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186 Cards in this Set
- Front
- Back
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The outer supporting layer of the "wall of the eye"
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Sclera
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continuous anteriorly with the cornea
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sclera
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continuous posteriorly with the cranial dural sheath
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sclera
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sheath surrounding optic nerve
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cranial dural sheath
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middle vascular layer of the "wall of the eye"
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Choroid
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neuronal layer of the wall of the eye
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retina
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folds of skin protecting the eye:
AKA |
palpebrae
eyelids |
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opening between eyelids
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palpebral fissure
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the angle at the corners of the eye
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canthus
(Lateral and medial for each eye) |
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plate of connective tissure giving eyelids their shape
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tarsus
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"sweat glands of the eye"
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Meibomian glands
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Meibomian ducts open onto where
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margins of eyelid
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What type of glands are the Meibomian glands
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modified sebaceous
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Secretions of the meibomian glands enable what
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airtight closure of the lids
prevents evaporation of tears |
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what type of muscle are the muscles of the eye
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striated
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Which muscle raises the upper lid
Which nerve innervates it |
levator palpebrae superioris
CN III |
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Which muscle closes the eyelid
Which nerve innervates it |
obicularis oculi
CN VII |
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what is the term for drooping of the eye?
What causes it? |
Ptosis
weakness of levator palpebrae superioris |
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Weakness of the obicularis oculi causes what
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inability to completely close eyelids
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Damage to what three locations can cause eyelid weakness
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cranial nerves
central nuclei in midbrain caudal pons |
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corneal irritation caused by the eyelashes curling inward would be called
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entropion
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eversion of the eyelid is known as..
is it normally bilateral or unilateral |
ectropion
bilateral |
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what may cause extropion
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relaxation of obicularis oculi due to CN VII damage or aging
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What is blepharitis
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inflamation of the eyelid skin and associated glands
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What are the two types of anterior blepharitis
what is each associated with |
seborrheic- scaley rash
Staphylococcal (S. epi or S. aureus) - ulcerative lesions |
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ulcerative lesions that grow a staphylococcal bacteria when cultured are associated with
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Staphylococcal anterior blepharitis
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Treatment of Anterior blepharitis may include
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careful cleaning w/ to remove scales, possibly antibacterial ointment if staph
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Symptoms of anterior blepharitis include
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irritation, burning, redness, and itching of the EYELID MARGINS
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If inflammation of the eye involves the meibomian glands it is considered what
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posterior blepharitis
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what often occurs with posterior blepharitis
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mild entropion
frothy/greasy tears |
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what is the treament for posterior blepharitis
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warm compress
antibiotic ointments (Tetracyclines or erythromycin) |
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What is the main difference between anterior and posterior blepharitis
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the involvement of the meibomian glands (posterior)
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What is the technical name for a stye
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hordelolum
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infection of the sebaceous glands is to ____ as infection of the meibomian glands is to _____
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hordeolum
posterior blepharitis |
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T/F
A hordeolum will be seen on the external side of the eyelid |
False, can be internal or external
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TX of hordeloum includes
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Antibiotic ointments (Bacitracin, erythromycin, quinilones), a warm compress, and possibly incision
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a GRANULOUS inflammation of the meibomian gland is known as a
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chalazion
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Chalazions may follow what
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internal hordeolum
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decribe the nodule associated with chalazion
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small and non-tender
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what may occur with a large chalazion
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distortion of vision due to pressure on the eyeball
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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 |
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what makes up tears
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Water (98), NaCl (1.5)
K+, glucose, albumin, Ig (A, E, G) |
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list the functions of tears
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abolish surface irregularities (smooth)
wet and protect Flush irritants and microorganisms provide cornea with nutrients |
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what secretes the superficial layer of the tear film
what is its role |
meibomian glands
slows evaporation |
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what secretes the aqueous layer of the tear film
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lacrimal glands
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what layer of the tear film wets the surface of the hydrophobic cell membranes
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mucinous layer
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What is the technical term for dry eyes
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keratoconjunctivitis sicca
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What population is Sjogren's syndrome seen in the most
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menopausal women
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dryness of the mucous membranes include the mouth and eyes is known as
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Sjogrens Syndrome
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What are some causes of Keratoconjunctivitis sicca
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aging, infection, certain meds
congintial defects, irradiation associated with cancers of the head and neck |
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What medications may cause keratoconjuntivitis sicca
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antihistamines and anticholinergics
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Purpuric spots, telangiectases, and bilateral parotid enlargement are associated with
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Sjogrens syndrome
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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 |
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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 |
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acute dacryocystitis often accompanies what
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upper respiratory infections and sinus issues
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what is the conjuctiva
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the mucous membrane that lines the posterior side of the palpebrae and tha anterior surface of the optic globe
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the conjuctiva covering the sclera is known as
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the bulbar conjunctiva
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the function of the bulbar conjunctiva is
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keep eye moist with it's lubricating mucous
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what is red/pink eye
what is the technical term for it |
inflammation of the conjuntiva
conjunctivitis |
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List the types of conjunctivits (5)
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allergic, bacterial, viral
chlamydial, opthalmia neonatorum |
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what is opthalmia neonatorum
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conjunctivitis obtain during passage through the birth canal
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symptoms that may be associated with any form of conjuctivitis are
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red eyes (injection), discharge, senstation of foreign body, eyelid crusting/sticking
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Is visual acuity affected with conjuctivits
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no, the eye will function normally
pupillary reflex is also ok |
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to determine that allergies are the cause of conjuctivitis you would look for what specifically
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itching as the dominant symptom
Hx of allergies no preauricular adenopathy |
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Is allergic conjuntivits bi or uni lateral
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bilateral because it is mediated by IgE which will be distributed to both eyes
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what can help you distinguish acute bacterial conjuctivitis from hyperacute
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hyperacute will have adenopathy associated with it
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what is the most common cause of hyperacute conjunctivits
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Neisseria gonorrhoae
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what is the risk of leaving hyperacute bacterial conjunctivitis untreated
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corneal ulceration leading to perforation and a possible loss of vision
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rapid onset of a severe yellow green discharge, chemosis, preauricular adenopathy with a hx of std is indicative of what
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hyperacute bacterial conjunctivitis
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conjuctival edema is aka
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chemosis
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Tx for hyperacute bacterial conjuctivits
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opthalmic emergency ( to avoid perforation), 5 days of rosefan + topical antibiotic, treat std also
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Pts presents with mild purulent discharge, conjuctival chemosis, and complains of eyelids being matted shut when they wake up
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acute bacterial conjuctivitis
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if pt wears contact lenses they are at risk for what
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pseudomonal keratitis
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what are the most common agents of bacterial conjunctivitis
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Strep. pneumoniae, Staph aureus, Haemophilus influenza
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what is a major concern in treatment of bacterial conjunctivitis
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that it is very contagious
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what are the common agents of viral conjunctivitis
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adenoviruses, herpesviruses, and enteroviruses
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pt presents with URI, watery mucous discharge, conjuctiva of the inferior palpebral follicles, and preauricular adenopathy
dx? |
viral conjunctivitis
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conjunctivitis associated with military recruits and other large, close groups
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adenovirus viral conj. type 4&7
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contamination of opthalmis products and equipment may lead to what
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adenovirus viral conjuc.type 8
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7yr old pt presents with conjuctivitis, fever, and pharyngitis
what type of conjuctivitis |
adenovirus viral conjunctivitis type 3
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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
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it would show discrete epithelial lesions on the cornea
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Would you use topical steriods for herpes conjunctivitis
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no, refer to opthalmologist
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conjunctivitis contracted from swimming in unchlorinated pools
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chlamydial conjunctivits
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type of conjunctivitis the is widespread in developing countries, a major cause of blindness worldwide and may be transmitted by throwing poo
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chlamydial conjuctivitis
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Tx of chlamydial conjunctivitis
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single dose azithromycin
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eye infections occuring in pts under 1 month, often contracted during birth
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opthalmia neonatorum
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if opthalmia neomatorum symptoms appear 7 hrs after birth but disappear spontaneously w/n 2 days you should suspect what type
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chemical (probably silver nitrate)
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This is pathognomonic of herpetic keratoconjunctvitis
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dendritic keratitis
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The typical appearance of gonorrheal opthalmia neonatorum is 2-5 days. It may appear earlier if what has occured
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premature rupture of membranes
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presence of translucent white nodule located centrally in an inflammed area on the outer layer of the sclera, most often unilateral
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episcleritis
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typical length of episcleritic episode and resolution
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2-3 weeks, usually resolves spontaneously
topical steroids for discomfort |
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Pt presents with severe, boring ocular pain, dilated scleral vessels and has hx of systemic disease
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scleritis
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how do yu distinguish scleritis from episcleritis
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pain in scleritis is more severe and injected vessels are dilated
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random tidbit concerning scleritis and visine
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visine won't clear up scleritis
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transparent layer of eye covering iris, pupil, and anterior chamber. Responsible for most of refraction and focus
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cornea
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dull, uneven, and hazy cornea
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corneal edema
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what are the layers of the cornea
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Bowman's membrane (outer)
stroma descemet (pumps fluid out of stroma) |
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blowing sand, extended contact lens wear, foreign bodies, and injury all amy cause
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corneal abrasion
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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?
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corneal abrasion
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when should you chack visual acuity
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at the beginning of exam for any ocular complaint
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should you patch the injured eye in corneal abrasion
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No
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inflammation of the cornea is known as
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keratitis
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list the types of keratitis and how to distinguish the two
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nonulcerative-epithelium remains intact
ulcerative-parts of epithelium and stroma are destroyed |
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what are the causes of non-ulcerative keratitis
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syphilis, tuberculosis, lupus
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causes of ulcerative keratitis
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any bacteria that can cause conjunctivitis, trauma, extended contact wear, acanthamoeba, viruses
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pain, redness, and photsensitivity of the eyes in soft contact wearer using homemade saline solution
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acanthamoeba
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most common cause of ulcerative keratitis in the US
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Herpes simplex keratitis
think dendritic keratitis |
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which Herpes simplex is responsible for the most keratitis?
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Simplex 1
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which herpes simplex is most likely to cause neonatalHSV keratitis
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Simplex 2
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pt presents w/ fever, headache, burning/itching of the eyes, keratitis, conjunctivitis, a rash that becomes pustular and involves the tip of the nose
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varicella zoster opthalmicus
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corneal deposit associated with greenish copper ring
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Kayser-Fleischer ring
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corneal deopsit associated wth grayish white ring and hyperlipidemia
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Arcus Senilis
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what is the main problem with corneal transplantation
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formation of scar tissue
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why is tissue rejection not much of an inssue in corneal transplantation
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cornea is not exposed to vascular system thus immune defenses
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what is the most common source for corneal transplantation
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cadavers
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presence of blood in the anterior chamber often due to concussive injury
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hyphema
(blood pooling leveled infront of iris) |
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Hyphema with IOP >27 mmHg should be treated how
pain? |
betablocker
acetaminophen NOT Aspirin |
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Pt living in arizona presents w/ yellowish, slightly raised deposit of collagen on conjunctiva
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pinguecula
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pinguecula that spreads into the cornea
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pterygium
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do you surgically excise a pterygium
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only if vision is impaired
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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
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probably coughing or vomiting
treatment is not necessary it will resolve itself |
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layer including choroid, ciliary body, and iris
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uveal tract
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dark brown vascular layer that prevents scattering of light and improves visual acuity
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choroid
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ring of tissue encircling lens, contributes to production of aqueous humor
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ciliary body
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adjustable diaphragm that permits changes in pupil size, responsible for eye color
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iris
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Three types of inflammation of the uveal tract
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anterior uvcitis
intermediate uvcitis posterior uvcitis |
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what is the most common type of uvcitis and what structure does it involve
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anterior
involves iris and ciliary body |
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inflammation of the choroid and retina
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posterior uvcitis
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pt presents w/ deep eye pain, photophobia, decerased visual acuity, and a smaller pupil with posterior synechiae (scarring bodies)
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anterior uvcitis
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parasympathetic system causes what changes in the pupil
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constriction/ miosis
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sympathetic activation causes what changes in the pupil
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dilation/mydriasis
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area of brain responsible for pupillary reflex
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pretectum of midbrain
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constriction of the contralateral pupil is known as
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consensual papillary light reflex
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does a cortically blind person have consensual light reflexes
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yes, direct
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if you see very constricted pupils, but they still respond to light stimulus what should you suspect instead of opiates or miotics
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damage to forbrain (thalamus and hypothalamus
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lesions where may lead to permanent pupilary constriction
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c-spine or ascending ganglionic sympathetic chain
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what could cause permanent pupilary dilation
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damage to CN III
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pupilary constriction
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miosis
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pupilary dilation
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mydriasis
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how might asystole correlate to dilated pupils
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the use of atropine is known to cause dilation
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what is aniscoria
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unequal pupils that react normally
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sympathetic palsy resulting in ptosis, miosis, and anhydrosis
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Horner syndrome
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What are the signs of Horner's syndrome
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ptosis, miosis, and anhydrosis
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signs of Argyll Robertson
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miosis, irregularly shaped pupils, loss of both direct and consensual pupillary reflex
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how might you distinguish Argyll Roberts from Horner syndrome
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Argyll is associated with irregularly shaped pupils
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what is a possible cause of Horner syndrome
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Cancers involving sympathetic tract, possibly lung
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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
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what produces aqueous humor
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ciliary epithelium
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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 |
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normal IOP
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9-21 mmHg
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optic neuropathy characterized by optic disk cupping and visual field loss
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glaucoma
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abnormalities in aqueous balance may lead to what
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glaucoma
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what are the two classifications of glaucoma
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open angle and angle-closure
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pressure induced degenrative changes are associated with what
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glaucoma
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what type of glaucoma is associated with occlusion of the anterior chambor by the iris
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angle-closure glaucoma
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who is predisposed for angle closure glaucoma
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older, farsighted people with pre-existing narrow anterior chambers
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high IOP, steamy cornea, ocular pain, blurred vision, halos around light, and shallow anterior chamber are indicative of what
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acute angle closure glaucoma
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dull ache in one eye accompanied by blurred vision enlarged pupil, shallow chamber, but normal IOP is indicative of what
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subacute angle closure glaucoma
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increased cup-disk ratio, gradula loss of peripheral vision, pathological cupping w/ persistent elevated IOP
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chronic angle closure glaucoma
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describe a person with the highest risk factors for glaucoma
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elderly asian female with cataracts using antidepressants
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most common form of glaucoma
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open angle
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how can you distinguish open from closed angle glaucoma
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presence of pain tends to accompany angle closure glaucoma
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the major risk factor for open angle glaucoma
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elevated IOP
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when do you expect central vision loss with glaucoma
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late in the disease
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Desribe someone at high risk for open angle glaucoma
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Elderly AA with diabetes, myopia, prolonged use of corticosteriods and family hx of glaucoma
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what is refraction and where does it begin
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change in direction of light rays
begins at convex corneal surface |
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list the locations where refraction occurs
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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
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changes in the shape of the lens to adjust focus
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accomodation
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how does accomodation change as we age
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decreases
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farsightedness =
corrected by what shape lens |
hyperopia
bi convex |
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nearsightedness =
corrected by what shape lens |
myopia
biconcave |
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nonuniform curvature of refractive medium
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astigmatism
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what is astigmatism most often the result of
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defect in cornea
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three things accomodation requires
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convergence, pupillary constriction, thickening of lens (through contraction)
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what pupillary shape helps myopia
hyperopia |
constriction
dilation |
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paralysis of pupillary muscle with loss of accomodation
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cyclopegia
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changes in vision due to aging are known as
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presbyopia
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how does the lens change with age
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it thickens and fibers become less elastic
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what is a cataract
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opacity of the lens that interferes with transmission of light to retina
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over 90% of cataracts are due to what
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aging
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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
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cataracts
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What drugs may increase the risk for cataracts
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amiodarone and corticosteroids
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what is the treatment for cataracts
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surgery
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what are some risk factors for cataracts
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age, genetics, uv light, heavy smoking, certain drugs, and injury
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How can you distinguish the red eye of conjunctivitis from corneal lesions or acute glaucoma
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conjunctivitis injects peripheral vessels and mild pain, the others inject around the limbus and severe pain
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pt presents with bilateral itching of eyes with injection
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allergic conjuntivitis
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