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102 Cards in this Set
- Front
- Back
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What are the different anterior segment disorders?
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Bacterial conjunctivits
Keratitis Uveitis Angle closure glaucoma Endophthalmitis Orbital cellulitis Orbital tumor Cataract Aphakia Pseudophakia Intraocular lens Contact lens |
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What are the different layers of the anterior segment? When does it end?
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Conjunctiva: smooth skin/mucosal membrane that lines the eye surface
Cornea: clear front layer Anterior chamger: space between the cornea and the lens Iris Lens It extends from the Conjunctiva to the lens |
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What are the components of the ocular adnexa?
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Eyelids
orbit |
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What structures are in the periorbital fat?
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Optic nerve
Ocular muslces Vasculature supplying the nerves |
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What are some common anterior segment disorders?
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Contact dermatitis
Chronic blepharitis Stye |
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What are the causes of contact dermatitis?
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Hypersensitivity reaction to topical medications or cosmetics
-Neomycin -Cycloplegics |
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What does contact dermatitis look like? What occurs to the conjunctiva?
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Erythematous, leather, scaly thickening of the skin
You get chemosis: edema of the conjunctiva |
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What is the treatment of contact dermatitis?
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Discontinue the offending agent!
If it's really bad, give a topical steroid cream |
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In contact dermatitis, when should you refer to an ophthalmologist?
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If the dermatitis doesn't resolve within 2 weeks.
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What is the definition of chronic blepharitis?
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Continuous inflammation of the eyelids
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What are some causes of infection of the anterior portion of the eyelids in chronic blepharitis?
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S. aureus infection of the skin, cilia follicles
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What are some causes of infection of the posterior portion of the eyelids in chronic blepharitis?
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Infection/inflammation of the meibomian glands
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What is another name for chronic blepharitis?
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Rosacia
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What is the clinical presentation of chronic blepharitis?
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Hazy corneas
Redness of the conjuctiva Skin surrounding the eye is all infected |
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What is the treatment of chronic blepharitis?
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Warm compresses for 5-10 minutes, 2x/day
Wash the lid specifically with baby shampoo If very bad, give ointment (bcitaracin) or oral antibiotics (doxy) |
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What is the purpose of giving doxycycline in chronic blepharitis?
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Antinflammatory agent
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What is the definition of a stye?
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A focal inflammation of the ciliary follicles
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What is the clinical presentation of a stye?
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Painful, tender focal mounding over days
Mild conjunctival hyperemia |
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What is the treatment for a stye?
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Warm compresses up to 4x a day
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What would cause a stye to have to be removed?
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Chalazion: a chronic, granulomatous inflammation that causes buildup/bump
Basically, it's a stye that has gotten really serious |
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What are some of the super concerning anterior segment disorders?
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Bacterial conjunctivitis
Keratitis Uveitis Angle closure glaucoma Endopthalmitis Orbital celulitis Orbital tumor |
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How does someone present with bacterial conjunctivits?
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Ocular pain
Diffuse hyperemia, swelling Purulent discharge |
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What are some of the bugs that cancause bacterial conjunctivitis?
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The hospital pathogens:
S. aureus S.pneumoniae H. influenzae Also, N. gonorrhoeae |
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What is the treatment for bacterial conjunctivitis?
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Topical:
Erythromycin, aminoglycoside, trimethoprim, fluoroquinolone |
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If you're thinking that N. gonorrhoeae as the cause of bacterial conjunctivitis, what should you give the person?
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IV ceftriaxone
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When should you refer someone to the ophthalmologist when they have bacterial conjunctivitis?
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If there's puss
If it's N. gonorrhoeae Contacts Recent eye surgery |
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What is a serious complication of N. gonorrhoeae bacterial conjunctivitis?
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The cornea can MELT!
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What isopthalmia neonatorm?
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Conjunctivits in kids
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What are causes of opthalmia neonatorum?
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Silver-nitrate prophylaxis
Infection in the birth canal |
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What are some of the different bugs that can cause opthalmia neonatorum?
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Chlamydia trachomatis
Neisseria gonorrhoeae Herpes simplex |
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What's on the differential diagnosis for bacterial conjunctivitis?
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Other types of conjunctivitis
Episcleritis Scleritis Pinguecula Pterygium Subconjunctival hemorrhage |
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What's the most common cause of red eye?
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Viral conjunctivitis
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What's the timecourse of viral conjunctivits?
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Self-limited
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What's the clinical presentation of viral conjunctivitis
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Diffuse hyperemia with the follicles
Watery discharge Ocular fullness, warmth TENDER, SWOLLEN PREAURICULAR NODE |
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What's the treatment for viral conjunctiviti?
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No antibacterials!!
Topical lubrication Cold compresses (to reducethe edema) Hygeine- you don't want to spread this guy!! |
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What kinds of viruses most commonly cause viral conjunctivitis?
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Adenoviruses
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What are the different types of conjunctivits chlamydia?
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Trachoma
Neonatal inclusion Adult inclusion |
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What is the clinical presentation of conjunctivitis chlamydia?
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Hyperemia conjunctiva with follicles
Mild mucoid discharge |
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When do you think that something is conjunctivitis chlamydia?
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You first think it's a viral conjunctivitis that doesn't resolve
Send a scraping for culture |
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What is the treatment for conjunctivitis chlamydia?
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Oral:
Erythromycin Doxycycline Azithromycin |
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What is the clinical presentation of allergic conjunctivitis?
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Seasonal!
Itching Eyelid edema Watery discharge Conjunctival hyperemia |
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What's the treatment of allergic conjunctivitis?
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Systemic antihistamines
OTC vasoconstrictors H1-blockers Topical NSAIDs |
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What is the definition of episcleritis?
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Idiopathic focal inflammation of the deep subconjunctival tissue
Superficial to the sclera, but it's penetrated the conjunctiva |
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What's the clinical presentation of episcleritis?
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Eye pain
Focal or diffuse hyperemia |
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What's the treatment for episcleritis?
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Oral NSAIDs
Topical lubrication |
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When should you refer a case of episcleritis to an ophthalmologist?
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When the pain is severe
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What's the definition of scleritis?
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Focal or diffuse inflammation of the sclera
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What systemic conditions is scleritis associated with?
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Rheumatoid arthritis
Wegeners granulomatosis Relapsing polychondritis |
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What is the clinical presentation of scleritis?
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Severe pain
Scleral thinning with a dark purple color |
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What's the treatment for scleritis?
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You've got to think systemic conditions here!
Systemic immunosuppression |
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What's the definitionfo pingueculum?
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Degeneration of collagen in the nasal or temporal bulbar conjunctiva
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What's the cause of pingueculum?
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People who are exposed to the sun and wind
The farmer's eye disease!!! |
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What's the clinical presentation of pingueculum?
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Mild ocular discomfort
Focal hyperemia |
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What's the definition of pterygium?
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Fibrovascular proliferationof bulbar conjunctiva browing over the cornea
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What's the clinical presentation of pterygium?
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Hyperemic growth over the cornea
Burred vision |
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What's the cause of subconjunctival hemorrhage?
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increase of intrathoracic pressure
-sneezing -coughing -valsalva -HTN -anticoagulation -blood dyscrasias |
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What does subconjunctival hemorrhage look like?
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Blood pooling in the sclera
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What is the definition of keratitis?
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Inflammation of the cornea
-Infection -Dry eyes -Contact lens over wear -Autoimmune disorders |
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What's the clinical presentationof keratitis?
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Blurry vision
Pain Photophobia Foreign body sensation |
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If there is pathology of the cornea, what are the symptoms that you'll see?
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Pain
Light sensitivity Foreign body sensation |
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What's the pathogenesis of HSV to the eyes?
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Direct contact
-Shedding -Birth canal |
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What kind of HSV is genital? What type is orofacial/ocular?
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HSV1: orofacial/ocular
HSV2: genital |
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What's the clinical presentation of HSV keratitis?
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Varied presentation
-Unilatera follicular blepharoconjunctivitis -Vesicular dermatitis -Epithelial dermatitis -Epithelial keratitis PATHEMNEMONIC: DENDRITIFORM BODIES |
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How does someone all of a sudden get HSV keratitis?
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Everyone's infected, it's that only in a very small number of people, there's reactivation of the virus that's already there
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What's the clinical presentation of bacterial keratitis by gram positive organisms?
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Localized
Round ulceration Grayish-white stromal infiltrate |
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What's the treatment for gram-positive bacterial keratitis?
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Topical antibiotics: fluoroquinolones
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What's hypopyon?
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A layering of WBCs on the surface of the cornea
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What is the presentation of gram negative bacterial keratitis?
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ACUTE!
MORE INTENSE THAN GRAM POSITIVE Copious mucopurulent discharge Surrounding edema: ground glass Stromal abscess |
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What's the treatment for gram negative keratitis?
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Topical antibiotics: fluroquinolones
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What are the components of the uvea?
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Iris
Coroid Ciliary epithelium |
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What's the definition of anterior uveitis?
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Inflammation of the iris, ciliary muscle
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What is the pathogenesis of anterior uveitis?
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Autoimmune reaction
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What's the clinical presentation of anterior uveitis/
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Achey pain
Photophobia Blurry vision Ciliary flush: 360 vessels around the corrneat Irregular looking pupil |
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What should you do if you think someone has anterior uveitis?
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Refer!
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What's the treatment for anterior uveitis?
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Topical corticosteroids
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What's the definition of acute angle closure?
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Sudden elevation in intraocular pressure due to a blockage in the outflow of aqueous humor
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What's the clinical presentation of someone with acute angle closure?
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Acute periocular pain
Nausea/vomiting Headache Photophobia Blurry vision Ciliary flush |
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What's the pathway of aqueous humor in the eye?
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Ciliary epithelium-->around iris into anterior chamber--> through trabecular meshwork into Schlemm's canal
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What should you do if you susupect acute angle closurew?
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Refer urgently!
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What's the treatment for acute angle closure?
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Topical timolo
Oral acetazolamide: inhibit the production of aqueous humor |
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What is the definition of endophthalmitis?
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Infection inside the eye
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What are some causes of endophthalmitis?
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Trauma
Surgery Systemic infection |
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What's the clinical presentation of endophthalmitis?
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Pain
Vision loss Redness Hazy cornea Hypopyon |
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What should you do if you see someone with endophthalmitis?
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Refer immediately!!!
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What's the treatment for endophthalmitis?
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Culture the fluid so that you know what you're up against!
Intraocular, topical antibiotics |
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What's the definition of orbital cellulitis?
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Diffuse bacterial infection of the periocular tissue
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What are some conditions that can cause orbital cellulitis?
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Skin infection
Paranasal sinusitis |
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What's the clinical presentation of orbital cellulitis?
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Pain
Fever Swelling, discoloration of lids Mild conjunctival hyperemia Reduced ocular motility Proptosis Vision loss |
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What's the treatment for orbital cellulitis?
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IV antibiotics
Imaging Imaging and drainage |
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Where are some places that a tumor of the orbit can come from?
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Paranasal sinuses
Distant mets |
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What's the clinical presentation of an orbital tumor?
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Pain
Diplopia Proptosis Tearing Conjunctival hyperemia Visual loss |
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What's an orbital tumor that presents acutely?
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Rhabdomyosarcoma of the orbit
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What's the definition of a cataract?
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Any opacity of the lens that impairs vision by interfering with light transmission
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What are the different classes of cataracts?
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Cortical
Nuclear Posterior subcapsular Mature |
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What are the causes of cataract?
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Aging: the most common
Congenital |
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Why is it so important that you ALWAYS LOOK FOR CONGENITAL CATARACTS?!?!
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If you miss them the kid is going to have horrid vision for the rest of his life
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What's the presentation of a cataract?
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Painless, progressive visual decrease
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What's the management of cataract?
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SURGERY!
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When should you operate on a cataract?
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If there's a significant interference with visual tasks
You can't visualize the retina/optic nerve and you need to |
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What do you do after cataract surgery to help with vision?
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Restore the optical power of the natural lens by a number of ways:
-Glasses -Contact lenses -Intraocular lens implant -Corneal sugery |
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What are some of the complications of cataract surgery?
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Bleeding, infection
Corneal swelling Retinal probems (macular edema, retinal edema) Persistent inflammation, glaucoma |
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Where do cataracts cause their problems?
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At the lens
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