Chapter 13: OPHTHALMOLOGY

HORDEOLUM (AKA STYE)

A hordeolum (AKA stye) is a red and painful eye lesion noted at the rim of the eyelid (near the eyelashes) due to inflammation of the meibomian gland. They can be sterile or infected (typically with Staph). Prescribe warm compresses and possibly topical antibiotics as well.

PEARL: Do NOT prescribe oral antibiotics.

MNEMONIC: ho-RED-e-OWE-lum should remind you that this is a RED and PAINFUL eye lesion.

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CHALAZION

A chalazion is a much slower-growing, painless lesion that results from blockage of the meibomian gland. There can be erythema as well, but it is much less painful. It resolves on its own, and warm compresses can help.

PEARL: Ophthalmology should be involved if it is chronic or interferes with a patient’s vision.

MNEMONIC: “che-LAZY-on” the eye. This is the slow-growing, LAZY eye lesion.

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CORNEAL ABRASIONS

Use fluorescein staining to look for corneal abrasions. If any are present, order topical antibiotics.

PEARL: Do not order an eye patch.

HYPHEMA

Hyphema is a condition in which blood is present in the anterior chamber. Look for blood pooling at the bottom of the iris. If it is small and due to trauma, you may have the patient follow up with ophthalmology. If it is large, consider monitoring in the hospital and keeping the patient’s bed at a 45° angle. There is a danger of developing glaucoma (increased intraocular pressure).

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PAPILLEDEMA

Papilledema is swelling of the optic disc. The patient’s vision is usually not affected until there has been significant progression, so do NOT rule this out if the patient’s vision is 20/20. On exam, they will have loss of venous pulsations, blurring of the optic disc margins, and may have a bigger than usual blind spot.

PEARL: Papilledema is due to increased intracranial pressure, and is therefore a bilateral phenomenon. If you are given a patient with unilateral abnormalities, consider a different choice.

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PAPILLITIS

While papilledema is SWELLING of the optic disc, papillitis refers to INFLAMMATION. It may look similar on exam, but will be associated with photophobia, pain, sensitivity to light pressure applied to the eye, and may be noted following a recent viral illness.

PEARL: Choose this answer over papilledema if the finding is unilateral or associated with a loss of visual acuity or visual fields.