Dry eye is more prevalent in
Hispanic and Asian populations pg 245
Dry eye occurs due to
mechanical abnormalities
lacrimal gland malfunction
mucin deficiency pg 245
Epiphoria is
excessive tearing pg 245
The most important thing for the clinician to know in the case of eye pain, and in dealing with eye problems in general is
referral to an opthalmologist pg 246
The most common condition of red eye is
viral conjunctivitis pg 246
bacterial conjunctivitis has a
thick purulent discharge, crust eyelids in the morning pg 247
bacterial conjunctivitis occurs more commonly during the
fall and winter pg 247
preauricular lymph nodes are not palpable in
bacterial conjunctivitis, allergic conjunctivitis, iritis, and acute glaucoma pg 247
in viral conjunctivitis, preauricular lymph nodes are
palpable pg 247
allergic conjunctivitis discharge is
stringy, mucoid pg 247
allergic conjunctivitis symptoms of conjunctival abnormalities are
itching and burning, mild,and diffuse pg 247
viral conjunctivitis discharge is
watery pg 247
allergic conjunctivitis occurs more commonly during the
fall and spring, sneezing and rhinorrhea are common pg 247
acute glaucoma presents with
severe pain, the anterior chamber may appear narrow with penlight exam, the pupil is mid-dilated nonreactive or sluggish, nausea, vomiting and headache may be present pg 247
a patient between ages 50-85 presents with sudden onset of severe eye pain, vomiting, headache, the conjunctiva may be injected, steamy cornea, pupil may be fixed, partially dilated, narrow chamber angle. Does this require urgent treatment?
yes - symptoms of Acute glaucoma pg 248
a patient usually older than 40 but may occur in younger patients presents with decreased peripheral field of vision, decreased central vision is a later sign, increased intraocular pressure, increased cu-to-disc ratio. Does this require urgent treatment?
Usually no - symptoms of Chronic glaucoma pg 248
Should any patient newly diagnosed with diabetes be referred to an opthalmologist?
Yes pg 272
bacterial conjunctivitis is usually caused by
Streptococcus pneumoniae,
Haemophilus influenzae,
group A Streptococcus
S. aureua
pseudomonads pg 259
Bacterial conjunctivitis should be treated with
broad spectrum topic agents pg 259
chlamydial conjunctivitis is a leading cause of blindness in developing nations and should by treated with systemic antibiotics in addition to topical agents. The drug of choice is
Azithromycin 1g as single dose or doxycycline 100mg bid x7 days. Treat the sexual partner simultaneously pg 259
herpes simplex conjunctivitis requires
systemic or topical agents and should be referred to an opthalmologist pg 259
viral conjunctivitis does not require
antibiotics unless there is a 2nd infection, use lubrication for comfort pg 259
Medications for Allergic conjunctivitis are
Mast cell stabilizers - lodaxamide, nedocromil 2%, pemirolast 0.1%
Antihistamine - emedastine 0.05%, Levocabastine 0.05%
Combination mast-cell & antihistamines
Nonsteroidal antiinflammatory pg 258
iritis requires
prompt attention by an opthalmologist pg 261
a Pterygium commonly is seen at
3 and 9 oclock in the eye position pg 262
A patient presents with sudden eye pain and blurred vision. Has nausea and vomiting. Reports seeing rainbow halos around lights, there is corneal cloudiness, with diffuse conjunctival hyperemia. The pupil of the affected eye will be moderately dilated and
acute closed-angle glaucoma and should be referred immediately to an opthalmologist pg 262
Cataracts are classified as
Type I - visual acuity better than 20/40 in the affected eye(s)
Type II - visual acuity of 20/40 or worse in the affected eye(s)
pg 265
normal intraocular pressure is typically
8-21mm Hg pg 269
10-20 mm Hg pg 270
acute angle-closure glaucoma IOP can occur as high as
40-80 mm Hg pg 269
systemic steroids may interfere with
glaucoma control pg 272
diabetic retinopathy is a
noninflammatory disorder of the retina that develops in patients with diabetes pg 272
diabetic retinopathy is divided into three stages,
background diabetic
preproliferative diabetic
proliferative diabetic
pg 273
background diabetic retinopathy,
microaneurysms, intraretinal hemorrhage, macular edema, and lipid deposits may be apparent pg 273
As the preproliferative diabetic disease progress,
nerve fiber layer infarctions (cotton wool spots), venous beading and dilation, edema and in some cases extensive retinal hemorrhage will be noted
pg 273
all diabetic patients should be seen by an opthalmologist at least
annually pg 273
patients with background retinopathy should be followed up with the opthalmologist every
six months pg 273
patients with proliferative retinopathy should be followed up with the opthalmologist every
3-4 months pg 273
patients with active proliferative retinopathy should be followed up with the opthalmologist every
8 weeks pg 273
Lisinopril is the only pharmacologic agent found to
slow the progression of diabetic retinopathy pg 273
The American Diabetes Association sets an acceptable level of
HgbAIC at
less than 7% pg 273
A hallmark of macular degeneration is
visual difficulties in low light pg 275
If a patient with bacterial conjunctivitis wears contacts,
it is important to treat her with a more broad-spectrum antibiotic drop, such as macrolide. handout
Up to 1/2 of potentially fatal sebaceous cell carcinomas resemble
chronic, benign inflammatory disease such as a chalazion and blepharoconjunctivitis pg 251
carcinomas may mimic
styes or chalazions pg 251
Eye Conditions requiring immediate referral:
Severe or sudden vision loss
Eye pain
Corneal ulceration
Trauma
Foreign body
Herpetic infection of the eye (ppt in week 2)
Inflammation of the conjunctiva
Highly contagious
Direct contact with secretions
S/S
Redness
Purulent or mucopurulent discharge
Unilateral at onset
Eyelids "glued" shut in morning
Eyelid edema
bacterial conjunctivitis (ppt in week 2)
Major Pathogens in Acute Bacterial Conjunctivitis In Adults
Gram-Positive Organisms
Staphylococcus aureus
Streptococcus species
Gram-Negative Organisms
Escherichia coli
Pseudomonas species
Moraxella species (ppt week 2)
Major Pathogens in Acute Bacterial Conjunctivitis in Children
Gram-Positive Organisms
Streptococcus pneumoniae
Staphylococcus aureus
Gram-Negative Organisms
Haemophilius Influenzae
Moraxella species (ppt week 2)
preauricular lymph nodes are palpable in
Viral conjunctivitis pg 247
Presentation
Painless or mild discomfort
"gritty"
Watery to serous discharge
Unilateral at onset then bilateral w/in 1-2 days
Preauricular lymphadenopathy
Treatment
Adenovirus is most common pathogen
Antihistamine
Lubricant drops
Cool compresses
Often tre
viral conjunctivitis (ppt week 2)
Prevention and education regarding conjunctivitis
Bacterial & Viral conjunctivitis are contagious
24 hours of therapy prior to school, daycare etc.
Good handwashing
Washcloths, pillowcases in laundry
Proper contact use
No contacts X 1 week
New contacts, eye makeup etc. (ppt, week 2)
A palpable preauricular node is usually present
Treatment - Doxycycline 100mg BID x 7-10 days or Azithromycin 1 gram po in combination with topicals
Chlamydia Conjunctivitis (ppt week 2)
Reduction of visual acuity
Ciliary flush
Photophobia
Severe foreign body sensation that prevents the pt from opening eye
Fixed pupil
Severe headache/nausea
Corneal opacity
Eye - Red flags (ppt week2)
S/S:
eye pain
hesitant or unable to open eye
Foreign body sensation
Important to identify situation leading to abrasion - scratching the eye, trauma, or contact lens irritation
Corneal abrasion (ppt week 2)
Visual Acuity
Penlight & fundoscopic exam
Check for pupillary response
Foreign body
Direct trauma
Fluorescein stain and use cobalt blue filter
Eye assessment (ppt week 2)
No tetracaine needed if patient is not photophobic
Will permanently stain clothing
Ulcers fluoresce distinctive round lesions
Abrasions may be singular or multiple with an "ice rink" appearance
Foreign bodies fluoresce around FB and the center is dark
Rin
Fluorscein Stain (ppt week 2)
Treat all contact lens wearers with a red eye as a corneal ulcer. Close follow up and eye drops of either tobramycin or quinilones. No contacts. Do not patch.
No steroid eye drops unless Opthalmology consult obtained and recommends.
Corneal abrasions trea
Treatment (ppt week 2)
Common history
Burning, itching
Feels like something is in the eye
Crusting of eyelids/lashes
Warm compresses 5-10 mins bid
Scrub lash with diluted baby shampoo bid
Treatment
Bacitracin
Erythromycin
Azithromycin drops
Blepharitis (ppt week 2)
Acutely presenting, erythematous, tender lump within the eyelid
Involves infection or inflammation of hair follicles of the eyelashes along the eyelid margin
Caused by blocked meibomian gland or infection in sebaceous glands of the eyelash
Hordeolum (ppt week 2)
Pimple or abscess in either upper or lower lid
External. Next to eyelash
Internal. Under eyelid
Painful swelling
Develop suddenly
Hordeolum presents as (ppt week 2)
Treatment
Warm compresses 15mins/ 4x per day
Do NOT squeeze or pop stye
Antibiotic drops if persistent/ edema of eyelid
Hordeolum treatment consists of (ppt week2)
Prevention
Good handwashing
Proper contact lense care
Take off eye makeup each night
Prevention of Hordeolum consists of (ppt week 2)
A hordeolum that does not resolve and eventually forms granulation tissue
Slow-developing, painless, hard mass
Pea-sized nodule within the eyelid, typically top eyelid
Chalazion (ppt week 2)
A Chalazion is
Not an infection.
Blocked meibomian gland.
Develop over weeks to months.
Typically self-limiting
If persistent - refer to opthamology. (ppt week 2)
Tasks of an APRN
Learn the patient's history/history of present illness
Perform the physical exam
Appropriate use/interpretation of tests
Appropriate choice of therapies
Consider need for consultation and/or collaboration
Negotiate decisions with the patient
Evaluate outc
In treating a patient with allergic conjunctivitis, the most appropriate treatment option is:
Opthalmological antihistamines
One distinguishing characteristic between conjunctivitis and iritis is:
A ciliary flush
An acutely presenting, erythematous, tender lump within the eyelid is called:
Hordeolum
In assessing a client with bacterial conjunctivitis, the nurse practitioner finds:
Minimal itching, moderate tearing, and profuse exudate.