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59 Cards in this Set
- Front
- Back
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What are the 5 diff diagnosis for red eye?
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Conjunctivitis
Keratitis Episcleritis/scleritis uveitis Acute glaucoma |
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what is the cause of the itching symptoms of red eye
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usually suggest an allergy
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what is the cause of the scratchiness symptoms of red eye
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foreign body or dry eye
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what is the cause of the burning symptoms of red eye
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think "lid disorder" like blepharitis, especially first thing in the AM. Slso conjunctival or corneal disorders
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what is the cause of the localized tenderness symptoms of red eye
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stye or chalazion
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cause of deep intense pain in red eye
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corneal abrasion, iritis (inflammation within the eye), acute glaucoma, or sinusitis (this can give pain around eye)
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cause of photophobia in red eye
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corneal abrasions, iritis, acute glaucoma (associated with secondary uveitis)
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cause of halo vision (suggests that the cornea is swelling) in red eye
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corneal edema (as intraocular pressure is rising, this acan lead to glaucoma)
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blepharitis
what is it patient complaints? what population commonly found in? what is the main root of this problem? who is the main microbiological culprit? what type of ointment could you give and what are two examples? |
chronic condition of lid margin caused by chronic inflamation of the eyelid
patient complains of burning early in the morning, eyes are red and scratchy common in nursing home patients and other debilitated patients because they can't pay attention to their own hygiene and caregivers are afraid to clean eyes not cured by antibiotics because it is a hygiene problem. oils from gland builds up and staph colonized this. the exotoxins are shd into the eye. the treatment is the use warm compress and non irritating shampoo and you can give antibiotic ointments such as gentomycin or erythromycin to kill the spaph. |
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Stye/Chalazion
cause treatment |
meibomian gland orifices get plugged - not really an infectious problem
treatment is to apply a warm compress and light digital compression |
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What are the non vision threatening red eye disorders?
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subconjunctival hemorrhage
stye chalazion blepharitis conjunctivitis dry eyes corneal abrasions (most) |
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What are the vision threatening red eye disorders?
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Corneal infections
scleritis iritis acute glaucoma orbital cellusitis |
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What disease is blepharitis associated with?
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acne rosacea
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hordeolum
aka _____ treatment how would you distinguish this from a basal cell carcinoma |
abscess of the internal lamellum or in some literature stye
treatment is warm compress and massage. if this does not work you can lance them by either opening it from the back or from the front. basal cell carcinoma in centrally ulcerated. |
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preceptal cellulitis
where is location caused by? if definitely preceptal, what is the treatment if orbital cellulitis, what is the treatment how is it diff from orbital cellulitis |
in front of the orbital septum outside of the orbit
caused by insect bit around the eyelid or an abrasion if definitely preseptal oral antibiotic and outpatient if orbital cellulitis admission and high dose antibiotics necessary. Orbital cellulitis presents with: -patient has a lot of pain -if the eye is pushed out -any effects on visual acuity -optic disc swollen means that there’s a compressive process in the back of the orbit -pupil doesn’t react normally -due to penetrating trauma or ethmoid sinusitis All these signs and symptoms would lean toward an orbital cellulitis |
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What is the treatment for orbital cellulitis?
compilcations? |
-hospitalization
-consults- may need an ethmoidectomy to resolve this problem -culture to isolate organism for treatment purposes -CT scan is imperative -x-ray the sinuses -IV antibiotics which cover staph, strep, and H.flu (especially in children 6mos-5yrs old) -Diabetics and immunosuppressed patients can have fungus in their orbit and this requires surgical debridement -complications: infections can travel and get into the cavernous sinus (cavernous sinus thrombosis) and it can also spread to the brain meningitis |
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where is lacrimal gland located and what component of the tear film does it make up?
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located in superiolateral orbitlal area and makes up the aqueous commponent of the tear film
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what is the 7 step process of tear flow
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tears flow across the eye→excretory part of the system→2 openings called the lacrimal puncta→lacrimal caniculli→lacrimal sac→nasolacrimal duct (which is vertically oriented)→opens into the inferior meatus or the nasal cavity
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if excritory system is blocked what happens
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if excritory system is blocked this makes for a very good culture medium in the lacrimal sac
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What is the treatment for an acquired nasolacrimal duct obstruction?
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temporary nasal decongestants
systemic antibiotics if infected surgical drainage procedures |
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what are the three main bacterial causes of acquired nasolacrimal duct obstrustion
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staph, strep and H. Influ
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What are the three causes of conjunctivitis
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allergy
viral, chemical bacterial |
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what would signal a viral conjunctivitis
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preauricular lymphadenopathy
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in conjunctivitis, what type of mucus signifies an allergic condition?
bacterial? viral? chemical? |
allergic - stringy and white
bacteria - pus like discharge viral and chemical - clear watery discharge |
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what infective cause does preauricular lymphadenopathy point to?
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viral or possibly chlamydial
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hyperacute bacterial cinjunctivities
caused by? 2 bugs how long is manafestation? effect on cornea? treatment? what in a clinical signal? |
caused by neisseria meningitis and neisseria gonorrhea
can manifest within hours corneal opacification organisms can penetrate through the cornea so admit to the hospital immediately pt wil have a preauricular node |
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viral conjunctivitis
incidence compared to bact, infxn. progression? |
more common than bact.
starts in one eye then can go to the other. |
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what are the 4 causes of bacterial conjunctivitis?
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staphylococcus
streptococcus haemophilus pseudomonas |
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7 common finding with viral conjunctivitis
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watery discharge
highly contagious palpable preauricular lymph node URI, sore throat, fever common associated with normal visual acuity |
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what are the causes of neonatal conjunctivitis
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chemicals (silver nitrate)
bacteria (gonococcus, staphylococcus) Chlamydia viruses (HSV) systemic infections |
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Time of onset is helpful in diagnosing neonatal conjunctivitis. List the causes and the time of onset for each cause.
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silver nitrate - 12-24 hours after exposure
gonococcus - 1-2 days after birth other bacteria (staph, strep, h. influ) - 3-4 days herpes - 1 week chlamydia - 1-6 weeks |
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why is silver nitrate no longer used in US...and what do we use instead
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not used in uS because it doesn't protect againt chlamydia. we use erythromycin ointment in newborns
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how is gonococcus acquired in the newborn and how does it present
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typically acquired in birth canal and it is hyperacute and hyperpurulent
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is the bacterial neonatal conjuntivitis bilateral?
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yes
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how does herpes in a newborn present
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presents with vesicles on skin around eyes
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how is the neocatal chlamydia acquired?
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birth canal
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what is by far the most common cause of neonatal conjunctivitis?
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chlamydia
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in geemsa stain what do intracytoplasmic inclusions indicate?
intranucleaar inclusions? what does the monoclonal antibody test test for? |
chlamydial infxn - intracytoplasmic inclusion
herpes - intranuclear inclusion monoclonal antibody test - chlanydia |
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what is a pinguecula?
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Raised, yellowish area on bulbar conjunctiva
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what is a pterygium?
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a triangular patch of hypertrophied bulbar subconjunctival tissue, extending from the medial canthus to the border of the cornea or beyond, with apex pointing toward the pupil
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what is the management plan for both pinguecula and pterygium?
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artificial tears
sunglasses with UV protection topical vasoconstrictors if severe, refer |
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what is the etiology of episcleritis?
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usually autoimmune, not infectious
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what is one main thing that separates episcleritis from conjunctivitis?
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episcleritis often has "sectoral" appearance.
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what diseases damages the goblet cells?
lacrimal glands? |
goblet cells - stevens-johnson syndrome
lacrimal glands - rheumatoid arthritis |
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what is the sjogren's syndrome triad
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dry eyes, dry mouth, and connective tissure disorder
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common cause of exposure keratoconjunctivitis
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thyroid disease
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name for when the eyes are open while sleeping
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lagothalmos
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what is a common cause of keratitis and corneal opacification....which type is the most common
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herpes keratitis and the most commontype is HSV type I.
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what is one thing that definitely should not be prescribed in herpes keratitis?
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DON'T PRESCRIBE TOPICAL STEROIDS.
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what are the side effects of topical steriods
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enhanced corneal penetration of HSV
elevate IOP (steroid-induced glaucoma) cataract formation enhanced corneal penetration of fungi |
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visually what is diagnostic of herpes keratitis?
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dendritic, branching pattern and sometimes vesicles
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where does the herpes virus live during its suppressed stage
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trigeminal ganglion
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what are the side effects of topical steroids
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enhanced corneal penetration of HSV
elevate IOP (steroid-induced glaucoma) cataract formation enhanced corneal penetration of fungi |
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what are the signs and symptoms of iritis? (6)
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circumcorneal redness
pain photophobia decreased vision miosis IOP normal or decreased |
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What are the autoimmune diseases associated with uvelitis
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Juvenile Rheumatoid Arthritis (JRA)
HLA-B27 associated Systemic Lupus Erythematosis Sarcoidosis |
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acute angle closure glaucoma is characterized by what?
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Acute Angle-Closure Glaucomais characterized by a sudden risein IOP in Susceptible individuals with Dilated pupils
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what are the symptoms of acute angle closure glaucoma (5)
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severe ocular pain and redness
blurred vision halos around lights headache nausea and vomiting |
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what are 4 signs of uveitis
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• Hypopyon –when you see white cells layered out in anterior chamber. This is a great indicator of inflammation. We already saw once already today in association w/ corneal ulcer.
• Slide of a non-round pupil – iris is stuck to anterior lens capsule – called posterior synechiae – this is absolutely a sign of inflammation in anterior chamber either current or previous. If you’re not sure what is going on, look in both eyes, might see previous indications of Ant. Uveitis in the other eye. • Opacities on red reflex view, lymphocytes are stuck on the back of the cornea • Keratic Precipitates (reliable & specific sign). Photomicrograph shown of cornea w/ keratic precipitates. Can often see w/ direct opthalmoscope if you use a red reflex technique. |
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what is the initial treatment for acute angle closure glaucoma
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topical beta-blocker (aqueous suppressant), one drop
acetazolamide (aqueous suppressant) p.o. or intravenous oral isosorbide (osmotic agent) pilocarpine 2% (miotic) once IOP starts to come down |
