

• palpable

- non-tender

Question 14

lymph nodes with hyperacute conjunctivitis (caused by gonnorhea) are:

Answer 14

• palpable

- tender

Question 15

lymph nodes with pre-septal cellulitis or orbital cellulitis are

Answer 15

• palpable

- tender

Question 16

lymph nodes with ocular-glandular syndrome (syphilis, tularemia, cat scratch) are:

Answer 16

• visible
• palpable
• tender

Question 17

lymph node involvement in a red eye usually indicates:

Answer 17

viral disease

Question 18

what red-eye disease can cause neuro-retinitis?

Answer 18

cat scratch disease

Question 19

what diseases can a fever help differentiate

Answer 19

preseptal vs. orbital cellulitis

orbital typically presents with temp > 102 degrees

Question 20

DDx for swelling/edema in red eye

Answer 20

• preseptal cellulitis
• orbital cellulitis
• rxn to drops
• severe dry eye/ MGD
• viral
• Grave’s (proptosis, baby eyelids)

Question 21

1 cause of bilateral proptosis is

Answer 21

Grave’s disease

Question 22

what can vitiligo be associated with?

Answer 22

uveitis (some)

Question 23

what can a port wine stain be associated with?

Answer 23

Sterge-Weber

glaucoma angle closure associated

Question 24

what is it called when palpebral conj is stuck to bulbar conj? what can is be associated with?

Answer 24

called symblepheron

-can be associated with chemical burns, chronic inflammation, Steven’s Johnson syndrome

Question 25

indications for performing exophthalmometry

Answer 25

- proptosis - Grave's - Tumor - Enophthalmos

Question 26

exophthalmometry norms for children

Answer 26

14.5 - 16 mm

Question 27

exophthalmometry norms for caucasians

Answer 27

12 - 20 mm

Question 28

exophthalmometry norms for African Americans

Answer 28

12 - 24 mm

Question 29

exophthalmometry norms for Asians

Answer 29

12 - 18 mm

Question 30

exophthalmometry measurements should be within ___ mm of each other

Answer 30

2 mm

Question 31

if there is greater than a __ mm difference between the eyes on exophthalmometry, further investigation should be done

Answer 31

3 or greater

Question 32

which exophthalmometry has a base number to record

Answer 32

Hertel

Question 33

which exophthalmometry is transparent, faster, easiest, least expensive, but not as accurate

Answer 33

Luedde

Question 34

demodex (parasite) "mites" in the lashes are called

Answer 34

folliculorum

Question 35

demodex (parasite) "mites" in the meibomian glands are called

Answer 35

brevis

Question 36

how does demodex "mites" survive and cause damage?

Answer 36

0eat epithelial cells at hair follicle - microabrasions from claws lead to cylindrical dandruff at base of lashes - inflammation due to chitin (extoskeleton)

Question 37

treatment for demodex (mites)

Answer 37

- tea tree oil (needs to be mixed with something else since dangerous to cornea) - Cilradex wipes (with tee tree oil) - ointment to suffocate them - warm compresses - lid scrubs

Question 38

describe the debridement-scaling technique

Answer 38

-remove devitalized tissue and debris from line of marx (LOM), area of contact between the lid margin and bulbar conj/cornea with lissamine green and spud tool

Question 39

which one of the following tools is less risky at squeezing meibomian glands too hard and damaging them? (Mastrota paddle or tears meibomian expresser forcep)

Answer 39

Mastrota paddle less risky

Question 40

what is meibography useful for?

Answer 40

to look at meibomian glands and to see atrophy or drop out

Question 41

a diffuse beefy engorged vessels usually more prominent in the inferior 1/3 of the conj (especially the fornices) is descriptive of a:

Answer 41

bacterial

Question 42

diffuse injection can be descriptive of

Answer 42

viral, scleritis, corneal ulcer, blepharoconjunctivitis, herpes simplex keratitis, herpes zoster keratitis, toxic conjunctivitis

Question 43

very mild diffuse injection (chemosis is greater) is indicative of

Answer 43

allergic

Question 44

circumlimbal pattern is descriptive of

Answer 44

uveitis, angle closure, CLARE- contact lens associated red eye

Question 45

sectoral pattern is descriptive of a

Answer 45

episcleritis, pingueculitis, inflamed ptyregium, phylectenulosis, foreign body

Question 46

sub conj heme is indicative of

Answer 46

trauma, valsalva, blood too thin (INR), hypertension

Question 47

corkscrew injection indicative of

Answer 47

carotid cavernous sinus fistula

Question 48

in what conditions can you see conjunctival chemosis? which is most common?

Answer 48

- most often seen in allergic conjunctivitis | - can be seen in other types of inflammation/ infection such as endophthalmitis, orbital cellulitis, retrobulbar mass

Question 49

define chemosis

Answer 49

protein rich fluid leaking from walls of inflamed blood vessels

Question 50

in what conditions do you see papilla?

Answer 50

bacterial, allergic, toxic, VKC, SLL or any chronic irritation

Question 51

what is a papillae and what does it look like?

Answer 51

- raised small bumps (0.1 to 0.2mm) - location of humoral immunity and site of release of PMN and eosinophils - each papilla has central vessel running to surface - GPC > 1.0 mm

Question 52

what are follicles and what do they look like?

Answer 52

- pale, yellow-white, elevated nodules - aggregate of lymphocytes 0. 5-1.0 mm in size (5x size of papillae) - not vascular (no central blood vessel) - most marked in lower tarsal conj

Question 53

what is folloculosis?

Answer 53

children can develop it- a follicular response with no etiology

Question 54

what are some causes of follicles?

Answer 54

viral, chlamydial or toxic

Question 55

pseudomembrane can be indicative of a

Answer 55

adenoviral infection

Question 56

true membranes can be indicative of

Answer 56

gonnhorrea, Stevens-Johnson, chemical/thermal burn

Question 57

"conjugated exudate adherent to the conj epithelium" is describing

Answer 57

pseudomembrane

Question 58

"coagulated exudate infiltrating the conj epithelium" is describing

Answer 58

true membrane

Question 59

copious, overflowing mucopurulent discharge describes

Answer 59

hyperacute (gonorrhea)

Question 60

mucopurulent discharge describes

Answer 60

bacterial

Question 61

watery discharge describes

Answer 61

acute allergy/ viral

Question 62

thin, ropy transparent mucus discharge describes

Answer 62

chronic bacterial (lasting more than 3 weeks)

Question 63

thick, ropy mucoid discharge describes

Answer 63

vernal keratoconjunctivitis (VKC)

Question 64

frothing describes

Answer 64

MGD