Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
69 Cards in this Set
- Front
- Back
eye anatomy
|
1. lid
-areolar tissue glands (Meibomian, Zeiss, Moll) 2. Cornea -avascular 3. Conjunctiva -vascular -mucosal surface can be associated w systemic disease involving skin/mucous membrane (rheumatoid disorders), thyroid diseases, etc -exposed to environmental stressors -papillae |
|
eye: symptoms of self-treatable conditions
|
-eyestrain
-burning -itching -stinging -mild discharge -mild redness of eyelid -mild, diffuse redness of conjunctiva |
|
eye: when to refer
|
-pain
-photophobia -altered vision -severe redness of conjunctiva or eyelid -trauma to eye -floating spots (disconnection of retina) -abnormal pupils -headache -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 |
|
blepharitis
|
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: -conjunctivitis -keratitis -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) procedure: -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
|
non-infectious:
-blepharitis (allergic, chemical, chalazion) infectious: -blepharitis (bacterial) - refer -hordeolum (aka stye) |
|
allergic/chemical blepharitis due to:
|
-contact hypersensitivity
-chemical irritant commonly: -smoke -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
|
acute
|
|
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
|
sterile
|
|
chalazion onset
|
chronic
|
|
chalazion location
|
blockage of Meibomian glands
|
|
Chalazion Sn/Sx
|
-unilateral, localized pea-like swelling +/- erythema
-usually larger than styes -> dry eye, visual disturbance |
|
chalazion
|
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
|
non-infectious:
-dry eye -subconjunctival hemorrhage - refer -conjunctivitis (allergic) infectious -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 -pain -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 (-) -soln -oinment Bacitracin -against G(+) -ointment (doesn't go into soln) Gramicidin -against G(+) -soln |
|
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 -burning *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
-decongestants -antihistamines -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) |