Opthalmology

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Author:
ckitejr
ID:
297892
Filename:
Opthalmology
Updated:
2015-03-09 20:57:07
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opthalmalogy
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Description:
Opthalmology for physician assistants
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  1. Diabetic Retinopathy
    etiology
    • leading cause of blindness in US
    • blood vessel damage --> ischemia
  2. Diabetic retinopathy
    sings and symptoms
    • Non-proliforative--blot and dot hemorrhages, flame hemorrhages, cotton wool spots, hard exudates
    • Proliforative--neovascularization
    • Maculopathy--macular edema, exudates, blurred vision, central vision loss
  3. Diabetic retinopathy
    treatment
    • preventative glycemic control
    • laser photocoagulation
    • VEGF inhibitors (Bevacizumab)
  4. Hypertensive retinopathy
    etiology
    hypertension --> retinal vessel damage
  5. Hypertensive retinopathy
    signs and symptoms
    • arterial narrowing
    • abnormal light reflexes with cooper or silver wiring
    • AV nicking
    • Flame hemorrhages, cotton wool spots
    • papilledema
  6. Retinal detachment
    signs and symptoms
    • unilateral loss of peripheral vision
    • "drawing of shade" on visual field
    • painless
    • nonerythematous
  7. Retinal detachment
    risk factors
    • age > 50
    • cataract surgery
    • diabetes
    • sickle cell
    • myopia
  8. Retinal detachment
    diagnosis
    • fundascopic exam--retina hanging out in vitreous
    • + Schaffer's sign
  9. Retinal detachment
    treatment
    • emergent surgery
    • keep patient supine
    • Miotics are contraindicated
  10. Retinal vein occlusion
    etiology
    • second MC form of unilateral vision loss
    • central type more common than branch
  11. retinal vein occlusion
    signs and symptoms
    • sudden onset painless monocular vision loss
    • blurry vision
    • neovascularization and retinal hemorrhaging
  12. Retinal vein occlusion
    risk factors
    • age > 50
    • 50% have cardiovascular disease
    • Hx of diabetes
    • in younger patients those in hypercoaguable states
  13. Retinal vein occlusion
    treatment
    • referral
    • intravitreal injection of bevacizumab (VEGF inhibitor)
  14. Retinal artery occlusion
    etiology
    • central or branch types
    • central --> more profound vision loss
    • amaurosis fugax
  15. Retinal artery occlusion
    signs and symptoms
    • Cherry red spot on macula
    • sudden monocular loss of vision
    • no pain or redness
  16. Retinal artery occlusion
    risk factors
    • Atherosclerotic disease
    • age >50
    • A-fib
    • oral contraceptives
  17. Retinal artery occlusion
    diagnosis
    • Fluorescein angiography after visual acuity
    • referral
    • carotid bruits?
  18. Retinal artery occlusion
    treatment
    • lay flat
    • high concentration O2
    • Acetazolamide--to lower pressure in eye
    • ocular massage
  19. Glaucoma
    etiology
    more common is Asians and Innuit populations because of drainage of eye through canal of schlem
  20. Glaucoma
    risk factors
    • age
    • anticholinergic use
    • race--Asian or Inuit
    • hyperopia (far sightness)
    • fam Hx
    • pupillary dilation
  21. Glaucoma
    clinical findings
    • closed--unioccular severe pain, blurred vision with halos around lights, tunnel vision
    • eye is red with cloudy cornea
    • eye is hard to palpation
    • open--gradual loss of peripheral vision, asymptomatic
    • cupping of optic disc
    • elevated intraocular pressure
  22. Glaucoma
    treatment
    • IV dose of acetazolamide
    • topical beta blocker (timolol)--only Tx for open
    • Pilocarpine, carbachol miotics
    • Mannitol if refractory to acetazolamide
    • Oeripheral iridotom is definitive Tx
  23. Cataracts
    etiology
    • cigarette smoking
    • corticosteroids
    • DM, NF type 2, Age
  24. Cataracts
    clinical findings
    • impaired red reflex
    • lens opacification
  25. Cataracts
    diagnosis
    slit lamp with dilated eye revealing opacities
  26. Cataracts
    Treatment
    surgical extraction of opacified lens
  27. Cataracts
    risk factors
    • smoking
    • corticosteroids
    • ToRCH syndrome (Toxoplasmosis, Rubella, CMV, HSV)
    • Aging
  28. Hordeolum (stye)
    • swollen painful lump on eyelid
    • 95% staph aureus
    • warm compress
    • ABX if draining--erythromycin, Bacitracin ointment
    • I/D if not draining in 48 hours
  29. Chalazion
    • painless granuloma of sebaceous gland
    • hard nontender eyelid swelling
    • Tx eyelid hygiene, warm compress
    • if affecting vision --> curettage, corticosteroid, or incision
  30. Blepharitis
    etiology
    • Anterior--staph aureus, viral or seborrheic
    • Posterior--meibomain gland dysfunction
  31. Blepharitis
    clinical presentation
    • crusting scaling red rimming of eyelid
    • eyelash flaking
  32. Blepharitis
    treatment
    • Anterior--eyelid hygiene, warm compress, ABX Tx
    • Posterior--eyelid massage/expression of Meibomian gland regularly
  33. Endotropion
    • inward turning of lower lid
    • Botox injections can be temp fix
    • surgery indicated if lashes touching cornea
  34. Dacryocystitis
    etiology
    • biphasic--infants and over 40
    • staph aureus and beta hemolytic strep
    • Candida albicans in chronic
  35. Dacryocystitis
    presentation
    • unilateral
    • pain swelling tenderness near the tear sac
    • purulent material may be expressed
  36. Dacryocystitis
    treatment
    • systemic ABX
    • surgical relief is elective or in some urgently acute cases
  37. Lacerations of eyelid
    • if lid margin is lacerated then Pt should be referred b/c of scarring
    • elsewhere can be sutured w/o complications
  38. Bacterial conjunctivitis
    etiology
    • staphylococci and streptococci are most common
    • Haemophilus, pseudomonas, Moraxella 2nd MC
    • Gonococcal if Hx supports
  39. Bacterial conjunctivitis
    presentation
    • NO blurring of vision
    • absence of ciliary injection
    • copious purulent discharge
    • If hyperpururlent culture for gonococcal
  40. Bacterial conjunctivitis
    treatment
    • resolves 10-14 days intreated
    • fluroquinolone for pseudomonas coverage in contact lens wearers
    • topical sulfonamide or systemic ABX will clear in 2-3 days
    • If gonococcal Tx with ceftriaxone and azithromycin
    • admit for IV therapy for chlamydial or gonococcal
  41. Allergic conjunctivitis
    presentaiton
    • red eyes
    • rhinorrhea, fever, malaise, pharyngitis
    • cobblestone mucosa
    • photophobia
    • bilateral
  42. Allergic conjunctivitis
    treatment
    H1 blockers topical (Olopatadine)
  43. Viral conjunctivitis
    etiology
    • adenovirus is MC
    • eye clinics and swimming pools
  44. Viral conjunctivitis
    presentation
    • bilateral
    • copious watery discharge
    • foreign body sensation
    • fever malaise, preauricular adenopathy
    • last 10 days
  45. Viral conjunctivitis
    treatment
    • ABX or topical sulfonamides to prevent 2ndary bacterial infection
    • HSV Tx with topical antivirals
    • cold compress
  46. Uveitis
    etiology
    • acute nongranulatomous anterior and granulomatous anterior are MC
    • anterior inflammation of iris or ciliary body
    • posterior inflammation of choroid
    • systemic diseases HLA-B27, spondyloarthropathies, sarcoid, Behcet's disease
    • CMV, toxoplasmosis, syphilis, TB
  47. Uveitis
    presentation
    • anterior--unilateral ocular pain, redness, photophobia
    • posterior--blurred vision, floaters, no pain, absence of anterior signs
    • ciliary injection
    • consensual photophobia
    • inflammatory cells and flare within aqueous
  48. Uveitis
    treatment
    • Anterior--topical steroids (prednisolone--under direct instruction only)
    • Posterior--corticosteroids
  49. Orbital cellulitis
    etiology
    • S. pneumonia, streptococci, H. influenza
    • Recent URI
  50. Orbital cellulitis
    presentation
    • fever, proptosis, restriction of extraoccular movements
    • swelling with redness of lids
  51. Orbital cellulitis
    treatment
    • cefazolin, ceftriaxone IV
    • Vancomycin or clindamycin for MRSA coverage
    • Surgery to drain
  52. Uveitis
    diagnosis
    • dots on slit lamp exam
    • limbic flush
  53. Foreign body
    etiology
    • something in my eye--conjuntival or corneal
    • something hit my eye--intraoccular
  54. Foreign body
    diagnosis
    • Visual acuity test first
    • proparacaine and oblique illumination
    • sterile fluorosine--Seidal sign as fluorosine adheres to injury
    • Intraoccular if no FB detected with Hx of hitting my eye
  55. Foreign body
    treatment
    • irrigation with sterile sailine
    • cotton swab
    • if - Seidel sign (no globe perforation) tease out with needle
    • Metal will present with rust ring that will need to be ground out
  56. Abrasion
    etiology
    • contact lens
    • paper
    • finger nail
  57. Abrasion
    presentation
    • severe pain photophobia
    • watery eye
    • Hx of trauma
  58. Abrasion
    diagnosis
    • pain relieved with tetracaine
    • fluoroscine with black light to visualize abrasions
  59. Abrasion
    treatment
    • children will heal in 12 hours
    • smoking delays healing
    • NSAIDs for pain relief
    • If narcotic required--red flag
    • Erythromycin ointment
  60. Corneal ulcer
    etiology
    breaks in epithelial layer from trauma or systemic disease
  61. Corneal ulcer
    presentation
    • photophobia
    • Hx of trauma
    • cloudy appearing cornea
    • exquisite pain
  62. Corneal ulcer
    diagnosis
    tetracaine only minorly relieves pain
  63. Corneal ulcer
    treatment
    • cycloplegic drops for pain
    • ophthalmology referral
    • topical ABX
  64. Hyphema
    presentation
    • blood in anterior chamber of eye
    • loss of vision
    • pain
    • photophobia
  65. Hyphema
    treatment
    • elevate bed to 30-45 degrees
    • cycloplegia for pain
    • sickle cell alpha or beta blockers topically
  66. Burns
    etiology
    • UV--welding or skiing "snow blindness"
    • Chemical acids or bases (bases worse b/c of lack of protein absorption)
  67. Burns
    diagnosis
    slit lamp to assess severity of burn
  68. Burns
    treatment
    flush with tap water, sterile saline, or buffering solution ASAP
  69. Subconjunctival hemorrhage
    etiology
    valsalva maneuver
  70. Subconjunctival hemorrhage
    presentation
    • pain
    • diminished visual acuity
    • photophobia
    • flat, bright red, smooth limited to the bulbar conjunctiva and sharply demarcated at the limbus
  71. Subconjunctival hemorrhage
    treatment
    • cool compress
    • reassurance
    • no referral needed
  72. Strabismus
    etiology
    • 4% of children < 6yo
    • Commitment is MC type
    • noncommitment associated with neurologic disorders, trauma, or systemic diseases
  73. Strabismus
    presentation
    • misalignment of eyes
    • eso-inward
    • exo-outward "walleye"
    • hyper-up
    • hypo-down
  74. Strabismus
    diagnosis
    • Hirshber corneal light test
    • compare reflection of light in pupils
  75. Strabismus
    treatment
    • surgical alignment
    • complication if untreated is amblyopia
  76. Amblyopia
    • caused by untreated strabismus
    • loss of vision in one eye
  77. Macular degeneration
    etiology
    • > 75
    • leading cause of permanent visual loss in elderly
    • white, female, fam Hx, smoker
  78. Macular degeneration
    presentaiton
    • Dry (atropic) small yellow round spots on outer retina Drusen
    • Wet (neovascular or exudative)--rare shows neovascularization  which leak bleed and lead to scarring
    • atropic--gradual bilateral loss of vision
    • neovascular--rapid visual loss and more severe
    • Dx Wet with fluorescein angiography
  79. Macular degeneration
    treatment
    • Dry--Amsler grid @ home to monitor, Vit A, C, & E, zinc may slow progression
    • Wet--Anti-angiogenics bevacizumab (VEGF inhibitors)

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