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Clin Med Exam 2 (Lauren) > The Red Eye > Flashcards

The Red Eye Flashcards

(86 cards)

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1
Q

What kind of humor is in the anterior chamber

A

Aqueous humor

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2
Q

What kind of humor is in the posyerior chamber?

A

Vitreous humor

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3
Q

What is ophthalmology’s vital sign?

A

Visual acuity

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4
Q

What do you do if someone’s vision is worse than 20/400 and you can’t do a snellen chart?

A

Count fingers, hand motion, light perception

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5
Q

What intraocular pressure is an emergency?

A

Over 30

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6
Q

What is normal intraocular pressure

A

8-21

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7
Q

What is the more common device to measure intraocular pressure in primary care or ED

A

TonoPen

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8
Q

What causes blepharitis?

A

Meibomian gland dysfunction

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9
Q

What are the symptoms of blepharitis?

A

Chronic itching, burning, scratching

Worse in AM**

NO vision decrease

Erythema, scales, debris

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10
Q

How do you treat blepharitis?

A

Warm compress
Baby shampoo lid scrubs
Topical antibiotics:
Bacitracin, erythromycin, azithromycin

Oral antibiotics
Ophthalmology refer if not improving. They can prescribe steroid drops. YOU should never mess with them

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11
Q

Does blepharitis affect dry eyes?

A

Yes makes it worse. Remember blepharitis is a meibomian gland dysfunction

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12
Q

What ate the symptoms/signs of dry eye?

A

Chronic itching, burning and scratching

“Tired” eyes in PM

Vision may be worse

Poor tear film

Small erosions in cornea

+schirmer test

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13
Q

What is a schirmer test?

A

Little strips to measure tear production

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14
Q

What is the treatment for dry eye?

A

Artificial tears

Optho referral for cyclosporine, steroids, or punctual plugs

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15
Q

What causes hordeolum?

A

Infected eyelash root

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16
Q

What is the presentation of hordeolum?

A

PAINFUL

Swelling that may cover whole eyelid**

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17
Q

What causes a chalazion?

A

Clogged meibomian gland

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18
Q

What is the presentation of a chalazion?

A

NOT painful

Rarely causes whole eyelid to swell

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19
Q

What is the treatment for hordeolums and chalazions?

A

Warm compress

Abx if needed

Steroid injection

Surgical drainage

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20
Q

What is dacryoadenitis?

A

Inflammation of lacrimal gland

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21
Q

What causes dacryoadenitis?

A

Acute: viral or bacterial source: mumps, EBV, staph, gonococcal

Chronic: inflammatory disorders, thyroid dz,

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22
Q

How do you treat dacryoadenitis?

A

CT w/ contrast if you don’t know what it is

Biopsy if you think its a tumor

Viral cause- warm compress

Other- treat underlying cause

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23
Q

What usually causes periorbital cellulitis

A

Extension of sinus infection, ethmoid sinus most common

Also may come from dental/facial infection

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24
Q

What are some of the differences between the presentations of preseptal and orbital cellulitis?

A 
Preseptal:
No proptosis
No vision impairment
No pain with ocular movement
Chemosis rare (conjunctival swelling)

Orbital:
Fever common
Proptosis common
Impaired and painful ocular movement
Diplopia may be present
Chemosis may be present
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25
How do you diagnose periorbital cellulitis?
CT w contrast or MRI so you can figure out if it’s preseptal or orbital
26
Does orbital cellulitis need to be admitted to the hospital
Yes
27
What it the treatment for preseptal cellulitis?
Outpatient: Clindamycin Bactrim Inpatient: Vancomycin Optho consult
28
What is the treatment for orbital cellulitis?
``` IV cefotaxime IV ceftriaxone IV vancomycin Hospital admission+optho consult Surgery if abscessed or to decompress orbit ```
29
Name the conjunctivitis: Bilateral Severe injection Watery discharge Preauricular lymphadenopathy +/- photophobia and foreign body sensation Following URI
Viral conjunctivitis
30
What is the treatment for viral conjunctivitis?
Warm compress Supportive Self limiting 2-3 weeks
31
NAme that conjunctivitsL; Acute Unilateral or bilateral Moderate injection Thick, mucopurulent discharge
Bacterial
32
What bacteria usually cause bacterial conjunctivitis in adults?
S. Aureus
33
What bacteria usually cause bacterial conjunctivits in childern?
S. Pneumoniae H. Influenzae M. cattarrhalis
34
What is the treatment for bacterial conjunctivits?
Erythromycin Trimethoprim-polymyxin B Ciprofloxacin Azithromycin 5-7 days No contact wearing until infection resolved
35
How does conjunctivitis caused by c.trachomatis (chlamydia) present?
Bilateral Marked follicular response Non-tender preauricular lymphadenopathy Associated keratitis
36
How do you diagnose conjunctivitis caused by c. Trachomatis? (Chlamydia)
Giemsa stain Culture PCR
37
How do you treat conjunctivits caused by c. Trachomatis?
Erythromycin Azithromycin
38
How does conjunctivitis caused by n.gonorrhea present?
Unilateral or bilateral TONS of purulent discharge Chemosis (conjunctival swelling) Moderate to severe injection Irritation and tenderness lid swelling Preauricular lymphadenopathy Severe and sight threatening HYPERACUTE onset within 12 hours
39
How do you manage conjunctivitis caused by n.gonorrhea?
Hospitalization-risk of vision loss Topical erythromycin IV ceftriaxone Ophtho consult
40
Name that conjunctivitis: Bilateral Mild injection Chemosis Stringy discharge
Allergic conjunctivitis
41
What is the hallmark sign of allergic conjunctivitis ?
Itching
42
How do you treat allergic conjunctivitis
Lubricating eye drops Cool compress OTC antihistamine Antihistamine eye drops
43
What kind of conjunctivitis has the longest duration?
Allergic- weeks to months
44
How does subconjunctival hemorrhage present?
Sudden painless appearance of blood in the conjunctiva “Loud bark, no bite”
45
What is the difference between episcleritis and scleritis
Episcleritis: No pain ``` Scleritis: Severe pain and photophobia Deep bluish hue +/- nodule Potentially blinding! ```
46
What are episcleritis and scleritis associated with?
Systemic autoimmune disease
47
How do we treat episcleritis and scleritis?
Refer to ophthalmology for slit lamp exam Topical lubricants NSAIDS Topical steroids Immunosuppressive medications for scleritis only
48
What are the symptoms of a corneal abrasion?
Acute onset of pain and foreign body sensation Epiphora (lots of tears) Vision may be affected Epithelial defect
49
How do we manage corneal abrasion?
Topical lubricants Topical antibiotics Oral pain meds NEVER EVER topical anesthetics
50
What can happen if you give anesthetic drops to someon with a corneal abrasion?
Anesthetic keratitis - eye gets covered in white corneal exudate. Very bad
51
How do we manage chemical injury to the eye?
Irrigate Irrigate Morgan lens for irrigation Topical lubricants and abx Ophthalmology consult STAT
52
What do you need to be aware of before you go trying to remove a corneal foreign body?
Figure out what got in there and beware of intraocular foreign body
53
What is keratitis?
Infection of the cornea/ corneal ulcer
54
What usually causes keratitis/corneal ulcer?
Sleeping in contact lenses
55
Name it: Acute onset of pain Mucous discharge Contact lens abuse Vision decrease White infiltrate seen without fluorescin stain +/- hypopyon
Keratitis/ corneal ulcer
56
How do you treat keratitis/corneal ulcer?
Intense topical antibiotics Optho referral
57
What should you think about if you see a “dendritic pattern” with fluorescin staining?
Herpes simplex virus causing keratitis
58
How do you treat keratitis caused by herpes simplex?
Topical antivirals refer to ophtho NEVER use steroids
59
What is hyphema?
Blood in the anterior chamber casiued by trauma to iris/pupil
60
Name it: Acute onset of pain Photophobia Nausea/vomiting Layered heme +/- vision decrease
Hyphema
61
What should you think about if you see a “dendritic pattern” with fluorescin staining?
Herpes simplex virus causing keratitis
62
How do you treat keratitis caused by herpes simplex?
Topical antivirals refer to ophtho NEVER use steroids
63
What is hyphema?
Blood in the anterior chamber casiued by trauma to iris/pupil
64
Name it: Acute onset of pain Photophobia Nausea/vomiting Layered heme +/- vision decrease
Hyphema
65
What do you need to be aware of before you go trying to remove a corneal foreign body?
Figure out what got in there and beware of intraocular foreign body
66
What is keratitis?
Infection of the cornea/ corneal ulcer
67
What usually causes keratitis/corneal ulcer?
Sleeping in contact lenses
68
Name it: Acute onset of pain Mucous discharge Contact lens abuse Vision decrease White infiltrate seen without fluorescin stain +/- hypopyon
Keratitis/ corneal ulcer
69
Name it: Acute onset of pain Photophobia Nausea/vomiting Layered heme +/- vision decrease
Hyphema
70
How fo you treat hyphema?
Correct any underlying coagulopathy Treat pain Treat nausea/vomiting (vomiting increases IOP) Elevate head of bed (drain eye) ``` Refer to ophtho- sight threatening! Ophtho will do these: Control IOP Cycloplegics to dilate eye Steroids Short-term topical anesthetic drops ```
71
As the grade of hyphema increases, what happens to their prognosis of regaining 20/50 vision?
Decreases
72
When do we usually use eye patches and eye shield?
Trauma and post-op *they can worsen infections
73
What is uveitis/iritis?
Uveitis: inflammation of the uveal tissue Iritis: inflammation of the anterior uveal tissue (the iris) most common presentation of uveitis
74
What can cause uveitis/iritis?
Trauma Infection Autoimmune disease
75
Name it: Acute onset of photophobia Eye pain/blurred vision Ciliary flush (white around iris then lots of vasculature elsewhere) +/- hypopyon
Uveitis/iritis
76
How do you manage uveitis/iritis?
Refer to ophtho Topical steroids/NSAIDS Cycloplegics Typically resolves in 6-8 weeks
77
What are some complications of uveitis/iritis?
Irregular pupil due to scar tissue Cataracts Swelling Increased IOP
78
When do we use topical anesthetcis for eyes?
Only during exam. Never prescribe them. Only ophtho may prescribe it for hyphema
79
Should YOU as a PA prescribe steroids for the eyes?
NO. Can cause glaucoma and cataracts Can worsen infections
80
Should you ever use gentamicin in eyes?
NO
81
What is your best friend when it comes to topical antibiotics for eyes
Erythromycin ointment
82
WHen should you just refer to ophthalmology?
Vision/eye threatening Infection worsening Contact lens wearers Rapidly progressing/severe disease Chronic eye conditions Uncertain diagnosis worried patient Worried PA
83
What is hyphema?
Blood in the anterior chamber casiued by trauma to iris/pupil
84
How do you treat keratitis caused by herpes simplex?
Topical antivirals refer to ophtho NEVER use steroids
85
What should you think about if you see a “dendritic pattern” with fluorescin staining?
Herpes simplex virus causing keratitis
86
How do you treat keratitis/corneal ulcer?
Intense topical antibiotics Optho referral

Clin Med Exam 2 (Lauren) (6 decks)

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