eye diseases

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created 10 years ago by brclancy
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updated 10 years ago by brclancy
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1
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presenting with pain, photophobia, tearing

papillary conjuctiva present on eyelid

Bacterial keratitis

pseudomonas especially for contact lens wearers
can be staphylococcal or other gram + and -

Tx:
if central and large: fortifieds q1h alternating every half hour
tobramycin and vancomycin

if peripheral and small: flouroquinolones
vigamox q2h

2
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patient had vacationed in a tropical climate
experienced recent trauma with vegetative matter

Fungal keratitis

grey/white, feathery boarders, satellite lesions
do corneal scrape to test

tx: antifungals
amphotericin q1hfor candida (it burns)
natamycin for filamentous fungi q1h w/ epithelial debridement q2-3 days:

3
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presents with pain out of proportion with findings, blurred vision

may also see subepithelial infiltrates or perineuritis

Acanthamoeba keratitis

protozoa found in ponds, pools, streams
active and cyst form... cyst form resistant to treatment
do corneal scrape with silver stain (to stain cysts)/culture on E.coli agar

tx: pool cleaners basically
brolene
PHMB
clotrimazole

4
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presents with photophobia and tearing

Herpes simplex keratitis
dendritic ulcers

decreased corneal sensation
flourescin stain/rose bengal stain
debridement/ culture
conjunctiva follicles

Tx: Never prescribe steroids!
triflouridine 9x a day
gangciclovir 5x a day
acyclovir PO 5x a day

5
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Herpes simplex keratitis
geographic ulcer

Never prescribe steroids!

6
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Herpetic simplex disciform keratitis

intact epithelium, stromal edema, granulomatous keratinous precipitate
anterior uveitis is frequent

tx: pred forte topical (don't prescribe this... refer to ophtho)
acyclovir PO BID vs triflouridine QID
if recurrent, use acyclovir as prophylaxis

7

IOP

inter-ocular pressure

8
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whoopsie-daisy!

Corneal foreign body

possible associated tearing, photophobia
if metallic, possible rust ring
possible anterior chamber reaction
may be superficial or full thickness, in which case hold on testing IOP

tx: anesthetize; if superficial remove with cotton tip applicator, otherwise refer to ophtho
if full thickness, OR removal w/ possible suturing
cycloplegia if cilliary pain

9
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foreign body under eyelid

linear abrasions seen with flourescein exam
flip eyelid and FB might still be there

tx: anesthetize and get it out, man.
antibiotic drops, sure, too.

10

indicators of globe rupture

sever pain, loss of vision, hyphema, deviation of pupil towards laceration, loss of anterior chamber depth, or severe conjunctival hemorrhage fully around cornea

11

positive Seidel test

with flourescein, a dark (diluted) stream in a pool of bright green (concentrated)

showing laceration with the aqueous humour draining and mixing with the flourescein dye

12

Marcus Gunn pupil

abnormal slight pupillary contraction or dilation of effected eye when conducting the swinging flashlight test

13

ruptured globe management

- do not manipulate
-rule out interocular foreign body w/ CT

Tx: NPO, make shield, cefazolin

14

proptosis

one eye is bulging out farther than the other

15

chemosis

conjunctival swelling