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59 Cards in this Set

  • Front
  • Back
What are the 5 diff diagnosis for red eye?
Acute glaucoma
what is the cause of the itching symptoms of red eye
usually suggest an allergy
what is the cause of the scratchiness symptoms of red eye
foreign body or dry eye
what is the cause of the burning symptoms of red eye
think "lid disorder" like blepharitis, especially first thing in the AM. Slso conjunctival or corneal disorders
what is the cause of the localized tenderness symptoms of red eye
stye or chalazion
cause of deep intense pain in red eye
corneal abrasion, iritis (inflammation within the eye), acute glaucoma, or sinusitis (this can give pain around eye)
cause of photophobia in red eye
corneal abrasions, iritis, acute glaucoma (associated with secondary uveitis)
cause of halo vision (suggests that the cornea is swelling) in red eye
corneal edema (as intraocular pressure is rising, this acan lead to glaucoma)
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.
meibomian gland orifices get plugged - not really an infectious problem
treatment is to apply a warm compress and light digital compression
What are the non vision threatening red eye disorders?
subconjunctival hemorrhage
dry eyes
corneal abrasions (most)
What are the vision threatening red eye disorders?
Corneal infections
acute glaucoma
orbital cellusitis
What disease is blepharitis associated with?
acne rosacea
aka _____
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.
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
What is the treatment for orbital cellulitis?
-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
where is lacrimal gland located and what component of the tear film does it make up?
located in superiolateral orbitlal area and makes up the aqueous commponent of the tear film
what is the 7 step process of tear flow
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
if excritory system is blocked what happens
if excritory system is blocked this makes for a very good culture medium in the lacrimal sac
What is the treatment for an acquired nasolacrimal duct obstruction?
temporary nasal decongestants
systemic antibiotics if infected
surgical drainage procedures
what are the three main bacterial causes of acquired nasolacrimal duct obstrustion
staph, strep and H. Influ
What are the three causes of conjunctivitis
viral, chemical
what would signal a viral conjunctivitis
preauricular lymphadenopathy
in conjunctivitis, what type of mucus signifies an allergic condition?
allergic - stringy and white
bacteria - pus like discharge
viral and chemical - clear watery discharge
what infective cause does preauricular lymphadenopathy point to?
viral or possibly chlamydial
hyperacute bacterial cinjunctivities
caused by? 2 bugs
how long is manafestation?
effect on cornea?
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
viral conjunctivitis
incidence compared to bact, infxn.
more common than bact.
starts in one eye then can go to the other.
what are the 4 causes of bacterial conjunctivitis?
7 common finding with viral conjunctivitis
watery discharge
highly contagious
palpable preauricular lymph node
URI, sore throat, fever common
associated with normal visual acuity
what are the causes of neonatal conjunctivitis
chemicals (silver nitrate)
bacteria (gonococcus,
viruses (HSV)
systemic infections
Time of onset is helpful in diagnosing neonatal conjunctivitis. List the causes and the time of onset for each cause.
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
why is silver nitrate no longer used in US...and what do we use instead
not used in uS because it doesn't protect againt chlamydia. we use erythromycin ointment in newborns
how is gonococcus acquired in the newborn and how does it present
typically acquired in birth canal and it is hyperacute and hyperpurulent
is the bacterial neonatal conjuntivitis bilateral?
how does herpes in a newborn present
presents with vesicles on skin around eyes
how is the neocatal chlamydia acquired?
birth canal
what is by far the most common cause of neonatal conjunctivitis?
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
what is a pinguecula?
Raised, yellowish area on bulbar conjunctiva
what is a pterygium?
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
what is the management plan for both pinguecula and pterygium?
artificial tears
sunglasses with UV protection
topical vasoconstrictors
if severe, refer
what is the etiology of episcleritis?
usually autoimmune, not infectious
what is one main thing that separates episcleritis from conjunctivitis?
episcleritis often has "sectoral" appearance.
what diseases damages the goblet cells?
lacrimal glands?
goblet cells - stevens-johnson syndrome
lacrimal glands - rheumatoid arthritis
what is the sjogren's syndrome triad
dry eyes, dry mouth, and connective tissure disorder
common cause of exposure keratoconjunctivitis
thyroid disease
name for when the eyes are open while sleeping
what is a common cause of keratitis and corneal opacification....which type is the most common
herpes keratitis and the most commontype is HSV type I.
what is one thing that definitely should not be prescribed in herpes keratitis?
what are the side effects of topical steriods
enhanced corneal penetration of HSV
elevate IOP (steroid-induced glaucoma)
cataract formation
enhanced corneal penetration of fungi
visually what is diagnostic of herpes keratitis?
dendritic, branching pattern and sometimes vesicles
where does the herpes virus live during its suppressed stage
trigeminal ganglion
what are the side effects of topical steroids
enhanced corneal penetration of HSV
elevate IOP (steroid-induced glaucoma)
cataract formation
enhanced corneal penetration of fungi
what are the signs and symptoms of iritis? (6)
circumcorneal redness
decreased vision
IOP normal or decreased
What are the autoimmune diseases associated with uvelitis
Juvenile Rheumatoid Arthritis (JRA)
HLA-B27 associated
Systemic Lupus Erythematosis
acute angle closure glaucoma is characterized by what?
Acute Angle-Closure Glaucomais characterized by a sudden risein IOP in Susceptible individuals with Dilated pupils
what are the symptoms of acute angle closure glaucoma (5)
severe ocular pain and redness
blurred vision
halos around lights
nausea and vomiting
what are 4 signs of uveitis
• 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.
what is the initial treatment for acute angle closure glaucoma
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