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EYES
Blepharospasm
Periodic involuntary closure of the eye (form of focal dystonia)
Tx: Botulinum toxin injection
Hordeolum (Stye)
Abscess located over upper or lower eyelid
Dacryocystitis
Infection of lacrimal sac
Trauma
Severe eye pain, red eye
Mx: referral and daily examination, removal of foreign body, eye patch for < 24 hrs (if trauma associated with contact lens then eye patch C/I), antibiotics, cycloplegics (these do not relieve foreign body sensation but reduce pain and photophobia), no anesthetics / steroids
Endophthalmitis
Ophthalmologic emergency
Assn: intraocular surgery, h/o eye injury
Symptoms: flashing lights, severe pain
Signs: hypopyon, failure to visualize retinal vessels (80% of cases)
Mx: urgent referral to Ophthalmology, vitreous or aqueous culture and intavitreal antibiotics, vitrectomy, or enucleation
Tx of Candida endophthalmitis → vitrectomy + IV Amphotericin B
Sympathetic Ophthalmia
“Spared eye injury”, immune-mediated inflammation of one eye (the sympathetic eye) after penetrating injury to other eye
Mechanism → “uncovering of hidden antigen”
Alkaline Solution Splash
Extremely dangerous
Tx: Immediate irrigation
Eye Discharge
-In neonate:
1-3 days old → physiological
3-5 days old → mucopurulent discharge → can gonococcal conjunctivitis, Tx → topical antibiotics
Mucoid discharge, few days after birth → Chlamydia Conjunctivitis, Tx → oral (systemic) antibiotics to prevent pneumonia
-In child:
Purulent discharge, crusting in the morning → bacterial conjunctivitis
Clear watery discharge, bilateral, h/o URTI → viral conjunctivitis
Corneal Ulcers
Cause: Herpes Simplex
Dx: Vesicles over tip of nose, dendritic ulcers on fluorescein slit lamp exam
Tx: Corticosteroid + Oral Acyclovir / Urgent → refer pt to ER / Ophthalmology
-HSV Keratitis in HIV
Painful lesions, fundoscopic findings of peripheral pale lesions, central retinal necrosis
Herpes Zoster Ophthalmicus
Elderly pts, burning & itching in periorbital area, vesicles in distribution of cutaneous branch of 1st branch of trigeminal nerve (Ophthalmic nerve)
Trachoma
Leading infectious cause of ocular morbidity
Chronic keratoconjunctivitis, neovascularization of cornea (pannus), caused by obligate intracellular bacterium Chlamydia trachomatis
Conjuctivitis
Types:
-Allergic
Seasonal (summer and spring), cobblestone appearance
-Viral
Cause: adenovirus
Tx: none usually necessary
-Bacterial
Cause: Staph, S. pneumoniae, H. influenzae
Tx: topical antibiotics
-Gonococcal
Purulent discharge
Tx: 1gm Ceftriaxone
Uveitis
Inflammation of iris, ciliary body and choroids
Clinical: Decreased vision, red eye, small and irregular pupils
Dx: Ophthalmoscopy → inflammatory cells, aqueous flare (turbidity of aqueous humor caused by increased protein levels and cells), Keratic Precipitate (KP) diagnostic
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