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69 Cards in this Set

  • Front
  • Back
eye anatomy
1. lid
-areolar tissue glands (Meibomian, Zeiss, Moll)
2. Cornea
3. Conjunctiva
-mucosal surface can be associated w systemic disease involving skin/mucous membrane (rheumatoid disorders), thyroid diseases, etc
-exposed to environmental stressors
eye: symptoms of self-treatable conditions
-mild discharge
-mild redness of eyelid
-mild, diffuse redness of conjunctiva
eye: when to refer
-altered vision
-severe redness of conjunctiva or eyelid
-trauma to eye
-floating spots (disconnection of retina)
-abnormal pupils
-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)
glands of the eyelid
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
inflammation of eyelid
blepharitis goals of therapy
1. improve pt comfort
-reduce/relieve pain, inflammation, appearance
2. reduce risk of recurrence
3. reduce risk of complications:
-altered visual fxn
-structural damage to eyelids, ocular surface

blepharitis: general measures
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

eyelid margin hygiene
-acute exarcebations: qhs or bid
-maintenance: daily to twice weekly
(pts w chronic disease will continue maintenance indefinitely)

-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)
eyelid conditions
-blepharitis (allergic, chemical, chalazion)

-blepharitis (bacterial) - refer
-hordeolum (aka stye)
allergic/chemical blepharitis due to:
-contact hypersensitivity
-chemical irritant

-plants (eg. Poison Ivy)
-Metal (eg Nickel)
-cosmetics, nailpolish
-medications (eg. neomycin, pilocarpine, tetracaine, timolol)
allergic/chemical blepharitis: non-drug
-eliminate cause
-cool, moist compresses x 5-10 min several times daily (if there are crusts use warm compress)
allergic/chemical blepharitis: when to refer
basic care ineffective within 48h (or symptom progression)
infectious blepharitis cause
usually S. aureus or S. epidermis
infectious blepharitis onset
often chronic, recurring
infectious blepharitis location
posterior or anterior lid margins and associated glands
infectious blepharitis Sns/Sx
-usually bilateral and diffuse
-swelling and erythema
-possible photophobia
-eyelids may stick together after sleep
posterior blepharitis (infectious)
-inflammation and obstruction of Meibomian glands
-yellow, greasy scales
-associated w derm conditions

-chronic: posterior lid margin becomes thickened
anterior blepharitis (infectious)
-area of dysfxn = glands of Moll, Zeis
-anterior lid margin becomes inflamed, red
-S. Aureus: dry, flaky scales - tiny ulcerations around eyelashes
infectious blepharitis tx
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
infectious blepharitis: non-drug
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
hardeolum (stye) cause
usually S aureus
hareolum (stye) onset
hardeolum (stye) location
external (glands of Zeis or Moll) or internal (Meibomian glands)
Hardeolum (stye) Sns/Sx
-unilateral, localized lid swelling w erythema
External stye
(Anterior lid)
-blockage and infection of Glands of Moll/Zeis
-often points -> skin
-smaller, more superficial
Internal stye
(Posterior lid)
-blockage and infection of Meibomian gland
-points -> conjunctiva or skin
-large, more prolonged, rarely drains spontaneously
stye: non-drug
-warm, moist compresses (5-15min bid-qid)
-eyelid hygiene
-do not squeeze! (can get orbital cellulitis)
stye: when to refer
-if basic care ineffective in 48h
-increased pain (particularly internal styes)
-multiple styes
chalazion cause
chalazion onset
chalazion location
blockage of Meibomian glands
Chalazion Sn/Sx
-unilateral, localized pea-like swelling +/- erythema
-usually larger than styes -> dry eye, visual disturbance
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)
chalazion: non-drug
-apply warm compress for 10-15min qid then massage cyst for ~1min
-eyelid hygiene: particularly to prevent recurrence
-topical Abx not recommended
chalazion when to refer
if no drainage within 48h

note: refer immediately if pt complains of pain or impaired vision
conjunctival conditions
-dry eye
-subconjunctival hemorrhage - refer
-conjunctivitis (allergic)

-conjnctivitis (viral) - refer
-conjunctivitis (bacterial)
conjunctivities: immediate referral
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
viral conjunctivitis: sx
-diffuse, acutely red
-possible itching
-copious, clear, serous (watery) discharge
-conjunctival swelling
-mild photophobia
-foreign body sensation
-possible tender periauricular nodes
viral conjunctivitis: affected eye
onset: bilateral or unilateral -> quickly bilateral (within 24h spread to other eye)
viral conjunctivitis duration
usually self-limiting; lasts 2-4wk
cause of viral conjunctivitis
adenovirus (common cold)
-may follow URTI

also: herpes virus, VZV, others
viral conjunctivitis Tx
refer because many possible differential diagnosis
-basic care

viral conjunctivitis non-drug
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
bacterial conjunctivitis sx
-diffuse redness
-minimal or no itching
-moderate, mucopurulent or purulent (yellow-white) discharge
-mild photophobia
-irritation; lids may stick together; crusting
-foreign body sensation
bacterial conjunctivitis affected eye
onset: bilateral or unilateral -> quickly bilateral
bacterial conjunctivitis duration
~65% of untreated cases resolve spontaneously within 2-5d

(chronic form also)
causes of bacterial conjunctivitis
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
conjunctivitis goals of therapy
-cure infection
-prevent transmission to others
-prevent complications
bacterial conjunctivitis: non-drug
-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)
bacterial conjunctivitis: drug
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
bacterial conjunctivitis: OTC tx
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
bacterial conjunctivitis: eg of OTC products
Polymixin B
-against G (-)

-against G(+)
-ointment (doesn't go into soln)

-against G(+)
bacterial conjunctivitis: when to refer
-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)
allergic conjunctivits sx
-diffuse redness
-often severe itching (hallmark sx)
-moderate, clear, commonly serous or mucoid discharge
-mild eyelid swelling

*often history of hay fever/allergic rhinitis
allergic conjunctivits affected eye
usually bilateral
allergic conjunctivits: duration
chronic through allergy season w perennial; recurrent

allergic conjunctivitis: cause
Perennial: dust, smoke, molds, animal dander

seasonal: grass, pollens

symptoms often decrease w age
allergic conjunctivitis goals of therapy
-prevent symptoms
-alleviate signs and symptoms produced by the allergic response
-improve quality of life
allegic conjunctivitis: non-drug
-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)
allergic conjunctivitis tx
-tear substitutes/lubricants
-combination: AH + D
-mast cell stabilizers
allergic conjunctivitis: artificial tears
-instilled 2-6x daily
-preferably preservative-free
-used to soothe eyes and wash away allergens
allergic conjunctivitis: ocular decongestants
-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
allergic conjunctivitis: ocular AH
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
allergic conjunctivitis: ocular AH + D
-Antazoline + naphazoline
-Pheniramine + naphazoline
-considered more effective than either agent alone
-cautions for each product apply (eg. max 3d for decongestant)
allergic conjunctivitis: mast cell stabilizers
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
allergic conjunctivitis: when to refer
-if medications ineffective within 72h
-severe - need DDX
eg. VKC - Vernal Keratoconjunctivitis
GPC - Giant Papillary conjunctivitis
AKC - Atopic Keratoconjunctivitis
subconjunctival hemorrhage
onset: sudden
fades: 2-3 wks

subconjunctival hemorrhage tx
refer to rule out serious diagnosis
subconjunctival hemorrhage causes
-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)