Cataracts, Lacrimal Apparatus, Eyelid Disorders, & Disorders of Retina

composition of the lens

capsule

nucleus

cortex

any opacity of the lens whether it is visually significant or not

cataract

features of coronary type cortical cataract

club shaped peripheral opacities with clear central lens

slowly progressing

features of cuneiform cataract

peripheral spicules and central clear lens

slowly progessive

nuclear sclerotic cataract

diffuse opacity principally affecting nucleus

slowly progressing

posterior subcapsular cararact

plaque of granular opacity on posterior capsule

may be rapidly progressive

morgagian type cataract

entire lens is opaque and the lens nucleus has fallen inferiorly

congenital causes of cataracts

genetic

intrauterine infections

inherited metabolic disorders

TORCH stands for

toxoplasmosis

other infections

rubella

CMV

HSV

most common cause of cataracts

age related

chronic steroid use can cause what kind of cataract?

posterior sub-capsular

function of the eye lens

bend and focus light on the retina

highest concentration of cones is found at _

fovea

age related cataract types

nuclear sclerotic

cortical

posterior sub-capsular

acquired causes of catraracts

trauma

electric shock

radiation

previous surgery

steroids

DM

smoking

hallmark symptom of cataract

painless, progressive blurred vision

cataract symptoms

glare, halos

decreased color perception

myopic shift

monocular diplopia

what is myopic shift

become more nearsighted

most common cataract surgery

phacoemulsification

steps of manual extra-capsular cataract extraction

incision is made in the eye beneath iris

diseased lens pulled out

prosthetic lens is placed through incision

most common post-op complication of cataract surgery

posterior capsule opacification

post-op complications of cataract surgery

posterior capsule opacification

endophthalmitis

elevated intraocular pressure

corneal edema

retinal detachment

dislocation of intraocular lens

lacrimal apparatus components

lacrimal gland

canaliculi

lacrimal sac

lacrimal duct

what is dacryostenosis

nasolacrimal duct obstruction

congenital nasolacrimal duct obstruction

dacryostenosis

most frequent cause of persistent tearing and ocular discharge in infants and young children

dacryostenosis (nasolacrimal obstruction)

persistent tearing term

epiphora

clinical presentation of dacryostenosis

persistent tearing

watery eye discharge

crusting of eyelashes

cause of dacryostenosis

congenital failure of distal nasolacrimal duct to open

what clinical feature distinguishes dacryostenosis from other conditions

lack of conjunctival injection

treatment for dacryostenosis

most cases resolve spontaneously

lacrimal sac massage

clean discharge

acute dacrocytosis

infection of the lacrimal sac

clinical findings of acute dacryocystitis

painful swelling of medial canthus

erythema and edema of lacrimal sac

epiphora

purulent discharge from punctum

pathophysiology of acute dacryocystitis

obstruction -> tear stasis -> secondary bacterial infection

dacryocystitis treatment

warm compresses and analgesics

oral antibiotics

IV antibiotics

I+D if abscess develops

definitive treatment for dacryocystitis

dacryocystohinostomy

most common pathogens for dacryocystitis

staph a and streptococcus

pathogens of dacryocystitis for diabetic and immunocompromised patients

gram negative bacteria

lacrimal gland inflammation

dacryoadenitis

dacryoadenitis can be caused by _

infectious agents

inflammatory

dacryoadenitis clinical findings

painful swelling of lateral upper eyelid

redness and swelling over lacrimal gland

S-shaped deformity

fever, tearing, preauricular lymphadenopathy

preauricular lymphadenopathy is associated with

dacryoadenitis

"S-shaped" deformity of the upper eyelid

dacryoadenitis

viral cause of dacryoadentitis

EBV

mumps

bacterial cause of dacryoadentitis

Staph a

streptococcus

inflammatory causes of dacryoadentitis

sarcoidoisis

sjogren syndrome

IgG4

dacryoadenitis in children

most commonly infectious - viral

dacryoadenitis in adults is caused by

more commonly inflammatory or autoimmune

viral dacryoadentitis treatment

supportive care

COOL compresses, analgesics, antipyretics

dacryoadentitis treatment

oral antibiotics if bacterial

supportive care if viral

anatomy impacted by anterior blepharitis

eyelashes

lid margin

glands of Zeis

anterior blepharitis presentation

eyelid erythema

crusting of eyelashes

tender lids

posterior blepharitis affected anatomy

meibomian gland

posterior meibomian glands presentation

hyperemic posterior lid margin

telangectasias

inflammed meibomian gland openings

first line blepharitis treatment

warm compreses

eyelid hygiene

artifical tears

anterior blepharitis treatment

topical antibiotic ointment

topical antibiotics for anterior blepharitis

erythromycin

bacitracin

posterior blepharitis treatment

oral doxycyline

short course of topical corticosteroid

consult ophthamology before prescribing _

steroid eyedrops

keratoconjunctivitis sicca is known as

dry eye disease

cause of keratoconjunctivitis sicca

loss of tear-film homeostasis

clinical findings of keratoconjunctivitis sicca

dryness

foreign body sensation

irritation

blurred vision

paradoxical tearing

risk factors for dry eye disease

age

blepharitis

sjogren disease

contact lens use

medications

condition caused by decreased tear production or increased tear evaporation

keratoconjunctivitis sicca

diagnosis of keratoconjunctivitis sicca

tear-film assessment

ocular surface staining

what disease should be considered with keratoconjunctivitis sicca

Sjogren disease

first line therapy for keratoconjunctivitis sicca

artificial tears and lubricants

second line therapy for keratoconjunctivitis sicca

reduce environmental triggers

treat gland dysfunction

preservative-free tears

Chronic granulomatous inflammation caused by obstruction of a meibomian gland

chalzion

clinical findings of chalazion

firm, painless eyelid nodule

localized eyelid swelling

blurred vision if pushing on cornea

risk factors for chalazion

chronic blepharitis

rosacea

meibomian gland dysfunction

pathophysiology of chalazion

blocked meibomian gland -> retained sebum -> chronic granulomatous inflammation

first line treatment for chalazion

warm compresses

gentle eyelid

eyelid hygeine

chalazion medical management

oral doxy for recurrent chalazia

persistent chalazion treatment

IL corticosteroid injection

incision and currettage

medical term for a stye

horedolum

cause of stye

bacterial infection of eyelid gland

causative agent of stye

Staph a

clinical findings of stye

painful

red

pustule at eyelid margin

external hordeolum involves _

gland of Zeis

gland of Moll

internal hordeolum involves

meibomian glands

treatment for hordeolum

warm compresses

topical antibiotic ointments

I+D if persistent

what distinguishes a horedolum

painful

usually resolves spontaneously

outward eyelid malposition

ectropion

inward eyelid malposition

entropion

drooping of the eyelid

blepharoptosis

excessive opening of the eyelid

eyelid retraction

ectropion and entropion more commonly affect which eyelid?

lower eyelid

outward turning of the lower eyelid

epiphora

eye irritation, redness, dryness

ectropion

common cause of etropion

age related eyelid laxity

facial nerve palsy, scarring, trauma

treatment for ectropion

lubricating eye drops

definitive treatment of ectropion

surgical correction

eyelashes rub against the cornea and conjunctiva

gritty sensation

irritation

entropion

severe entropion can lead to _

corneal abrasion or ulceration

main cause of entropion

age related eyelid laxity

scarring

muscle spasm

entropion treatment

lubricating eye drops to protect cornea

taping of the eyelid

botulinum toxin*

botulinum toxin can be used to temporarily correct _

entropion

drooping of the upper eyelid

ptosis

weakening of the _ can lead to age related ptosis

levator aponeurosis

upper eyelid sits lower than normal

visual field may be obstructed

either unilateral or bilateral

ptosis