Term
| dangerous anterior segment disorders |
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Definition
bacterial conjunctivitis
keratitis
uveitis
angle closure glaucoma
enhophthalmitis
orbital cellulitis
orbital tumor |
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Term
| common anterior segment disorders |
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Definition
contact dermatitis
chronic blepharitis
stye
cataract |
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Term
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Definition
eyelids and orbit
houses extra-ocular muscles and the course of the optic nerve |
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Term
| disorders of adnexal tissues |
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Definition
common: contact dermatitis, chronic blepharitis, stye
dangerous: dacryocystitis, orbital cellulitis, orbital tumor |
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Term
contact dermatitis
presentation |
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Definition
hypersensitivity reaction to topical meds or cosmetics (characteristic distribution)
erthematous, leathery, scaly, thickening of skin |
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Term
contact dermatitis
treatment |
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Definition
discontinue offending agent
may need steroid cream (note: can increase eye pressure and cataract formation overtime)
refer to ophthalmologist if not resolved in 2 weeks |
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Term
chronic blepharitis
what is it? |
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Definition
inflammation of eyelids
anterior: staph a infection of skin, cilia, follicles
posterior: infection/inflammation of meibomian glands |
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Term
chronic blepharitis
clinical presentation |
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Definition
foreign body sensation, crusting upon awakening
redness, swelling, scaly, flaky debris on lid margins
mild conjunctival hyperemia |
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Term
|
Definition
warm conpresses (5-10min 2x/day)
lid hygiene with baby shampoo
antibiotic ointment or oral antibiotics may be needed if it is severe |
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Term
stye
clinical presentation |
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Definition
a focal inflammation of ciliary follicles
painful, tender, focal mounding over days
mild conjunctival hyperemia
small abscess in sebaceous gland |
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Term
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Definition
warm compresses up to 4 times per day
chalazion (chronic granulomatous inflammation) may develop from scarring of a stye requiring excision |
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Term
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Definition
*dangerous*
inflammation of the lacrimal sac (medial corner of the orbit/globe)
secondary to bacterial infection due to nasolacrimal passage obstruction |
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Term
dacryocystitis
presentation |
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Definition
tender, swelling in medial lower lid
discharge tearing
hyperemia of conjunctiva |
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Term
|
Definition
depends on severity - slightly different in kids vs. adults
definitely antibiotics at first |
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Term
dacryocystitis
treatment in children |
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Definition
oral amoxicillin/calvulanarte 10 days
IV cefuroxime if super sick
if not imroved in 24 hours - referral to ophthalmologist for imagaging and incisions of abscess |
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Term
dacryocystitis
treatment in adults |
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Definition
oral cephalexin for 10 days
IV cefazolin with severe systemic illness
incision and drainage of external abscess
imaging to rule out sinusitis, cancer of deformity |
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Term
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Definition
*dangerous*
diffuse bacterial infection of periocular tissue secondary to skin infection or paranasal sinusitis
periorbital edema
inflammatory spread throughout orbital fat surrounding the globe - can spread to brain, but treat urgently |
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Term
orbital cellusitis
clinical presenation |
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Definition
pain, fever
swelling, discoloration of lids
mild conjunctival hyperemia
reduced ocular motility (from fat involvement), proptosis (bulging globe), vision loss (with optic nerve involvement) |
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Term
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Definition
IV antibiotics
imaging
incision and drainage |
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Term
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Definition
*dangerous*
orbital extension
-paranasal sinuses
-distant metastasis |
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Term
orbital tumor
clinical presentation |
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Definition
pain
diplopia, proptosis (pushing on globe, not actually involving the globe)
tearing
conjunctival hyperemia
visual loss |
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Term
|
Definition
imaging with CT and MRI
referral within 48 hours for further management |
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Term
| dangerous disorders of the conjunctiva/scerla |
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Definition
conjunctivitis (only if bacterial)
sceritis
squamous carcinoma |
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Term
| common disorders of the conjunctiva/sclera |
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Definition
viral conjunctivitis
episcleritis
pinguecula
pterygium
subconjunctival hemorrhage |
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Term
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Definition
*dangerous*
more common in immunocompromised patients or exposed to hospital pathogens |
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Term
bacterial conjunctivitis
clinical presentation |
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Definition
ocular pain
diffuse hyperemia and swelling
purulent discharge - significant amount of copious discharge helps distinguish bacterial from viral conjunctivitis |
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Term
bacterial conjunctivitis
treatment |
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Definition
mild - observe 24 hours
topical erythromycin, aminoglycoside, trimethoprime, fluroquinolone
if from n. gonorrhoeae - IV ceftriaxone |
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Term
| bacterial conjunctivitis patients that need to be referred to ophthamologist |
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Definition
with pus, all infants and compromised adult hosts
when n gonorrhoeae is suspected
any contact lens patient (bc might have corneal involvement)
after recent eye durgery |
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Term
|
Definition
bacterial conjunctivitis present at birth
silver-nitrate prohylaxis; infection of birth canal (chlamydia, gonorrhoeae, herpes simplex) |
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Term
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Definition
most common cause of red eye
self-limited
most of adenovirus |
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Term
viral conjunctivitis
clinical presentation |
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Definition
diffuse hyeremia with follicles
watery discharge
ocular fullness (boggy/inflammed lids), warmth
tender, swollen, preauricular node
often UNIlateral
more acute onset |
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Term
viral conjunctivitis
treatment |
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Definition
does NOT need anti-microbial agents
topical lubrication (artificial tears)
cold compress
proper hygiene to avoid spread |
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Term
chylamdial conjunctivitis
clinical presentation |
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Definition
trachoma, neonatal, adult
hyperemia conjunctiva with follicles
mild mucoid discharge |
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Term
chylamidial conjunctivitis
treatment |
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Definition
send conjunctival scraping for culture
oral erythromycin, doxycycline or azithromycin
treat sexual partners or parents (to eliminate reinfection) |
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Term
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Definition
ITCHING
eyelid edema, watery discharge
conjunctival hyeremia
BIlatera, more CHRONIC course |
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Term
| autoimmune conjunctivitis |
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Definition
systemic diseases can sometimes present in the eye first: Graves, RA, sjogren, lupus, Wegener, relapsing polychonritis
chronic, low grade conjunctival hyperemia
minimal discharge |
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Term
autoimmune conjunctivitis
treatment |
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Definition
treat underlying condition
refer within 2 weeks to rule out other causes
often requires systemic or local immunosuppression |
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Term
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Definition
*dangerous*
focal or diffuse inflammation of the sclera
associated with RA, Wegener, relapsing polychondritis |
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Term
scleritis
clinical presentation |
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Definition
severe pain
scleral thickening with dark purple color |
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Term
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Definition
evaluation for systemic involvement
systemic immunosuppression
EMERGENCY |
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Term
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Definition
idiopathic focal inflammation of deep subconjunctival tissue
usually NOT associated with systemic disease |
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Term
episcleritis
clinical presentation |
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Definition
eye pain
focal or diffuse hyperemia |
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Term
|
Definition
refer to ophthalmologist with severe apin to make sure no other conditions
oral NSAIDs
topical lubrication |
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Term
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Definition
degeneration of collagen in the nasal or temporal bulbar conjunctiva
secondary to wind and sun exposure (UV light) |
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Term
pingueculum
clinical presentation |
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Definition
mild ocular discomfort
focal hyperemia |
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Term
|
Definition
topical vasoconstrictors
(usually just observation) |
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Term
|
Definition
| fibrovascular proliferation of bulbar conjunctiva growing over cornea |
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Term
pterygium
clinical presentation |
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Definition
hyperemic growth over cornea
blurred vision |
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Term
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Definition
| may require surgery if large |
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Term
| subconjunctival hemorrhage |
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Definition
very common
due to sudden increase in intrathoracic pressure: sneezing, couching, strain, HTN, anticoagulation, blood dyscrasias |
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Term
subconjunctival hemorrhage
treatment |
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Definition
usually no treatment is necessary
will resolve on its own in 1-2 weeks |
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Term
| corneal causes of red eye |
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Definition
abrasion (corneal abrasion, corneal foreign body)
non-traumatic keratopathy (dangerous!
-infection
-drying
-corneal endothelial dysfunction |
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Term
|
Definition
inflammation of the cornea
-infection
-dry eyes
-contact lens over wear
-autoimmune disorders |
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Term
keratitis
clinical presentation |
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Definition
blurry vision
pain (cornea is highly innervated)
photophobia
foreign body sensation |
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Term
|
Definition
primary HSV can cause:
trigeminal nerve infections
URI
unilateral folliular blepharoconjunctivitis
vesicular dermatitis
conjunctival ulcers
epithelial keratitis |
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Term
infections corneal ulcer
clinical presentation |
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Definition
pain, decreased vision, photophodia, epiphora
conjunctival injections
lid edema
*epithelial ulceration with suppurative stromal inflammation*
anterior chamber reaction |
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Term
gram + pathogens
clinical features |
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Definition
localized, cause less inflammation
round ulceration, grayish-white stromal infiltrate with distinct borders
minimal surrounding edema
stromal abscess
perforation |
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Term
gram (-) pathogens
clinical presentation |
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Definition
acute progression with intense inflammatory response
copious muculopurulent discharge
surrounding edema, stromal abscess, perforation
hypopyon: layering of WBCs
likely to affect vision more, even after resolution |
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Term
| anterior chamber causes of red eye |
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Definition
ALL are dangerous conditions:
uveitis
angle closure glaucoma
infection (endophthalmitis) |
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Term
|
Definition
inflammation of the iris and ciliary muscle
usually autoimmune reaction |
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Term
anterior uveitis
clinical presentation |
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Definition
pain, photophobia, blurry vision, ciliary flush, irregular pupil
posterior synechiae and lens pigment - pigment from inflammatory cells on surface of the lens |
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Term
anterior uveitis
treatment |
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Definition
refer to ophthalmologist for work up
topical corticosteroids, cycloplegic |
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Term
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Definition
| sudden elevation in intraocular pressure causing a blockage in outflow of aqueous humor |
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Term
acute angle closure
clinical features |
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Definition
acute periocular pain (severe)
nausea/vomiting
headache around eye
photophobia
blurry vision
ciliary flush |
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Term
acute angle closure
treatment |
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Definition
topical timolol & oral acetazolamid - aqueous reducing agents
refer to ophthalmologist urgently |
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Term
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Definition
infection of the inside of the eye
-trauma
-surgery
-systemic infection |
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Term
endophthalmitis
clinical presentation |
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Definition
pain, vision loss, redness
hazy cornea, hypopyon
opacified cornea, diffuse edema, conjunctiva hyperemic |
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Term
|
Definition
refer to ophthalmologist immediately
intraocular fluid culture to diagnose bacterial process
intraocular and topical antibiotics |
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Term
|
Definition
diffuse, radial dilation of blood vessels
+ foreign body sensation = corneal problem
+ lots of light sensitivity = inflammation IN eye (uveitis) |
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Term
|
Definition
keratitis
bacterial conjunctivitis
uveitis
angle closure glaucoma
endophthalmitis
orbital cellulitis
orbital tumor |
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Term
|
Definition
any lens opacity
impairs vision by interfering with light transmission through the lens to retina
most common cause of visual loss in adults |
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Term
|
Definition
consists of an outer capsule (basement membrane of lens epithelial cells), inner cortex, central nucleus
there are no vessels, lymphatics, nerves or connective tissue that go to the lens |
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Term
|
Definition
classification based on area that is opacified
cortical (outer layer, in cortex, peripheral)
nuclear
posterior
subcapsular
mature (very dense, cause significant loss of vision) |
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Term
|
Definition
most commonly caused from aging
congenital is UNcommon but looked for in infancy bc surgery must be done right away
others: traumatic, med induced, metabolic disease, inflammation |
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Term
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Definition
usually progresses asymmetrically
as nuclear cataracts progress - the may produce a myopic shift in the lens, increasing converging power and producing a temporary improvement in near vision |
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Term
|
Definition
history of painless, progressive visual decrease (often with glare symptoms)
evaluate red reflex and with ophthalmoscope |
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Term
|
Definition
surgery (there are NO known diets, meds, supplements that can reverse or prevent cataracts)
indications for surgery:
-significant interference with visual tasks
-visualization of the retina/optic nerve
-treatment of lens related problems
*don;t recommend cataract surgery unless there is impairment |
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Term
| restoration of vision after cataract surgery |
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Definition
vision may not be improved - especially if there was previous ocular damage
cornea - scarring, edema, inflammation
retina - macular degen, DB, retinal detach
optic nerve - atrophy, optic neuritis, glaucoma
if surgical complications |
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Term
| complications of cataract surgery |
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Definition
bleeding, infection (endophthalmitis), "wound" problems, poor healing
corneal edema
retinal problems (macular edema, retina detachment)
persistent inflammation, glaucoma
opacification of capsular bag |
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