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64 Cards in this Set

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excessive tearing. Causes include obstruction of the normal tear drainage system and excessive production of tears caused by irritation and inflammation. Excessive tearing in one of both eyes of an infant is a cardinal sign of glaucoma but this is a rare condition. More often in infants this indicates congenital obstruction of a naso lacrimal duct. If no underlying cause is apparent the patient should be referred to an ophthalmologist
Sensitivity to light. May occur for no known reason but most any condition that resulting in ocular irritation or inflammation may cause photophobia. Consider uveitis, conjunctivitis, conjunctival or corneal FB, corneal abrasion, keratitis, congenital glaucoma in infants, and acute glaucoma in adults. Occurs most commonly in arc welder, swimmers, or skiers who do not use lenses for protection from excessive direct or reflected ultraviolet light exposure
degenerative lesion of the conjunctiva. Often considered precursor of pteryguim. Confined to the bulbar conjunctiva. Occurs most often in patients with long hx of outdoor activity. Appears as an elevated, yellowish growth almost always on the nasal aspect of the palpebral conjunctiva. When inflamed is usually erythematous. Elevated lesions disrupt normal tear film distribution causing symptoms of dry eye.
degenerative lesion of the conjunctiva. Extends on to the cornea usually from the nasal aspect. Occurs most often in patients with long hx of outdoor activity. Is characterized by a vascularized lesion that usually extends from the conjunctiva of the nasal palpebral fissure onto the nasal cornea. If it extends to the visual axis, vision loss occurs. May become inflamed and produce ocular discomfort. Contact lens wearers experience discomfort and problems sooner
invasive growth of keratin-producing squamous epithelial cells typically found within the middle ear or mastoid space. Congenital choleseatoma are often asymptomatic. Acquired choleseatomas have a history of recurring ear infections and drainage or TM retractions due to Eustachian tube dysfunction. Impaired hearing may be the first sign of middle ear destruction from a choleseatoma
Describe the clinical presentation of cataracts
Initially the patient complains of blurry vision or a film that obscures vision. May also complain of glare from any source of bright light or altered color perception or a gradual loss of vision. Occasionally a significant unilateral cataract will appear to cause a sudden loss of vision. The vision loss is not really sudden. The patient perceives it as sudden when the non-affected eye becomes obscured in some way and the patient cannot see effectively from the affected eye
What is a hordeolum
A hordeolum is called a stye. The external hordeolum is and infection of the gland of Moll or Zeis. An internal hordeolum is an infection of the meibomian gland. It presents with localized erythematous swelling and is often tender to palpation. There is no visual disturbance unless lid swelling is excessive. An internal hordeolum points either externally to the skin or internally to the conjunctival surface. An external hordeolum is more superficial and points to the lid margin
How is hordeolum treated
Warm, moist compresses often hasten the process of pointing and draining. If associated with a specific eyelash, pulling that eyelash will hasten draining. Topical antibiotics may be helpful and should be used 4 times a day and continued for one week. Recurrent lesions require daily lid margin scrubs and topical antibiotics.
How is chalazion treated
Warm, moist compresses hasten liquification of glandular secretions. Antibiotics are not indicated. Chronic chalazion may require steroid injection. If this is not effective surgical excision may be indicated
What is a chalazion
A chalazion involves the meibomian gland but is a granulomatous inflammatory lesion rather than an infectious process. Although an acute infection of the meibomian gland is actually an internal hordiolum, it is sometimes referred to as an acute chalazion. Sometimes associated with blepharitis. Presents with localized erythematous swelling but is not tender to palpation. There is no visual disturbance unless lid swelling is excessive. Larger lesion may press on the corneal surface and induce astigmatism which decreases vision. A chalazion is usually located in the mid-tarsus away from the lid margin. It is usually a chronic lesion that presents with or without inflammation
What are the potential complications of orbital and periorbital cellulitis
*Cavernous sinus thrombosis
*Central retinal artery or vein thrombosis
*Retinal ischemia resulting from increased intraocular pressure
*Sub-periosteal, orbital, epidural, subdural, or brain abscess
*Optic nerve involvement with subsequent blindness
*Involvement with paresis of CNs iII, IV, V, VI
*Fungal orbital cellulitis in immunosuppressed and diabetic patients
What disease processes are associated with abnormalities of the auricle
*Addison’s disease = calcifications of the cartilage
*Hansen’s disease = nodules on the earlobe and present as multiple nodules on the ear and face
*Chronic arthritis = hard rheumatoid nodules develop in the auricle and are the same as those in the hands, elbows, knees, or heels
*High uric acid levels = tophi (painless, hard or gritty, irregular uric acid crytal deposits) develop in the auricle. Pressure on these nodules results in expulsion of a white crystalline substance
*Blood disorders or trauma = hematoma of the auricle that presents as a tender, blue doughy mass that if not drained results in a deformity commonly referred to as “cauliflower ear”
What is the principle cause of cochlear damage and sensorineural hearing loss
Noise trauma
History of present illness quesitons re: eye lesion
*Is it painful?
*Does it itch or cause any other discomfort?
*Are you having any visual difficulties?
*Do you use eye makeup?
*When was the last time you bought new eye makeup?
*Do you share eye makeup with anyone else?
*Do they have any eye lesions?
*Have your eyes been drier than usual?
*Have you had any eye drainage? If so what did it look like?
*What makes your eye better or worse?
*What home treatment have you tried on your eye?
*What difference did it make?
Past medical history quesitons re: eye lesions
*Is this the first one of these you have had? If you have had others when was the last one?
*Has anyone ever told you that you had blepharitis of your eyelids?
*Has anyone ever told you that you were diabetic?
*Do you have any drug or other allergies?
*What medications do you take?
Management of Hordeolum
*Frequent warm moist compresses (will hasten pointing and drainage)
*Topical antibiotic should be avoided unless the hordeolum recurs frequently or does not respond to other therapy. If needed then choose from the following: (neomycin/polymixin B/gramicidin {Neosporin ophthalmic solution}, tobramycin 0.3% {tobrex ophthalmic solution}, ofloxacin 0.3% {Ocuflox ophthalmic solution}, ciprogloxacin {Ciloxzan ophthalmic solution})
*Recurrent lesions require daily lid margin scrubs and topical antibiotics.
*Discard open eye makeup to avoid reinfection
Describe the ocular examination re: red eye
*Observe pupils for symmetry and response to light
*Examine eyelids for erythema, swelling or hyperemia
*Evert upper eyelid and tarsal conjunctival surface checked for a cobblestone appearance which indicates allergic response
*Fluorescein staining and check eyes with ultraviolet light and magnification for herpetic lesions, foreign bodies
*Observe sclera and conjunctiva for redness, edema, or discharge
*Evaluate cornea for clarity
What would be the rationale for palpation of the pre-auricular lymph nodes during an ocular exam for red eye?
*Palpate preauricular and submandibular glands for the presence of lymphadenopathy. *Swollen glands and mucopurulent drainage can indicate Chlamydia.
*Chlamydia is found in up to 1/3 of patients with gonococcal conjunctivitis
Treatment for Viral conjunctivitis
*viral conjunctivitis is usually self-limiting
*Cool compresses may provide some relief.
*Anti-infectives, steroids and topical vasoconstrictors should not be used
Patient Education re: viral conjunctivitis
*You have viral conjunctivitis. This condition usually runs its course in a week or so.
*Viral conjunctivits does not require any prescription medications.
*Take precautions at home to avoid spreading the infection to others.
*Do not share towels or washcloths
*Do not share pillows or other linens
*You might want to discard all your open eye makeup containers, and disinfect or discard your contact lens case and opened solutions.
Which forms of red eye should be referred immediately to an ophthalmologist?
*Orbital cellulitis
*Angle-closure glaucoma
*Chemical exposure
*Episcleritis/scleritis (non-urgent referral)
*Pinguecul and pterygium (non-urgent referral)
Disorders associated with ocular surface redness:
*Orbital cellulitis
*Angle-closure glaucoma
*Chemical exposure
*Episcleritis/scleritis (non-urgent referral)
*Pinguecul and pterygium (non-urgent referral)
*Angle-closure glaucoma
*Chemical exposure
*Corneal FB, abrasion or ulcer
*Dry eye
*Pinguecula and pterygium
*Subconjunctival hemorrhage
Rationale for obtaining Past Medical History from patient during eye examination
Helps identify disorders commonly associated with ocular manifestations such a diabetes and hypertension; may avoid adverse effects such as system beta-blocker potentiation by ophthalmic beta agonists; many systemic medications may induce blurred vision or dry eye; it is always important to know present medications, allergies and sensitivities; identifies glasses or contact lens use; identifies previous ocular injuries or surgeries or eye patching or poor vision in childhood; history of previous ocular surgery can help identify the cause of an abnormally shaped pupil; knowing that patching occurred in childhood can help in evaluating the difference in right and left visual acuity as an adult
Rationale for obtaining Family History from patient during eye examination
Assess for familial presence of glaucoma, diabetes, cataracts, macular degeneration, retinitis pigmentosa, retinoblastoma, kerato-conus, color blindness, mystagmus, albinism, choroideremia and corneal dystrophies. The most significant medical conditions with ocular manifestations are diabetes, hypertension, hyperthyroidism, vascular disorders, migraine headache, von Recklinghausen’s disease, Marfan syndrome, sickle cell anemia, and arthritis
Rationale for obtaining Social History from patient during eye examination
A general assessment of employment and leisure activities may identify concerns related to environmental hazards and the potential for ocular injury or trauma. This information is useful for patient education related to ocular injury prevention and protective eyewear. Assessment of contact lens wear and hygiene practices may identify other ocular risks
Disorders associated with ocular adnexa redness
*Orbital cellulitis
*Periorbital cellulitis
*Eyelid lesions
*Soft tissue hemorrhage
What otoscopic findings for otitis media?
TM slightly erythematous OR TM red, inflamed and bulging with obscure landmarks OR TM gray, effusions interior to TM noted
Treatment/Management of otitis media?
*Treat pain with acetaminophen or ibuprofen.
*Most cases resolve without antimicrobial treatment.
*If antibiotics are used, Amoxicillin 250 – 500mg TID X10 days is the first choice. FYI – other regimens: Septra DS one tab BID X10 days; Erythromycin 333 – 500mg TID X7 – 10 days; Augmentin 250 – 500mg TID X10 days; Cefaclor 500mg TID X10 days.
*Nasal sprays are recommended for symptomatic relief of effusions or serous otitis; NasalCrom one spray in each nostril 4 -6 Xday or Beconase AQ 1 – 2 sprays in each nostril BID.
Clinical presentation of Otits Media
"Has a cold"
Ear pain
Ear Throbbing
Clinical presentation of Serous Otits Media
*No ear pain
*Eat feels full
*Pt has difficulty hearing
Otoscopic exam of otitis media
dull, pale TM with a fluid level
Management of Serous Media
Augmentin 250 – 500mg TID X10
Clinical examination of patient presenting with ear pain and fullness
Palpate lymph nodes,
Inspect external ear canal
Attempt visualization of TM and auditory canal
Assess hearing deficit but hearing tests not indicated
If severe otitis, culture of discharge prn
ESR prn for malignant otitis
CT/MRI prn for osteomyelitis
Clinical presentation of Otitis Externa
May begin with patient's ear itching.
Becomes painful
May have some difficulty hearing
May feel slightly dizzy.
Discharge is clear and odorless
Physical examination reveals tenderness on movement of the tragus and pinna
Auditory canal appears inflamed and swollen
Most likely patient is afebrile
Differential Diagnosis
Sudden Unilateeral Vision Loss
Acute close angle glaucoma
Central retinal vessel occlusion
Hyphema or other trauma
Optic neuritis
Temporal arteritis
retinal hemorrhage
retinal detachment
Differential Diagnosis
Gradual Unilateeral Vision Loss
Corneal Opacities
Macular Degeneration
Vitreous Opacities
Differential Diagnosis
Sudden Bilateral Vision Loss
Hyphema or Other Trauma
Retinal Hemorrhage
Retrobulbar Neuritis
Differential Diagnosis
Gradual Bilateeral Vision Loss
Macular Degeneration
Pituitary Tumor
Possible Causes of Ocular Pain with Photophobia
Acute Glaucoma
Corneal trauma
Differential Diagnosis:
Ocular Pain associated with Nausea and Vomiting
Acute Glaucoma
Differential Diagnosis:
Ocular Pain associated with Itching
Chemical Injury
Severe Dry Eye
Differential Diagnosis:
Ocular Pain associated with Foreign Body sensantion
Corneal ulcer or abrasion
Overexposure to UV light
Conjunctival or eyelid lesions (Important to rule out actual corneal or conjunctival Foreign Body)
Differential Diagnosis:
Ocular Pain associated with Pain with eye movement
Orbital Pseudotumor
Posterior Scleritis
Optic Neuritis
Orbital Cellulitis
Amaurosis fugax
trainsient, periodic visual loss associated with ophthalmic artery spasm in occulsice disease of internal Carotid Art or abnor. of Aortic Arch.

S/S and Mgmt of Blepharitis
S/S: Ocular burning, eyelid margins red with scaling or crusting, pain
Mgmt: Warm compresses, daily lid scrubs, erythomycin or bacitracin ophthamic ointment for anterior blepharitis
S/S and Mgmt of Cellulitis Orbital
S/S: Vision may or may not be affected, localized tenderness, erythema, edema, fever, proptosis
Mgmt: Referral to ophthal. for Hospitalization, IV antibx
S/S and Mgmt of Cellulitis Periorbital
S/S: Vision usually not affected, localized tenderness, erythema, edema, fevermay or may not be present
Mgmt: Systemic, brad spectrum antibiotic, office follow up visit in 12 to 24 hours
S/S and Mgmt of Dacryocystitis
S/S: Chronic tearing, eyelash crusting lacoalized tenderness, circumscibed erythema, edema in the inferior medial canthal area, may be able to express purulent material from te nasolacrimal duct
Mgmt: Wam compresses, genle massage, topical and.or systemic antibiotics
S/S and Mgmt of Chalazion
S/S: Non tenderness, Localized erythema, edema or eyelid(s)
Mgmt: Warm compresses, daily lid scrubs, lip massage
S/S and Mgmt of Hordeolum
S/S: Localized tenderness, erythema, edema or eye lid(s). internal lesions point to external or internal eyelid surface; external lesions point to eyelid margin
Mgmt: Warm compresses, lid scrubs for recurrent lesions, topical antx
S/S and Mgmt of Soft Tissue Hemorrhage
S/S: Localized tenderness may or may not be present, erythema, ecchymosis, edema of affected area
Mgmt: Cold compresses, if orbital floor fracture suspected, tomograms or CT scan
S/S and Mgmt of Acute Close Angle Glaucoma
S/S: Severe pain, N/V, halos, around lights, photophobia, cornea may be cloudy w/variable decrease in vision, conjuntical hyperemia, pupil middilated and fixed, firm globe, shallow anterior chamber
Mgmt: Refer emergently to ophthal. Consider pilocarpine 2% 1 ggt q 15 minutes and/or acetazolamide 250-500 mg PO stat
S/S and Mgmt of Chemical Exposure
S/S: Pain, conjunctival hyperemia, chemosis, corneal haze, decreased visual acuity
Mgmt: Immediate copious irrigation essential, refer emergently to ophthal
S/S and Mgmt of Allergic Conjunctivitis
Pruitis, conjunctival hyperemia, chemosis, watery or stringy discharge
Mgmt: Avoid allergen, cold compresses, topical and/or systemic medication (antihistimines)
S/S and Mgmt of Bacterial Conjunctivitis
Photophobia w/blepharospasm, mucopurulent dischage with eyelash matterin, edema, hyperemia, preauricular adenopathy onyl with hyperacute disorder
Mgmt: Topical antx, systemic anbx needed for gonococcal or chlamydial etiology
S/S and Mgmt of Viral Conjunctivitis
Acute onset often associated w/systemic illness, photophobia or foreign boy sensation, preaucular adenopathy, hyperemia, chemosis, watery discharge, classic dendritic conrneal lesion present with herpes simplex, periocular lesions present with herpes zoster ophthalmicus
Mgmt: Supportice tx, incl. cool compresses, topical artificial tears, ref to ophth. for herpetic conjunctivitis
S/S and Mgmt of Corneal Foreign Body, abrasion or ulcer
S/S: Foreign body sensation with intense pain, photophobia, conjunctival hyperemia, may have decreased visual acuity, ulcers usually present as white or opaque corneal lesion, immediate prior history of trauma usually precedes abrasion but not erosion
Mgmt: Topical antibiotics (prohy) and systemic pain relievers in abrasions and after foreign body removal, no patching generally, NEVER with ulcers or contact lens-related problems, urgent referral to ophthal. for erosion, emergent referral for ulcers
S/S and Mgmt of Dry Eye
S/S: Sandy, gritting, foreign body sensation, burning, pruitis, conjunctival hyperemia, decreased visual acuity
Mgmt: Topical artificial teras, lubricating ointemtns at night, warm compresses, gentle eyelid massage, evaluation for systemic disorder
S/S and Mgmt of Episcleritis/Scleritis
S/S: Mild to Severe pain
Circumstribed erythema of affected sclera
vision uneffected
Mgmt:Episcleritis usually self limiting
Scleritis- refer to ophthal.
S/S: Microspocic or visible blood layering in ant. chamber usually after blunt trauma, oftem associated with other ocular symptoms, Painful
Mgmt: Refer urgently to Ophthal.
S/S: Pain, photophobia, conjunctival hyperemia, pupil constriction, may have epiphora but no mucopurulent discharge, Painful
Mgmt: Refer urgently to ophthal
S/S: Pain, photophonia, conjunctival hyperemia, corneal cloudiness, with stromal involvement
Mgmt: Refer urgently to ophthal
Pinguecula and Pterygium
Ocular irritation or pain when inflamed, dry eye symptoms, flesh lesions medial on conjunctiva with pterygium, lesion extends onto cornea
Mgmt: Ocular lubricants; topical NSAIDs. With Pterygium, refer routinely to Ophthal.
Subconjunctival Henorrhage
S/S: No subjective symptoms, bright red spot of blood visible under overlying conjunctiva, remainder or conjunctiva is white
Mgmt: Reassurance: no treatment necessary