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Final Review

Identify causes, differential testing, treatment, and management strategies for various eye conditions such as follicles, conjunctivitis, papillae, blepharokeratitis, and optic nerve abnormalities. Includes tips on diagnosis with keywords to look for symptoms.

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Final Review

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Presentation Transcript

  1. Final Review Kelli Shaon, O.D.

  2. Identify

  3. Follicles • 4 main causes: • Chlamydia • Viral (HSV, Adenovirus) • Topical med toxicity • Parinaud oculoglandular syndrome (rare) • Are a collection of lymphocytes • Appear as flesh colored raised lesion • Size varies • Has vessels surrounding or encapsulating the follicles

  4. Further testing for Differentials • Location of follicles • Upper > Lower – think Chlamydia • Lower>>> Upper – other etiologies • Look for type of discharge • Watery – viral • Mucopurulent - Chlamydia • Check preauricular nodes for adenopathy • Yes – think viral or Chlamydia • Ask about recent colds/flu symptoms

  5. Adenovirus Conjunctivitis • EKC is most severe form • Start unilateral but bilateral w/in 1 wk • Very contagious for 7-10 days after symptoms begin – stress hygeine and minimal personal interaction • Palliative care: Cool compresses & artificial tears • Rule of 8’s: conjunctivitis, SPK, SEI • Watch for psuedomembrane - REMOVE

  6. Identify

  7. Herpetic blepharokeratitis • Blepharitis if skin lesion only • Keratitis if corneal involvement • Dendritic, disciform, or stromal (may get uveitis if stromal) • Unilateral red eye • Often recurrent • Decreased corneal sensitivity common (**Perform cotton wisp test)

  8. Treatment for HSV • Topical Viroptic 5x/day • Some recommend bacitracin ung to spread over skin lesion to prevent bacterial infection of compromised skin • NO STEROIDS IF EPITEHIAL DISEASE • Oral Anti-virals –debatable • HEDS 1: Topical steroids useful in stromal disease, No benefit in PO in stromal Dz • HEDS 2: PO reduced rate of outbreaks and reduces rate of stromal herpes by 50%

  9. Identify

  10. Papillae • Numerous causes: • Allergies • Bacterial • Contact lenses • Chronic lid disease • Floppy eyelid syndrome • Is hyperplastic conjunctival tissue infiltrated with inflammatory cells • Contains a CENTER, feeder vessel

  11. Further testing for Differentials • Ask if h/o allergies, rhinitis, etc.. • Ask about itch • Allergies will ITCH *** • Chronic blepharitis may cause some itch • Ask about type of discharge • Watery &/or ropy, stringy mucous – Allergy • Mucopurlent – bacterial • Ask about contact lens wear

  12. Allergic conjunctivitis • Remove allergen • Don’t rub or itch – increases cascade of inflammation which worsen symptoms • Cool compresses • Artificial tears • Topical antihistamine/mast-cell stabilizer

  13. Bacterial conjunctivitis • Lid hygiene • Antbiotic ung will cover lids, cornea, and conjunctiva (ie. Polysporin) but will blur vision OR a topical antibiotic drop can be used (no use for expensive med if just conjunctivitis)

  14. Blepharitis vs. Meibomianitis • Blepharitis • Seborrhea: greasy, matted lashes with flakes • Staphylococcal: collarettes, ulceration, redness, thickening of lid margins • Tx: lid scrubs & antibiotic ung • Meibomianitis • Clogged/compacted oil glands – toothpaste like discharge • Frothy tears • Tx: Warm compresses, masssage, artifical tears(b/c dry eye), Doxycycline PO – if severe (b/c effect on fat inoil gland)

  15. Chalazion vs. Hordeloum • A chalazion is a residual aggregation of inflammatory cells following an eyelid infection such as hordeolam • Hordeloum will be tender to touch..Chalazion will not • Tx: Warm compresses QID and Orals if severd, Kenalog or I&R may be needed • If recurrent chalazion in same location…. Need to have biopsy to r/o sebaceous gland carcinoma

  16. Identify

  17. Optic nerve drusen • No small vessel obscuration by NFL at the ONH margins • May look lumpy/bumpy • Drusen may autofluoresce with red-free • Helpful to get HVF and/or B scan

  18. Identify

  19. Optic nerve edema • (+) small vessel obscuration by NFL at the ONH margins • Due to increase ICP from intracranial mass (papilledema) or Psuedotumor Cerbri • Need MRI to look for mass followed by LP to measure ICP

  20. Identify

  21. Normal variations • Picture 1: Tilted disc may have PPA associated • Picture: Myelinated Nerve fibers

  22. Identify

  23. Disc variations • Picture 1: Optic nerve hypoplasia • Picture 2: Megalopapillae (larger ONH) – often has large cup • Can use direct o-scope test to determine (small spot aperture)

  24. Glaucoma

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