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186 Cards in this Set

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The outer supporting layer of the "wall of the eye"
Sclera
continuous anteriorly with the cornea
sclera
continuous posteriorly with the cranial dural sheath
sclera
sheath surrounding optic nerve
cranial dural sheath
middle vascular layer of the "wall of the eye"
Choroid
neuronal layer of the wall of the eye
retina
folds of skin protecting the eye:
AKA
palpebrae
eyelids
opening between eyelids
palpebral fissure
the angle at the corners of the eye
canthus
(Lateral and medial for each eye)
plate of connective tissure giving eyelids their shape
tarsus
"sweat glands of the eye"
Meibomian glands
Meibomian ducts open onto where
margins of eyelid
What type of glands are the Meibomian glands
modified sebaceous
Secretions of the meibomian glands enable what
airtight closure of the lids
prevents evaporation of tears
what type of muscle are the muscles of the eye
striated
Which muscle raises the upper lid
Which nerve innervates it
levator palpebrae superioris
CN III
Which muscle closes the eyelid
Which nerve innervates it
obicularis oculi
CN VII
what is the term for drooping of the eye?
What causes it?
Ptosis
weakness of levator palpebrae superioris
Weakness of the obicularis oculi causes what
inability to completely close eyelids
Damage to what three locations can cause eyelid weakness
cranial nerves
central nuclei in midbrain
caudal pons
corneal irritation caused by the eyelashes curling inward would be called
entropion
eversion of the eyelid is known as..
is it normally bilateral or unilateral
ectropion
bilateral
what may cause extropion
relaxation of obicularis oculi due to CN VII damage or aging
What is blepharitis
inflamation of the eyelid skin and associated glands
What are the two types of anterior blepharitis
what is each associated with
seborrheic- scaley rash
Staphylococcal (S. epi or S. aureus) - ulcerative lesions
ulcerative lesions that grow a staphylococcal bacteria when cultured are associated with
Staphylococcal anterior blepharitis
Treatment of Anterior blepharitis may include
careful cleaning w/ to remove scales, possibly antibacterial ointment if staph
Symptoms of anterior blepharitis include
irritation, burning, redness, and itching of the EYELID MARGINS
If inflammation of the eye involves the meibomian glands it is considered what
posterior blepharitis
what often occurs with posterior blepharitis
mild entropion
frothy/greasy tears
what is the treament for posterior blepharitis
warm compress
antibiotic ointments (Tetracyclines or erythromycin)
What is the main difference between anterior and posterior blepharitis
the involvement of the meibomian glands (posterior)
What is the technical name for a stye
hordelolum
infection of the sebaceous glands is to ____ as infection of the meibomian glands is to _____
hordeolum
posterior blepharitis
T/F
A hordeolum will be seen on the external side of the eyelid
False, can be internal or external
TX of hordeloum includes
Antibiotic ointments (Bacitracin, erythromycin, quinilones), a warm compress, and possibly incision
a GRANULOUS inflammation of the meibomian gland is known as a
chalazion
Chalazions may follow what
internal hordeolum
decribe the nodule associated with chalazion
small and non-tender
what may occur with a large chalazion
distortion of vision due to pressure on the eyeball
what are the parts of the lacrimal system (3)
what does each do
lacrimal gland-produces tears
puncta/tear sac- collect tears
nasolacrimal duct-empties tears into nasal cavity
what makes up tears
Water (98), NaCl (1.5)
K+, glucose, albumin, Ig (A, E, G)
list the functions of tears
abolish surface irregularities (smooth)
wet and protect
Flush irritants and microorganisms
provide cornea with nutrients
what secretes the superficial layer of the tear film
what is its role
meibomian glands

slows evaporation
what secretes the aqueous layer of the tear film
lacrimal glands
what layer of the tear film wets the surface of the hydrophobic cell membranes
mucinous layer
What is the technical term for dry eyes
keratoconjunctivitis sicca
What population is Sjogren's syndrome seen in the most
menopausal women
dryness of the mucous membranes include the mouth and eyes is known as
Sjogrens Syndrome
What are some causes of Keratoconjunctivitis sicca
aging, infection, certain meds
congintial defects, irradiation associated with cancers of the head and neck
What medications may cause keratoconjuntivitis sicca
antihistamines and anticholinergics
Purpuric spots, telangiectases, and bilateral parotid enlargement are associated with
Sjogrens syndrome
T/F
A dx of sjogrens syndrome is bad
TX =
False, it is usually benign

artificial tears, sipping water, sugar free gum, and good oral hygiene
Elderly pt presents with unilateral infection of the lacrimal sac. Culture positive for B-hemolytic strep.
dx ? and most often caused by what
Acute dacryocystitis
infection often secondary to an obstruction of the the lacrimal system
acute dacryocystitis often accompanies what
upper respiratory infections and sinus issues
what is the conjuctiva
the mucous membrane that lines the posterior side of the palpebrae and tha anterior surface of the optic globe
the conjuctiva covering the sclera is known as
the bulbar conjunctiva
the function of the bulbar conjunctiva is
keep eye moist with it's lubricating mucous
what is red/pink eye
what is the technical term for it
inflammation of the conjuntiva
conjunctivitis
List the types of conjunctivits (5)
allergic, bacterial, viral
chlamydial, opthalmia neonatorum
what is opthalmia neonatorum
conjunctivitis obtain during passage through the birth canal
symptoms that may be associated with any form of conjuctivitis are
red eyes (injection), discharge, senstation of foreign body, eyelid crusting/sticking
Is visual acuity affected with conjuctivits
no, the eye will function normally
pupillary reflex is also ok
to determine that allergies are the cause of conjuctivitis you would look for what specifically
itching as the dominant symptom
Hx of allergies
no preauricular adenopathy
Is allergic conjuntivits bi or uni lateral
bilateral because it is mediated by IgE which will be distributed to both eyes
what can help you distinguish acute bacterial conjuctivitis from hyperacute
hyperacute will have adenopathy associated with it
what is the most common cause of hyperacute conjunctivits
Neisseria gonorrhoae
what is the risk of leaving hyperacute bacterial conjunctivitis untreated
corneal ulceration leading to perforation and a possible loss of vision
rapid onset of a severe yellow green discharge, chemosis, preauricular adenopathy with a hx of std is indicative of what
hyperacute bacterial conjunctivitis
conjuctival edema is aka
chemosis
Tx for hyperacute bacterial conjuctivits
opthalmic emergency ( to avoid perforation), 5 days of rosefan + topical antibiotic, treat std also
Pts presents with mild purulent discharge, conjuctival chemosis, and complains of eyelids being matted shut when they wake up
acute bacterial conjuctivitis
if pt wears contact lenses they are at risk for what
pseudomonal keratitis
what are the most common agents of bacterial conjunctivitis
Strep. pneumoniae, Staph aureus, Haemophilus influenza
what is a major concern in treatment of bacterial conjunctivitis
that it is very contagious
what are the common agents of viral conjunctivitis
adenoviruses, herpesviruses, and enteroviruses
pt presents with URI, watery mucous discharge, conjuctiva of the inferior palpebral follicles, and preauricular adenopathy
dx?
viral conjunctivitis
conjunctivitis associated with military recruits and other large, close groups
adenovirus viral conj. type 4&7
contamination of opthalmis products and equipment may lead to what
adenovirus viral conjuc.type 8
7yr old pt presents with conjuctivitis, fever, and pharyngitis
what type of conjuctivitis
adenovirus viral conjunctivitis type 3
Pts presents w/ hx of burning and discharge in L eye with slight photophobia. L preauricular node is palpable. You believe dx to be Herpes virus conjunctivitis. What role would flouracine play in the diagnosis
it would show discrete epithelial lesions on the cornea
Would you use topical steriods for herpes conjunctivitis
no, refer to opthalmologist
conjunctivitis contracted from swimming in unchlorinated pools
chlamydial conjunctivits
type of conjunctivitis the is widespread in developing countries, a major cause of blindness worldwide and may be transmitted by throwing poo
chlamydial conjuctivitis
Tx of chlamydial conjunctivitis
single dose azithromycin
eye infections occuring in pts under 1 month, often contracted during birth
opthalmia neonatorum
if opthalmia neomatorum symptoms appear 7 hrs after birth but disappear spontaneously w/n 2 days you should suspect what type
chemical (probably silver nitrate)
This is pathognomonic of herpetic keratoconjunctvitis
dendritic keratitis
The typical appearance of gonorrheal opthalmia neonatorum is 2-5 days. It may appear earlier if what has occured
premature rupture of membranes
presence of translucent white nodule located centrally in an inflammed area on the outer layer of the sclera, most often unilateral
episcleritis
typical length of episcleritic episode and resolution
2-3 weeks, usually resolves spontaneously
topical steroids for discomfort
Pt presents with severe, boring ocular pain, dilated scleral vessels and has hx of systemic disease
scleritis
how do yu distinguish scleritis from episcleritis
pain in scleritis is more severe and injected vessels are dilated
random tidbit concerning scleritis and visine
visine won't clear up scleritis
transparent layer of eye covering iris, pupil, and anterior chamber. Responsible for most of refraction and focus
cornea
dull, uneven, and hazy cornea
corneal edema
what are the layers of the cornea
Bowman's membrane (outer)
stroma
descemet (pumps fluid out of stroma)
blowing sand, extended contact lens wear, foreign bodies, and injury all amy cause
corneal abrasion
pt presents w/ eye pain, photophobia, and sensation of foreign body. Physical exam shows conjunctival injection, but normal visual acuity. What do you expect flourescein staining to show?
corneal abrasion
when should you chack visual acuity
at the beginning of exam for any ocular complaint
should you patch the injured eye in corneal abrasion
No
inflammation of the cornea is known as
keratitis
list the types of keratitis and how to distinguish the two
nonulcerative-epithelium remains intact
ulcerative-parts of epithelium and stroma are destroyed
what are the causes of non-ulcerative keratitis
syphilis, tuberculosis, lupus
causes of ulcerative keratitis
any bacteria that can cause conjunctivitis, trauma, extended contact wear, acanthamoeba, viruses
pain, redness, and photsensitivity of the eyes in soft contact wearer using homemade saline solution
acanthamoeba
most common cause of ulcerative keratitis in the US
Herpes simplex keratitis
think dendritic keratitis
which Herpes simplex is responsible for the most keratitis?
Simplex 1
which herpes simplex is most likely to cause neonatalHSV keratitis
Simplex 2
pt presents w/ fever, headache, burning/itching of the eyes, keratitis, conjunctivitis, a rash that becomes pustular and involves the tip of the nose
varicella zoster opthalmicus
corneal deposit associated with greenish copper ring
Kayser-Fleischer ring
corneal deopsit associated wth grayish white ring and hyperlipidemia
Arcus Senilis
what is the main problem with corneal transplantation
formation of scar tissue
why is tissue rejection not much of an inssue in corneal transplantation
cornea is not exposed to vascular system thus immune defenses
what is the most common source for corneal transplantation
cadavers
presence of blood in the anterior chamber often due to concussive injury
hyphema
(blood pooling leveled infront of iris)
Hyphema with IOP >27 mmHg should be treated how
pain?
betablocker

acetaminophen NOT Aspirin
Pt living in arizona presents w/ yellowish, slightly raised deposit of collagen on conjunctiva
pinguecula
pinguecula that spreads into the cornea
pterygium
do you surgically excise a pterygium
only if vision is impaired
Diabetic pt presents w/ flu like symptoms and ruptured blood vessels under the conjunctiva. What is the most likely cause of the subconjunctival hemorrhages and how do you treat
probably coughing or vomiting
treatment is not necessary it will resolve itself
layer including choroid, ciliary body, and iris
uveal tract
dark brown vascular layer that prevents scattering of light and improves visual acuity
choroid
ring of tissue encircling lens, contributes to production of aqueous humor
ciliary body
adjustable diaphragm that permits changes in pupil size, responsible for eye color
iris
Three types of inflammation of the uveal tract
anterior uvcitis
intermediate uvcitis
posterior uvcitis
what is the most common type of uvcitis and what structure does it involve
anterior
involves iris and ciliary body
inflammation of the choroid and retina
posterior uvcitis
pt presents w/ deep eye pain, photophobia, decerased visual acuity, and a smaller pupil with posterior synechiae (scarring bodies)
anterior uvcitis
parasympathetic system causes what changes in the pupil
constriction/ miosis
sympathetic activation causes what changes in the pupil
dilation/mydriasis
area of brain responsible for pupillary reflex
pretectum of midbrain
constriction of the contralateral pupil is known as
consensual papillary light reflex
does a cortically blind person have consensual light reflexes
yes, direct
if you see very constricted pupils, but they still respond to light stimulus what should you suspect instead of opiates or miotics
damage to forbrain (thalamus and hypothalamus
lesions where may lead to permanent pupilary constriction
c-spine or ascending ganglionic sympathetic chain
what could cause permanent pupilary dilation
damage to CN III
pupilary constriction
miosis
pupilary dilation
mydriasis
how might asystole correlate to dilated pupils
the use of atropine is known to cause dilation
what is aniscoria
unequal pupils that react normally
sympathetic palsy resulting in ptosis, miosis, and anhydrosis
Horner syndrome
What are the signs of Horner's syndrome
ptosis, miosis, and anhydrosis
signs of Argyll Robertson
miosis, irregularly shaped pupils, loss of both direct and consensual pupillary reflex
how might you distinguish Argyll Roberts from Horner syndrome
Argyll is associated with irregularly shaped pupils
what is a possible cause of Horner syndrome
Cancers involving sympathetic tract, possibly lung
a failure to regulate interocular pressure may be due to a defect of what epithelium
where is it located
ciliary epithelium located in posterior chamber
what produces aqueous humor
ciliary epithelium
order the flow of aqueous humor
using pupil, ciliary epithelium, trabecular network, anterior chamber, canal of Schlemm, anterior surface of lens, iridocorneal angle
ciliary epithelium
anterior surface of lens
through pupil
anterior chamber
iridocorneal angle
trabecular network
canal of Schlemm
normal IOP
9-21 mmHg
optic neuropathy characterized by optic disk cupping and visual field loss
glaucoma
abnormalities in aqueous balance may lead to what
glaucoma
what are the two classifications of glaucoma
open angle and angle-closure
pressure induced degenrative changes are associated with what
glaucoma
what type of glaucoma is associated with occlusion of the anterior chambor by the iris
angle-closure glaucoma
who is predisposed for angle closure glaucoma
older, farsighted people with pre-existing narrow anterior chambers
high IOP, steamy cornea, ocular pain, blurred vision, halos around light, and shallow anterior chamber are indicative of what
acute angle closure glaucoma
dull ache in one eye accompanied by blurred vision enlarged pupil, shallow chamber, but normal IOP is indicative of what
subacute angle closure glaucoma
increased cup-disk ratio, gradula loss of peripheral vision, pathological cupping w/ persistent elevated IOP
chronic angle closure glaucoma
describe a person with the highest risk factors for glaucoma
elderly asian female with cataracts using antidepressants
most common form of glaucoma
open angle
how can you distinguish open from closed angle glaucoma
presence of pain tends to accompany angle closure glaucoma
the major risk factor for open angle glaucoma
elevated IOP
when do you expect central vision loss with glaucoma
late in the disease
Desribe someone at high risk for open angle glaucoma
Elderly AA with diabetes, myopia, prolonged use of corticosteriods and family hx of glaucoma
what is refraction and where does it begin
change in direction of light rays
begins at convex corneal surface
list the locations where refraction occurs
anterior to posterior corneal surface, posterior corneal surface to aqueous humor, aq humor to anterior lens surface, ant lens to post lens, post lens to vitreous humor
changes in the shape of the lens to adjust focus
accomodation
how does accomodation change as we age
decreases
farsightedness =
corrected by what shape lens
hyperopia
bi convex
nearsightedness =
corrected by what shape lens
myopia
biconcave
nonuniform curvature of refractive medium
astigmatism
what is astigmatism most often the result of
defect in cornea
three things accomodation requires
convergence, pupillary constriction, thickening of lens (through contraction)
what pupillary shape helps myopia
hyperopia
constriction
dilation
paralysis of pupillary muscle with loss of accomodation
cyclopegia
changes in vision due to aging are known as
presbyopia
how does the lens change with age
it thickens and fibers become less elastic
what is a cataract
opacity of the lens that interferes with transmission of light to retina
over 90% of cataracts are due to what
aging
elderly pt complaining of blurred vision and ghosting. Also says glare makes driving at night hard and says she has been falling down more often
cataracts
What drugs may increase the risk for cataracts
amiodarone and corticosteroids
what is the treatment for cataracts
surgery
what are some risk factors for cataracts
age, genetics, uv light, heavy smoking, certain drugs, and injury
How can you distinguish the red eye of conjunctivitis from corneal lesions or acute glaucoma
conjunctivitis injects peripheral vessels and mild pain, the others inject around the limbus and severe pain
pt presents with bilateral itching of eyes with injection
allergic conjuntivitis