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200 Cards in this Set

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What is the most common cause of orbital cellulitis?
(usually staph aureus, other bacteria, virus , or fungi possible)
Paranasal sinusitis;which leads to the secondary infection throughout the lid tissue & sometimes involving the orbit.
Orbital cellulitis S/Sx;
Extreme orbital pain, Eyelid redness & swelling, Conjunctival hyperemia & edema, Exopthalmos (bulging eyes), Impaired mobility of the eye, fever & malaise.
What is hyperemia?
Congestion; an unusual amount of blood in a part.
Orbital cellulitis Dx?
Find primary site of infection;
Examine; skin, nasopharynx, teeth, & oral cavity
X-ray/CT of sinuses
Culture any discharge
Orbital cellulitis Tx;
Mild cases; Cephalexin 500mg q 6h x 14days
Severe cases (usually); Cefazolin 1g IV q 6f X 7days
I&D if no response to ABX
Change ABX as indicated by C&S
What six bones make up the orbit?
Frontal, Ethoidal, Lacrimal, Sphenoid bones, Maxilla, Zygoma.
What is a orbital FX?
A break in the orbit portion of 1 or more of the 6 orbital bones.
Orbital cellulitis complications;
Loss of vision from optic neuritis.
Thrombophlebitis of the orbital veins resulting in;
Cavernous sinus thrombosis
Spread of the infection to the meninges & brain
Blow out fx pathophysiology;
Usually in the orbital floor occurs as a result of hydraulic forces generated by the compressed liquid of the eye & direct buckling of the inferior floor.
Orbital Fx S/Sx;
Nerve Anesthesia, hx of blunt ocular trauma, pain, local tenerness, double vision, intense pressure or swelling of the eye, epitaxis, extraocular muscle entrapment, intramuscular or infraorbital hemorrhage, nerve damage, orbital emphysema (caused by communication w/adjoining sinuses.
In floor fx what can happen to the eye?
It can partially drop down into the maxillary sinus causing enophthalmos (recession of the globe) & intrapment of the inferior rectus or inferior oblique muscle.
What does intrapment lead to?
Limited down-gaze, no up-gaze.
Prolonged entrapment leads to fibrosis of the muscle, irreversible scarring, & permanent motility impairment.
What can be damaged w/medial wall fx?
The medial rectus &/or the lacrimal apparatus.
What is the greatest risk to consider w/medial wall fx?
Orbital cellulitis
What are the critical S/Sx of a recent blow out fx?
Edema & echymosis of lid tissues, restriction of ocular motility (especially vertical), obital crepitus, hypoesthesial of the ipsilateral cheek (due to entrapment of the infraorbital nerve)
What are the types of orbital fx?
Le Fort I-tooth bearing portion separated from upper maxilla.
Le Fort II-across orbital floor & nasal bridge.
Le Fort III-across frontozygomatic sutureline, entire orbit & nasal bridge.
What are the S/Sx for a pt that initally ignored tx for a orbital fx?
(Inflammatory manifestations of trauma have subsided)
relative enophthalmos, motility restriction (usually up-gaze), infraorbital hypoesthesia.
What is enophthalmos?
Recession of the eyeball into the orbit. Opposite of exophthalmos.
What is hypoesthesia?
A dulled sensitivity to touch.
Orbital fx diagnostic tests?
Ct is the procedure of choice.
(Better imaging of the bony structures than X-Ray or MRI)
Obtain both axial & coronal scans.
What orbital fx should be considered for surgical intervention?
Floor fx w/assiociated herniation of the orbital contents.
Generally surg is only for pts w/recent trauma w/diplopia in primary gaze or downgaz or cosmetically unacceptable enophthalmos. Specialists wait 10-14 days to allow resolution of edema & hemorrhage.
Is surgical repair necessary in a medial wall fx?
Not if it is a uncomplicated ethmoid fx, the condition will resolve spontaneously in 3-4 weeks.
What is a hordeolum?
Stye, a pimple at the lid magin, resulting from infection of small glands in the lid margin.
Hordeolum (stye) External S/Sx;
Pain, Diffuse redness, tenderness of lid margin, Small round tender area, photophobia, feeling that something is in the eye, yellow spot (abcess)that may rupture & relieve pressure & pain.
Hordeolum (stye) Internal S/Sx;
Can be seen through the conjunctive
Hordeolum (stye) tx;
Usually self limiting, (topical ABX is ineffective), (oral ABX are selsom recommended), Warm moist compress, I&D will expedite healing.
What is a Chalazion?
Chronic granulomatous enlargement of the melbomian gland from occlusion of its ducts often following inflammation of the gland & surrounding tissue.
Chalazion S/Sx?
Early it looks like a stye.
Lid edema
Later: Painless
Slowly growing round mass in lid
Red or gray mass
Chalazion D/Dx;
If in lower lid near inner canthus, chroic dacryocysitis must be ruled out.
Chalazion tx;
Resolve after a few months.
Hot compress TID-QID may help.
incession & curettage or corticosteroid administration if no resolution after 6 wks.
What is Blepharitis?
Inflammation of the lid margins w/redness, thickening & often the formation of scales & crusts or shallow marginal ulcers.
Blepharitis Etiology;
Acute bacterial infection (staph) of the lid margin.
Involves lash follicles & meibomian glands.
Chronic Seborrheic Blepharitis, asso. w/seborrheic dermatitis.
Blepharitis S/Sx;
Itch, burn, redness & edema of the lid, Loss of lashes, Conjunctival irritation w/lacrimation, photophobia, pustules, shallow ulcers, crusts, eyes glued together in the AM.
Seborrheic type of Blepharitis S/Sx;
Greasy scales
Easily removable
Plugged meibomian gland
Ulcerative type Blepharitis Tx;
Staph infection
ABX ointment (bacitracin/polymyxin B or gentamycin)
Seborrheic type Blepharitis Tx;
Improve eyelid hygiene
Scrub lid w/coton swab dipped in baby shampoo.
Tx other areas of face prn.
Warm compresses unplug meibomian glands.
What is dacrocystitis?
Infection of the lacrimal sac.
(usually secondary to dacryostenosis)
What is dacryostenosis?
Obstruction or narrowing of a lacrimal or nasal duct.
What are the S/Sx of acute dacrocystitis?
Pain, redness & swelling over the inner aspect of the lower eyelid, Epiphoria, Fever & severe erythematous swelling around the nasal aspect of the lower lid, Lacrimal sac mucopurulent d/c can be expressed from the inferior punctum, (pts w/poor hygiene are at greater risk)
What is Epiphoria?
Abnormal overflow of tears from overproduction or blocked lacrimal duct.
What are the S/Sx of chronic dacrocystitis?
Slight swelling of the sac, Pus, Lacrimal sac may become distended, abcess & fistula.
Acute dacrocystitis Tx;
(Mild) Hot compresses, Cephalexin 500mg QID po
(Severe) I&D
Cefazolin 500mg QID IV.
Chronic dacrocystitis Tx;
(stenosis may be causing problem)
Dilating nasolacrimal duct w/probe.
Nasolacrimal intubation.
What is Sjogern's Syndrome?
Chronic systemic inflammatory disorder of unkown cause, characterized by dryness of the mouth, eyes & other muccous membranes. Associated w/rheumatic disorders (SLE, RA).
Is Sjogern's Syndrome always an isolated phenomenon?
Not always it is sometimes associated w/SLE or RA & there is an increased risk on non-Hodgkin's lymphoma. (Lymphocytic infiltration)
How do you diagnose Sjogern's Syndrome?
Serology & salivary gland biopsy.
Sjogern's Syndrome Tx;
Artificial tears & ointments.
Lifestyle modifications, Humidifiers, Tx any related infections (Blepharitis) w/warm compresses etc.
Occlusion of the nasolacrimal punctum.
What is Keratoconjunctivitis Sicca?
Chronic, bilateral desiccation of the conjunctiva & cornea due to inadequate tear volume or excessive loss of tears due to accelerated evaporation.
What is desiccation.
The process of drying up.
What are the S/Sx of Keratoconjunctivitis Sicca?
Itch, Burning, Photophobia, Gritty sensation, Pressure behind the eye, Foreign body sensation.
When do the S/Sx of Keratoconjunctivitis Sicca worsen?
Reading, working, driving, watching TV, dusty, smoky areas, dry envoronments.
Keratoconjunctivitis Sicca Dx;
Scattered fine punctate loss of the corneal or conjunctival epithelium, Stain w/fluorescein, Conjunctive appear dry w/folds in some cases, Schirmer test.
Keratoconjunctivitis Sicca Tx;
Artificial tears & ointments.
Lifestyle modifications, Humidifiers, Tx any related infections (Blepharitis) w/warm compresses etc.
Occlusion of the nasolacrimal punctum.
What is ptosis?
A drooping of the upper or lower eyelid.
What are causes of ptosis?
Stroke, Myasthenia gravis (neuromuscular issue), damage to the oculomotor nerves, damage to the sympathetic nerve supply (Hormer's syndrome), Weakened muscle, relaxed tissues, weight of hemiated fat, congenital.
What is Myasthenia Gravis?
Neurological dz that results in bilateral ptosis worsening as the day progresses.
What is Horners Syndrome?
Nerve pathway between hypothalmus & eye interrupted causing unilateral ptosis, anhidrosis & pupillary miosis.
What is Entropion?

What causes Entropion?
Inversion of the eyelid.

Aging or scar formation.
What are S/Sx of Entropion?
Causes irritation as lashes rub against cornea.
Ulcers & scarring.
What is Ectropion?

What causes Ectropion?
Eversion of the eye lid.

Aging or scar formation.
Usually from the tissue relaxing w/aging.
What are the S/Sx of Ectropion?
Poor drainage of tears
What is Epiphora?
An abnormal overflow of tears down the cheek due to excess secretion of tears or obstruction of the lacrimal duct.
Entropion & Ectropion Tx;
Artificial Tears
What is Coloboma?
Congenital cleft in some part of the eye. (commonly in the iris, but may also occur in the lid(s) or pigment epithelium & chroid).
What is the cause of Coloboma?
Faulty closure during prenatal developmen; usually hereditary (secondary complication; cataracts).
What are conditions associated with Coloboma?
Microphthalmia, polydactyly (extra digits) & mental retardation.
What is Microphthalmia?
Abnormally small size of one or both eyes.
What can Coloboma cause?
Decreased visual aculity, nystagmus, strabismus, photophobia & loss of visual fields.
What are the S/Sx of Coloboma?
Decreased to no vision in the effected eye.
Loss of depth perception.
Cosmetic effects.
Coloboma Tx;
Cosmetic contact lenses & or sunglasses for colobomas of the iris.
Optical aids.
Surgery to repair the lids.
What is Epicanthus?
Vertical fold of skin that lies over the medial canthus.
(is normal in Asians) (seen in Down's syndrome & other congenital conditions.
What does Epicanthus falsely suggest?
Convergent strabismus.
What is Dermatocholasis?
Redundant & lax eyelid skin & muscle. Common in elderly & occasionally in young adults.
What causes Dermatocholasis?
Gravity, loss of elastic tissue in the skin, & weakening of the connective tissues of the eyelid. (more common in the upper eyelids)
Dermatocholasis Etiology (Dz)?
Thyroid eye dz, Renal failure, trauma (cutis laxa), Ehlers-Danlos syndrome, Amyloidosis, hereditary angioneurotic edema, Xanthelasma, Genetic factors.
Dermatocholasis Pathophysiology;
(aging issues) Loss of elastic fibers, thinning of the epidermis, redundancy of the skin, associated w/dermatitis (a nonspecific chronic infiltrate is seen), The pathology of blepharochalasis typically shows loss of elastic fibers, lymphedema, epithelial atrophy, & vasculitis.
Dermatocholasis S/Sx;
Superior visual field obstructed, ocular irritation, entropion of the upper eyelid, ectropion of the lower eyelid, blepharitis & dermatitis, fullness or heviness of the upper leyelids, bags in the lower eyelids (fat herniation), wrinkles in the lower eyelids & lateral canthus.
How much of visual field can be lost with Dermatocholasis?
Dermatocholasis Tx;
Pts w/blepharitis, lid hygiene & topical ABX.
Pts w/dermatitis, topical steroid ointment.
Pts w/dry eyes, topical lubricant,collagen puncial plugs, puncial cautery.
Define Blepharospasm;
Blink more frequently than normal, spontaneous involuntary forced blinking.
Blepharospasm Tx;
Anticholinergics, Phenothiazines of haloperidol, botulinum injections.
Conjunctivitis Pathophysiology;
Acute conjunctival inlammation, caused by bacteria or allergy.
What can cause Conjunctivitis?
Wind, dust, smoke, air pollution, intense ultraviolet light of electric arcs, sunlamps, reflection of snow.
What virus most commonly causes Viral Conjunctivitis?
What are the S/Sx of Viral Conjunctivitis?
Hyperemia, Watery discharge, Ocular irritation, Eyelids truck together in AM, Bilateral (usually starts in one eye), contract w/someone w/same, recent URI, Prequricular lymphadenopathy w/tenderness. Severe cases; Photophobia, foreign body sensation, pseudomembranes of fibrin lead to scarring.
Viral Conjunctivitis Tx;
Highly contagious, good hand washing, self limiting 1 wk, Treat w/ABX if sign of bacterial inf., No patching, good eye hygeine.
What is Bacterial Conjunctivitis?
Inflammation caused by nongonoccal bacterial infection. (Staph aureus, Strep Pneumoniae, Hib.)
Bacterial Conjunctivitis S/Sx;
Purulent discharge, ocular irritation, eyelids stuck together, more unilateral, intense hyperemic & edematous conjunctivae, enlarged pre-auricular lymph node.
Bacterial Conjunctivitis Tx;
Cultrue discharge, Avoid transmitting, good handwashing, do not patch, self limiting 3 weeks, Sulfacetamide sodium 10% gtts or trimethoprim/polymuxin B QID for 7-10 days.
What is Gonococcal Conjunctivitis?
Rare, severe, purulent conjunctivitis in adults that is acquired from a gonorrheal contact or from self-inoculation during a gonorrheal genital infection.
Gonococcal Conjunctivitis S/Sx;
Unilateral, Severe eyelid edema, Chemosis (edema of conjunctiva), Profuse purulent exudate.
Gonococcal Conjunctivitis Complications;
Gonococcal Conjunctivitis Tx;
Rocephine 1gm IM or Ciprofloxin 500mg BID po X5days and Bacitracin or gentamicin opthalmic ointment. Tx parteners as appropriate.
Define Allergic Conjunctivitis;
Acute seasonal conjunctival inflammation caused by an allergy (generally air borne pollens).
Allergic Conjunctivitis S/Sx;
Watery discharge, Ocular itching, Rhinitis, May have eczema or asthma, Seasonal symptoms, Bulbar & tarsal conjunctivae are hyperemic but predominately deematous.
Allergic Conjunctivitis Tx;
Topical OTC or antihistamine, OTC vasoconstrictors, NSAIDs, Topical mast cell inhibitors. (With caution topical corticosteroids in recurrent cases)
What is Pterygium?
Vascularization (or tissue) extending into the nasal aspect of the cornea, pt asymptomatic.
Pterygium S/Sx;
Vascularized pterygium may become red & inflamed, motivating pt to seek care.
Iregular surface can interfere w/stability of precorneal tear film, creating dry eye syndrome.
Rarely the pterygium may obscure the visual axis.
Pterygium D/Dx;
Ptergia must be distinguished from pingueculae.
Ptergia is more yelow in color & lies within the interpalpebral space, but does not encroach beyond the limbus.
pingueculae is more oval & ameboid in appearance.
Pterygium etiology;
Ultraviolet light exposure, Allergens, noxious chemicals & irritants, Heredity.
Pterygium Pathophysiology;
Conjunctival stroma replacement by thickened, tortuous elastotic fibers. Activated fibroblasts in the leading edge of the pterygium invade & fragment Bowman's layer & superficial corneal stroma. Pterygium development resembles actinic degeneration of the skin.
Pterygium Tx;
Avoid environmental factors. If inflammed or irritated tx w/topical decongestant/antihistamine &/or mild topical corticosteroids. Surgery sometimes is indicated.
Sjogren's Syndrome in a nutshell;
From lymphocytic infiltration, drying of mucus membranes, associated w/SLE & RA, Tx same as for Keratoconjunctivitis Sicca.
What is a Pinguecula?
Yellowish, slightly raised, interpalpebral lipid-like, deposits in the nasal & temproal conjunctiva.
Pinguecula Pathophysiology;
Older population, conjunctival degenerative process by exposure to noxious environmental stimuli & UV light. Solar radiation alters the collagen & elastic tissues of the conjunctival stroma, leads to elastotic degeneration & deposition of abnormalelastic fibers in the conjuctival substantia propria.
Pinguecula Tx;
Sunglasses, ocular lubricating drops, for inflammation use appropriate topical steroids, surgical resection in severe cases (interfere w/vision)
What is a Subconjunctival Hemorrhage?
Collection of blood under the ocular conjunctiva.
What are some causes of Subconjunctival Hemorrhage?
Can occur at any age, monor trauma, straining, sneezing, coughing, spontaneously,
Subconjunctival Hemorrhage Tx;
Absorbed spontaneously, self limiting in 2 wks. Reassure, Restrict activity (lifting, etc.) If pt is on anticoagulants, check bleeding times.
What is Keratitis?
Inflammation of the cornea.
Keratitis Etiology;
Bacterial, viral or fungal infections or may be non-infective, due to trauma or associated w/an auto-immune dz.
Keratitis S/Sx;
Painful red eye, reducted visual aculity due to cellular infiltration, Corneal edema, Circumcorneal Injection, Photophobia.
Corneal Ulcer Etiology;
Staph, Strep, Herpes Simplex or Zoster, Adenovirus, Rubeola, Rubella, Mumps, Trachoma, Infectious Mono, Pneumococcus, Vitamin A deficiency, Broad spectrum ABX drug reaction, Trauma.
Corneal Ulcer S/Sx;
Grayish white opacities, circumcorneal injection or hypopyon.
Corneal Ulcer Procedures;
Fluorescein staining & exam under slit lamp will reveal corneal ulcers.
What causes corneal scars;
Deep; Abrasion, Laceration, & Burns
Corneal Scar Tx;
If scarring is deep enough to effect vision, corneal transplant.
What is Arcus Senilis?
A gray-white arc or circle lipid deposit around the limbus. Is benign & does not affect vision.
What is Uveitis?
Inflammation of any component of the uveal tract (iris, cillary body or choroid)
What is Retinitis?
Inflammation of the overlying retina. (can occur w/uveitis)
What is Neuritis?
Inflammation of the optic nerve. (may occur w/uveitis)
What is Anterior Uveitis?
Localized primarily to the anterior segment of the eye and includes iritis & iridocyclitis.
Anterior Uveitis S/Sx?
Pain, Redness, Photophobia, Decreased vision, Pupillary miosis, Perilimbal flush, visual acuity not impaired, haziness, accommodative tasks more difficult & uncomfortable, mild to moderate congestion of the lids, resulting in pseudpotosis, IOP in affected eye is initially decreased.
What do slit lamp findings include w/Anterior Uveitis?
"Cells & flare" in the aqueous humor. (flare is protein from inflamed iris or ciliary body which gives the aqueous a particulate or smoky appearance.
What is Secondary Uveitic glaucoma?
Inflammatory by-products accumulate in the trabeculum. This debris builds significantly & the ciliary body resumes its normal output the IOP may rise sharply.
What is Intermediate Uveitis (Peripheral Uveitis)?
It is centered in the area immediately behind the iris & lens in the region of the ciliary body & pars plana. It includes; Retinitis, Choroiditis & Optic Neuritis.
What is Diffuse Uveitis?
Implies inflammation involving all parts of the eye, including anterior, intermediate & posterior structures.
Uveitis etiology;
May be associated w/underlying systemic dz.
May occur as a result of ocular trauma.
Inflammatory reactions in adjacent tissues can induce a secondary uveitis.
Which systemic diseases can cause Uveitis?
Anklosing spondylitis, Behcet's syndrome, Inflammatory bowel dz, Juvenile TA, Reiter's syndrome, Sarcoidosis, Syphilis, TB, Lyme dz.
Which labs should be ordered to R/O systemic dz w/Uveitis?
CBC w/differential, ANA, HLA-B27, rheumatoid factor, Angiotensin-converting enzyme, Florescent treponemal antibody absorption, Rapid plasma reagin (RPR), Chest X-ray, Lyme titer, PPD.
Uveitis complications;
Profound & irreversible loss of vision (cataract), Glaucoma, Retinal detachment, Neovascularization of the retina, optic nerve or iris. Cystoid macular edema.
What is the most common cause of decreased vision from uveitis?
Cystoid macular edema.
Uveitis Tx;
Immediate referal to ophthalmologist.
1.Immobllize the iris & cillary body.
2.Quell the inflammatory response. Cyclopleging the pt w/homatropine 5% TID/QID, scopolamine 0.25% BID/QID or atropine 1%BID. Topical steroid q 2-3h. Re-eval q 1-7 days.
What is Glaucoma?
Group of disorders, Open Angle (chronic) & Closed or Narrow Angle (Acute), that is characterized by damage to the eye due to IOP.
Which form of Glaucoma is the most common?
Open Angle
Open Angle Glucoma PE;
IOP decreases blood supply to the retinal structures.
The physiologic cup enlarges to more than 1/2 of the disc.
Vessels are displaced nasally.
Open Angle Glaucoma S/Sx;
Usually bilateral. There are no early Sx, no pain, & visual impairment is not noticed until optic nerve damage is significant. (tunnel vision)
What are some causes of Cataracts?
Congenital, Uveitis, Glaucoma, Aging, Neoplasia, Steriods & Miotics, Trauma, Maternal Infection, Chromosomal abnormalities, Hereditary disorders, Metabolic disorders, Cigarette smoking, & heavy ETOH use.
What are Moitics?
Makes pupil smaller
Constricts Pupil
What are Mydriatics?
Makes pupil stay open
Dilates Pupil
Which is the most common kind of cataract?
Nuclear Cataract
Nuclear Cataract Etiology;
Aging p 40, Opacity is in the central lens nucleus (the pit), develops slowly, can induce myopia in the presbyopic pt., Temporary improvement in sight may occur (this disappears as the cataract evolves).
How do Nuclear Cataracts present?
As an opaque gray area surrounded by a black background.
Cortical Cartact (Star Shaped Opacity) PE;
Forms in the outer cortex of lens, progressing faster than nuclear cataract, begins as wedge-shaped spokes, spokes extend from the outside of the lens to the center.
How do Nuclear Cataracts present (opthalmascope)?
May appear as a black center against the red reflex.
A large nuclear cataract will obliterate the red reflex.
Cortical Cartact (Star Shaped Opacity) PE (opthalmascope);
"Black spokes" are visible against the red reflex.
What is a major risk factor for a Cortical Cartact (Star Shaped Opacity)?
Does a Cortical Cartact (Star Shaped Opacity) affect vision?
Yes, May impair distant & near vision significantly, requiring surgery at an early stage.
Subcapsular Cataract Etiology;
Develops slowly as a small opacity under the capsule, usually in the lens posterior region.
Does the Subcapsular Cataract impair vision?
Impairment may not occur until cataract is well developed. Vision is affected because the opacity is located at the crossing point of the light rays from the viewed object.
Subcapsular Cataract S/Sx;
Glare & Blur
Risk factors for Subcapsular Cataract;
Severely myopic pts
Adults w/retinitis pigmentosa
Steroid use
What is a Morgagnian Cataract?
This cataract has been allowed to mature to where the lens cortex has become liquefied.
Can a Morgagnian Cataract be removed?
It must be removed because the lenses tend to leak & can produce phacoanaphylaxis, whish causes blindness.
Is a Morgagnian Cataract difficult to remove?
Yes, because the capsule is friable & splits easily. The nucleus is very hard & is no longer trapped by the cortex.
Morgagnian Cataract PE;
The lens nucleus is seen as the brownish discoloration near the capsule bottom.
Morgagnian Cataract S/Sx;
Vision problems depending on the progression, Sensitivity to light & glare, Increased nearsightness, & Blurred vision.
What is a Cataracts?
Clouding of the natural lens. Leading cause of visual loss among adults >55.
Cataracts Patho;
The lens is responsible for focusing light & producing images, is contained in a capsule as old cells die they become trapped within the capsule. Overtime the cells accumulate causing the lens to cloud.
Name some causes of Cataracts;
Eye injuries
Cataracts D/Dx;
Corneal Scarring
Cataracts Tx;
Referral for excision & lens implantation. Visual acuity improves in 95% of cases.
Arcus Senilis Etiology;
A common bilateral peripheral corneal condition. (can be related to hyperlipidemia)Found in 60% of people 40-60yrs (more common in blacks)
Arcus Senilis Patho;
The opacity is due to deposits of lipid droplets in the superficial & deep layers of the cornea. These deposits form the characteristic yelowish-white ring.
What is secondary glaucoma?
Glaucoma secondary to an intraocular disorder. Usually anterior uveitis or; Intraocular tumor, Enlarged cataracts, Central retinal vein occlusion, trauma, surgery, Intraocular hemorrhage, prolonged corticosteroid therapy.
Secondary glaucoma due to Steroid therapy?
Especially topical, (Steroid responders particularly sensitive) Can occur after 1 week of tx but typically 6 to 8th week, usually subsides by withdrawing steroids.
Secondary glaucoma tx;
Referral to ophthalmologist.
Chronic Open Angle Glaucoma Eitology;
Gradual rise in IOP, Insidious loss of peripheral vision, eventual blindness if uncontrolled.
Chronic Open Angle Glaucoma PE;
Anterior chamber structures apperar normal, imbalance between production & outflow obstruction, outflow impedance is mainly responsible, Vasomotor & emotional instability are contributors. Rarely unilateral.
Chronic Open Angle Glaucoma Risks;
DM, Myopia, Family hx, Pigment dispersion syndrome (Krukenberg's spindle),Blacks 4-5 times higher risk compared to whites.
Chronic Open Angle Glaucoma S/Sx;
>35yrs, frequent changes in eye glasses Rx, Mild H/A, Vague visual disturbances, Halos around electric lights, impaired darkness adapation.
Chronic Open Angle Glaucoma PE;
Single isolated normal pressure doesn't R/O glaucoma. Pressure rise in early glaucoma may be intermittent. Cupping of the optic disk is characteristic. Changes are insidious, a normal appearing disk doesn't R/O glaucoma.
Chronic Open Angle Glaucoma Early visual signs;
Early visual field changes may be subtle, a small scotoma above or below fixation, subtle nasal peripheral field defects, external eye appears normal.
Chronic Open Angle Glaucoma Tx;
Pilocarpine 0.5%
Timolol maleate
Chronic Open Angle Glaucoma Tx Complications;
Tx w/powerful miotics may cause cataracts or retinal detachmant. Avoid; Fatigue, Emotional upset, & Nicotine. Monitor intake of fluids.
Chronic Open Angle Glaucoma F/U;
Semi-annual tonometry
Laser trabeculoplasty
What is acute Angle-Closure Glaucoma?
Sudden attack of increased intraocular pressure. S/Sx caused by acute obstruction of the aqueous drainage of the eye.
What is acute Angle-Closure Glaucoma S/Sx?
Usually unilateral, Severe pain, Hazy, Steamy Cornea, w/severe pain. Loss of vision.
Angle-Closure Glaucoma Prodrome-transitory episodes S/Sx;
Diminished visual acuity, colored halos around lights, pain in the eye &/or head, pupil dilated & sluggish, Shallow anterior chamber, may last several hours.
What is acute Angle-Closure Glaucoma Acute attack S/Sx?
Hazy, Steamy Cornea, Rapid loss of sight, Severe throbbing pain in the eye, 5th cranial (trigeminal) distribution, Nausea & vomiting, Upper lid edema, Lacrimation, circumcorneal injection, Chemosis, Fixed Dialated pupil.
What is acute Angle-Closure Glaucoma Tx?
Oral glycerin 1-2gm/kg mixed 1:1 w/H2O (aborts attack & rapidly lowers IOP).
Oral carbonic anhydrase Inhibitors (Acetazolamide 500mg)
Topical miotics (Pilocarpine 4%q 15min.
Immediate Referral!!!
What is Glaucomatocyclitic crisis (Posner-Schlossman syndrome)?
Recurrent monocular rise in pressure, Simulates acute angle-closure.
How is Glaucomatocyclitic crisis (Posner-Schlossman syndrome) differentiated from Acute Angle-Closure Glaucoma?
Normal anterior chamber depth, Keratic, precipitates, other signs of uveitis.
Glaucomatocyclitic crisis (Posner-Schlossman syndrome) Tx;
Responds to topical steroids & carbonic anhydrase inhibitors. (Surgery is usually contrindicated)
What happens in Absolute Glaucoma's final stage?
Blindness from atrophy of retinal nerve head, Pupil dilated & fixed, Iris atrophied, Optic disk deeply excavated, No pain, the eyeball subsequently degenerates.
Retinal Artery Occlusion Exam;
Small occlusion-Flame shaped hemorrhage, "Cotton wool" spot.
Large occlusion-"Cherry red spot" in area of macula.
Retinal Artery Occlusion Tx;
Intermittent digital pressure to globe to dislodge embolus. Increase pCO2 to dilate artery. Urgent ophthamological consult.
Retinal Artery Occlusion S/Sx;
Sudden Monocular visual loss
May have several 'attacks' of blindness before final event.
Causes of Retinal Artery Occlusion;
Causes of Retinal Vein Occulsion;
Retinal Vein Occulsion S/Sx;
Monocular visual loss
Vision decreases over hours
Retinal Vein Occulsion Exam;
"blood-&-thunder' optic fundus
Massive hemorrhage covers retinal surgace & dilated veins.
Retinal Vein Occulsion Tx;
No immediate tx, Deficits are ofter reversible.
Look for underlying cause; HTN, Glaucoma, DM
Retinal Vein Occulsion Referral;
Pts need continous f/u w/ophthalmologist, Neovascularizaion of the retinal or iris probable, vitrectomy a surgical option.
Waht is Retinal Detachment?
Separation of the neurosensory layer from the underlying pigmented epithelium.
Retinal Detachment S/Sx;
Visual loss
Cloudy vision
Flashes of light
"Black curtain" across their vision.
Retinal Detachment Risk Factors;
Aging, Myopia, Eye surgery, Inflammation, Trauma, Prior Retinal Detachment, Family Hx of Retinal Detachment, DM w/retinal hemorrhages.
Retinal Detachment Exam;
Retina appears gray or opaque.
Arterioles & venules appear dark.
Floater may be visualized.
Retinal Detachment Tx;
Emergent referral for surgical correction (laser welding)
What is the most common cause of blindness in middle adulthood?
Diabetic Retinopathy