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127 Cards in this Set
- Front
- Back
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a sterile chronic granulomatous inflammation of the meibomian gland
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Chalazion
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Signs and symptoms of a Chalazion
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painless, localized swelling develops over a week. sweling points to conjunctival surface.
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Treatment of a chalazion large vs. small lesions
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1. surgical excision
2. intralesional steroid injections may be used in small lesions |
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Dacryoadenitis vs. Dacyrocystitis
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"adenitis"-acute inflammation of the lacrimal gland
"cystitis"-infection of the lacrimal gland |
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what is seen in children as a complication of mumps, measles, or influenzae.
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Dacryoadenitis
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when this infection occurs in adults it is associated with gonorrhea
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Dacyroadenitis
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Dacryocystitis is due to what?
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unilateral, due to obstruction of the nasolacrimal duct
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Dacryocystitis common infectious agents are?
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H.flu, S. aureus and beta-hemolytic streptococcus
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Dacryoadenitis signs and symptoms?
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severe pain, swelling, injection over the temporal aspect of the upper eyelid
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Dacryocystitis signs and symptoms?
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tearing and discharge. Inflammation, pain, swelling, and tenderness noted in the tear sac area.
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Treatment of Dacryoadenitis and Dacryocystitis?
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"adenitis"-observed, treated w/ antibiotics if needed
"cystitis"-antibiotics and relief of the obstruction. |
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Foreign body diagnosis
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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. |
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What is due to cause glaucoma?
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increased intraocular pressure causing optic nerve damage
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How do you get increased intraocular pressure?
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due to impaired outflow of aqueous humor or impaired access of aqueous humor to the drainage system.
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What is the leading cause of preventable blindness in the US?
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GLAUCOMA
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What are the 2 types of glaucoma?
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1. open-angle
2. angle-closure |
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What is the most common type of glaucoma and what is it due to?
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Open-angle and its due to inadequate drainage of the aqueous humor
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what causes a restricted flow of the aqueous humor?
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Angle-closure glaucoma
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what glaucoma is considered an ophthalmic emergency?
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Acute angle-closure glaucoma
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Primary angle-closure glaucoma signs/symptoms?
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sudden onset of eye pain, headache, blurred vision and halos, nausea and vomiting, fixed and dilated pupil and hyperemia
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What are the symptoms of open angle glaucoma?
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asymptomatic early w/gradual loss of peripheral vision, and halos around lights
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intraocular pressure is measured how?
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Tonometry (goldmann applanation and
Schiotz tonometry used |
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Normal ratio of intraocular pressure?
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10-24mmhg
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what is a Gonioscopy test
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determines anterior chamber angle is wide (open), narrow, or closed.
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What does the treatment of glaucoma consist of?
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Reduction of the aqueous production
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Treatment of glaucoma 1st line includes?
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Suppression of aqueous humor production: 1. topical beta-adrenergic blocking agents
ex: timolol maleate, levobunolol |
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Side effects of timolol and levobunolol are?
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depression, confusion and fatigue
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glaucoma treatment 2nd line?
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2. alpha-adrenergic agonists. ex: apraclonidine and brimonidine
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glaucoma 3rd line tx?
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carbonic anhydrase inhibitors. ex: topical meds dorzolamide hydrochloride and brinzolamide
systemic meds are acetazolamide (used in acute glaucoma). |
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how can you facilitate aqueous outflow?
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1. parasympathomimetic agents like pilocarpine and carbachol
2. prostaglandin analogs like bimatoprost, latanoprost and travoprost |
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what is the last line of treatment for glaucoma?
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surgical peripheral iridotomy, laser trabeculoplasty and trabeculectomy.
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Explain a Hordeolum?
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Infection of the eyelid and most are caused by staphylococcal species
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Hordeolum S/S?
internal vs. external |
pain, redness, and swelling.
Internal-point toward skin or conjunctiva external-points toward skin |
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Hordeolum treatment?
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1. warm compressions 3-4xday
2. no improvmnt 48hrs incision and drainage 3. antibiotic ointment |
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what is a Hyphema?
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Traumatic forces tear vessels and bleeding into the aqueous humor.
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Hyphema treatment?
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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
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This is age-related leading cause of permanent blindness in the elderly?
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Macular degeneration
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What are the 2 types of macular degeneration?
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1. non-exudative and exudative
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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.
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Non-exudative
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macular degeneration
1. visual impairment is variable in this? 2. vision loss is severe in this? |
1. non-exudative
2. exudative |
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neovascularization maybe noted in which form of macular degeration?
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1. neovascularization maybe noted on ophthalmoscopic exam in exudative macular degeneration.
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Treatment of exudative and non-exudative macular degeneration?
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exudative with out neovascularization no med or surg. tx needed. LASER PHOTOCOAGULATION is needed if neovasculartization present. NO WAY TO PREVENT NON-EXUDATIVE DEGENERATION
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what needs to be monitored in non-exudative macular degeration?
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loss of central vision with Amsler grid
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This is a result of trauma or extension of sinsusitis through the ethmoid sinus to the orbit?
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Orbital cellulitis
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Orbital cellulitis occurs most commonly in who? and what are the most common organisms?
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1. children
2. H.flu, S. pneumoniae |
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Orbital cellulitis S/S?
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edema, erythema, hyperemia, and pain
-infection spreads rapidly |
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Orbital cellulitis on PE?
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chemosis, limited eye mvmts (shown on postseptal cellulitis), reduction of vision and erythema
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Orbital cellulitis Diagnosis
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-Labs show leukocytosis
-CT scan or MRI needed to seperate pre from postseptal involvement |
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Orbital cellulitis treatment?
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1. nasal decongestants and vasoconstrictors
2. IV antibx -mild cases tx w/amoxicillin and severe cases treated w/ceftriaxone and vancomycin |
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What is a Pterygium?
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fleshy, triangular enroachment onto the cornea
typically bilateral/ on nasal side |
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This is due to irritation secondary to ultraviolet light, drying and wind
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pterygium
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what is a triangular lesion noted on the nasal side of the cornea?
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pterygium
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Treatment of pterygium?
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if large may be removed surgically
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Seperation of the sensory retina from the underlying pigmented epithelium.
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Retinal detachment
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Most common location of retinal detachment?
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superior temporal area
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retinal detachment can be caused by what? and who is most common with?
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Trauma or be spontaneous
m/c over 50 and severe myopia (near sightedness) |
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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 |
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Retinal detachment treatment?
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immediate ophthalmologic referral!!!
Keep head position so that gravity helps the detached portion of the retina fall back into place. |
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What presents with painless vision loss?
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Retinal vascular occlusion
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This is noted in patients over 50 and associated with cardiovascular dz?
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Central vein occlusion
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A painless monocular vision loss, often proceeded by AMAUROSIS FUGAX
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central retinal artery occlusion
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on funduscopic exam cherry-red spot is noted on the macula? what is this?
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Central retinal artery occlusion
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Sudden loss of visual field and reduced visual acuity?
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Branch retinal artery occlusion
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Funduscopic exam shows cotton-wool spots
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Branch retinal artery occlusion
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Sudden painless vision loss.
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Central retinal vein occlusion
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funduscopic exam varies from small retinal hemorrhages to cotton-wool spots to deep and superficial retinal hemorrhages
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Central retinal vein occlusion
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Retinal vascular occlusion treatment?
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Referral to an ophthalmologist is required!!
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IV acetazolamide is used for what?
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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.
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what else can be done to decrease intraocular pressure?
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ocular massage
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laser photocoagulation is treated for this if neovascularization is present?
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central vein occlusion
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DM retinopathy proliferative vs. non-proliferative.
1. proliferative |
Proliferative retinopathy
-neovascularization -hemorrhage in the vitreous body -may lead to retinal detachment |
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non-proliferative dm-retinopathy?
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-venous dilatation
-microaneurysms -retinal hemorrhages -edema -hard exudates |
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Treatment of dm-retinopathy?
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-management of blood sugar and blood pressure is vital
-Yearly ophthalmoscopic exam -neovascularization is treated with laser photocoagulation -Macular edema treated with laser surgery |
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Hypertensive dm-retinopathy signs and symptoms?
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-vision impairment
a) silver or copper b) Arteriovenous (AV) nicking c) flame-shaped hemorrhages d) cotton-wool spots e) retinal edema f) retinal pigmentation |
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HTN DM-retinopathy treatment?
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will have improvement with blood pressure control
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What is strabismus?
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deviation from perfect ocular alignment.
Esotropia is convergent strabismus (CROSSED EYES). Exotropia is divergent strabismus |
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Strabismus signs and symptoms?
and testing? |
diplopia, scotoma, amblyopia. Convergenfce testing used for disjunctive movements
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Strabismus diagnosis?
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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 |
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strabismus treatment?
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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 |
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Persistent or recurrent purulent otorrhea with TM perforation
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Chronic otitis media
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may have some degree of conductive hearing loss without pain?
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chronic otitis media
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What may develop a cholesteatoma?
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chronic otitis media
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What is a cholesteatoma?
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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
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Treatment of Chronic-OM?
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Mastoidectomy, myringoplasty, and tympanoplasty
systemic antibiotics may also be needed |
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What is "the bends"?
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(barotrauma)
decompression sickness, occurs most often after divers descend and remain deeper than 10 meters |
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decompression sickness ("the bends") is due to? S/S?
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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 |
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Treatment of decompression sickness?
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recompression therapy in a copmression chamber
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what are the 2 types of hearing loss?
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Conductive and sensorineural
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describe conductive hearing loss
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lesion in the auricle, external auditory canal or middle ear
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describe sensorineural hearing loss
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lesion in the inner ear or eighth cranial nerve
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How can you get CONDUCTIVE hearing loss?
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obstructin of external auditory canal due to ceruman, foreign body, swelling, neoplasm, or TM perforation, cholesteatoma, otosclerosis
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What is the most common cause of sensorineural hearing loss?
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Presbycusis, it is age associated
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How else can you get sensorineural hearing loss?
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Menier's dz, drug induced-common meds include salicylates, quinine, aminoglycosides, cisplatin and loop diuretics
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How to diagnosis conductive vs. sensorineural hearing loss? weber/Rinne test
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Weber-tuning fork-with unilateral conductive loss tone is perceived in affected ear. With unilateral sensorineural loss the tone is perceived in unaffected ear
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explain the Rinne test?
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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
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what do you have when bone conduction is greater than air conduction?
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conduction hearing loss
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Treatment of conductive and sensorineural hearing loss?
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1. conductive-surgical intervention and correction
2. sensorineural-permanent and corrected with hearing aids |
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What is a rare complication of otitis media?
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Mastoiditis
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Mastoiditis signs and symptoms?
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pain, swelling tenderness, and redness behind the ear in the area of the mastoid bone
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Xray of mastoid bone reveals what?
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soft-tissue swelling, loss of mastoid bone mass, and lytic lesions
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what are complications of mastoiditis?
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brain abscess and septal lateral sinus thrombosis
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results from malfunction of the endolymphatic sac in the inner ear.
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Meniere's disease
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debilitating vertigo, progressive sensorineural hearing loss and tinnitus are signs and symptoms of what?
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Meniere's disease
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onset of vertigo is sudden and lasts minutes to hours and rarely lasts longer than 24-48hrs
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Meniere's disease
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meniere's dz diagnosis
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electronystagmography with warm and cold calories can be used to differentiate central from peripheral causes of vertigo
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meniere's dz tx?
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1. diazepam for acute dz
2. trimethobenzamide hydrochloride 3. meclizine 4. dimenhydrinate 5. HCTZ 6. triamterene |
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meniere's dz tx if case is severe?
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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
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acute unilateral infxn or inflammation of the vestibular system.
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labyrinthitis (vestibular neuronitis)
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How can you get labyrinthitis?
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typically due to viral infxn or history of recent URI
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how long would labyrinthitis last?
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7-10 days and is typically self-limited
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presents with rotational vertigo, nystagmus, N/V.
doesnt have tinnitus or hearing loss |
labyrinthitis (vestibular neuronitis)
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on physical exam of labyrinthitis how long does vertigo last when patient opens or closes the eyes?
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in labyrinthitis vertigo remains whether the patient opens or closes the eyes
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how do you diagnose labyrinthitis?
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CT scan maybe needed to rule out central causes of dizziness
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what is the treatment of labyrinthitis?
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self-limiting and may require symptomatic tx.
1. diazepam 2. meclizine 3. dimenhydrinate s/e: drowsiness and sedation |
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infection and inflammatoin of the external auditory canal?
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otitis externa
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what are the 4 categories of otitis externa?
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1. acute localized
2. acute diffuse (swimmer's ear) 3. chronic 4. malignant |
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Organisms that can cause otitis externa?
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1. S. aureus
2. Group A streptococcus 3. Pseudomonas aeruginosa 4. Aspergillus |
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Acute localized infxn s/s?
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pain and tenderness. PE reveals erythematosus and tenderness is noted over the tragus. Preauricular lymphadenopathy possible
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Acute diffuse dz s/s?
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pain and itching. PE reveals canal is erythematous, swollen, and hemorrhagic
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chronic dz s/s?
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drainage and itching
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Malignant dz s/s?
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severe, necrotizing infxn. Assoc. w/elderly diabetic pts and infxn due to P. Aeruginosa
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Diagnosis and TX of otitis externa? and what is required for tx of malignant OE?
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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. |
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This occurs as a result of penetrating or noise trauma?
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TM perforation
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where in the ear canal does a TM perforation occur?
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pars tensa, anteriorly or inferiorly
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what are the S/S of TM perforation?
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acute onset of pain, hearing loss, and with or w/out bloody otorrhea. possible tinnitus and vertigo
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DX of TM perforation?
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perforation is noted on otoscopic exam
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What is the tx of TM Perforation?
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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 |
