Ophthalmology In Primary Care

Front 1

Most common eye problem encountered in primary care

Back 1

The Red Eye

Front 2

What should you always check first in an eye exam?

Back 2

Visual acuity

Front 3

Primary conjunctivitis

Back 3

will see diffuse vessel engorgement in the palpebral and bulbar conjunctiva without a ciliary flush

Front 4

produces ciliary flush

Back 4

Corneal or intraocular inflammation

Front 5

ciliary flush

Back 5

dilation of the fine capillaries around the corneal border, producing a red-violet halo

Front 6

What should you never use for conjunctivitis?

Back 6

Never use a topical ocular steroid for conjunctivitis! (or anything else for that matter)

Front 7

What is Iritis (intraocular inflammation) ?

Back 7

Deep pain and photophobia
Symptoms not ameliorated by topical anesthetic
Can result from infection(CMV iritis), trauma, or may be a systemic autoimmune disorder
May be idiopathic
Always managed by opthamologist

Front 8

Uveal tract disease

Back 8

Uveal tract includes iris, ciliary body, and choroid.
Usually idiopathic but may be associated with a large number of ocular and systemic diseases such as spondylitis, sprue, colitis, TB, syphilis, sarcoidosis, and juvenile rheumatiod arthritis
Symptoms:
Pain, photophobia, redness, and ciliary flush. Will see pupillary constriction with iritis
May be unilateral or bilateral
Exam:
May see cloudy anterior chamber
Slit lamp shows cells in anterior chamber and ‘flare’ increased aquaeus humor protein

Front 9

What does grossly purulent conjunctivitis suggest?

Back 9

suggests gonococcal infection which may scar or perforate the cornea or lead to systemic dissemination.

Front 10

usually see edema without the erythema

Back 10

Allergic conjunctivitis—usually

Front 11

S & S Conjunctivitis

Back 11

Discharge
Peripheral erythema
Normal vision
Lids stuck together in am
Absence of pain and photophobia
Etiology may be bacterial, viral, chemical, or allergic
In the absence of photophobia, pain, or change in visual acuity may be managed by the NP

Front 12

3 Types of conjunctivitis

Back 12

Viral-
Bacterial
Allergic

Front 13

More common in children

Back 13

Bacterial conjunctivitis

Front 14

TX of Bacterial conjunctivitis

Back 14

Use of antibiotics in both viral and bacterial is controversial because the condition is self-limited and will clear without treatment, however antibiotics speed time to recovery.
Usually limit treatment to 5-7 days. Can instruct patient to use for 2 days after all symptoms have disappeared.
Bacterial cultures not routinely done
Antibiotics in solutions tend to be washed out rapidly—over 50% lost on adminitration.
Ointments last longer, but can cause blurring

Front 15

Very contagious, usually associated with URI

Back 15

Viral conjunctivitis

Front 16

More common in older children and adults

Back 16

Viral conjunctivitis

Front 17

Usually starts in one eye and spreads to the other, pre-auricular nodes enlarged

Back 17

Viral conjunctivitis

Front 18

usually results form trauma, bleeding disorders, or a sudden increase in venous pressure such as cough. No pain, visual, change or discharge.

Back 18

Subconjunctival hemorrhage—usually

Front 19

Episcleritis—

Back 19

localized ocular redness from inflammation of the episcleral vessels. In natural light vessels appear pink, and are moveable over the scleral surface. Usually benign and self limited.

Front 20

Sign of vitamin A deficiency

Back 20

Bitot's spot

Front 21

Blepharitis

Back 21

Redness, scaling, and crusting of lid margin (dandruff of the eyelashes)
Staphylococcal
Seborrheic (greasy scales)
More common in fair skinned people
May wax and wane with no apparent pattern

Front 22

Tx for Blepharitis

Back 22

Johnson’s baby shampoo
Warm compresses
Bacitracin or erythromycin opthalmic ointment QID
With chronic blepharitis related to rosacea may use low dose tetracycline po

Front 23

Hordeolum

Back 23

Acute staphlococcal infection of the meibomian glands
Often find diffuse redness, tenderness, and edema
May also produce preseptal cellulitis
Mild cellulitis may be treated with dicloxacillin or erythromycin po
May respond to treatment for blepharitis, keep in mind may need referral to opthamologist for I&D

Front 24

Chalazion

Back 24

Beady nodule protruding on lid. Infection or retention cyst of meiobian gland. Non-tender, firm , discrete swelling with freely movable skin overlying nodule. If inflamed, it points inside—not on lid margin in contrast with stye.

Front 25

How are Chalazia different from hordeolums?

Back 25

Chalazia form as a result of gland obstruction and sterile inflammation and tend to be larger, less painful and occur less acutely. Hordeolums are a purulent infection

Front 26

Orbital cellulitis

Back 26

Usually caused by gram positive organisms that enter the orbit either directly from the sinuses or through venous channels.
Will see pain, fever, chemosis, exopthalmos, leukocytosis
May lead to paralysis of 3rd, 4th and 6th cranial nerves
Need admission for IV antibiotics

Front 27

Orbital cellulitis may lead to paralysis of which cranial nerves?

Back 27

3,4,6

Front 28

How should abrasions from contact use be treated?

Back 28

a good gram negative antibiotic to cover pseudomonas

Front 29

How are corneal abrasions visualized?

Back 29

Stained with flourescien

Front 30

What is glaucoma?

Back 30

Group of diseases characterized by optic neuropathy and visual field loss
Usually find increased ocular pressure
Primary open-angle glaucoma most commonly found in adults

Front 31

What happens to the optic nerve in response to increase in pressure?

Back 31

Damage can occur and messages can not get sent to the brain

Front 32

If the eyes drainage system becomes clogged what can happen?

Back 32

Too much fluid stays in the eyes and increases pressure which can damage the optic nerve

Front 33

2nd leading cause of blindness
amoung african americans

Back 33

Open angle glaucoma

Front 34

Risk factors for Open angle glaucoma

Back 34

Risk factors include:
Elevated intraocular pressure
Age
African American
Family history
Treatment with steroids
Cataracts
Less common risk factors
Myopia, diabetes, vasospasm (as in migraine)

Front 35

Only modifiable risk factor for open angle glaucoma

Back 35

Elevated intraocular pressure

Front 36

Pathophysiology of open angle glaucoma

Back 36

Loss of ganglion cell axons with the development of optic nerve cupping and visual field loss

Front 37

Leading cause of blindness in the elderly

Back 37

Macular degeneration

Front 38

What is affected in macular degeneration

Back 38

central vision
peripheral vision remains intact

Front 39

Leading cause of blindness in people less than 65 years of age

Back 39

Diabetic retinopathy

Front 40

2 types of retinopathy

Back 40

Nonproliferative
Early form
Will see microaneurysms, cotton-wool, retinal hemorrhages
Usually asymptomatic
Proliferative
Increased findings of the nonproliferative, but also an increased network of fine capillaries—the retina has responded to ischemia with neovascularization

Front 41

In what type of retinopathy will you see cotton wool spots?

Back 41

nonproliferative diabetic retinopathy

Front 42

Floaters

Back 42

Most noticable when looking at a blank wall
Usually benign, but new onset can mean retinal detachment, or intraocular hemorrhage

Front 43

Flashes

Back 43

Occur with mechanical stimulation of retina
Migraine
Seeing stars when suffering head trauma or cough

Front 44

Distortion (metamorphopsia)

Back 44

Often first sign of macular degeneration

Front 45

Zig-zag lines

Back 45

Migraine phenomena—usually last 20 minutes; sometimes followed by migraine

Front 46

Halos, discolorations, and visual hallucinations

Back 46

Dig toxicity
Glaucoma
Viagra

Front 47

Very common in post menopausal women.

Back 47

Dry eyes (keratoconjunctivitis sicca)