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152 Cards in this Set

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  • Back
What is Meibomianitis?
Inflammation of the meibomian glands with thickening of the secretions, causes dry eye, thickened lid margins, cysts on lid eversion. Yellow caps on meibomian glands.
When expressing meibomian glands what does the grading system of +1-+4 stand for?
+1-secretions clear but not easily expressed
+2-secretions whitish, not easily expressed
+3-thick and white like tooth paste
+4-no secretions expressible
What is an external hordeolum
staph infection of gland of zeiss or moll (stye)
white bump on lid margin that hurts. pain is localized. filled with puss. erythema
What things are associated with an external hordeolum?
acne rosacea, poor diet, stress, blepharitis
What should you do if you suspect an external hordeolum?
palpate lid, evert lid, evaluate meibomian glands
What is an internal hordeolum?
Staph infection of Meibomian gland. Bump on lid that hurts, swelling is localized. you can see puss coming out of it
1.What is associatied with internal hordeolums
2.what tests should you do if you suspect one?
1.acne rosacea and blepharitis
2.palpate lid, evert lid, evaluate meibomian glands
Differential diagnosis of internal hordeolum
preseptal cellulitis
sebaceous gland carcinoma
What is a chalazion?
granuloma of meibomian gland or gland of zeiss. caused by blockage of meibomian gland orifices and stagnation of meibomian gland secretions can be followed by an internal hordeolum.
What are the symptoms and signs?
Firm eyelid bump that is not tender or painful can cause astigmatism, hyperopic shift or meibomianitis
What is a chalazion associated with?
meibomianitis, blepharitis, seborhea, rosacea
What are some differential diagnosis for a chalazion?
internal hordeolum
sebaceous gland carcinoma
What is lagopthalmos?
The lids don't close all the way
What are some symptoms of lagopthalmos?
dry eye, FBS, grittiness ,burning, tearing, can be asymptomatic
test if you suspect lagopthalmos
stain with rose bengal or flouresin look for staining at the lower cornea. Ask patient to close their eyes as if they were sleeping.
what is lagopthalmos associated with?
lid surgery
What is entropian?
Eyelid is turned in towards the globe
What are the symptoms and signs of entropian lids?
ocular irritation, FBS, tearing, red eye, inward turning of eyelid margin, SPK, trichiasis, conjunctival injection
What are entropian lids associated with?
age, scarring, congenital, ocular disease causing a dry painful cornea.
What are ectropian lids?
Lower eye lid no oppossed to the globe
What are the symptoms and signs of ectropian lids?
tearing, eye or lid irritation, can be asymptomatic
outward turning of the lower eye lid, SPK, conj injection, eventual conj keratinization
What are some associations with ectropian lids?
age, congenital, 7th nerve palsy, scarring, lid tumor, allergic
What is dermatochalasis?
Baggy eyelid skin that can pull the eyelid down (upper lid into line of sight, lower lid away from eye). associated with aging
signs and symptoms of dermatochalasis:
Excessive eyelid skin
droopy lid, dryness, loss of vision,
What test can you do if you suspect dermatochalasis?
Visual fields without lid taping if you want surgery
What are the HABC's of determing if a something is benign or possibly cancerous?
H=hair good!
A=avascular good!,asymmatry Bad!
B=borders distinct good, bleeding bad!
C=color the same good!
and changing BAD!
S=size bigger tham 6mm suspicious!
What is staphyloccocus blepharitis?
infection and colonization of the lashes by staphylococcus
What are the signs and symptoms of staphylococcus blepharitis?
crusting and flaking around the lashes, FBS, collarettes, erythema, thickening of lid margins, SPK of the inferior cornea, erythema of lid margins,
What are somethings that are associated with staphylococcus blepharitis?
prone to dry eye, hordeoleum, chalzia, staph hypersensitivity, acne rosacea
Name three other types of blepharitis.
seborrheic blepharitis-greasy scales!
demodex folliculorum
atopic blepharitis-on eyelids
what is triciasis?
misdirected lashes rubbing against the globe
What are the signs and symptoms of trichiasis
misdirected lashes, ocular irritation, FBS, SPK, conj injection
if longstanding: ulceration, scarring, pannus
What is the etiology of trichiasis?
1.chronic blepharitis
2.cicatricial from trauma, trachoma, others
What is pannus?
Blood vessels growing into the cornea at the level of bowman's membrane
What are the ocular signs of pannus?
bv's growing into the cornea at the level of bowman's membrane with little to no elevation
What is the etiology of pannus?
secondary to contact lenses, blepharitis, trachoma, ocular rosacea, herpetic keratitis
What is a pterygium?
wing-shaped fold of fibrovascular tissue arising from interpalpebral conj and extending to the cornea.
What are the symptoms and signs of a pterygium?
wing shaped fold extending onto the cornea, injection, SPK, Irritated, red, decreased vision
How do you know if a pterygium is activly growing or not?
active-red blood cells at the head
inactive-stocker's line iron line at the head.
What are pterygiums associated with?
UV exposure and dryness
What is arcus?
stromal lipid deposition
What are some symptoms and signs of arcus?
"white/blue thing in eye"
Peripheral white corneal arc with a clear zone separating it from the limbus
what is arcus associated with?
aging, hyperlipidemia, high cholesterol
What is the limbal girdle of vogt?
limbal degeneration, subepithelial deposits of hyaline degeneration and elastosis, peripheral to where bowman's ends
What are the ocular signs of limbal girdle of vogt?
bilateral narrow crescents of chalk like flecks at the nasal and temporal interpalperable limbus it does not progress.
What are the associations of the limbal girdle of vogt?
What is superficial punctate keratitis?
pinpoint corneal epithelial defects
What are the signs and symptoms of SPK?
Pain, red eye, FBS, photophobia, pinpoint defects stain with flourescein, conj injection,
What are some possible etiologies of SPK?
dry eye syndrom, blepharitis, trauma, exposure keratopathy, topical drug toxicity, UV burn, contact lenses, Foreign body, conjunctivitis, trichiasis,entropian, ectropian, floppy eyelid syndrom , Thygeson's spk
What is a corneal abrasion?
loss of corneal epithelium
What are the symptoms and signs of corneal abrasion?
acute ocular pain, photophobia, tearing, usually a history of trauma, focal area of loss of corneal epithelium can be small or large.
When there is a corneal abrasion what is one very important thing to do?
Flip lids!
What are corneal abrasions associated with?
injury, recurrent corneal erosion
What is a corneal infiltrate?
collection of the WBC's within the corneal stroma.
What are the symptoms and signs of a corneal infiltrate?
red eye, photophobia, ocular pain, decreased vision, asymptomatic,
white stromal infiltrate, no epithelial defect, conj injection, stromal edema, inflammation around infiltrate, anterior chamber reaction, eye can be white and quiet.
What are the etiologies of a conneal infiltrate?
dry eye syndrom, collagen vascular disease, bacteria, virus, immune reaction to contact solution, fungi, acanthamoeba, herpes simplex, vit A deficiency
What is the most common cause of an infectious corneal ulcer?
(assume bacterial until proven otherwise)
What are the signs and symptoms of a bacterial ulcer?
red-eye, mild-severe ocular pain, photophobia, decreased VA, discharge
White corneal stromal infiltrate, overlying epithelial defect, conj injection, stromal edema, folds in desmente's membrane, hypopyon, mucopurlent discharge lid edema and corneal thinning.
What is guttata?
mushroom shaped bumps on descemet's membrane and a decrease or flattening of endothelial cells.
What are the signs and symptoms of guttata?
usually no symptoms. signs include bilateral guttata, fine dusting of pigment on the endothelium
What is associated with guttata?
corneal edema after cataract surgery, Fuch's endothelial dystrophy
What is krukenburg's spindle?
vertical band of pigment on the corneal endothelium, it is liberated when the iris bends back in the periphery and rubs against the zonules
What are symptoms of krukenburg's spindle?
episodes of blurred vision, eye pain, colored haloes, around light after dilation or excercise, or asymptomatic
What are the signs of krukenburg's spindle?
vertical band of pigment on corneal endothelium
What are the symptoms of pigment dispersion syndrom?
iris transillumination, krukenburg's spindle, dense brown pigment in the trabecular meshwork.
What are fifty percent of patients with pigment desperson syndrom at risk for?
pigment dispersion glaucoma
what is a pinguecula?
lipid deposits, abnormal elastic fibers, degenerated collagen fibers, sometimes with calcification
What are symptoms of a pinguecula?
irritation, redness, maybe asymptomatic
What are the ocular signs of a pinguecula?
yellow white conj lesion, slightly raised or flat in the interpalpebral fissure adjacent to the limbus. does not involve the cornea, bilateral possible injection or spk.
What is a pinguecula associated with?
dryness, uv light.
What is conjuntival epithelial melanosis?
benign pigment within the conj epithelium. with no symptoms
What are ocular signs of the conj epithelial melanosis?
bilateral brown flat patchy pigment areas scattered throughout the conj. presents in the first few years of life and is stable to adulthood. moves freely on globe with q-tip.
what is conj epithelial melanosis associated with?
african americans and dark complected people.
What is injection?
red eye because of engorged inflamed conj vessels
What are some of the etiologies of injection?
dry eye, ulcer, blepharitis, lagopthalmos, entropian, ectropian, triciasis, abrasion, spk, foreign body, MANY MORE!
What is chemosis?
swelling of the conj
what are symptoms of chemosis?
itchy and watery if allergy
What are signs of chemosis?
puffy conj, injection, watering
What is chemosis associated with?
ocular allergy, viral conjunctivitis
What is mucopurulant discharge?
excretion of mucous and pus in response to a bacterial ocular surface infection
What are the symptoms of mucopurulant discharge?
yellow-green stuff coming from the eye, eyes stuck together in the morning, red eye, FBS, burning.
What are the ocular signs of mucopurulant discharge?
discharge in conj fornices, bulbar conj, caruncle, along lashes
What is mucopurulant discharge associated with?
bacterial conjunctivitis, bacterial ulcer, preseptal cellulitis, dacryocystosis, canaliculitis
What are follicles?
hyperplasia of lymphoid tissue
What are the ocular signs of follicles?
each follicle surrounded by tiny bv's, usually inferior palpebral conj.
What are follicles associated with?
viral conjunctivitis, adenovirus, coxsackie virus, enterovirus, ect.
What are papillae?
hyperplastic conjunctival epithelium
What are the ocular signs of papillae?
vessels emerge from the center of a fibrovascular core. look like hyperemic polygons, separated by paler, channels, they leak pus. usually in the superior palpebral conj.
What are papillae usually associated with?
bacterial conjunctivitis
What is episcletitis?
inflammation of the episclera
What are symptoms of episcleritis?
acute onset of redness and mild pain, tenderness at area of engorgment, unilateral, often with reoccurance.
What are ocular signs of episcleritis?
sectoral redness of one or both eyes, no involvement of cornea or the anterior chamber
What happens if you instill 2.5% phenylephrine to the eye with episcleritis?
vessels will blanch
What is scleritis?
inflammation of the sclera
what are the symptoms of scleritis?
boring eye pain, radiates to forehead or jaw awakens at night, gradual onset, red eye tearing, photophobia, no discharge, often recurrent
What are the ocular signs of scleritis?
inflammation of scleral, episcleral, and conj vessesls,
Do vessels move with q-tip in scleritis?
Does 2.5% phenylephrine blanch the vessels in scleritis?
What color does the sclera appear in scleritis
it has a thinned bluish hue
What is an iris nevus?
localized swelling of iris stroma
when does an iris nevus usually appear?
what color irises are most common for iris nevus?
light irides
What are the signs of an iris nevus?
brown iris neoplasm, usually inferior iris, not vascular, flat or elevated
In what disease do people get multiple iris nevi?
What is a persistent pupillary membrane?
remnants of the tunica vasculosa lentis
What are the ocular signs of a persistent pupillary membrane?
strands that attach to the iris collarette peripherally can attatch to the anterior lens or float freely
What are epicapsular stars?
pigment spots on the anterior lens capsule where a persistant pupillary membrane was attached before it broke free
What kind of cataract is sometimes associated with a PPM?
anterior polar cataract
What can cause Neovascularization of the iris?
severe diffuse chronic retinal ischemia this stimulates vasoproliferative factors stimulates bv's to grow on retina, optic disc,IRIS, trabecular meshwork.
What are the complications and risks of Neovascularization of the iris?
fibrovascular membrane can grow over anterior chamber structures this can cause peripheral synechia and secondary angle closure glaucoma
What are the range of symptoms of NVI?
asymptomatic-->pain, red, eye photophobia-->decreased vision
--->blind painful eye
What are the three stages of NVI's?
1.capillary tufts on the pupillary margins. No glaucoms
2.neovascularization across iris joining with the ciliary body artery, proliferate over the CB and Scleral spur, increased IOP urgent!
3.reduced VA pain, partial or complete closure of angle, flare, pupil distortion, high IOP leads to blindness
What things are associated with NVI's?
ischemic retinal vein occlusion, diabetic retinopathy, ocular ischemic syndrom, central retinal artery syndrom, tumors, retinal detatchment, uveitis, trauma, etc.
What is iris transillumination?
you can see the red reflex through the iris with retroillumination through the pupil
What are some things associated with iris transillumination?(4)
1.pigment dispersion syndrom
3.herpes zoster opthalmicus
4.damage from surgery
What is a posterior synechia?
adhesion of the iris at the pupillary margin to the anterior lens capsule caused by anterior uveitis (anterior chamber cell and flare)
What are some ocular signs of a posterior synechia?
misshapen pupil, fixed pupil, iris bombe, increased ocular pressure, secondary angle closure
What is an anterior synechia?
adhesion of the peripheral iris to the peripheral corneal endothelium caused by anterior uveitis
What are the ocular signs of anterior synechia?
adhesion of the peripheral iris to the peripheral corneal endothelium in the corneal periphery covers up the TM. if too much TM is covered then IOP increases
What is associated with an anterior synechia?
anterior uveitis, chronic angle closure glaucoma
What is cell and flare in the anterior chamber?
intraocular inflammation causes uveal vessels to vasodilate stuff leaks out.
What are symptoms of acute cell and flare in the anterior chamber?
redness, pain, photophobia, decreased vision, asymptomatic
What are symptoms of chronic cell and flare in the anterior chamber?
minimal redness and pain, distorted pupil, decreased vision, asymptomatic
What are the ocular signs of cell and flare in the anterior chamber?
cells move from top the bottom in front and bottom to top in the back of the chamber
What are some things that are associated with cells and flare in the anterior chamber?
infections, immunological conditions, systemic diseases, foreign bodies
What is hypopyon?
WBC's settled into the bottom of the anterior chamber because of gravity
What are some symptoms of hypopyon?
pain, red, photophobia, decreased vision
What are the ocular signs of hypopyon?
inferior anterior chamber is filled with white stuff
What can a hypopyon lead to?
ant or post synechia, inflammatory glaucoma, blindness
What is a hypopyon associated with?
intraocular inflammation from infections, immunologic conditions, systemic diseases, foreign bodies
What is a hyphema?
RBC's that have settled in the inferior anterior chamber because of gravity
What are the symptoms of a hyphema?
dull aching pain, blurred vision,
What are the ocular signs of a hyphema?
inf. anterior chamber filled with red fluid, can have increased IOP, can cause optic nerve damage, possible corneal staining
What is a hyphema associated with?
blunt trauma, blood clotting disturbances, blood dyscrasias, Iris neovascularizations, after intraocular surgery.
What are Y sutures?
They are in the fetal nucleus beneath the capsule at birth. after birth secondary fibers are laid down over the nucleus, lens grows throughout life.
What is nuclear sclerosis?
older fibers in the nucleus of the lens degenerate, and the cell membrane dissolves, yellow brown pigment accumulates, nucleus becomes hard and dense, index of refraction increases
What are some specific symptoms to nuclear sclerosis?
monocular diplopia, glare, worse in dim light
What are some specific ocular signs?
myopic shift, increased spherical aberration, yellow-brown discoloration of the nucleus, may become red or black
What is cortical spoking?
lens cortex electrolyte imbalance
What are some symptoms of cortical spoking?
worse in bright light, slow progression, difficulty with reading and glare, mildly decreased color vision
What are the ocular signs of cortical spoking?
opacification of the lens, dim retinoscopy reflex, radial opacities in the cortex of the lens, start as vacuoles later look like spokes
What is a posterior subcapsular cataract?
posterior migration and proliferation of cells on the posterior capsule, with opacification of adjacent cortex
What are specific symptoms of post. subcapsular cataract?
less common, usually less than 50 years old, glare from headlights are problem, near vision is usually worse than distance, rapid progression
What are the specific ocular signs of a posterior subcapsular cataract?
looks like the surface of the moon, plaque on the posterior capsule, you can see it well with retro illumination
What are things that are associated with posterior subcapsular cataract?
steroid use, uveitis, diabetes, trauma, radiation,
What is iridodialysis?
splitting of the iris from the ciliary body at the root secondary to blunt trauma.
What are the symptoms of iridodialysis?
monocular diplopia, glare, asymptomatic
What are ocular signs of iridodialysis?
black area where iris is ripped away from the ciliary body, a D-shaped pupil
What 2 things are associated with iridodialysis?
1. blunt trauma
2. angle-recession glaucoma
What is an angle tumor?
A tumor in the anterior chamber angle can be benign or malignant
What are the ocular signs of an angle tumor?
dark fleshy mass in the angle, maybe a misshapened pupil
What are 4 types of angle tumors
1.metastasis to angle
2.adenoma of the iris pigment epithelium
3.iris melanoma
4.forward extension of ciliary body melanoma