The Red Eye Flashcards
(82 cards)
1
Q
OD
A
right eye
2
Q
OS
A
left eye
3
Q
What does tonometry measure?
A
inraocular pressure… normal IOP 8-21
4
Q
A pt presents w/ eyelid inflammation of both eyes. She complains of burning and itching that is worse in the morning. There is no loss of visual acuity. You notice scales, erythema and debris on both lids. What is your presumptive dx?
A
Blepharitis.
5
Q
How do you treat blepharitis
A
- warm compresses and baby shampoo scrubs
- bacitracin, erythromycin or azithromycin opthalmic ointment
- oral abx if topical ineffective
6
Q
How does dry eye present?
A
- chronic itching, burning, scratching, especially in pm
- vision fluctuation
- positive schirmer test
7
Q
A patient with a dry eye should be managed with…
A
- artificial tears
2. ophthalmology referral for topical cyclospirine, punctal plugs, glucocorticoids
8
Q
Pt. presents w/ painful, warm swollen red lump on the eyelid. What is your dx and how do you treat it?
A
- Hordeolum
2. Tx w/ carm compress +/- abx. steroid injection if needed after 48 hrs.
9
Q
Pt. complains of a mass on the interior eyelid. On inspection you see an erythematous, hard mass on the interior eyelid. Pt. does not complain of pain. What is your presumptive dx and tx?
A
- chalazion
2. warm compress, abx if needed, steroid injection, surgical I and D if needed.
10
Q
Dacroadenitis presents as inflammation of the …
A
lacrimal gland
11
Q
what pathogens can cause dacroadenitis?
A
- viral: mumps, EBV
2. Bacterial: staph, gonococcal
12
Q
A patient presents with swelling of the upper eyelid. Inspection reveals erythema and increased tear production (epiphora). Pt. complains of pain. Exam reveals preauricular LAD. What is your presumptive dx?
A
- dacroadenitis
2. ask duration… chronic can mean orbital tumor
13
Q
How do you confirm a diagnosis of dacryoadenitis?
A
CT w/ contrast, biopsy if tumor concern
14
Q
What is the preferred tx for dacryoadenitis?
A
- warm compresses for viral.
15
Q
How do you treat ectropion and endtropion?
A
- surgical repair indicated if excessive tearing, exposure keratitis, cosmetic distress, lash growth towards eye
16
Q
What are the common causes of ectropion?
A
- advanced age, trauma, infection, palsy of CN VII
17
Q
what is a key differentiator between pterygium and pingueculum?
A
pterygium will grow.
18
Q
Pt. presents w/ eyelid pain, eye pain, erythema, and swelling of orbit. No proptosis (bulging), no loss of vision, no pain with EOMs. No chemosis. What is your presumptive dx?
A
- Preseptal cellulitis
19
Q
What confirms a diagnosis of preseptal cellulitis?
A
CT w/ contrast or MRI
20
Q
How do you manage preseptal cellulitis?
A
- Clindamycin, bactrim + augmentin or cefpodoime
2. refer to ophthalmology
21
Q
Who requires inpatient tx for preseptal cellulitis?
A
consider under 2 yo, all under 1 yo.
inability to differentiate preseptal from orbital.
22
Q
What is the inpatient tx for preseptal cellulitis or orbital cellulitis?
A
vanco plus ceftriaxone plus metronidazole
23
Q
What differentiates orbital cellulitis from preseptal?
A
fever, proptosis, impaired EOMs, diplopia, chemosis, leukocytosis
24
Q
A pt. is being seen after previous dx of URI. Pt. complains of bilateral watery discharge. Exam reveals severe injection (hyperemia) and preauricular LAD. What is your presumptive dx and treatment?
A
- viral conjunctivitis
2. warm compress, supportive care. educate on self-limiting 2-3 week course
25
What differentiates bacterial conjunctivitis from viral?
1. acute onset
2. can be unilateral
3. moderate injection
4. thick, mucopurulent discharge w/ crusting
26
How would you manage a pt. with bacterial conjunctivitis?
Abx:
1. erythromycin ointment
2. trimethoprim-polymyxin B solution
3. cipro solution
4. azithromycin solution
rest for 5-7 days, no contact use
27
Pt. presents w/ chronic, bilateral conjunctivitis. Exam revels non-tender preauricular LAD and keratitis. What pathogen do you suspect is responsible, how do you confirm, and what is the tx?
1. c. trachomatis
2. dx w/ culture, PCR
3. Tx w/ erythromycin 500mg po qid x 7d, zithromax 1g po x 1
28
Pt. presents w/ unilateral profuse purulent discharge, chemosis, severe injection, and lid swelling. Exam notes preauricular LAD. Pt. notes onset was rapid. What pathogen is responsible, what should you be careful for, how do you dx and treat?
1. N. gonorrhea infx
2. this is vision threatening
3. dx w/ giemsa stain, gram stain, culture on selective media.
4. Hospitalization required w/ ophthalmology consult. Tx. w/ ceftriaxone 1gm IM x 1
29
What should you be on the look out for w/ a patient you suspect of allergic conjunctivitis?
1. chronic sxs bilaterally
2. mild injection
3. chemosis (conjunctival swelling)
4. stringy discharge
5. itching!!!
6. hx of atopy
30
Tx for allergic conjunctivitis?
1. lubricating drops
2. cool compress
3. OTC antihistamine
4. ophthalmic antihistamine drops
31
3 subtypes of scleritis w/ prevalence.
1. Anterior diffuse (50%)
2. Anterior Nodular (20-40%)
3. Anteriornecrotizing (rare)
4. Posterior scleritis (same subtypes)
32
Pt. presents w/ severe, constant eye pain that is worse in the morning. pain radiates to face and is increased w/ EOMs. Pt. complains of headache and epiphora (increased tears). You notice diffuse hyperemia. What is your presumptive dx?
Anterior diffuse scleritits.
33
How do you diagnose anterior scleritis vs. posterior scleritis?
Anterior:
violaceous redness of eye, pain w/ eyelid pressure, scleral edema on slit lamp.
Posterior:
orbit will appear normal, slit lamp shows inflammation, choroidal thickening.
34
Tx for scleritis?
1. ASAP referral to ophthalmology and rheumatology.
2. slit lamp exam
3. oral NSAIDs
4. Oral glucocorditoids
35
A woman complains of abrupt onset of eye redness, irritation, epiphora. Denies pain, denies change to visual acuity. What is the presumptive dx?
episcleritis
36
How do you manage episcleritis?
1. ophthalmology referral
2. slit lamp exam
3. topical lubricants
4. topical/oral nsaids
5. topical glucocorticoids
6. assess for systemic disease
37
How does corneal abrasion typically present?
1. acute onset of pain, foreign body sensation
2. epiphora
3. vision may or may not be affected
4. epithelial defect
38
How do you treat a corneal abrasion?
1. florescein stain to confirm
2. topical lubricants and abx
3. oral analgesics if severe
4. NO PATCHING
5. NO ANESTHETIC DROPS
39
a chemical worker presents with acute pain and burning in the eye. The vision is decreased and blurred. How do you manage this apparant chemical injury?
1. immediate irrigation
2. morgan lens for prolonged irrigation
3. topical lubricants/antibiotics
4. urgent ophthalmology
40
Pt. presents w/ acute onset of eye pain and mucous discharge. Vision is decreases and white infiltrate is visible.. Pt. states hasn't changed contacts in a while. What is the presumptive dx and how do you treat it?
Keratitis, intensive topical abx and ophthalmology referral
41
Pt. presents w/ sxs of keratitis with dendritic pattern of white infiltrate. What pathogen is responsible and how do you treat?
1. HSV
2. treat w/ topical antivirals.
3. refer to ophthalmology
4. NO STEROIDS
42
How is hyphema treated?
1. correct coagulopathy
2. sx tx of pain and NV
3. eye shield/bed rest
4. elevate bed
5. ophthalmology referral
43
What are the common causes of uveitis?
1. HSV, CMV, syphilis, TB, West Nile
44
Pt. presents w/ pain x 7 days, photophobia, hypopyon, blurred vision and epiphora. You notice ciliary flush and increased IOP is noted. What is your presumptive dx?
1. anterior uveitis
45
How does posterior uveitis present and what is effected?
1. painless, floaters and blurred vision.
| 2. affects the lens. leukocytes present in vitreous humor
46
How do you dx uveitis
clinical, slit lamp exam
47
Tx for uveitis?
1. ophthalmology referral
2. topical glucocorticoids/NSAIDs
3. cyclopegic drops if increased IOP
48
Three primary components to glaucoma...
1. increased IOP (urgent if > 30mmHg)
2. optic nerve damage
3. visual field loss
49
What causes angle closure glaucoma?
1. primary: anatomic predisposition
50
Test for angle-closure glaucoma?
penlight test to look for crescent shadow.
51
A patient presents w/ severe eye pain, NV, headache, blurry vision, halos around lights and acute vision loss. The pupil reacts poorly to light and you can visualize a steamy, cloudy looking cornea. What is your presumptive tx?
Angle-closure glaucoma
52
How do you manage angle-closure glaucoma?
1. ophthalmologic emergency!
2. dx w/ gonioscopy
3. Tx w/ anti-hypertensive medications, oral/IV mannitol, laser peripheral iridotomy, surgical trabeculectomy
4. DO NOT USE CYCLOPLEGICS
53
Pt. complains of tunnel vision. Exam notes increased cup/disc ratio. What is the presumptive dx?
Open angle glaucoma
54
How do you manage open-angle glaucoma?
1. ophthalmology referral
| 2. topical ocular anti-hypertensives, laser trabeculoplasty, surgical trabeculectomy
55
What are some risk factors for cataracts?
1. smoking tobacco
2. CS use
3. UV exposure
4. DM
5. Aging
56
Pt. complains of gradual loss of vision w/out pain. pt. stopped night driving due to glare from headlights. On exam, red reflex is absent and you notice a yellowing of the lens. What is the presumptive dx?
Cataracts
57
How do yo umanage cataracts?
1. rx glasses, surgery if ADLs impaired.
58
What are the risk factors for age-related macular degeneration?
1. over 50 yo
2. smoking/etoh use
3. fh
4. hx of nitro, beta blockers, aspirin
59
General presentation of ARMD?
1. gradual or acutely blurred vision
2. metamorphopsia
3. central scotoma
4. amsler grid distortion
60
A patient presents w/ central scotoma, drusen deposits, loss of retinal pigment and geographic atrophy in macula. What type of ARMD do you suspect?
dry ARMD
61
Patient presents with fibrosis and scarring, rapid vision distortion, metamorphopsia and central scotoma unilaterally. what type of ARMD do you suspect?
1. wet ARMD due to fibrosis and scarring from subretinal neovascular degeneration.
62
Treatments for ARMD?
1. ophthalmology referral
2. vitamins
3. smoking cessation
4. daily amsler grid
5. low vision aids
WET:
1. photocoagulation, photodynamic therapy
2. intravitreal steroid/monoclonal antibodies
63
Risk factors for retinal detachment:
1. history of myopia
2. cataract surgery
3. current fluoroquinolone use
4. fh
64
Rhegmatogenous RD features`
1. full thickness tear of retina
| 2. posterior vitreous detachment most common cause
65
Nonrhegmatogenous RD features
1. caused by vitreus traction pulling on retina, traction RD
| 2. associated w/ diabetes
66
exudative RD features
caused by exudate beneath retina, no real tear. extremely rare
67
Pt. presents w/ floaters, curtain like loss of vision. Exam reveals raised whitish retina. What is the presumptive dx?
1. RD
68
How do you treat RD?
1. lack of tx progresses to involve whole retina
2. urgent opthalmology referral
3. small tear = laster photocoagulation
4. surgery
69
A patient presents to a well-exam with abnormal fundoscopic exam findings. you see copper wiring, silver wiring, AV nicking, cotton wool spot, hemorrhages and disc edema. What do you suspect?
hypertensive retinopathy
70
How do you treat hypertensive retinopathy?
BP control and ophtho referral
71
Pt. presents w/ blurred vision, retinal hemorrhage, retinal and macular edema, cotton wool spots, venous dilation and hard exudates on fundoscopic exam. What type of diabetic retinopathy do you suspect and why?
1. non-proliferative due to absence of neovascularization, RD, and macular edema.
72
Pt. presents with neovascularization, hemmorrhage and retinal detachment. What type diabetic retinopathy do you suspect?
Proliferative due to neovascularization, hemorrhage and RD
73
How do you manage diabetic retinopathy>
1. blood sugar control
2. ophtho referral
3. laster photocoagulation
4. vitrectomy
74
Risk factors for central retinal artery occlusion?
1. over 40, male
2. carotid artery artherosclerosis
3. htn
4. hyperlipidemia
5. DM
75
Is CRAO embolic or thrombotic
embolic. CRVO is thrombotic
76
Risk factors for central retinal vein occlusion
1. old age
2. htn
3. dm
4. smoking
5. obesity
6. hypercoagulable state
7. glaucoma
77
patient presents with total, acute, painless loss of vision unilaterally. "no light perception", afferent puillary defect. Exam notes ischemic retinal whitening and a cherry red spot at macula. What type of retinal occlusion is this?
CRAO
78
pt. presents w/ acute, variable painless loss of vision in one eye. pt. coplains of scotoma w/ blurred vision. Exam notes blood and thunder appearance. What type of central retinal occlusion is this?
CRVO
79
CRAO tx:
ophtho referral-emergent
| poor prognosis
80
CRVO tx
ophtho referral
aspirin
observation
tx for retinal edema/ischemia
81
what causes optic neuritis?
1. demyelination of optic nerve. 30% will develop MS
82
pt. presents w/ central scotoma, painful EOMs, abnormal color vision, photopsias, optic disc edema and shrunken, pale optic nerve. What is the presumptive dx and how do you tx?
Optic neuritis.
Get MRI of brain and orbit w/ contrast.
start IV methylprednisolone for severe vision loss or 2 or more white matter brain lesions on MRI
