Unit 1 Essentials

things from essentials page plus learning issues

conjunctivitis

AKA pink eye - inflammation of bulbar and palpebrae conjunctiva

watery or mucopurulent discharge, erythema of sclera, slightly reduced visual acuity

VIRAL: adenovirus. usually bilateral. Tx: artificial tears, cold compresses

BACTERIAL: Staph, Strep. usually unilateral, commonly seen in children. Tx: polymyxin w/ trimethoprim drops 1 drop q6h x 7 days OR azithromycin 1% 1 drop q12h × 2 days, then once daily x 5 days

ALLERGIC: will be itchy, bilateral. Tx: olopatadine 0.2-0.7% 1 drop daily (antihistamine), artificial tears, cold compresses

cataracts

progressive opacification of the lens

oxidative damage to the lens cuases proteins to become insoluble → loss of transparency

painless, progressive blurring, glares/haloes especially at night, dimming of colors, monocular diplopia

diagnosis: slit-lamp, fundus exam, Snellen acuity

Tx:surgery incision with foldable intraocular lens implantation

corneal ulcer

epithelial defect with underlying and surrounding stromal inflammation

bacterial (pseudomonas, Staph), fungal, viral (HSV, VZV), parasitic, chemical burns

eye pain, red eye, photophobia, purulent discharge with visible white/gray corneal infiltrate on penlight exam (hypopyon)

risk: contact wearers

Tx: bacterial (moxifloxacin 0.5%), fungal (topical natamycin), viral (oral acyclovir)

infectious keratitis cornea

microbial invasion of cornea that is sight-threatening

bacterial (pseudomonas, Strep, Staph), fungal (molds), viral (HSV), parasitic

risk: contact wearers

rapid-onset eye pain, red eye, photophobia, purulent discharge, visible white/grey corneal infiltrate

MEDICAL EMERGENCY

Tx: bacterial (moxifloxacin 0.5%), fungal (topical natamycin), viral (oral acyclovir), fungal (tpical natamycin)

pterygium

benign, wing-shaped fibrovascular growth of degenerative conjunctival tissue that extends across the limbus onto the cornea

associated with chronic UV radiation exposure

eye irritation, foreign-body sensation, redness, dryness of eye

Tx: surgical excision

iritis

inflammation of the iris and often ciliary body too

eye pain, aching, redness, consensual photophobia, blurred vision, typically unilateral, keratic precipitates on iris

Tx: prednisolone actetate 1% (topical corticosteroid), atropine (topical cycloplegic agent)

scleritis

uveitis

dacryoadenitis

infection of the lacrimal gland

superolateral errythema

dacryocystitis

infection of the lacrimal sac (presents near medial canthus of the eye)

errythema

dacryostenosis

keratonconjuncivitis

AKA dry eye - eyes either do not produce enough tears OR tears dry up too quickly

caused by: screen time, dry environments, meibomian dysfunction, contacts, antihistamines, blepharitis

scratchy, gritty sensation, blurred vision, burning, light sensitivity, eye discharge, watery eyes

more common in children

Schirmer test → measures tear production AND tear break-up time → measures how quickly tear film breaks after blinking

treatment: cold compresses, use of humidifier, dual action topical antihistamine/mast cell stabilizer drops, Dexamethasine 0.1% if viral

blepharitis

chalazion

a granuloma (cluster of white blood cells)

inflammation of the tarsal (meibomian) glands due to blockage and build-up of oil

firm and red, but not painful, usually eyelid central

Tx: hot compresses, lid massage. recurrent - 2-3 intralesional triamcinolone acetonide injections or I&D last resort

ectropion

OUTWARD turning of the eyelid, might be due to scarring of the outer skin or sagging of the eyelids

entropion

eyelid INVERSION due to scarring (cicatrization) in the conjunctiva

causes trichiasis (eyelashes brushing against the cornea that will cause blindness)

hordeolom

AKA stye

purulent infection of eyelid glands by Staph

internal: infxn of tarsal glands

external: infxn of ciliary glands (Zeiss - sebaceous oily, or Moll - eccrine watery or aprocine milky)

NO pain with eye movement

Tx: warm compresses, lid scrubs. recurrent - erythromycin ointment, I&D last resort

nystagmus

rapid, uncontrolled movement of eye (up, down, side-to-side, or circular)

cause: congenital, inner ear disorders, neurological complications, medication side affects (like anti-seizures, sedatives, alcohol)

Tx: acquired side-to-side - gabapentin (anti-seizure), up and down - aminopydridines, alternating - baclofen (muscle relaxer)

optic neuritis

papilledema

optic nerve swelling at the optic disc

cup:disc ratio on fundescopic view is hard to see

ICP causes this b/c of blockage of axoplasmic flow and by causing ischemia thru the central retinal artery

must evaluate for this before doing a spinal tap (b/c high ICP can cause the brain to herniate)

MEDICAL EMERGENCY

Tx: weight loss/bariatric surgery, Acetazolamide 1-4g/day in divided doses

orbital cellulitis

post septal bacterial infection of the contents of the eye

Staph (MRSA), Strep, anaerobes

erythema, edema, purulent drainage, painful, mild entrapment (eyes not quite oriented identically), opthalmoplegia (limited EOM movement)

90% of the time evolves from ethmoid sinusitis

MEDICAL EMERGENCY - can cause blindness

Tx: vancomycin + ceftraioxone + Metronidazole IV, surgical decompression if needed

periorbital cellulitis

macular degeneration

most common cause of vision loss among the elderly

DRY: (drusen) cholesterol droplets + proteins + calcium phosphate. material extravasates and collects in the retina therefore block highest acuity vision

WET: endothelial injury → hemorrhaging + scarring. treated with laser therapy to intentionally scar the retina to stop bleeding

Dry Tx: AREDS2 formulation supplements

Wet Tx: lazer therapy to intentionally scar retine to stop bleeding, anti-VEGF injections, Aflibercept

retinal detachment

(diabetic) retinopathy

associated with uncontrolled glycation of important biomolecules, therefore making delicate blood vessels even more fragile

hard exudates (small, sharp, yellow), cotton wool spots (less defined, yellow-orange) and hemorrhages (dark) will be present in fundescopic view

PROLIFERATIVE: excessive young blood vessels stemming from the optic disc (response to retinal ischemia and upregulation of VEGF) and can cause loss of peripheral vision

Tx: Anti-VEGF injections, BG management

blowout fracture

AKA inferior orbit wall fracture

tender and edema to the surrounding eye, periocular ecchymosis, decreases sensation to the affect side cheek, orbital emphysema

severe = entrapment of inferior rectus (diplopia and decreased downward gaze)

could cause increase in intraorbital pressure = exophthalmos (protrusion of eye)

CT scan shows teardrop sign, teardrop sign + hemorrhage into maxillary sinus

Tx: surgery if true muscle strangulation, most just heal on own

corneal abrasion

globe rupture

hyphema

central retinal vein occlusion

“blood and thunder” thrombotic (of fibrin and platelets) event + cotton wool spots

retina suffers from a sudden imbalance of blood flow in and out

monocular loss of vision, painless*

predisposing conditions include: leukemia, diabetes, hyperlipidemia, glaucoma, atherosclerotic disease

Tx: anti-VEGF

amaurosis

amblyopia

closed angle glaucoma

when the trabecular meshwork is pinched too closely to the cornea so fluid cannot exit through it - instead fluid builds up behind the iris

MEDICAL EMERGENCY as it causes rapid spike in intraocular pressure which could transmit to the optic nerve and risk blindness within hours

“injected” red eye, very painful eye, distorted hazy vision, haloes around lights, hazy cornea, n&v

Tx: B-blocker, A-agonist, acetazloamide → laser peripheral iridotomy and lens extraction by ophthalmologist same day

presbyopia

strabismus

cerumen impaction

otitis externa

infection of moist macerated skin of external ear canal

common in children (Pseudomonas a.)

ear pain, itching, redness to ear canal, purulent discharge

diagnostics: otoscopy, pinna traction test (pain when pinna is pulled), tragus test 9pain when tragus is pushed)

Tx. topical corticosteroid - hydrocortisone-polymyxin drops 2-3 drops x 7-10 days

acoustic neuroma

dysfunction of eustachian tube

mucosal lining of the eustachian tube becomes swollen and does not open or close properly

viral, bacterial, allergic, GERD, altitude chanegs

feeling of ear fullness, hearing loss, localized pain or discomfort, tinnitis

eardrums is dull and full, nasal passage is swollen

Patulous (stuck open), obstructive (stuck closed), baro-challenge induced (trouble with pressure changes)

Tx: NSAIDs, decongestants, saline sprays, serious = myringotomy, ear tubes

labyrinthitis

inflammation of the labyrinth (inner ear)

swelling of both branches of the vestibulocochlear nerve

balance issues, blurred vision, dizziness, hearing loss, n&v, nystagmus, tinnitis, vertigo

viral or bacterial

Tx: dimenhydrinate… corticosteriods, antibiotics, antivirals

vertigo

cholesteatoma

otitis media

bacterial infection that stems from viral upper respiratory infection (Strep pn.)

*bulging TM

caused by: synctial virus, rhinovirus, enteriovirus, covid, flu, adenovirus…

Tx: amoxicillin 90 mg/kg/day, amoxicillin/clavulanate (cefdinir if allergic to penicillins), recurrent → tympanostomy tubes

otosclerosis

tympanic membrane perforation

conductive hearing impairment

sound transmission is blocked b/w the opening of the external ear and cochlear hair cells

ex. fluid in the middle ear

fluid, foreign objects, allergies, ruptured eardrum, impacted earwax, infections, genetic disorders, head trauma

*most common cause is from otitis media in childhood cases

Tx: irrigation, foreign body removal, treat underlying infection

sensorineural hearing impairment

arises from a defect in the neural transmission of sound; a defect in the cochlear hair cells (won’t regenerate) of the auditory nerve

aging, noise damage, drug side effects, auditory tumors, blast/explosions

*most commonly congenital sensory defect

Tx: prednisone 1 mg/kg/day, intratympanic steroids (dexamethasone 10 mg/mL)

mastoiditis

Meniere disease

exact etiology unknown, but associated with excess endolymph (membranous labyrinth) in the inner ear

episodic tinnitus, intermittent vertigo, nausea, hearing loss

treat with low sodium diet and caffeine and alcohol limitations, anti-vertigo meds, intratympanic steroid injections

Tx: acute attack: antihistamines (dimenhydrinate 25 mg q6h), benzodiazapines (diazepam 5 mg q8h). low sodium diet, diuretics

tinnitus

involuntary ringing, buzzing, hissing, etc. in the ears

to distinct etiology as it usually coexists with something else like reoccurring infections, otosclerosis, cochlear damage, loud music, or lesions in auditory path

barotrauma of the ear

orbital rim fracture

fracture of the bones forming the outer rim of the bony orbit

occurs mostly b/w maxilla and zygomatic or maxilla and frontal

corneal abrasion

globe rupture

hyphema

benign neoplasm

malignant neoplasm

epistaxis

sinusitis

rhinitis

nasal polyps

oropharyngeal angioedema

aphthous ulcers

candidiasis

deep neck infections

dental abscess

dental caries

epiglottitis

gingivitis

herpes simplex (oropharyngeal)

laryngtiis

peritonsillar abscess

pharyngitis

sialadenitis

parotitis

leukoplakia

open angle glaucoma

when something is wrong with the trabecular network (like a clog) and circulation of fluids get disrupted

some pts are naturally predisposed b/c their anterior chamber is too narrow (older population)

asymptomatic, loss of peripheral visual fields, can progress to blindness over time

Tx: reduce IOP - beta blocker (timolol, betaxolol), trabeculectomy

horner’s syndrome

*a sign, not a disease

disruption of the sympathetic chain (effects pupil size and superior tarsal muscle and skin dryness)

miosis (anisecoria), ptosis, anhydrosis

can be caused by: stroke, carotid dissection, Pancoast tumor as apex of lung)

hypertensive retinopathy

signifies significantly high BP (like 210/140)

Av nicking due to atherosclerosis in an artery that is sufficiently hard as to occlude which veins it overlies

arterioles narrow → AV nicking/ copper wiring → hemorrhages + hard exudates —> papilledema

Tx: treat HTN - low sodium diet, low saturated fats, physical activity, thiazide diuretics, ACE inhibitor (lisinopril), ARBs (losartan)