Term
| Leading cause of blindness in the U.S. is? |
|
Definition
|
|
Term
| 2nd leading cause of blindness in the U.S. |
|
Definition
|
|
Term
| 3rd leading cause of blindness in the U.S. |
|
Definition
|
|
Term
| What condition is characterized by red eye, watery discharge, excessive tearing and FB sensation? |
|
Definition
|
|
Term
| Most common pathogen for viral conjunctivitis is? name 2 others. |
|
Definition
| Adenovirus (others: HSV, coxsackie, VZV, EBV, influenza) |
|
|
Term
| What symptoms would you see with a person that has pharyngoconjunctival fever? (associated with viral conjunctivitis). How long does this condition last? |
|
Definition
1. fever of 101 or higher
2. malaise
3. preauricular adenopathy
4. sore throat.
lasts approx 10 days. |
|
|
Term
| What is the treatment for viral conjunctivitis? |
|
Definition
1. cold compress
2. topical sulfa abx to prevent 2ndary infection
3. acyclovir for HSV |
|
|
Term
| What is the key characteristics of vernal allergic conjunctivitis? |
|
Definition
|
|
Term
| When is vernal conjunctivitis most common? |
|
Definition
1. late childhood/early adulthood
2. spring/summer |
|
|
Term
| Stringy rope like discharge with a (pale to milky) red eye, hyperemia and sudden chemosis is characteristic of what condition? |
|
Definition
|
|
Term
| What is atopic keratoconjunctivitis? key characteristic? how is treatment different from vernal? |
|
Definition
1. allergic conjunctivitis-chronic and occuring in adulthood.
2. characterized by: fine papillary conjunctivitis (lower lid), entropion, trichiasis
3. SYSTEMIC anti-histamine |
|
|
Term
| What is the most common infection that causes blindness world wide? |
|
Definition
| Trachoma - chlamydial keratoconunctivitis. |
|
|
Term
| What type of bacterial conjunctivitis is considered an ophthalmologic emergeny? why? |
|
Definition
1. Gonococcal conjunctivitis
2. involves corneal and can lead to rapid perforation of cornea |
|
|
Term
| What is medication treatment for Gonococcal Conjunctivitis? |
|
Definition
1g dose IM ceftriaxone
(can also give topical erythromycin and bacitracin) |
|
|
Term
| bilateral glued eyes upon waking and copious purulent discharge are characteristics signs of what condition? |
|
Definition
| Bacterial conjunctivitis. |
|
|
Term
| what is treatment for chlamydial keratoconjunctivitis? |
|
Definition
|
|
Term
| What is keratoconjunctivitis sicca? Who is most likely to have this? what medical condition presents with this condition? |
|
Definition
(aka dry eyes)
1. females
2. anticholinergic medications
3. imbalance in tear production
4. Sjogren syndrome (auto immune) |
|
|
Term
| What is closed angle glaucoma? |
|
Definition
| obstruction of flow of aqueous fluid in the ant. chamber causing increase in IOP. |
|
|
Term
| Asians/Inuits, Elderly and those who are farsighted are predisposed to what type of glaucoma? |
|
Definition
| primary closed angle glaucoma |
|
|
Term
| What condition is characterized by extreme pain, cloudy cornea, fixed dilated pupils and blurry vision with halos? |
|
Definition
| Primary closed angle glaucoma |
|
|
Term
| increased IOP of > 50mmHg is indicative of what condition? |
|
Definition
| primary closed angle glaucoma |
|
|
Term
| what is the most common form of glaucoma? |
|
Definition
| primary OPEN angle glaucoma |
|
|
Term
| Elderly, African Americans, Diabetics, and strong family history predisposes one to what condition? |
|
Definition
| primary OPEN angle glaucoma |
|
|
Term
| Progressive "cupping" of optic disc is present in what type of glaucoma? |
|
Definition
| primary OPEN angle glaucoma |
|
|
Term
| progressive loss of visual fields aka TUNNEL VISION is key in what condition? |
|
Definition
| primary OPEN angle glaucoma |
|
|
Term
| What is open angle glaucoma? |
|
Definition
| increased IOP due to reduced drainage of aqueous fluid |
|
|
Term
| Primary closed angle glaucoma usually affects just one or both eyes? |
|
Definition
|
|
Term
| primary OPEN angle glaucoma usually affects just one or both eyes? |
|
Definition
|
|
Term
| what is medication/tx for primary CLOSED angle glaucoma? |
|
Definition
| 500MG IV acetazolamide then 250mg PO QID |
|
|
Term
| What are 3 key physical/objective findings that you would find in primary OPEN angle glaucoma? |
|
Definition
1. increased IOP > 21mmHg
2. optic disc cupping> 0.3 or asymmetry of discs.
3. normal ant chamber angle |
|
|
Term
| what is first line treatment for primary OPEN angle glaucoma? |
|
Definition
prostaglanin analogs
-also do topical beta-adrengeric blocking agents
-carbonic anhydrase inhibitors
-surgical tabeculectomy (especially for asthma and HF pts so no vasoconstriction) |
|
|
Term
| Secondary OPEN angle glaucoma can result from what 3 things? what about secondary CLOSED angle glaucoma? |
|
Definition
OPEN
1. uveitis
2. ocular trauma
3. corticosteroid therapy (any route)
CLOSED:
1. ant. uveitis
2. dislocation lens
3. topiramate therapy (seizure medication) |
|
|
Term
| What procedure can be done for primary CLOSED angle glaucoma as prophylaxis for the other eye? |
|
Definition
| iridoplasty (using laser to burn small holes in peripheral of iris to widen the anterior chamber) |
|
|
Term
| What is surgical trabeculectomy? what is it used to treat? |
|
Definition
| removal of some of eye's trabecular meshwork. used to treat primary OPEN angle glaucoma. |
|
|
Term
| What complication can occur as a result of untreated primary closed angle glaucoma? |
|
Definition
| vision loss if untreated in 2-5 days. |
|
|
Term
| what is normal IOP in the eye? |
|
Definition
|
|
Term
| What is normal cup to disk ratio? abnormal? |
|
Definition
normal = 0.3
abnormal = 0.5 or asymmetrical |
|
|
Term
| Goldman tonometer determines how much force or pressure is needed to flatten the cornea. a higher reading says what about pressure? |
|
Definition
|
|
Term
| Shiotz tonometer uses an indention type pressure to pick up a reading. a lower reading says what about pressure? |
|
Definition
| lower reading = higher pressure |
|
|
Term
| What are the risk factors for cataracts? |
|
Definition
1. african american
2. smoking
3. exposure to ionizing radiation (xrays and sunlight)
4. diabetes |
|
|
Term
| What are the 3 types of cataracts? |
|
Definition
1. cortical
2. nuclear
3. posterior subscapular |
|
|
Term
| "Myopic shift" and yellow or brown (brunescent)discoloration of the central lens is characteristic of what? |
|
Definition
|
|
Term
| difficulty reading, seeing glare especially when driving at night is characteristic of? |
|
Definition
| posterior subscapsular cataract |
|
|
Term
| Posterior subcapsular cataracts are associated with what systemic conditions or other injuries? |
|
Definition
1. diabetes
2. trauma/inflammation of the eye |
|
|
Term
| Opaque lens, no red reflex, decreased visual acuity, decrease color vision especially to blue are signs of what? |
|
Definition
|
|
Term
| Systemic hypertension is a significant risk factor for what type of cataract? |
|
Definition
| posterior subcapsular cataract |
|
|
Term
| Acute nongranulomatous anterior uveitis (aka iritis) is caused by what 3 immunologic conditions? |
|
Definition
1. Crohn Disease
2. reactive arthritis
3. ulcerative colitis |
|
|
Term
| What are the immunologic causes of granulomatous anterior uveitis (iritis) and posterior uveitis (choroiditis)? |
|
Definition
1. sarcoidosis
2. toxoplasmosis
3. tuberculosis
4. syphilis |
|
|
Term
| Anterior uveitis generally affects one or both eyes? |
|
Definition
|
|
Term
| posterior uveritis commonly affects one or both eyes? |
|
Definition
|
|
Term
| What are key signs and symptoms of anterior uveritis (nongranulomatous) |
|
Definition
1. acute pain
2. unilateral eye
3. pain, redness
4. PHOTOPHOBIA
5. visual loss
6. hypopon
7. small irregular pupil
-NO IRIS NODULES (found in granulamatous ant uveitis) |
|
|
Term
| Describe the type of vision loss you'd expect to see in a patient with anterior or posterior uveitis. |
|
Definition
1. anterior (nongranuloma) = vision loss
2. anterior (granuloma) = blurry vision with VERY inflamed eye
3. posterior = gradual vision loss bilaterally |
|
|
Term
| Large "mutton fat" keratic precipitates on the corneal epithelium and IRIS nodules with hypopyon are characteristic of what condition? |
|
Definition
| anterior uveitis (granulomatous) |
|
|
Term
| yellow lesions with indistinct margins on fundocopic exam are indicative of what condition? |
|
Definition
| Posterior uveitis (choroiditis) |
|
|
Term
| What is the treatment plan for all types of uveitis? |
|
Definition
1. refer to ophthalma (urgently for acute nongranulomatous)
2. acute = topical corticosteroids
3. posterior = systemic perocular or intravitreal corticosteroid therapy |
|
|
Term
|
Definition
| dropping of the upper eyelid > 2mm below corneal margin. |
|
|
Term
| Ptosis can be associated/caused by what systemic conditions? |
|
Definition
1. Myasthenia gravis (damage to oculomotor nerve)
2. Horner's syndrome (damage to sympathetic nerve)
3. 3rd nerve palsy |
|
|
Term
| Ptosis is accentuated when the patient gazes which way? |
|
Definition
|
|
Term
| What are the 5 types of ptosis? |
|
Definition
1. involutional (aponeurotic)
2. mechanical
3. myogenic
4. neutrogenic
5. congenital |
|
|
Term
| what is involutional (aponeurotic) ptosis caused by? |
|
Definition
| aging, surgery, or trauma. good levator function |
|
|
Term
| What is mechanical ptosis caused by? |
|
Definition
1. mass effects of tumor
2. dermatochalsis (scarring)
3. blepharochaisis (scarring) |
|
|
Term
| What is myogenic ptosis caused by? |
|
Definition
muscle disorder ie. myotonic dystrophy.
POOR levator function |
|
|
Term
| What is neurogenic ptosis caused by? |
|
Definition
faulty innervation to the levator
1. CN 3 palsy
2. Horner's syndrome
3. MS
levator function varies |
|
|
Term
| What is congenital ptosis caused by? |
|
Definition
| usually myogenic and UNILATERAL due to fibrosis and fat infiltration of the levator muscle. POOR levator function. |
|
|
Term
| What is treatment for ptosis? |
|
Definition
| refer to ophthalmology, surgical correction depending on the extent. |
|
|
Term
|
Definition
| inward turning of the eyelid |
|
|
Term
|
Definition
| occasionally in older people with aging as result of degeneration of the lid fasica *per lecture notes- most common in young adults* |
|
|
Term
| A person with pain, burning, tearing, FB sensation and trichiasis would likely have what condition? What complications might this person face and what are possible treatment plans? |
|
Definition
1. entropion
2. scarring of the cornea
3. (A) lid eversion with tape (if mild)
(B) surgery
(C) Botox |
|
|
Term
|
Definition
| outward turning of the lower eyelid |
|
|
Term
|
Definition
| common with advanced aging |
|
|
Term
| What is a key physical complaint in a patient with ectropion? |
|
Definition
| epiphora (excessive tearing) b/c no longer draining properly. |
|
|
Term
| When would surgery be indicated for a patient with ectropion? |
|
Definition
1. excessive tearing
2. exposure keratitis
3. cosmetic problems |
|
|
Term
| what is anterior blepharitis? |
|
Definition
| inflammation of eyelid, skin, lashes and associated glands |
|
|
Term
| what is posterior blepharitis? |
|
Definition
| dysfunction of meibomian gland orifice |
|
|
Term
| What is the primary pathogen found in blepharitis? |
|
Definition
|
|
Term
| What are key characteristics of anterior blepharitis? |
|
Definition
1. RED RIMMED eyes
2. scales or granulations clinging to the eyelash (flaky = ulcerative, seborrheic if meibomian)
3. possible trichiasis |
|
|
Term
| What are key characteristics of posterior blepharitis? |
|
Definition
1. DRY EYES
2. acneforms (acne roscea associated with blepharitis)
3. mild entropion
4. GREASY FROTHY TEARS or dry filmy eyes with "toothpaste like material" |
|
|
Term
| Patient presents with scales or granulations seen clinging to eyelashes. what condition is this? |
|
Definition
|
|
Term
| patient presents with greasy frothy tears, dry eye, and mild entropion. what condition is this? |
|
Definition
|
|
Term
| How would you treat anterior blepharitis? |
|
Definition
1. warm compress and remove scales
2. eye hygiene
3. abx only with acute cases |
|
|
Term
| How would you treat posterior blepharitis? |
|
Definition
1. express secretions
2. artificial tears
3. systemic abx or NSAIDS
4. check for corneal damage |
|
|
Term
| Dacrocytosis is most commonly seen in what age group(s)? |
|
Definition
| infants and people > 40 y/o |
|
|
Term
|
Definition
| infection of lacrimal sac. can be acute or chronic |
|
|
Term
| In acute dacrocytosis, you will experience pain, tenderness, and purulent discharge. what is important NOT to do for acute cases? |
|
Definition
| do NOT probe the lacrimal system |
|
|
Term
| what is the difference in symptoms of acute versus chronic dacrocytosis? |
|
Definition
1. acute = painful and poss red
2. chronic = not painful or red |
|
|
Term
| In a patient with dacrocytosis, what should you also look for to try and rule out possible underlying orbital cellulitis? |
|
Definition
| look for proptosis and check EOMs. |
|
|
Term
| What is the difference in treatment between afebrile patient with dacrocytosis? |
|
Definition
1. afebrile (no fever) = oral abx and RTC daily for recheck
2. febrile (fever) = hospitalize and IV Abx |
|
|
Term
| once acute phase of dacrocytosis is over, patient is candidate for what treatment? |
|
Definition
|
|
Term
| What is orbital cellulitis? |
|
Definition
| inflammation of eye tissues posterior to the orbital septum. (spread into eye socket from adjacent sinuses or through the blood) |
|
|
Term
| What are common pathogens found in orbital cellulitis? |
|
Definition
1. S. pneumonia
2. H. influenza
3. less common S. aureus
**Think or organisms that affect sinuses** |
|
|
Term
| Orbital cellulitis is characterized by what signs and symptoms? |
|
Definition
1. abrupt onset fever
2. PROPTOSIS
3. restricted EOMs
4. swelling and redness of lids |
|
|
Term
| Orbital cellulitis is often a result of what conditions/events? |
|
Definition
1. infection of paranasal sinuses
2. extension of local infection (dacrocystitis, tooth abscess)
3. post trauma
4. post surgery |
|
|
Term
| treatment for orbital cellulitis? |
|
Definition
1. IMMEDIATE referral to ophthalmologist.
2. IMMEDIATE IV Abx. usually a type of PCN (ie. nafcillin) poss in addition to metronidazole or clindamycin.
3. consider clinda or vancomycin for suspected MRSA |
|
|
Term
|
Definition
| staph infection/abscess of the eyelid margin (external) or the meibomian gland (internal) |
|
|
Term
| How is a hordeolum different than a chalazion? |
|
Definition
1. TENDERNESS! (hordeolum is tender. chalazion is not)
2. POINT (hordeolum comes to a point, chalazion does not)
3. DEPTH (hordeolum is superficial, chalazion is deeper)
4. hordeolum is an infection, chalazion is inflammation |
|
|
Term
| Signs and symptoms of a hordeolum? |
|
Definition
1. red localized tenderness and swelling upper or lower lid
2. "pimple" on the eyelid
3. comes to a point
4. superficial |
|
|
Term
| signs and symptoms of chalazion? |
|
Definition
1. hard, NONTENDER, swelling of meibomian gland either upper or lower eyelid
2. slight redness
3. mild inflammation
4. poss serous oily fluid secreted not pus |
|
|
Term
|
Definition
1. warm compress QID
2. I+D if not resolved in 48hrs
3. Abx (erythromycin or bacitracin) q3hrs. |
|
|
Term
|
Definition
1. corticosteriod injection (remember this condition is caused by inflammation and corticosteroids help bring down inflammation- not an infection so no Abx needed unless it is very deep)
2. according to CMDT (pg. 163) usually I&D (would be done by ophthalmalogist) |
|
|
Term
| A yellow nodule on the nasal side of the eye after prolonged exposure to wind, sun, sand, or dust is indicative of what condition? |
|
Definition
|
|
Term
| What treatment would you recommend for a patient that presents with a yellow nodule on the nasal side of the eye after prolonged exposure to wind, sun, sand, or dust? |
|
Definition
1. no treatment needed, rarely grows
2. avoid sun/dust/wind/sand / UV light (use sunglasses/hat etc)
3. artificial tears may be beneficial |
|
|
Term
| What is the difference between a pinguecula and a pterygium? |
|
Definition
pinguecula is yellow nodula, avascular, that stops at the border of the iris.
pterygium is a fleshy triangular encroachment of conjunctiva, has its own blood supply, and EXTENDS INTO THE IRIS |
|
|
Term
| What is treatment plan for pterygium? |
|
Definition
1. no treatment necessary
2. artificial tears are beneficial
3. according to CDT pg. 167-short course of topical NSAIDS or wear corticosteroids may be necessary
3. excision/surgery |
|
|
Term
| When is surgery indicated for patient with pterygium? What is the concern/complication with performing surgery on the pterygium? |
|
Definition
1. if growth threatens vision by encroaching on visual axis
2. marked induced astigmatism
3. severe ocular irritation
Recurrence is common and often more aggressive (comes back worse) than primary lesion! |
|
|
Term
| What is subconjunctival hemorrhage? |
|
Definition
| rupture of small conjunctival vessels |
|
|
Term
| Subconjunctival hemorrhage can be caused spontaneously in what instances/with that diseases? |
|
Definition
1. HTN (hypertension)
2. coughing
3. straining / valsalva manuever (like straining to poop! haha)
4. bleeding disorders
5. atherosclerosis |
|
|
Term
| subconjunctival hemorrhage can be caused post traumatically after what kind of trauma? |
|
Definition
1. blunt-eye trauma
2. foreign body
3. penetrating injury |
|
|
Term
| what are important history questions to ask a patient with subconjuntival hemorrhage? |
|
Definition
1. any previous occurance?
2. any use of aspirin?
3. any hx of trauma? |
|
|
Term
| What are signs and symptoms of subconjunctival hemorrhage? |
|
Definition
1. well demarcated bright red patch on the sclera.
2. mild to no pain. no vision disturbances. PEARL |
|
|
Term
| What are you worried about for a person with recurrent subconjunctival hemorrhages? |
|
Definition
|
|
Term
| In a person with subconjunctival hemorrhages, you should always check what things to rule out orbital cellulitis? |
|
Definition
1. proptosis
2. EOMs
3. IOP |
|
|
Term
| What is the treatment for subconjunctival hemorrhages? |
|
Definition
1. reassurance. scary looking but they'll be ok.
2. hemorrhage will reabsorb in 2-3 weeks
3. warm compress or lubricating drops may help relief any symptoms |
|
|
Term
| Contact wearers are most at risk for infection by what pathogen? What condition does it lead to? |
|
Definition
1. Pseudomonas aeruginosa
2. bacterial keratitis |
|
|
Term
| Key s/s of bacterial keratitis? |
|
Definition
| HAZY cornea with CENTRAL ULCER and hypopon |
|
|
Term
| Bacterial keratitis has what precipitating factors? |
|
Definition
1. contact lens wear (esp. overnight)
2. corneal trauma (ie. refractive surgery) |
|
|
Term
| What is the most common cause of corneal ulceration? |
|
Definition
|
|
Term
| What is a key physical finding in someone with herpetic/herpes simplex keratitis? |
|
Definition
| dendritic ulcer on the cornea best visualized after staining. |
|
|
Term
| HSV colonizes the trigeminal ganglion so reoccurances my be precipitated by what conditions? |
|
Definition
1. fever
2. stress
3. overexposure to UV light
4. local or systemic immunodeficiency |
|
|
Term
| symptoms of corneal abrasion? |
|
Definition
1. severe pain and photophobia
2. irritation with lid movement
3. abrasion seen w/dye
4. circumcorneal redness (injection) |
|
|
Term
|
Definition
1. "something in my eye"
2. pain and irritation with lid movement
3. photophobia
4. circumcorneal redness (injection)
5. blepharospams
6. reactive myopia (constriction of pupils) |
|
|
Term
| for metal FB in eye- you should be concerned with what? |
|
Definition
| making sure rust ring is removed |
|
|
Term
| what do you suspect in a patient that presents with recent history of trauma to the eye such as with fingernail, piece of paper, or contact lens? What symptoms do they complain of? |
|
Definition
1. corneal abrasion
2. severe pain and photophobia |
|
|
Term
| what is treatment for corneal abrasion? |
|
Definition
1. polymyxin-bacitracin ophthalmic ointment (Abx)
2. mydriatic (this is cycloplegic) (cyclopentolate 1%)
3. topical or oral analgesic |
|
|
Term
| Under what conditions would you refer a patient with a corneal FB to an ophthalmologist |
|
Definition
1. if FB can not be removed
2. if you suspect corneal infection
3. FB in there > 24hrs. |
|
|
Term
| Medication treatment for corneal FB? |
|
Definition
| polymxin-bacitracin (abx drops) |
|
|
Term
| Treatment for bacterial keratitis? |
|
Definition
Fluoroquinoles (ie. levoflaxin) hourly day and night x 48hrs.
-use cephalosporin if gram +
-use aminoglycoside if gram - |
|
|
Term
| HSV is self limiting. Patients with this condition should avoid/be careful of what type of medication? Why? |
|
Definition
1. avoid/careful monitoring of corticosteroids
2. it can lead to scarring of the cornea and enhances viral replication |
|
|
Term
| What is the treatment for HS keratitis? |
|
Definition
1. urgent referral to ophthalm.
2. topical antiviral
3. oral acyclovir |
|
|
