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Clinical Medicine II > The Red Eye > Flashcards

The Red Eye Flashcards

(103 cards)

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1
Q

Evaluation of Orbital Cellulitis may include a CT with contrast if ?

A
  • Limited eye movements
  • Pain with eye movements
  • Failure to improve within 24-48 hours of starting antibiotics
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2
Q

Hospital Management of Orbital cellulitis includes?

A

IV

  • Ampicillin/Sulfbactam

Or

  • Ceftriaxone plus metronidazole

Or

  • Clindamycin

Or

Vancomycin plus one of the following drug

  • Ceftriaxone
  • Cefotaxime
  • Ampicillin/sulfbactam
  • Piperacillin tazobactam
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3
Q

T of F

Once you are seeing improvement (24 - 48hrs) in orbital cellulitis with a pt on IV, consider switching to oral abx

A
  • True
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4
Q

T or F

Pinguecula affects the Conjunctival tissue BUT does not encroach on the cornea ?

A
  • True
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5
Q

T or F

Pterygium affects the conjunctival tissue and IT DOES encroach on the cornea

A
  • True

- Wing shaped

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6
Q

Pinguecula & Pterygium is caused by?

A
  • Sunlight exposure

&

  • Chronic eye irritation
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7
Q

Treatment of Pinguecula & Pterygium includes?

A
  • Mild artificial tears
  • Mild topical steroids
  • Surgery if
  • Pterygium threatens visual axis
  • Excessive irritation
  • Interfering with contact lens
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8
Q

T or F

Pinguecula & Pterygium can both become cancer?

A
  • True
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9
Q

Conjunctivitis is a diagnosis of exclusion, what must you exclude ?

A
  • Acute Angel Closure Glaucoma
  • Keratitis
  • Iritis
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10
Q

What are RED FLAGS for Conjunctivitis that could be signs of more serious condition’s like

  • Acute Angel Closure Glaucoma
  • Infectious Keratitis
  • Infectious Iritis ?
A
  • Decrease in visual acuity
  • Cillary flush
  • Photophobia
  • Severe foreign body formation
  • Corneal opacity
  • Fixed pupil
  • Severe headache with nausea
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11
Q

What is the Conjunctiva ?

A
  • Mucus membrane that lines the globe up to the limbus
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12
Q

What does the Bulbar Conjunctiva cover?

A
  • Globe
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13
Q

What does the Tarsal Conjunctiva cover?

A
  • Inner Eye lids
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14
Q

T or F

Conjunctivitis “inflammation of the conjunctiva” is benign and self limiting, but must rule out other serous conditions ?

A
  • True, must rule out
  • Acute angle closure glaucoma
  • Infectious Iritis
  • Infectious keratitis
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15
Q

Bacterial acute conjunctivitis causes in kids?

A
  • H. Influenza
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16
Q

Bacterial acute conjunctivitis in pt’s wearing contact lenses ?

A
  • Pseudomonas
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17
Q

Other causes of bacterial acute conjunctivitis?

A
  • Staph. aureus
  • Staph. epidermidis
  • Strep pneumonaie
  • N. gonorrhoeae
  • N. meningidis
  • C. trachomatis
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18
Q

Viral causes of acute conjunctivitis?

A
  • Adenovirus
  • Herpes simplex
  • Herpes zoster
  • Flu
  • Measles
  • Mumps
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19
Q

Non infectious Allergic conjunctivitis causes?

A
  • Seasonal allergies

- Atopy (Heighten immune response)

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20
Q

Non infectious Non allergic acute conjunctivitis causes?

A
  • Topical medications
  • Wind
  • Uv light exposure
  • Smoke
  • Autoimmune
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21
Q

Bacterial Conjunctivitis Symptoms include?

A
  • Affected eye stuck shut in the morning
  • Copious purulent discharge that returns after wiping it away
  • Mild pruritus
  • Unilateral redness and discharge
  • Injected bulbar conjunctiva
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22
Q

Bacterial Conjunctivitis initial treatment ?

A
  • No contacts
  • Clean eyes
  • Cool compresses x 3 days
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23
Q

Bacterial Conjunctivitis treatment if unresolved after 3 days?

A
  • Polymyxin B-bacitracin ophthalmic ointment

OR

  • Polymyxin B-trimethoprim drops

OR

  • Erythromycin ointment

OR

  • Tobramycin ointment

OR

  • Gentamicin drops
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24
Q

Hyperacute Bacterial Conjunctivitis is caused by?

A
  • Gonococcal Neisseria infection

or

  • Meningococcal infection
  • Transmission from genitals to hands to eyes
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25
T or F Hyperacute Bacterial Conjunctivitis pt will have a concurrent urethitis?
- True
26
T or R Hyperacute Bacterial Conjunctivitis is life threathening and requires emergency attention?
- True
27
Symptoms of a pt with hyperacute bacterial conjunctivitis include?
- Copious purulent discharge within 12 hours of exposure - Tender pre-auricular lymphadenopathy - Marked chemosis (swelling of conjunctiva) - Redness - Irritation - Lid swelling
28
Treatment of hyperacute bacterial conjunctivitis?
- Ceftriaxone IM (1g) plus - Topical bacitracin ophthalmic ointment - plus - Azithromycin
29
Simple bacterial conjunctivitis
- Children - H. Influenza or Staph - Acute redness - Discharge
30
Gonococcal bacterial conjunctivitis
- Neisseria Gonorrhea - Hyperacute onset - Severe copious purulent discharge
31
Follicular Conjunctivitis
- Acute follicular conjunctivitis is usually associated with viral infections - Follicular Eruption on the Tarsal Conjunctiva - Follicles can be seen in the inferior and superior tarsal conjunctiva - Follicles appear as gray-white, round to oval elevations
32
Adult Inclusion Conjunctivitis
- Sexually transmitted - Chlamydia trachomatis - STI usually also present
33
Adult Inclusion Conjunctivitis symptoms include?
- Unilateral or occasionally bilateral Follicular conjunctivitis - Last weeks to months - Does not respond to antibiotic therapy - Preauricular lymphadenopathy
34
Adult Inclusion Conjunctivitis Dx is done by?
- Giemsa stain - Direct fluorescent antibody staining of conjunctival smear - Cultures
35
Progression of Trachoma is the leading cause of ?
- Blindness in the world
36
Progression of Chlamydia trachomatis from Follicular conjunctivitis leads to ?
- Scaring and contraction of the conjunctiva - Causes Eyelashes to scratch cornea - More infection, More scaring - Vision lost
37
Viral Conjunctivitis starts in one eye and then spreads to the other T or F
- True ``` - Caused by Adenovirus Herpes Simplex Herpes Zoster Flu Measles Mumps ```
38
#1 Pt affected by Viral Conjunctivitis ?
- Children
39
T or F Viral Conjunctivitis may be accompanied viral prodrome ?
- True - Adenopathy (preauricular) - Fever - Pharyngitis - URI symptoms
40
Viral Conjunctivitis symptoms include?
- Watery discharge - Second eye infected within 24-48hrs - Mild Follicular eruption (Tarsal conjunctiva) - Burning, sandy or gritty FB sensation - Unilateral symptoms do not rule out a viral origin
41
T or F Viral Conjunctivitis is self limited like the common cold ?
- True - Worsening symptoms the first few days - Resolves gradually 1-2 weeks
42
Viral Conjunctivitis treatment includes?
- Cool compresses | - Lubrication ointment
43
Allergic Conjunctivits is caused by?
- airborne allergens that contact the eye
44
Allergic Conjunctivits symptoms include?
- Bilateral redness - Watery discharge - Itching Cardinal symptom - Help differentiate from viral conjunctivitis - Chemosis
45
T or F Allergic rhinitis symptoms are usually also present with allergic conjunctivitis ?
- True
46
Cardinal symptoms differentiating Allergic conjunctivitis from viral conjunctivitis ?
- Itching in Allergic Conjunctivitis
47
Allergic Conjunctivitis Treatment includes ?
- Topical antihistamine (Naphazoline) | - Olopatadine drops (antihistamine plus mast cell stabilizer)
48
T or F Phone triage and treatment for conjunctivitis is a good idea?
- False | - Pt must be seen in person
49
T or F Topical glucocorticoids have NO ROLE in the treatment of conjunctivitis?
- True
50
T or F Must be on antibiotics for a minimum of 24 hours before returning to school or day care?
- True | - Problem is its Viral conjunctivitis
51
Hyphema definition?
- Blood in the front (anterior) chamber of the eye | - Appears as a small pool of blood at the bottom of the iris or in the cornea
52
Hyphema in the eyes is commonly caused by?
- Blunt or penetrating trauma | - Bleeding results from tears in the vessels of the cillary body or iris
53
T or F A Hyphema can also occur spontaneously?
- True - DM - Clotting disorders - Medications that inhibit platelet function
54
What are the signs and symptoms of a Hyphema?
- Photophobia (Eye pain with Consensual constriction) - Decreased visual acuity (Ophthalmologist ASAP) - Anisocoria (Torn iris sphincter muscle = Miosis or Mydirasis) - Elevated intraocular pressure (>21 tested with Tonopen) - Corneal blood staining
55
A traumatic hyphema can be an indication of other ocular injuries like ?
- Open globe - Corneal abrasion - Traumatic iritis - Dislocated lens
56
T or F Management of a Hyphema should include Prompt evaluation by an ophthalmologist ?
- True
57
What are the PE's included in a pt with a Hyphema?
- Visual acuity - Pupillary response - Extraocular movements - Intraocular pressure - Slit-lamp exam - Fluoroscein stain
58
Corneal Abrasion refers to any defect in the corneal surface epithelium, what must you rule out?
- Penetrating trauma - Infectious infiltrate (HSV) - Ask about prolonged contact lens wear (Increases infection chances)
59
Corneal Abrasions requires a good eye exam, you may use anesthetic drops to facilitate eye? T or F
- True
60
Corneal Abrasion eye exams include what to help with the Dx?
- Visual acuity - Fluorescein examination - Inspect Lids / lashes, Periorbital swelling - EOMI / PERRLA (Direct and consensual reaction) - Signs of Hyphema
61
Fluorescein examination is done with the woods lamp to help detect corneal abrasions?
- True
62
Corneal Abrasions heal fast if properly treated ? T or F
- True | - 24 to 48 hours
63
Management of corneal abrasions should include?
- Update tetanus - Topical antibiotics (ASAP) Erythromycin Ciprofloxacin Tobramycin - Pain control Tylenol MAYBE Consideration of ophthalmic NSAIDS - CAREFUL
64
Why don't you give pt's topical steroids ?
- Pt's tend to over use and can cause themselves Corneal Abrasions
65
When to refer a pt with a Corneal abrasion?
- Rust ring - Chemical burn - Corneal ulcer or infiltrate - Herpetic keratitis - Failure to heal (3 to 4 days) - Inability to remove a foreign body - Increase size of abrasion after 24 hours - Penetrating injury - Hyphema (blood) - Hypopyon (pus) - Vision loss of >20/40
66
When should you follow up with a pt with a corneal abrasion?
- In 24 hours
67
What Corneal abrasion pt's should be followed up with in 24hrs?
- Abrasion >4mm - Contact lenses - Decreased vision
68
Bacterial Keratitis in an infection involving what?
- Cornea
69
Bacterial Keratitis common pathogens include?
- S. aureus - Pseudomonas - S. Pneumoniae - Polymicrobial
70
#1 cause and risk factor of bacterial keratitis
- Improper contact lens wear
71
T or F Bacterial Keratitis can lead to corneal abrasions if not treated correctly ?
- True - Sleeping in them - Improper cleaning
72
Bacterial Keratitis pt's MUST be referred to Ophthalmology ?
- True | - ER ASAP
73
Symptoms of Bacterial Keratitis include?
- Photophobia Intense pain - Foreign body sensation - Cloudy cornea (WBC's) - Trouble keeping affected eye open - Purulent discharge
74
Viral Keratitis is caused by ?
- HSV
75
Viral Keratitis S & S?
- Dendritic lesion (Fluorescein / woods lamp exam) - Watery discharge - Red eye - Photophobia - Foreign body sensation
76
Management of Viral Keratitis includes?
- Ophthalmologist referral | - Hospitalized for anti viral therapy IV
77
Iritis / Uveitis
- Inflammation of the anterior (Front) uveal tract - Consists of three parts 1) Iris 2) Ciliary body 3) Choroid
78
If Ciliary body is involved in Iritis / Uveitis its called?
- Iridocyclitis
79
Iritis / Uveitis S & S include?
- **Ciliary flush** around Iris - Pain - Photophobia - Blurred vision - Pain with consensual pupillary reaction - Pain in the affected eye when light is shined in the unaffected eye
80
Causes of Iritis include?
- Toxoplasmosis - TB - Sarcoid - Syphilis - Idiopathic (Autoimmune 60%, other)
81
What should you consider in a pt with repeated episodes of Iritis?
- Autoimmune 60% or - Infectious agent
82
Management of Iritis?
- Ophthamologist referral ASAP - Typically treated with topical steroids - Monitor side affects - Treat cause
83
Acute Angle Closure Glaucoma
- Increases with age | - Narrowing or closure of the anterior chamber angle which allows aqueous humor drainage
84
Acute Angle Closure Glaucoma causes what?
- Inadequate drainage of aqueous humor - Increase in IOP - Damage to the optic nerve
85
What are the two types of Acute angle closure glaucoma?
1) Primary | 2) Secondary
86
Acute angle closure glaucoma is an rare emergency?
- True
87
What is the second leading cause of blindness?
- Glaucoma
88
Risk factors of glaucoma include?
- Family history - > 60y/o - Female - Hyperopia (Far Sightedness) - Certain medications
89
Medications that increase the chances of acute angle closure glaucoma include?
- Alpha/beta adrenergic agonists (Phenylephrine, Ephedrine) - Anticholinergic agents (Atropin, Scopopamine) - Antihistamines (Diphenhydramine) - Beta2 adrenergic agonists (Abuterol) - Diuretics (HTZ) - Psych drugs (Tricyclic AD, SSRI's) - Stimulants
90
Acute angle closure glaucoma S & S depend on the degree of IOP?
- Decreased vision - Halo around lights - Headache - Eye pain - Nausea / vomiting
91
What are the symptoms that suggest a rapid rise in IOP in acute angle closure glaucoma?
- Conjunctival redness - Corneal edema or cloudiness - Mild dilated pupil that reacts poorly to light
92
Acute angle closure glaucoma evaluation should include?
- Anterior chamber depth test - VA - Evaluation of the pupils - Measure IOP (Tonomery pen) - Slit lamp examination of the anterior segments - Visual field testing
93
Acute angle closure glaucoma evaluation of the anterior chamber depth includes ?
- Light shined on one side of pt's pupil - Normal = Light shines on both sides of iris - Abnormal = One side of the iris is darkened
94
Management of acute angle closure glaucoma if within 1 hour of S&S?
- Ophthalmologist ASAP if within 1 hour
95
Management of acute angle closure glaucoma if > 1 hour of S&S?
- 0.5% Timilol Beta Blocker Reduces the production of aqueous fluid - Apraclonidine Alpha 2 agonist Reduces the production of aqueous fluid ``` - Pilocarpine Stimulation of cholinergic receptors Results in contraction of the iris sphincter (miosis) Constriction of the ciliary muscle Lowering IOP ```
96
T or F Pt receiving medication tx for acute angle closure glaucoma will need nausea and pain control ?
- True | - Keep Pt supine
97
Viral conjunctivitis
- Acute - Bilateral, may be asymmetric - Itching, burning, soreness - Watery - Preauricular lymphadenopathy
98
Bacterial conjunctivitis
- Acute - Unilateral or bilateral - Burning - Heavy, mucopurulent - Lids possibly adherent
99
Chlamydial conjunctivitis
- Subacute, chronic - Usually unilateral - Burning, irritation - Scant, mucopurulent - More often in young adults
100
Herpes simplex conjunctivitis
- Acute - Unilateral - Photophobia, irritation - No discharge - Dendritic ulcer on cornea vesicles on lid
101
Allergic conjunctivitis
- Chronic - Bilateral - Itching - Stringy, mucoid - Seasonal, atopic pts
102
Blepharitis
- Chronic - Bilateral - Itching, burning, foreign body sensation - Usually no discharge - Inflammation, crusting of lid margins
103
Dry eye
- Chronic - Bilateral - Foreign body sensation - If severe case, mucoid - Punctate fluorescein staining of cornea

Clinical Medicine II (9 decks)

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