Eent Quiz: Week Four

A subconjunctival hemorrhage is a condition where blood vessels in the conjunctiva, the clear membrane covering the white part of the eye, rupture and bleed. This can occur even in trivial situations such as a cough, sneeze, or valsalva maneuver (forceful exhalation with a closed mouth and nose). These actions can cause a sudden increase in pressure in the blood vessels, leading to their rupture and subsequent bleeding. Therefore, a subconjunctival hemorrhage can occur in these trivial situations.

Based on the patient's symptoms of tearing, conjunctival injection, ciliary flush, headache, and slight photophobia, along with the picture provided, the most likely diagnosis is a Conjunctival or Corneal foreign body. These symptoms are consistent with the presence of a foreign object in the eye, causing irritation and inflammation of the conjunctiva and potentially the cornea. The picture may show redness and swelling in the affected area, further supporting this diagnosis.

Chemical conjunctivitis refers to inflammation of the conjunctiva, which is the clear tissue that covers the white part of the eye and the inner surface of the eyelids. This inflammation occurs as a result of exposure to chemical irritants. The symptoms of chemical conjunctivitis may include redness, itching, burning, and a foreign body sensation in the eye. It is important to flush the eye with water immediately after exposure to the irritant and seek medical attention if the symptoms persist or worsen.

Upper lid eversion is performed in the case of a foreign body under the upper eyelid. This procedure involves flipping the upper eyelid inside out to locate and remove any foreign object that may be causing irritation or discomfort. It is a common method used by healthcare professionals to address foreign body sensation or eye irritation caused by the presence of a foreign object trapped under the upper eyelid.

Ultraviolet keratitis is a condition that is also known as diffuse punctuate keratopathy and "welder's flash." It can be caused by ultraviolet burns of the cornea, typically from using a sunlamp without protection, exposure to a welding arc, or exposure to the sun when skiing ("snow blindness"). This condition is characterized by inflammation and damage to the cornea due to excessive exposure to ultraviolet radiation. Symptoms may include pain, redness, tearing, blurred vision, and sensitivity to light. Treatment usually involves the use of lubricating eye drops, pain medications, and avoiding further exposure to ultraviolet radiation.

Orbital cellulitis is an infection of the tissue within the eye socket, which presents with symptoms such as fever, proptosis (bulging of the eyeballs), restriction of eye movements, and swelling and redness of the eyelids. This condition typically has an abrupt onset and can be accompanied by pain and decreased vision. It is important to promptly diagnose and treat orbital cellulitis to prevent complications such as vision loss or spread of infection to the brain.

Based on the symptoms described, such as eye pain, blurred vision, headache, purulent discharge, swollen and red eyelid, and inability to move the eye, the most likely diagnosis is orbital cellulitis. Orbital cellulitis is an infection of the tissues surrounding the eye, usually caused by a bacterial infection that spreads from the paranasal sinuses. The symptoms and signs mentioned are consistent with this condition, indicating inflammation and infection in the orbital tissues. Optic neuritis is inflammation of the optic nerve, which does not explain the other symptoms. Papilledema refers to swelling of the optic nerve head, which is not mentioned in the scenario. Ocular trauma and conjunctivitis do not account for the severe symptoms and signs described.

A subconjunctival hemorrhage refers to the bleeding underneath the conjunctiva, the clear tissue covering the white part of the eye. Although it may appear alarming due to the redness in the eye, it typically does not cause any pain or affect the patient's visual acuity. Therefore, the statement is true.

Using topical anesthetic drops in the office for a patient with a corneal abrasion can be beneficial as they help in performing a more thorough examination and provide pain relief. However, these drops should not be sent home with the patient because they can inhibit the healing process.

Fluorescein staining is a type of test that can be done to confirm the diagnosis of corneal abrasion. This test involves placing a few drops of fluorescein dye onto the surface of the eye. The dye highlights any damage or irregularities on the cornea, making it easier for the healthcare provider to visualize and diagnose a corneal abrasion. It is a commonly used and effective method for diagnosing this condition.

A perforated globe injury refers to a rupture or hole in the eyeball caused by penetrating trauma. These injuries can be subtle and easily overlooked because they may not always present with obvious external signs. However, they are considered serious because they can lead to severe vision loss or even loss of the eye itself. Therefore, the statement is true.

Occluding the nasolacrimal duct after instilling eye drops can increase the ocular availability of the agent and decrease the systemic effects. This is because when the nasolacrimal duct is occluded, the eye drops are prevented from draining into the nasal cavity and subsequently entering the systemic circulation. As a result, more of the medication remains in the eye, increasing its local effect and reducing the potential for systemic side effects.

Unsupervised self-administration of local anesthetics is dangerous because the patient can further injure the eye and not feel it. Also, these drugs can actually interfere with the healing process!

Papilledema is a condition characterized by swelling of the optic nerve head, which is usually caused by increased intracranial pressure. It is typically a bilateral process, meaning that it affects both eyes. Although it may be slightly asymmetric, with one eye being more affected than the other, the condition still generally involves both eyes. Therefore, the correct answer is "Bilateral."

False!! Hospitilization and immediate treatment with IV antibiotics is necessary to prevent optic nerve damage and spread of infection to the cavernous sinuses, meninges, and brain.

Optic neuritis is strongly associated with demyelinating diseases such as multiple sclerosis, as it involves inflammation and damage to the myelin sheath surrounding the optic nerve. However, it can also occur with viral infections, as these can trigger an immune response that leads to inflammation and damage in the optic nerve. Therefore, optic neuritis can be seen in both demyelinating diseases and viral infections.

False!! NO attempts should be made to do ANY of these things!!

Ophthalmic drops are usually preferred over ointments because they do not interfere with vision. Drops are liquid medications that are instilled directly into the eye, providing quick and targeted relief. They are easily absorbed and do not cause any visual disturbances. On the other hand, ointments are thicker and can blur vision temporarily after application. Therefore, ophthalmic drops are the preferred choice for eye treatment to avoid any interference with vision.

A blow-out fracture is the result of a direct compressive force to the globe of the eye, such as being hit by a baseball. This occurs when the force causes a fracture in the bones surrounding the eye, typically the orbital floor or the medial wall of the orbit. The fracture creates a defect through which the orbital contents, including the eye, can herniate into the surrounding sinuses or tissues. This can lead to double vision, restricted eye movement, and other symptoms. Therefore, a blow-out fracture is the correct answer in this case.

In general, the LOWEST concentration of ophthalmic antibiotic drops are the most effective! :)

The question is asking for the correct order of infections involved in orbital cellulitis. Pre-septal infection involves only the eyelid with periorbital swelling, but no ocular symptoms. Orbital infection is suspected in the presence of proptosis, decreased VA, retinal venous engorgement, papilledema, and extraocular muscle motility disturbances. Intracranial infection manifests with meningeal signs and changes in mental status. Therefore, the correct order is Pre-septal, Orbital, Intracranial.

The patient's symptoms of binocular diplopia, restricted eye movement, decreased sensation over the inferior orbital rim, and enophthalmos are all indicative of a blow-out fracture. This type of fracture occurs when there is a fracture of the orbital floor or medial wall, causing the orbital contents to be displaced. The picture shown also supports this diagnosis as it demonstrates the enophthalmos and possible swelling. A blow-out fracture can be caused by a direct blow to the face, such as being hit by a softball, and can result in double vision, restricted eye movement, and other associated symptoms.

The correct answer is ruptured corneal epithelial cells. When performing a fluorescein stain, the dye is applied to the eye's surface. In the case of ultraviolet keratitis, the corneal epithelial cells may become damaged or ruptured due to exposure to ultraviolet radiation. The dye uptake in multiple little pinpoint areas indicates the presence of these ruptured corneal epithelial cells, which can help confirm the diagnosis of ultraviolet keratitis.

If a patient has a subconjunctival hemorrhage involving the extreme lateral portion of the globe following blunt trauma, a fracture of the zygomatic arch should be considered. The zygomatic arch is a prominent bony structure that forms the lateral border of the eye socket. Blunt trauma to this area can cause a fracture, leading to bleeding and subsequent subconjunctival hemorrhage. The other options listed do not directly involve the lateral portion of the globe and are less likely to be associated with this specific presentation.

The patient's symptoms of pain, photophobia, blurred vision, and nausea and vomiting, along with the presence of blood in the picture, suggest a diagnosis of hyphema. Hyphema refers to the accumulation of blood in the anterior chamber of the eye, which can occur due to trauma or other underlying conditions. The symptoms described are consistent with hyphema, and the presence of blood in the picture further supports this diagnosis.

Ointments are most advocated for overnight usage due to their greater therapeutic effectiveness and greater contact with the eye surface for a longer period of time. Ointments have a thicker consistency compared to drops or lotions, which allows them to stay in the eye for a longer duration. This prolonged contact ensures that the medication in the ointment has more time to be absorbed by the eye, leading to greater therapeutic effectiveness. Additionally, ointments provide a protective barrier on the eye surface, which can be beneficial during overnight usage.

Based on the patient's symptoms of tearing, photophobia, injection, foreign body sensation, and blepharospasm, the most likely diagnosis is a corneal abrasion. A corneal abrasion is a scratch or injury to the cornea, which is the clear front surface of the eye. The accidental poke with the paperclip could have caused a scratch on the cornea, leading to the symptoms described by the patient. Subconjunctival hemorrhage, conjunctival or corneal foreign body, hyphema, and corneal ulcer are less likely diagnoses based on the given symptoms.

A central scotoma refers to a black or blind spot in vision. This means that there is an area in the center of the visual field where a person is unable to see clearly or at all. It can be caused by various conditions such as macular degeneration or damage to the optic nerve. This term specifically describes a loss of vision in the central part of the visual field, as opposed to peripheral vision.

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Hyphema is the correct answer because it refers to a condition where there is bleeding in the anterior chamber of the eye, which can disrupt the blood vessels that support the iris or ciliary body. This can occur as a result of injury to the eye. Subconjunctival hemorrhage refers to bleeding under the conjunctiva, not specifically related to the anterior chamber. Optic neuritis is inflammation of the optic nerve, not related to injury of the anterior chamber. Bloody chemosis refers to swelling and redness of the conjunctiva, not specifically related to injury of the anterior chamber. Papilledema refers to swelling of the optic disc due to increased intracranial pressure, not related to injury of the anterior chamber.

False!! Topical anesthetics are toxic to the cornea, and should NEVER be indicated for long-term use. They are usually only used to permit a complete ocular examination.

Based on the given symptoms of sudden, monocular loss of vision with a blind spot and loss of color vision, along with pain in the eye, particularly with eye movements, and pain on palpation of the globe, the most likely diagnosis is ocular neuritis. Ocular neuritis refers to the inflammation of the optic nerve, which can cause vision loss, blind spots, and color vision impairment. The presence of pain in the eye and with eye movements further supports this diagnosis. Conjunctivitis, papilledema, orbital cellulitis, and ocular trauma do not typically present with these specific symptoms.

Papilledema is the correct answer because it refers to a swelling of the optic nerve head, typically caused by increased pressure within the skull. This condition is often associated with elevated intracranial pressure and can cause temporary changes in vision. Optic neuritis is inflammation of the optic nerve, chronic glaucoma is a long-term condition characterized by increased pressure within the eye, acute glaucoma is a sudden increase in eye pressure, and orbital cellulitis is an infection of the tissues surrounding the eye.

In case they have a fragment of metal in their eye, you risk moving the object and causing further damage with the magnetic field of the MRI :)

A blow-out fracture refers to a fracture of the bones surrounding the eye, typically the orbital floor, which results in the herniation of orbital contents downwards. This can cause an "opaque teardrop hanging from the roof of the antrum" appearance on Waters and Caldwell plain x-ray films. Intraocular foreign body, corneal abrasion, conjunctival or corneal foreign body, and perforated globe are not associated with this specific radiographic finding.

Papilledema is the correct answer because it is characterized by swelling of the optic disc with a blurred margin, dilated and tortuous venules, obscured optic cup, flame hemorrhages, infarctions in the nerve fiber layer, and edema in the surrounding retina. This condition is typically caused by increased intracranial pressure, which can be due to conditions such as brain tumors, intracranial hemorrhage, or meningitis. It is important to identify papilledema as it can indicate a serious underlying condition that requires immediate medical attention.

False! Alkali injuries are worse and require more irrigation because alkalis are not precipitated by the proteins of the eyes, like the acids naturally are.

The head of the bed should be slightly elevated!

A patient with a conjunctival or corneal foreign body who is complaining of headache and photophobia should be administered a short-acting cycloplegic medication. This type of medication helps to relax the muscles of the eye and reduce pain and discomfort. It can also help to dilate the pupil, which can be beneficial in cases of corneal foreign body. Anesthetic medications may provide temporary relief but do not address the underlying issue. Antibiotic ointment or drops may be necessary if there is an associated infection, but they do not specifically address the symptoms of headache and photophobia.

A sterile, moist cotton tipped applicator should be used to remove a foreign body from the conjunctiva or cornea. Moistening the cotton tip helps to prevent further damage to the eye and provides a gentle and effective way to remove the foreign body. Sterility is important to prevent infection. Using a cotton tipped applicator coated in antibiotics or a dry cotton tipped applicator may cause discomfort or irritation to the eye. A small pair of tweezers or a tongue depressor are not appropriate tools for removing a foreign body from the eye.

When fluorescein stain streams away from what is suspected to be a corneal abrasion, it indicates a corneal perforation. A corneal perforation refers to a hole or rupture in the cornea, which is the clear front surface of the eye. This condition can be serious and requires immediate medical attention. The streaming of fluorescein stain suggests that the fluid is leaking out of the cornea through the perforation, confirming the presence of a corneal perforation.

The Morgan Lens is a medical device that is specifically designed for eye irrigation with lactated Ringers' solution. This solution is used to rinse the eyes in cases of chemical burns, foreign body removal, or to flush out any irritants or contaminants. The Morgan Lens allows for continuous irrigation of the eye, ensuring thorough cleansing and promoting healing. It is a safe and effective method for eye irrigation in various medical settings.

The correct answer is "Neutralization of an acid with an alkali or vice versa." This is not an appropriate part of treatment for chemical conjunctivitis because neutralizing an acid with an alkali or vice versa can potentially cause further damage to the eye. It is important to remove any particulate matter, irrigate the eye with lactated Ringers' solution to restore the pH, dilate the pupil with cyclopentolate for relief, and start prophylactic topical antibiotics to prevent infection. However, neutralization should not be attempted as it can worsen the condition.

The use of multiple-drop bottles of fluorescein is not recommended because cross-contamination provides a culture medium for Pseudomonas aeruginosa. This bacteria is known to be opportunistic and can cause infections in various parts of the body, including the eyes. Cross-contamination can occur when the same bottle is used for multiple patients, allowing the bacteria to spread and potentially cause infections. Therefore, it is important to use single-use containers to prevent the growth and transmission of Pseudomonas aeruginosa.

After a patient has suffered from a corneal abrasion, it is important for them to follow up with the healthcare provider within 1-2 days. This is because corneal abrasions can lead to complications such as infection or delayed healing, and early intervention is crucial to prevent any further damage or complications. By scheduling a follow-up appointment within this timeframe, the healthcare provider can assess the patient's progress, monitor for any signs of infection or complications, and adjust the treatment plan if necessary.

The patient's complaint of visual loss, along with the apparent cornea/sclera wound and opacity, suggests that there is an object inside the eye, causing damage and visual impairment. This indicates an intraocular foreign body, which refers to any object that has entered the eye and is lodged inside the eye. It is important to identify and remove the foreign body promptly to prevent further damage and complications.

The blood from a subconjunctival hemorrhage is limited to the bulbar conjunctiva, which is the clear membrane that covers the white part of the eye. It appears as a bright red patch on the eye and is flat in shape. The bleeding stops abruptly at the limbus, which is the border between the cornea and the sclera (the white part of the eye).

When a foreign body is stuck to the upper eyelid, it can cause abrasion on the cornea. This abrasion appears as a pattern similar to the surface of an ice-rink when viewed under fluorescein staining. The term "ice-rink" is used to describe this specific pattern of corneal abrasion.

Optic neuritis is inflammation of the optic nerve. Retro-bulbar optic neuritis refers to inflammation that occurs behind the eyeball. When examining the fundus, which includes the back part of the eye including the retina, optic disc, and blood vessels, no abnormalities are seen in cases of retro-bulbar optic neuritis. Therefore, the correct answer is "Fundus."

The correct answer is "Perforated globe." Based on the patient's history of being poked in the eye with a sharp object, the presence of a teardrop-shaped pupil that points towards the area of penetration, and the findings of a loss of anterior chamber depth and prolapse of choroid through the wound, it is likely that the globe (eyeball) has been perforated. This is a serious condition that requires immediate medical attention to prevent further damage and potential loss of vision.