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190 Cards in this Set
- Front
- Back
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Malignant Eyelid Tumors
Do you refer? |
Yes
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Malignant Eyelid Tumors
Is this condition life threatening? |
Yes
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Malignant Eyelid Tumors
Does this threaten vision? |
yes
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What are the clinical features of malignant eyelid tumors?
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Asymmetrical, vascularized, ulcerated, fast growth
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What procedure do you do for malignant eyelid tumors?
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Biopsy with surgical excision.
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Ptosis
Do you refer? |
?
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Ptosis
Is it life threatening? |
?
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Ptosis
Does it threaten vision? |
?
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What are the clinical features of ptosis?
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Asymmetry to upper lid position. Possible coincident ocular muscle palsy or pupil defects.
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What is the management procedure for ptosis?
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If mild, chronic- monitor and document
If acute, onset- neuro eval, surgical repair PNR |
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Proptosis and eyelid retraction
Do you refer? |
Yes
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Proptosis and eyelid retraction
Does it threaten vistion? |
Yes
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Proptosis and eyelid retraction
Is this condition life threatening? |
?
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What are the clinical features of Proptosis and eyelid retraction?
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if mild- exposure keratopathy, coincident thyroid disease
if severe- above mild features, restricted ocular motility, diplopia, optic neropathy from orbital crowding NOTE: Watch for asymmetry |
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What medical procedure is done for Proptosis and eyelid retraction?
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Mild- lubricate, mgmt thyroid disease
Severe- lubricate, pt. may be hospitalized CT/MRI or orbits, surgical reposition of eyelids and orbital decompression NOTE: if asymmetrical suspect orbital neoplasm, refer ASAP |
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Preceptal Cellutitis
Do you refer? |
Yes
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Preceptal Cellutitis
Is this condition life threatening? |
No
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Preceptal Cellutitis
Does this condition threaten vision? |
No
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What are the clinical features of Preceptal Cellutitis?
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Periorbial tenderness and swelling.
Vision, pupils, and ocular motility normal. NOTE: What out for fever, blood toxicity sx |
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How would you manage Preceptal Cellutitis?
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Children: augmentin p.o.
Adults: keflex or E-mycin p.o, hot compress, polysporin ung, surgical drain any abcess or biopsy mass NOTE: May need to be hospitalized for IV Abx if fever or general toxicity sx |
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Orbital Cellulitis
Do you refer? |
Yes
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Orbital Cellulitis
Is this life threatening? |
Yes
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Orbital Cellulitis
Does this threaten vision? |
Yes
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What are the clinical features of Orbital Cellulitis?
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Pain, pupil defeat, reduced acuity, proptosis, diplopia, fever, possible rapid onset
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What is the management for Orbital Cellulitis?
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A medical emergency requiring inpatient admin (pt. may be hospitalized) of IV Abx by internists or pediatrician. ENT consultation for sinusitis mgmt. Surgically drain any abcess
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Blow-out Fracture of Orbital Floor
Do you refer? |
Yes
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Blow-out Fracture of Orbital Floor
Is this life threatening? |
No
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Blow-out Fracture of Orbital Floor
Vision threat? |
Yes
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What are the clinical features of Blow-out Fracture of Orbital Floor?
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Trauma Hx, Ecchymosis, Enophthalmos, diplopia, ocular motility limitation
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What is the management for Blow-out Fracture of Orbital Floor?
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orbital imaging, Pt. may be hospitalized. Diliated retinal exam to check for retinal detachment, surgical repair
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Nasolacrimal duct obstruction
Do you refer? |
Yes
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Nasolacrimal duct obstruction
Is it life threatening? |
No
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Nasolacrimal duct obstruction
Does it threaten vision? |
Yes
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What are the clinical features of Nasolacrimal duct obstruction?
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Unilateral epiphora, unilateral recurrent conjunctivits, epiphora, infant population, coincident swollen lacrimal sac.
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What is the management of Nasolacrimal duct obstruction?
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Can CAFL appear on tissue after pt. blows nose?-- Massage nasolacrimal sac area with hot compresses, p.o. broad spectrum Abx w/ topial Abx. Surgical probing of duct if non-resolved in 12 mo old infants
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Chronic blepharitis
Do you refer? |
Nope
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Chronic blepharitis
Is it life threatening? |
Clearly if you don't refer its not life threatening... so NO
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Chronic blepharitis
Threaten vision? |
Yuppers
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What are the clinical features of Chronic blepharitis?
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Morning ocular irritaion, flakes in lashes, red eye margins, coincident conjunctivitis or hordeolum, bilateral
its like dandrif.. for eyes.. head and shoulders bitches! |
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What is the management for Chronic blepharitis?
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D/C contact lens use. Lid scrubs and hot compresses BID for 2 weeks. Topical abx gtt for ung. Ung BID for 1 week. Abx/steroid ung combo for severe cases. May need p.o abx for chronic seborrheic blepharitis.
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Bacterial Conjunctivitis
Do you refer? |
No
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Bacterial Conjunctivitis
Is it life threatening? |
Nope
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Bacterial Conjunctivitis
Threaten vision? |
Yes
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What are the clinical features of Bacterial Conjunctivitis?
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Mild to moderate- unilateral mildmoderate discharge and crusting especially in AM, burning /irritation coincident contact lens use. Usually unilateral
Severe- purulent or mucopurulent discharge, rapid onset, Hx of STD? in other words...That hooker gave me pink eye! |
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What is the management for Bacterial Conjunctivitis?
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D/C contact lens use.
Mild/Moderate- topical abx gtt. QID gtt for 7 days. Sever- start flouroquinolone abx gtt Q1H w/ abx ung BID w/ possibliy adding p.o broad spectrum Abx. If culture done (purulent or mucopurulent cases) adjust ts PRN based off culture results (done in 24-48 hrs) |
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Viral Conjunctivitis
Do you refer? |
No
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Viral Conjunctivitis
Life Threatening? |
No
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Viral Conjunctivitis
Vision Threat? |
Yes
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What are the clinical features of Viral Conjunctivitis?
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From EKC or PCF. May have coincident fever, malaise, PAL signs, URI. Unilateral waters discharge taht becomes a bilateral conjunctivitis. May get secondary keratitis
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What is the management for Viral Conjunctivitis?
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D/C contact lens use and considet pt. contagious until the eyes are white. Palliative tx: compresses and artificial tears to irrigate out viral toxicity.
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Allergic Conjunctivitis
Do you refer? |
No
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Allergic Conjunctivitis
Is it life threatening? |
No
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Allergic Conjunctivitis
Is it vision threatening? |
No
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What are the clinical features of Allergic Conjunctivitis?
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Itching and bilateral stringy discharge. May have acute or chronic presentation.
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What is the management for Allergic Conjunctivitis?
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Avoid or remove allergen. Tx prophylatically of recurrent environmental exposures. If ocular sx only: use Rx alltergy gtt. w/ cold compress. If ocular and systemic sx: p.o antihistamines/ allergy meds. May need nasal steroid.
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Toxic/ Chemical Conjunctivitis
Do you refer? |
?
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Toxic/ Chemical Conjunctivitis
Is it life threatening? |
No
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Toxic/ Chemical Conjunctivitis
Is it vision threatening? |
Yes
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What are the clinical features of Toxic/ Chemical Conjunctivitis?
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Acid (less severe) or alkaline (more damaging) burn. Irritating agent or chemical toxic to ocular surface
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What is the management for Toxic/ Chemical Conjunctivitis?
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If chemical- splash immediately irrigated for 15-30 min, check pH periodically w/ litmus strips. Get (irrigate and "float") contact lens out. Steroid gtt. Cycloplege w/ Atropine 1%. Abx gtt or ung coverage. Surgical reconstruction or corneal transplant
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Keratoconjunctivitis Sicca
(AKA dry eye) Do you refer? |
No
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Keratoconjunctivitis Sicca
(AKA dry eye) Is it life threatening? |
No
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Keratoconjunctivitis Sicca
(AKA dry eye) Is it vision threatening? |
No
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What are the clinical features for Keratoconjunctivitis Sicca
(AKA dry eye)? |
Burning, foreign body sensation, spontaneous blur, redness and swelling. Especially during extened compuuter use and reading or in contact lens users. NAFL staining of cornea
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What is the management for Keratoconjunctivitis Sicca
(AKA dry eye)? |
Gtt or ung OTC lubricant. Plug tear ducts. More frequent blinking
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Pteryguim
Do you refer? |
?
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Pteryguim
Life Threatening? |
No
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Pteryguim
Vision Threatening? |
?
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What are the clinical features of Pteryguim?
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Triangular sheet of conjunctival fibrovascular tissue invading the nasal cornea. Correlated to significant dust and sun exposure
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What is the management for Pteryguim?
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Lubricate, steroid gtt PRN, surgical removal if encroaching to line of sight (pupil)
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Pinguecula
Do you refer? |
No
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Pinguecula
Life threatening? |
No
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Pinguecula
Vision Threatening? |
No
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What are the clinical features of Pinguecula?
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yellow-white raised patch at 3 and 9 o'clock on conjunctiva. Correlated to significant dust and sun exposure
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What is the management for Pinguecula?
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lubricate, steroid gtt PRN
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Disorders of the Conjunctiva
Do you refer? |
No
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Disorders of the Conjunctiva
Is it life threatening? |
No
(? for subconj heme) |
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Disorders of the Conjunctiva
Is it vision threatening? |
No
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What are the clinical features for Disorders of the Conjunctiva?
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concretions- benign, possibly FB sensation
Conj cyst- benign and cosmetic subconjunctival heme- collection of blood within the conjunctiva as a result of damaged blood vessel within |
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What is the management for Disorders of the Conjunctiva?
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May need to rarely remove a concretion if give FB sensation. Monitor conj cyst unless giving FB sensation. If recurrent or bilateral sunconj heme it may be a sign of end organ damage from HTN, so check BP w/ possible blood work.. too anticoag??
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Microbial Keratitis (AKA bacterial corneal unler)
Do you refer? |
Yes
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Microbial Keratitis (AKA bacterial corneal ulcer)
Is it life threatening? |
No
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Microbial Keratitis (AKA bacterial corneal ulcer)
Vision threatening? |
Yes
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What are the clinical features of Microbial Keratitis (AKA bacterial corneal ulcer)?
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contact lens users. unilateral oval white area on cornea staining w/ NAFL dye w/ surrounding edema
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What is the management for Microbial Keratitis (AKA bacterial corneal ulcer)?
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Topical flouroquinolone gtt Q1H 2-3 days, Cycloplege with Atropine 1%. Consider fortified abx or corneal specialist consult for nonresponsive, large, or central ulcers.
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Viral Skin Lesions
Do you refer? |
No
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Viral Skin Lesions
Life threatening? |
No
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Viral Skin Lesions
Vision threatening? |
No
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What are the clinical features of Viral Skin Lesions?
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HSV is active infection = upper and lower lids involved. Children. Check if ocular involvement.
HZO is not an active infection = obeys dermatome, midline and no lower lid. Painful skin lesions. Older adults and immunocompromised. Check if ocular involvement. |
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What is the management for Viral Skin Lesions?
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HSV tx = oral antiviral with topical abx ung with warm soaks to skin lesions with drying agents.
HZO tx = start therapy ASAP, above p.o. antivirals but double dose with steroid/abx ung to skin lesions to keep moist. Pain mgmt with p.o. meds. Pt. may be hospitalized. |
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Viral Keratitis (ocular involvement of HSV or HZO)
Do you refer? |
Yes
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Viral Keratitis (ocular involvement of HSV or HZO)
Life threatening? |
No
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Viral Keratitis (ocular involvement of HSV or HZO)
Vision threatening? |
Yes
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What are the clinical features of Viral Keratitis (ocular involvement of HSV or HZO)?
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Photophobia, FB sensation, recurrent infection. Dendrite epithelial defect ID with NAFL stain.
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What is the management for Viral Keratitis (ocular involvement of HSV or HZO)?
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Use above mgmt with topical antiviral gtt Q2H for first 2 days then Q2H-Q4H for next 4-7 days the QID for 7 more days. Monitor closely, watch for corneal toxicity.
NOTE: 12mo tx with p.o. Acyclovir reduces viral keratitis recurrences by 50% !!!! |
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Contact Lens Complications
Do you refer? |
?
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Contact Lens Complications
Life threatening? |
No
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Contact Lens Complications
Vision threatening? |
Yes
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What are the clinical features of Contact Lens Complications?
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See microbial keratitis above. Can get corneal edema and neovascularization from contact lens overuse.
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What is the management for Contact Lens Complications?
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See microbial keratitis above.
Change contact lens fit, material, wear habits, etc. |
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Episcleritis
Do you refer? |
Yes
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Episcleritis
Life threatening? |
No
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Episcleritis
Vision threatening? |
No
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What are the clinical features of Episcleritis?
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Superficial focal or patch red area on white part of eye. Discomfort or irritation.
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What is the management for Episcleritis?
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Steroid gtt.
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Scleritis
Do you refer? |
Yes
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Scleritis
Life threatening? |
Danger Will Robinson!!!
that means YES! |
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Scleritis
vision threatening? |
Yes
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What are the clinical features of Scleritis?
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Granulomatous inflammation of the scleral coat. Deep red or bluish area on white part of eye. PAINFUL.
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What is the management for Scleritis?
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Oral steroid for 7 days then taper. Pt. may be hospitalized. Pain mgmt with p.o. meds. Monitor for secondary uveitis or glaucoma.
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Corneal Foreign Body
Do you refer? |
?
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Corneal Foreign Body
Life threatening? |
No
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Corneal Foreign Body
vision threatening? |
?
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What are the clinical features of Corneal Foreign Body?
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Get Hx of FB velocity. Record visual acuity before you do anything. Document depth and location. May see puncture wound into iris, lens. Corneal leaking/ perforation? NAFL stain.
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What is the management for Corneal Foreign Body?
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Counsel patient if vision loss eminent. Locate and remove FB under topical anesthesia. Seidel test? Abx gtt coverage e.g. QID gtt for 7 days. Cycloplege with Atropine 1%. Pain mgmt with topical NSAID QID or p.o. meds.
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Corneal Abrasion
Do you refer? |
No
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Corneal Abrasion
life threatening? |
No
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Corneal Abrasion
vision threatening? |
?
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What are the clinical features of Corneal Abrasion?
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Get Hx of injury/ substance. Record visual acuity before you do anything. Document depth and location. May see perforation…corneal leak? NAFL stain.
NOTE: check for ocular globe laceration by noting flat anterior chamber, reduced IOP, iris prolapse, irregular pupil, bubbles in anterior chamber. |
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What is the management for Corneal Abrasion?
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Counsel patient if vision loss eminent. May need to examine under topical anesthesia. Seidel test? Abx gtt coverage QID gtt for 7 days. Cycloplege with Atropine 1%. Pain mgmt with topical NSAID gtt QID or p.o. NSAIDs.
NOTE: If globe laceration suspected don’t press on eye, pt limit eye mvmt, apply eye shield and get to surgeon ASAP. |
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Chemical Burn
Do you refer? |
?
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Chemical Burn
life threatening? |
No
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Chemical Burn
vision threatening? |
Yes
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What are the clinical features of Chemical Burn?
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See Toxic/ Chemical Conjunctivitis
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What is the management for Chemical Burn?
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See Toxic/ Chemical Conjunctivitis
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Uveitis Associated with Arthritis
Do you refer? |
Yes
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Uveitis Associated with Arthritis
life threatening? |
?
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Uveitis Associated with Arthritis
vision threatening? |
Yes
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What are the clinical features of Uveitis Associated with Arthritis?
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Photophobia, redness, reduced vision, tearing, pain or tenderness, cells and flare in anterior chamber, precipitates on back side of cornea.
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What is the management for Uveitis Associated with Arthritis?
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Complete ocular examination. Check IOP. Cycloplege, frequent steroid gtt. Follow inflammation reduction and IOP.
Lab testing for recurrent uveitis. Communication with GP. |
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Trauma-related uveitis
Do you refer? |
Yes
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Trauma-related uveitis
life threatening? |
No
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Trauma-related uveitis
vision threatening? |
Yes
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What are the clinical features of Trauma-related uveitis?
|
(Above features are seen late after trauma healing/ recovery). May see immediate hyphema and disfiguration of iris and other anterior ocular segment structures. Very difficult to control IOP !!!
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What is the management for Trauma-related uveitis?
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Check for ruptured/ lacerated globe with Seidel’s Test. Topical abx gtt coverage, treat pain PRN. Elevate pt’s head with pt resting. Avoid/ try to D/C ASA or anticoagul. Meds. Refer to ophthalmology ASAP to monitor IOP !!!
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Primary Open-Angle Glaucoma
Do you refer? |
Yes
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Primary Open-Angle Glaucoma
Life threatening? |
No
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Primary Open-Angle Glaucoma
Vision threatening? |
Yes
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What are the clinical features of Primary Open-Angle Glaucoma?
|
Strong family Hx. Elevated (>21mmHg) IOP or normal IOP. Visual field loss on confrontations. Increased C/D ratio.
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What is the management for Primary Open-Angle Glaucoma?
|
Glaucoma gtt surgery PRN to reduce IOP if glaucoma gtt not effective.
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Angle-closure glaucoma
Do you refer? |
Yes
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Angle-closure glaucoma
life threatening? |
No
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Angle-closure glaucoma
vision threatening? |
Yes
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What are the clinical features of Angle-closure glaucoma?
|
Unilateral sudden onset of pain, blur with halos, nausea, redness.
NOTE: Irreversible vision (glaucomatous visual field loss) damage in hours!!! |
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What is the management for Angle-closure glaucoma?
|
Pt. may be hospitalized and usually goto ER vs eye care practitioner’s office. Treat Emergently: Frequent instillation of topical glaucoma gtt with topical steroid gtt (e.g. pred forte) with oral diuretics Refer to ophthalmology once above tx in process
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Peripheral Retina Degeneration and/ or Retina Detachment
Do you refer? |
Yes
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Peripheral Retina Degeneration and/ or Retina Detachment
Life threatening? |
Yes
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Peripheral Retina Degeneration and/ or Retina Detachment
vision threatening? |
Yes
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What are the clinical features of Peripheral Retina Degeneration and/ or Retina Detachment?
|
Sudden onset of new unilateral floaters or flashes. Perceives wavy object or a “curtain” in periphery. High spectacle Rx. H/O trauma to globe or head e.g. a fall or MVA.
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What is the management for Peripheral Retina Degeneration and/ or Retina Detachment?
|
Careful documentation of pt’s sx. Dilated fundus examination ASAP for dx. Surgical repair of retina detachment PRN ASAP.
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Diabetic Retinopathy
Do you refer? |
Yes
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Diabetic Retinopathy
life threatening? |
Yes
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Diabetic Retinopathy
Vision threat? |
Yes
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What are the clinical features of Diabetic Retinopathy?
|
High risk if IDDM or DM for many years or poor blood glucose control. Iris neovascularization. Retinal neovascularization, hemorrhages, infarct of nerve tissue.
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What is the management for Diabetic Retinopathy?
|
Tight control of underlying systemic disease. Frequent dilated fundus exams. PRN laser photocoagulation of retina
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Retinal Vein Occlusion
Do you refer? |
Yes
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Retinal Vein Occlusion
Life threatening? |
?
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Retinal Vein Occlusion
vision threatening? |
Yes
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What are the clinical features of Retinal Vein Occlusion?
|
Less acute than artery occlusion. Retinal hemorrhages. Central vein occlusion = significant visual loss. Branch vein = regional patches of blurred vision. May have retinal ischemia months later.
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What is the management for Retinal Vein Occlusion?
|
Ensure pt is anticoagulated. Tight control of underlying systemic disease. Frequent dilated fundus exams. If retinal ischemia may have extensive neovascularization and glaucoma so PRN laser photocoagulation tx of retina.
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Retinal Artery Occlusion
Do you refer? |
Yes
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Retinal Artery Occlusion
Life threatening? |
?
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Retinal Artery Occlusion
Vision threatening? |
Yes
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What are the clinical features of Retinal Artery Occlusion?
|
Sudden loss of vision/ amarosis fugax sx. More acute than vein occlusion. Usually normal looking fundus with sclerotic retinal artery visible months after. Central artery occlusion = significant visual loss. Branch artery = regional patches of blur.
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What is the management for Retinal Artery Occlusion?
|
If amarosis fugax sx (fleeting loss of vision e.g. episode of entire vision in one or both eyes “blacking out” ) then risk of Giant Cell Arteritis so do immediate Erythrocyte Sedimentation Rate with Westergren Method. Tight control of underlying systemic disease. Frequent dilated fundus exams. Do embolic workup.
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Hypertensive Retinopathy
Do you refer? |
Yes
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Hypertensive Retinopathy
Life threatening? |
?
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Hypertensive Retinopathy
vision threatening? |
Yes
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What are the clinical features of Hypertensive Retinopathy?
|
Artery and vein changes. Blur. Retinal/ macular exudates. Check BP in office.
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What is the management for Hypertensive Retinopathy?
|
Tight control of underlying systemic disease. Frequent dilated fundus exams. PRN laser photocoagulation of retina.
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Retinal Artery Occlusion
Do you refer? |
Yes
|
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Retinal Artery Occlusion
Life threatening? |
Yes
|
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Retinal Artery Occlusion
vision threatening? |
Yes
|
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What are the clinical features of Retinal Artery Occlusion?
|
Sudden loss of vision/ amarosis fugax sx. More acute than vein occlusion. Usually normal looking fundus with sclerotic retinal artery visible months after. Central artery occlusion = significant visual loss. Branch artery = regional patches of blur.
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What is the management for Retinal Artery Occlusion?
|
If amarosis fugax sx (fleeting loss of vision e.g. episode of entire vision in one or both eyes “blacking out” ) then risk of Giant Cell Arteritis so do immediate Erythrocyte Sedimentation Rate with Westergren Method. Tight control of underlying systemic disease. Frequent dilated fundus exams. Do embolic workup.
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Optic Neuropathies
Do you refer? |
Yes
|
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Optic Neuropathies
life threatening? |
?
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Optic Neuropathies
vision threatening? |
Yes
|
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What are the clinical features of Optic Neuropathies?
|
Sudden reduced vision, amarosis fugax sx?, pupil defect, optic nerve abnormal appearance, significant upper or lower visual field loss.
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What is the management for Optic Neuropathies?
|
Lab tests for systemic etiologies (If amarosis fugax sx then risk of Giant Cell Arteritis so do Erythrocyte Sedimentation Rate Westergren Method)? Imaging studies. Pt. may be hospitalized. Once medical condition stabilized refer for low vision rehabilitation with optometry.
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Abnormal Pupil Reactions
Do you refer? |
?
|
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Abnormal Pupil Reactions
Life threatening? |
?
|
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Abnormal Pupil Reactions
vision threatening? |
Yes
|
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What are the clinical features of Abnormal Pupil Reactions?
|
Anisocoria, afferent pupil defect, fixed or non-responsive pupil. Frequently related to crainial nerve disease in older patients. H/O trauma or surgery?
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What is the management for Abnormal Pupil Reactions?
|
Careful pupil evaluation or diagnostic eval. Lab tests for systemic etiologies. Imaging studies PRN. Frequent dilated fundus exams.
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Crainial Nerve Disease
Do you refer? |
Yes
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Crainial Nerve Disease
life threatening? |
?
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Crainial Nerve Disease
vision threatening? |
Yes
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What are the clinical features of Crainial Nerve Disease?
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Reduced ocular motility, may have abnormal pupils, diplopia.
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What is the management for Crainial Nerve Disease?
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Careful pupil evaluation or diagnostic eval. Lab tests for systemic etiologies. Imaging studies PRN. Pt. may be hospitalized. Frequent dilated fundus exams
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