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69 Cards in this Set
- Front
- Back
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eye anatomy
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1. lid
-areolar tissue glands (Meibomian, Zeiss, Moll) 2. Cornea -avascular 3. Conjunctiva -vascular -mucosal surface can be associated w systemic disease involving skin/mucous membrane (rheumatoid disorders), thyroid diseases, etc -exposed to environmental stressors -papillae |
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eye: symptoms of self-treatable conditions
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-eyestrain
-burning -itching -stinging -mild discharge -mild redness of eyelid -mild, diffuse redness of conjunctiva |
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eye: when to refer
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-pain
-photophobia -altered vision -severe redness of conjunctiva or eyelid -trauma to eye -floating spots (disconnection of retina) -abnormal pupils -headache -redness around the cornea -untreated conditions lasting > 48h -self-medication > 48h w anti-infectives (w/o improvement) -self-medication > 72h w other agents (w/o improvement) |
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glands of the eyelid
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Meibomian glands
-secrete sebum -single row of 20-30 run perpendicular to lid margin in each eye Gland of Zeis -secretes sebum -located around middle of eyelash follicle Gland of Moll -sweat gland -located at base of eyelash follicle |
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blepharitis
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inflammation of eyelid
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blepharitis goals of therapy
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1. improve pt comfort
-reduce/relieve pain, inflammation, appearance 2. reduce risk of recurrence 3. reduce risk of complications: -conjunctivitis -keratitis -altered visual fxn -structural damage to eyelids, ocular surface |
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blepharitis: general measures
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manage contributing factors (eg. dermatologic conditions)
basic care: -avoid touching eyes as much as possible -avoid squeezing lesions -wash hands before and after touching eye area -clean towels (own hand towel + 1 for each eye) -eyelid margin hygiene where appropriate |
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eyelid margin hygiene
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-acute exarcebations: qhs or bid
-maintenance: daily to twice weekly (pts w chronic disease will continue maintenance indefinitely) procedure: -apply warm compress to closed eyelids for 5-10min -then gently scrub (closed) lid margin -Q-tip or face towel w warm water (+/- baby shampoor) or a commercial product (1-3 drops baby shampoo in 100mL water, dip Q-tip in then scrub) |
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eyelid conditions
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non-infectious:
-blepharitis (allergic, chemical, chalazion) infectious: -blepharitis (bacterial) - refer -hordeolum (aka stye) |
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allergic/chemical blepharitis due to:
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-contact hypersensitivity
-chemical irritant commonly: -smoke -plants (eg. Poison Ivy) -Metal (eg Nickel) -cosmetics, nailpolish -medications (eg. neomycin, pilocarpine, tetracaine, timolol) |
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allergic/chemical blepharitis: non-drug
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-eliminate cause
-cool, moist compresses x 5-10 min several times daily (if there are crusts use warm compress) |
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allergic/chemical blepharitis: when to refer
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basic care ineffective within 48h (or symptom progression)
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infectious blepharitis cause
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usually S. aureus or S. epidermis
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infectious blepharitis onset
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often chronic, recurring
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infectious blepharitis location
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posterior or anterior lid margins and associated glands
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infectious blepharitis Sns/Sx
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-usually bilateral and diffuse
-swelling and erythema -possible photophobia -eyelids may stick together after sleep |
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posterior blepharitis (infectious)
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-inflammation and obstruction of Meibomian glands
-yellow, greasy scales -associated w derm conditions -chronic: posterior lid margin becomes thickened |
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anterior blepharitis (infectious)
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-area of dysfxn = glands of Moll, Zeis
-anterior lid margin becomes inflamed, red -S. Aureus: dry, flaky scales - tiny ulcerations around eyelashes |
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infectious blepharitis tx
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Refer because:
-dx difficult, potential long term complications (disfigured lid margin, eyelash loss, keratitis) under physician supervision: -OTC Abx (eg polysporin ointment) or Rx Abx (acute: qid x 1-2wk, chronic: as per acute then continue hs x another 4-8wk) -if seborrheic: anti-seborrheic shampoo to scalp 1-2x weekly + artificial tears bid-qid -if chronic: artificial tear gel |
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infectious blepharitis: non-drug
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AFTER the pt has seen the MD:
1. warm, moist compresses -5-15 min daily-qid 2. lid cleansing -CRITICAL component -margins only acute: bid (am & pm) chronic: daily to twice weekly |
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hardeolum (stye) cause
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usually S aureus
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hareolum (stye) onset
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acute
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hardeolum (stye) location
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external (glands of Zeis or Moll) or internal (Meibomian glands)
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Hardeolum (stye) Sns/Sx
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-unilateral, localized lid swelling w erythema
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External stye
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(Anterior lid)
-blockage and infection of Glands of Moll/Zeis -often points -> skin -smaller, more superficial |
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Internal stye
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(Posterior lid)
-blockage and infection of Meibomian gland -points -> conjunctiva or skin -large, more prolonged, rarely drains spontaneously |
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stye: non-drug
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-warm, moist compresses (5-15min bid-qid)
-eyelid hygiene -do not squeeze! (can get orbital cellulitis) |
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stye: when to refer
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-if basic care ineffective in 48h
-increased pain (particularly internal styes) -multiple styes |
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chalazion cause
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sterile
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chalazion onset
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chronic
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chalazion location
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blockage of Meibomian glands
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Chalazion Sn/Sx
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-unilateral, localized pea-like swelling +/- erythema
-usually larger than styes -> dry eye, visual disturbance |
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chalazion
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may develop over and last for weeks or months
-25% resolve spontaneously within a few days -more common in adults -associated w chronic skin conditions (eg seb derm, acne rosacea) |
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chalazion: non-drug
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-apply warm compress for 10-15min qid then massage cyst for ~1min
-eyelid hygiene: particularly to prevent recurrence -topical Abx not recommended |
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chalazion when to refer
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if no drainage within 48h
note: refer immediately if pt complains of pain or impaired vision |
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conjunctival conditions
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non-infectious:
-dry eye -subconjunctival hemorrhage - refer -conjunctivitis (allergic) infectious -conjnctivitis (viral) - refer -conjunctivitis (bacterial) |
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conjunctivities: immediate referral
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hyperacute and acute:
-acutely red -copious tearing and/or green-yellow mucopurulent discharge -unilateral (at onset) -pain, photophobia, blurred vision that does not clear w blink, foreign body sensation |
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viral conjunctivitis: sx
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-diffuse, acutely red
-possible itching -copious, clear, serous (watery) discharge -pain -conjunctival swelling -mild photophobia -foreign body sensation -possible tender periauricular nodes |
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viral conjunctivitis: affected eye
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onset: bilateral or unilateral -> quickly bilateral (within 24h spread to other eye)
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viral conjunctivitis duration
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usually self-limiting; lasts 2-4wk
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cause of viral conjunctivitis
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adenovirus (common cold)
-may follow URTI also: herpes virus, VZV, others |
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viral conjunctivitis Tx
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refer because many possible differential diagnosis
-basic care |
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viral conjunctivitis non-drug
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post diagnosis:
basic care: -cool, moist compresses qid -prevent spread (hygiene) -discard make-up, disposable lenses, etc -avoid contact lens until resolved -highly contagious; avoid contact w others for at least 7d or until discharge resolved (may be up to 14d) artificial tears may provide soothing relief |
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bacterial conjunctivitis sx
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-diffuse redness
-minimal or no itching -moderate, mucopurulent or purulent (yellow-white) discharge -mild photophobia -irritation; lids may stick together; crusting -foreign body sensation |
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bacterial conjunctivitis affected eye
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onset: bilateral or unilateral -> quickly bilateral
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bacterial conjunctivitis duration
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~65% of untreated cases resolve spontaneously within 2-5d
(chronic form also) |
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causes of bacterial conjunctivitis
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adults: (viral is more likely)
-Staphylococcus species -S. pneumoniae -H. influenza children (bacterial more likely) -S pneumonaie -H. influenza -M catarrhalis -S aureus Neonates (refer) -N gonorrhoeae (less common) -C trachomatis -persistent and increasingly purulent conjunctivitis 3-21d post-delivery |
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conjunctivitis goals of therapy
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-cure infection
-prevent transmission to others -prevent complications |
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bacterial conjunctivitis: non-drug
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-avoid contact lens and eye patch use until full recovery
-ensure good hygiene; prevent spreading to others (wash hands, use separate towels, wash linens, discard make-up, lenses, etc) -apply warm compresses if eyelids crusted over -clean purulent discharge w gauze compresses or lid cleanser prior to instilling eye preps (tap water saline, or commercial eye wash products) -avoid ocular decongestants (mask signs of infection) |
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bacterial conjunctivitis: drug
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suspected bacterial conjunctivitis:
empiric tx w topical Abx -reduces time to clinical cure -benefit is small (use if no improvement of sx in 1-2d) -decrease person-person spread? culture positive bacterial conjunctivits: -topical Abx: cure rates increased in first week -no evidence of longer-term beneift |
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bacterial conjunctivitis: OTC tx
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eg polysporin
soln: i-ii drops bid-qid ointment: 0.5cm strip inside lower lid daily to tid duration: 2d post sx (usually 5-10d) SEs: stinging (soln), long-term use may cause corneal epithelial toxicity |
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bacterial conjunctivitis: eg of OTC products
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Polymixin B
-against G (-) -soln -oinment Bacitracin -against G(+) -ointment (doesn't go into soln) Gramicidin -against G(+) -soln |
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bacterial conjunctivitis: when to refer
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-abx ineffective within 48h
-neonate, child or debilitated pt (C&S) (note 25% of children w H flu conjunctivits develop otitis media) -contact lens wearer (risk of bacteral keratitis 30 per 100 000) |
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allergic conjunctivits sx
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-diffuse redness
-often severe itching (hallmark sx) -moderate, clear, commonly serous or mucoid discharge -mild eyelid swelling -burning *often history of hay fever/allergic rhinitis |
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allergic conjunctivits affected eye
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usually bilateral
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allergic conjunctivits: duration
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chronic through allergy season w perennial; recurrent
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allergic conjunctivitis: cause
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Perennial: dust, smoke, molds, animal dander
seasonal: grass, pollens symptoms often decrease w age |
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allergic conjunctivitis goals of therapy
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-prevent symptoms
-alleviate signs and symptoms produced by the allergic response -improve quality of life |
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allegic conjunctivitis: non-drug
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-avoid allergen (if possible)
-modify environment -cool compresses several x daily -discontinue contact lens wear temporarily -minimize rubbing the eyes (wearing cotton gloves may prevent rubbing) |
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allergic conjunctivitis tx
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-tear substitutes/lubricants
-decongestants -antihistamines -combination: AH + D -mast cell stabilizers |
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allergic conjunctivitis: artificial tears
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-instilled 2-6x daily
-preferably preservative-free -used to soothe eyes and wash away allergens |
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allergic conjunctivitis: ocular decongestants
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-vasoconstrictoin; decrease interstitial fluid accumulation
indication: to relieve conjunctival redness and eyelid edema contraindications: presence of infection (cough/cold CI) ADRs: stinging, risk of rebound vasodilation directions: q-2 gtts q3-4h prn (max 3d) -remove contact lenses during use |
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allergic conjunctivitis: ocular AH
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RX: ketotifen, olopatadine, etc
OTC: available in combo w D MOA: selective histamine H1 antagonism indication: ocular allergies ADRs: stinging, dry eyes directions: 1-2 gtts bid-qid |
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allergic conjunctivitis: ocular AH + D
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-Antazoline + naphazoline
-Pheniramine + naphazoline -considered more effective than either agent alone -cautions for each product apply (eg. max 3d for decongestant) |
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allergic conjunctivitis: mast cell stabilizers
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MOA: stabilize mast cells and prevent release of inflammatory mediators (no AH or D action)
indication: prevention of Sx of allergic conjunct., generally for recurrent/persistent sx ADRs: stinging, buringn directions: 1-2 gtts 4-6 times per day -Symptomatic improvement in 3 for some pts, often much longer for max effect -regular use reqd to prevent allergic Sxs |
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allergic conjunctivitis: when to refer
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-if medications ineffective within 72h
-severe - need DDX eg. VKC - Vernal Keratoconjunctivitis GPC - Giant Papillary conjunctivitis AKC - Atopic Keratoconjunctivitis |
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subconjunctival hemorrhage
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onset: sudden
fades: 2-3 wks |
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subconjunctival hemorrhage tx
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refer to rule out serious diagnosis
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subconjunctival hemorrhage causes
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-severe or minimal trauma
-sudden rise in venous pressure, particularly in the elderly eg. cough, straining, sneezing, vomiting -systemic disease eg. hypertension, blood dyscrasias -adenovirus/bacterial conjunctivitis -spontaneous (unknown cause) |
