Blood floating in eye, usually from blunt trauma
s/s of hyphema
- blurry vision
- pain sensitive to light
Tx for hyphema.
- Will heal on its own in about 2 weeks
- (increased risk of rebleed during first week)
How is viral conjunctivitis spread?
- hand-to-eye contact
- hand-to-object contact
Most common cause of viral conjunctivitis.
How is bacterial conjunctivitis spread?
- direct hand-to-eye contact from contaminated hands
- large respiratory tract droplets
S/S of Nasolacrimal Duct Obstruction (NLDO)
- excessive tearing
- overflow of tears onto eyelashes, lids, cheeks
- eyelids red & swollen
s/s of secondary infection from NLDO.
tenderness & swelling over lacrimal duct
tx for NLDO
- spontaneously resolves usually by 1 yoa
- if no improvement by 9 mos, refer to opthamologist
Infection in one of the oil glands that surrounds an eyelash follicle.
Usual cause of hordeolum (stye).
s/s of hordeolum (stye)
- local or diffuse swelling of eyelid
- erythema spreading away from localized site of infection
- occasional sensation of "grit" or foreign object in eye
Tx for hordeolum (stye).
- warm compresses,10-15 min qid (most resolve)
- cleanse daily w/ neutral soap 1:1 w/ water
- abx drops or erythromycin ointment bid x 7 days if persists
Develops in meibomian glands on the conjunctival side of lid (chronic granuloma or result of chronic hordeolum/prior excision).
localized lesions, hard, nontender, minimal erythema.
Where is a chalazion usually located?
away from lid border
tx for chalazion
- if small & asymptomatic, no tx
- if lg or secondary infection, tx as with hordeolum
Inflammation of eyelid margins (usually chronic).
What causes blepharitis?
- seborrheic dermatitis, rosacea, or allergies
S/S of blepharitis.
- scaling of eyelid margins
- itching, crusting, erythema
- burning, discomfort, poss feeling of foreign body
s/s of severe and chronic blepharitis
- purulent discharge
- permanent changes in eyelid structure can occur over time
Pts with blepharitis usually have a h/o?
recurrent chalazio or hordeola
Tx for blepharitis
- cellufresh or bio tears if dry
- warm wet compress 2 min 2-4x daily to lids
- then gently scrub eyelids qd baby shampoo 1:1 w/ water
- flares: topical abx
How is blepharitis associated with seborrhea often improved?
dandruff shampoo on scalp & eyebrows
_________ usually results from a sinus infection and is localized anterior to the orbital septum, outside the body orbit.
periorbital (preseptal) cellulitis
s/s of periorbital (preseptal) cellulitis.
- eye pain
- epiphora (blurry, erythema, edema)
Chandlar stage I of periorbital (preseptal) cellulitis.
Chandlar stage II of periorbital (preseptal) cellulitis.
inflammatory orbital edema
Chandlar stage III of periorbital (preseptal) cellulitis.
Chandlar stage IV of periorbital (preseptal) cellulitis.
Tx of periorbital (preseptal) cellulitis.
- In older children & adults: abx that would tx URI
- (amox/clavulanic acid or 1st gen cephalosporin; IM ceftriaxone)
- younger: need hospital eval
If no improvement in periorbital (preseptal) cellulitis in 48-72 hours, what is tx?
consider IV abx
An acute infection of the tissues immediately surrounding the eye, including eyelids, eyebrow, & cheek. Also involves infection of fat & muscle w/in bony orbit.
What is the usual cause of Orbital Cellulitis?
- bacteria from a sinus infection
- also can be caused by styes, bug bites, eyelid injury
Eye infection that is dangerous with potentially serious complications - get worse quickly and if left untreated can lead to blindness.
S/S of Orbital Cellulitis.
- painful swelling of upper & lower eyelid, can include cheek & eyebrow
- bulging eyes
- decreased vision
- eye pain, esp w/ movement of eye
- fever (usually 102 or higher)
- shiny, red/purple eyelid
Tx for Orbital Cellulitis.
- IV abx
- surgery may be necessary to drain abscesses
Diffuse dilation of vessels with redness that tends to be maximal at periphery.
Conjunctival injection (pink eye; conjunctivitis)
Result of small BV rupture in conjunctival tissue.
s/s of subconjunctival hemorrhage.
no s/s - usually someone else notices or noticed in mirror
Causes of subconjunctival hemorrhage.
- coughing, vomiting, straining
- HTN; blood thinners
- in infants during vag births
tx for subconjunctival hemorrhage
- blood will gradually reabsorb in about a week. No tx
- (color of blood will change)
Often benign inflammation of covering of sclera.
s/s of Episcleritis
- bilateral mild stinging
- tearing, photophobia
- peripheral injection
- *no visual acuity impairment or discharge*
tx for Episcleritis
usually improves w/o tx
How is scleritis different than episcletiritis?
- scleritis can result in destructive disease, is unilateral, & visual acuity can be affected
- episcleritis is benign inflammation, bilateral, & visual acuity is not affected
s/s of scleritis
- unilateral pain & ciliary injection
- visual acuity can be affected
Inflammation of the iris & ciliary body.
Anterior uveitis or iritis
s/s of Anterior uveitis or iritis
- moderate & aching eye pain
- decreased visual acuity
- minimal eye discharge
- pupil smaller
- *central redness of eye w/ ciliary flush
Involves choroid, a layer of BV, and CT.
posterior uveitis or choroiditis
Which can develop with systemic infection or autoimmune disease - posterior uveitis (choroiditis) or anterior uveitis (iritis)?
posterior uveitis (choroiditis)
Which one can be idiopathic or in response to coexistent infection or trauma - posterior uveitis (choroiditis) or anterior uveitis (iritis)?
anterior uveitis (iritis)
Tx for posterior uveitis (choroiditis) or anterior uveitis (iritis).
- sun protection
- poss steroid eye drops or pupil dilation drops
- if pain continues, refer.
infection/irritation of the cornea.
s/s of keratitis.
- moderate to severe eye pain
- some discharge, tearing
- decreased visual acuity; photophobia
- cloudy corneadiffuse peripheral injection
- ciliary flush
Tx for keratitis.
- depends on cause
- if noninfectious - eye patch 24 hrs + eye lube
s/s of corneal abrasion
- eye pain, feeling of foreign object in eye
tx of corneal abrasion.
- minor - heal w/in 72 hrs
- remove foreign body if present
- abx ointment/drop
- no eye make-up or contacts til healed
s/s of primary angle-closure glaucoma
- unilateral h/a
- visual blurring
Physical exam findings for primary angle-closure glaucoma.
- non-reactive, semi-dilated pupils
- scleral injection
A common non-cancerous growth of the conjunctiva in one or both eyes and extends into cornea, usually from nasal aspect.
A small, yellowish nodule on the conjunctiva near cornea; usually on nasal side.
Tx for pinguecula.
usually none needed
Pinguecula can be a precursor for __________.
_______ is confined to the bulbar conjunctiva.
RF for pterygium.
- exposure to sunny, dusty, sandy, or windblown areas
- farmers, fishermen
- living near equator
- rare in kids
Tx for pterygium.
Eye does not focus light on retina evenly & objects appear blurry & stretched out.
Difficulty focusing on near objects b/c eye no longer able to change shape as easily.
S/S of cataracts.
- decreased vision
- glare (oftenwhen driving at night)
- straight edges appear wavy; double vision
- altered color perception
RF for cataracts.
- steroid therapy
- tobacco & ETOH
What will be noted on a mature cataract?
leukokoria (white pupil)
An abnormality in the trabecular angle tissue causing resistance to fluid flow; onset is slow and insidious; chronic condition.
Primary Open Angle Glaucoma
With Primary Open Angle Glaucoma, there is a gradual loss of ___________.
Primary symptom of Primary Open Angle Glaucoma.
loss of peripheral vision
__________ is affected late in Primary Open Angle Glaucoma.
central visual acuity
What is photopsia?
flashes in the eye
What is entopsia?
floaters in the eye
s/s of retinal detachment.
- sudden increase in floaters
- light flashes
- peripheral vision loss
Can feel like a "curtain going down on eye."
Leading cause of blindness in US
age-related macular degeneration
Macular degeneration may be asymptomatic or associated with gradual loss of ________.
Rapid vision loss d/t development of abnormal BV under retina that leak fluid; straight lines often appear wavy.
Exudative/wet AMD (age-related macular degen)
Light-sensitive cells of the macula slowly break down; there is gradual loss of central vision; three stages.
Nonexudative/dry AMD (age-related macular degen)
Physical exam for macular degeneration.
- visual acuity test
- dilated eye exam
Tx for exudative/wet AMD (age-related macular degen)
- laser sx
- photodynamic therapy
- injections of meds to stop growth of BV
Tx of nonexudative/dry AMD (age-related macular degen).
- if has reached advanced stage, NO tx
- if found early, zinc/antioxidant supplements