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127 Cards in this Set

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a sterile chronic granulomatous inflammation of the meibomian gland
Chalazion
Signs and symptoms of a Chalazion
painless, localized swelling develops over a week. sweling points to conjunctival surface.
Treatment of a chalazion large vs. small lesions
1. surgical excision
2. intralesional steroid injections may be used in small lesions
Dacryoadenitis vs. Dacyrocystitis
"adenitis"-acute inflammation of the lacrimal gland
"cystitis"-infection of the lacrimal gland
what is seen in children as a complication of mumps, measles, or influenzae.
Dacryoadenitis
when this infection occurs in adults it is associated with gonorrhea
Dacyroadenitis
Dacryocystitis is due to what?
unilateral, due to obstruction of the nasolacrimal duct
Dacryocystitis common infectious agents are?
H.flu, S. aureus and beta-hemolytic streptococcus
Dacryoadenitis signs and symptoms?
severe pain, swelling, injection over the temporal aspect of the upper eyelid
Dacryocystitis signs and symptoms?
tearing and discharge. Inflammation, pain, swelling, and tenderness noted in the tear sac area.
Treatment of Dacryoadenitis and Dacryocystitis?
"adenitis"-observed, treated w/ antibiotics if needed
"cystitis"-antibiotics and relief of the obstruction.
Foreign body diagnosis
1. visual acuity
2. intraocular foreign bodies a slit lamp(to locate site of entry) 3. ct scan or xray done to identify radiopaque particles.
What is due to cause glaucoma?
increased intraocular pressure causing optic nerve damage
How do you get increased intraocular pressure?
due to impaired outflow of aqueous humor or impaired access of aqueous humor to the drainage system.
What is the leading cause of preventable blindness in the US?
GLAUCOMA
What are the 2 types of glaucoma?
1. open-angle
2. angle-closure
What is the most common type of glaucoma and what is it due to?
Open-angle and its due to inadequate drainage of the aqueous humor
what causes a restricted flow of the aqueous humor?
Angle-closure glaucoma
what glaucoma is considered an ophthalmic emergency?
Acute angle-closure glaucoma
Primary angle-closure glaucoma signs/symptoms?
sudden onset of eye pain, headache, blurred vision and halos, nausea and vomiting, fixed and dilated pupil and hyperemia
What are the symptoms of open angle glaucoma?
asymptomatic early w/gradual loss of peripheral vision, and halos around lights
intraocular pressure is measured how?
Tonometry (goldmann applanation and
Schiotz tonometry used
Normal ratio of intraocular pressure?
10-24mmhg
what is a Gonioscopy test
determines anterior chamber angle is wide (open), narrow, or closed.
What does the treatment of glaucoma consist of?
Reduction of the aqueous production
Treatment of glaucoma 1st line includes?
Suppression of aqueous humor production: 1. topical beta-adrenergic blocking agents
ex: timolol maleate, levobunolol
Side effects of timolol and levobunolol are?
depression, confusion and fatigue
glaucoma treatment 2nd line?
2. alpha-adrenergic agonists. ex: apraclonidine and brimonidine
glaucoma 3rd line tx?
carbonic anhydrase inhibitors. ex: topical meds dorzolamide hydrochloride and brinzolamide
systemic meds are acetazolamide (used in acute glaucoma).
how can you facilitate aqueous outflow?
1. parasympathomimetic agents like pilocarpine and carbachol
2. prostaglandin analogs like bimatoprost, latanoprost and travoprost
what is the last line of treatment for glaucoma?
surgical peripheral iridotomy, laser trabeculoplasty and trabeculectomy.
Explain a Hordeolum?
Infection of the eyelid and most are caused by staphylococcal species
Hordeolum S/S?
internal vs. external
pain, redness, and swelling.
Internal-point toward skin or conjunctiva
external-points toward skin
Hordeolum treatment?
1. warm compressions 3-4xday
2. no improvmnt 48hrs incision and drainage
3. antibiotic ointment
what is a Hyphema?
Traumatic forces tear vessels and bleeding into the aqueous humor.
Hyphema treatment?
1. pts should rest if more than 5% of anterior chamer filled w/blood. 2. steroid drops 3. will resolve by spontaneous absorption 4. if intraocular pressure remains elevated surgical intervention maybe required
This is age-related leading cause of permanent blindness in the elderly?
Macular degeneration
What are the 2 types of macular degeneration?
1. non-exudative and exudative
which type of macular degneration shows -drusen are noted ophthalmoscopically and are discrete, round yellow-white depositis beneath the pigment epithelium and scattered throughout the macula.
Non-exudative
macular degeneration
1. visual impairment is variable in this?
2. vision loss is severe in this?
1. non-exudative
2. exudative
neovascularization maybe noted in which form of macular degeration?
1. neovascularization maybe noted on ophthalmoscopic exam in exudative macular degeneration.
Treatment of exudative and non-exudative macular degeneration?
exudative with out neovascularization no med or surg. tx needed. LASER PHOTOCOAGULATION is needed if neovasculartization present. NO WAY TO PREVENT NON-EXUDATIVE DEGENERATION
what needs to be monitored in non-exudative macular degeration?
loss of central vision with Amsler grid
This is a result of trauma or extension of sinsusitis through the ethmoid sinus to the orbit?
Orbital cellulitis
Orbital cellulitis occurs most commonly in who? and what are the most common organisms?
1. children
2. H.flu, S. pneumoniae
Orbital cellulitis S/S?
edema, erythema, hyperemia, and pain
-infection spreads rapidly
Orbital cellulitis on PE?
chemosis, limited eye mvmts (shown on postseptal cellulitis), reduction of vision and erythema
Orbital cellulitis Diagnosis
-Labs show leukocytosis

-CT scan or MRI needed to seperate pre from postseptal involvement
Orbital cellulitis treatment?
1. nasal decongestants and vasoconstrictors

2. IV antibx
-mild cases tx w/amoxicillin and severe cases treated w/ceftriaxone and vancomycin
What is a Pterygium?
fleshy, triangular enroachment onto the cornea

typically bilateral/ on nasal side
This is due to irritation secondary to ultraviolet light, drying and wind
pterygium
what is a triangular lesion noted on the nasal side of the cornea?
pterygium
Treatment of pterygium?
if large may be removed surgically
Seperation of the sensory retina from the underlying pigmented epithelium.
Retinal detachment
Most common location of retinal detachment?
superior temporal area
retinal detachment can be caused by what? and who is most common with?
Trauma or be spontaneous

m/c over 50 and severe myopia (near sightedness)
Retinal detachment S/S?
What is shown on funuscopic exam?
-curtain came down over their eye.
-blurry vision and progressively worsens.
-flashes and floaters
EXAM: retina noted hanging in the vitreous fluid
Retinal detachment treatment?
immediate ophthalmologic referral!!!
Keep head position so that gravity helps the detached portion of the retina fall back into place.
What presents with painless vision loss?
Retinal vascular occlusion
This is noted in patients over 50 and associated with cardiovascular dz?
Central vein occlusion
A painless monocular vision loss, often proceeded by AMAUROSIS FUGAX
central retinal artery occlusion
on funduscopic exam cherry-red spot is noted on the macula? what is this?
Central retinal artery occlusion
Sudden loss of visual field and reduced visual acuity?
Branch retinal artery occlusion
Funduscopic exam shows cotton-wool spots
Branch retinal artery occlusion
Sudden painless vision loss.
Central retinal vein occlusion
funduscopic exam varies from small retinal hemorrhages to cotton-wool spots to deep and superficial retinal hemorrhages
Central retinal vein occlusion
Retinal vascular occlusion treatment?
Referral to an ophthalmologist is required!!
IV acetazolamide is used for what?
central retinal artery occlusion-to decrease intraocular pressure. Thrombolytic agent infused into the artery can result in return of vision if given w/in 8hrs.
what else can be done to decrease intraocular pressure?
ocular massage
laser photocoagulation is treated for this if neovascularization is present?
central vein occlusion
DM retinopathy proliferative vs. non-proliferative.
1. proliferative
Proliferative retinopathy
-neovascularization
-hemorrhage in the vitreous body
-may lead to retinal detachment
non-proliferative dm-retinopathy?
-venous dilatation
-microaneurysms
-retinal hemorrhages
-edema
-hard exudates
Treatment of dm-retinopathy?
-management of blood sugar and blood pressure is vital

-Yearly ophthalmoscopic exam
-neovascularization is treated with laser photocoagulation
-Macular edema treated with laser surgery
Hypertensive dm-retinopathy signs and symptoms?
-vision impairment
a) silver or copper
b) Arteriovenous (AV) nicking
c) flame-shaped hemorrhages
d) cotton-wool spots
e) retinal edema
f) retinal pigmentation
HTN DM-retinopathy treatment?
will have improvement with blood pressure control
What is strabismus?
deviation from perfect ocular alignment.
Esotropia is convergent strabismus (CROSSED EYES).
Exotropia is divergent strabismus
Strabismus signs and symptoms?
and testing?
diplopia, scotoma, amblyopia. Convergenfce testing used for disjunctive movements
Strabismus diagnosis?
1. angle of strabismus determined by cover-uncover test

2. Hirschberg test used to determine eye position by evaluating for centering of light reflection in both eyes
strabismus treatment?
ASAP
1. Occlusion therapy used to treat amblyopia (the sound eye is covered to stimulate the amblyopic eye.

2. spectacles are used to treat strabismus and prismss used to treat diplopia

3. Resection and recession are used to strenghten and weaken the appropriate muscles
Persistent or recurrent purulent otorrhea with TM perforation
Chronic otitis media
may have some degree of conductive hearing loss without pain?
chronic otitis media
What may develop a cholesteatoma?
chronic otitis media
What is a cholesteatoma?
a mass of squamous epithelium debris that forms at the site of invasion. This mass can invade surrounding bone and lead to meningitis and brain abscess. this happens in chronic otitis media
Treatment of Chronic-OM?
Mastoidectomy, myringoplasty, and tympanoplasty

systemic antibiotics may also be needed
What is "the bends"?
(barotrauma)
decompression sickness, occurs most often after divers descend and remain deeper than 10 meters
decompression sickness ("the bends") is due to? S/S?
nitrogen becoming insoluble and forming bubbles in the blood and tissue.

steady, throbbing pain in the joints, pruritis, HA, seizures, hemiplegia, visual disturbances, substernal pain, dyspnea, cough
Treatment of decompression sickness?
recompression therapy in a copmression chamber
what are the 2 types of hearing loss?
Conductive and sensorineural
describe conductive hearing loss
lesion in the auricle, external auditory canal or middle ear
describe sensorineural hearing loss
lesion in the inner ear or eighth cranial nerve
How can you get CONDUCTIVE hearing loss?
obstructin of external auditory canal due to ceruman, foreign body, swelling, neoplasm, or TM perforation, cholesteatoma, otosclerosis
What is the most common cause of sensorineural hearing loss?
Presbycusis, it is age associated
How else can you get sensorineural hearing loss?
Menier's dz, drug induced-common meds include salicylates, quinine, aminoglycosides, cisplatin and loop diuretics
How to diagnosis conductive vs. sensorineural hearing loss? weber/Rinne test
Weber-tuning fork-with unilateral conductive loss tone is perceived in affected ear. With unilateral sensorineural loss the tone is perceived in unaffected ear
explain the Rinne test?
Tuning fork ploaced near opening of auditory canal (air conduction) then placed on mastoid process (bone conduction) normally with sensorineural loss air conduction is greater than bone conduction
what do you have when bone conduction is greater than air conduction?
conduction hearing loss
Treatment of conductive and sensorineural hearing loss?
1. conductive-surgical intervention and correction

2. sensorineural-permanent and corrected with hearing aids
What is a rare complication of otitis media?
Mastoiditis
Mastoiditis signs and symptoms?
pain, swelling tenderness, and redness behind the ear in the area of the mastoid bone
Xray of mastoid bone reveals what?
soft-tissue swelling, loss of mastoid bone mass, and lytic lesions
what are complications of mastoiditis?
brain abscess and septal lateral sinus thrombosis
results from malfunction of the endolymphatic sac in the inner ear.
Meniere's disease
debilitating vertigo, progressive sensorineural hearing loss and tinnitus are signs and symptoms of what?
Meniere's disease
onset of vertigo is sudden and lasts minutes to hours and rarely lasts longer than 24-48hrs
Meniere's disease
meniere's dz diagnosis
electronystagmography with warm and cold calories can be used to differentiate central from peripheral causes of vertigo
meniere's dz tx?
1. diazepam for acute dz
2. trimethobenzamide hydrochloride
3. meclizine
4. dimenhydrinate
5. HCTZ
6. triamterene
meniere's dz tx if case is severe?
surgical drainage of the endolymphatic system or ablation of the 8th cranial nerve or labyrinth maybe needed. PTs need to be instructed to avoid caffeine, alcohol, and smoking
acute unilateral infxn or inflammation of the vestibular system.
labyrinthitis (vestibular neuronitis)
How can you get labyrinthitis?
typically due to viral infxn or history of recent URI
how long would labyrinthitis last?
7-10 days and is typically self-limited
presents with rotational vertigo, nystagmus, N/V.

doesnt have tinnitus or hearing loss
labyrinthitis (vestibular neuronitis)
on physical exam of labyrinthitis how long does vertigo last when patient opens or closes the eyes?
in labyrinthitis vertigo remains whether the patient opens or closes the eyes
how do you diagnose labyrinthitis?
CT scan maybe needed to rule out central causes of dizziness
what is the treatment of labyrinthitis?
self-limiting and may require symptomatic tx.
1. diazepam
2. meclizine
3. dimenhydrinate
s/e: drowsiness and sedation
infection and inflammatoin of the external auditory canal?
otitis externa
what are the 4 categories of otitis externa?
1. acute localized
2. acute diffuse (swimmer's ear)
3. chronic
4. malignant
Organisms that can cause otitis externa?
1. S. aureus
2. Group A streptococcus
3. Pseudomonas aeruginosa
4. Aspergillus
Acute localized infxn s/s?
pain and tenderness. PE reveals erythematosus and tenderness is noted over the tragus. Preauricular lymphadenopathy possible
Acute diffuse dz s/s?
pain and itching. PE reveals canal is erythematous, swollen, and hemorrhagic
chronic dz s/s?
drainage and itching
Malignant dz s/s?
severe, necrotizing infxn. Assoc. w/elderly diabetic pts and infxn due to P. Aeruginosa
Diagnosis and TX of otitis externa? and what is required for tx of malignant OE?
dx: based on history and PE
TX: 1. gentle cleaning w/saline or alcohol and acetic acid mixture
2. topical neomycin, polymyxin, and quinolone
3. IV anti-pseudomonal antibx, (ceftaxidime or piperacillin, plus aminoglycosides or flouroquinolones, are required for the tx of malignant otitis externa.
This occurs as a result of penetrating or noise trauma?
TM perforation
where in the ear canal does a TM perforation occur?
pars tensa, anteriorly or inferiorly
what are the S/S of TM perforation?
acute onset of pain, hearing loss, and with or w/out bloody otorrhea. possible tinnitus and vertigo
DX of TM perforation?
perforation is noted on otoscopic exam
What is the tx of TM Perforation?
1. Most heal spontaneously
2. follow-up hearing test is needed to confirm that hearing has returned to baseline
3. PT should be instructed not to get any water in the ear