631 - 5 Bacterial Keratitis, Ocular Disease

Front 1

how long does it take for the epithelium on the cornea to heal when the basement membrane is not damaged and when it is?

Back 1

not damaged then 2-3 days
damaged then 6-8 days

Front 2

can scarring occur in bowmans?

Back 2

yes b/c it will never heal just scars

Front 3

the greatest supply of nerves is in the anterior or posterior stroma

Back 3

anterior

Front 4

what is the fluid barrier of the stroma to keep out aquous? what is the semi permeable barrier?

Back 4

endo is a non permeable but has pumps to keep cornea clear and descemets is the semi

Front 5

is corneal endo able to regenerate

Back 5

no

Front 6

SPK consists of two forms, according to dr. erickson

Back 6

PEE and PEK (puctate epithelial keratopathy)

Front 7

PEE stains well with what?

Back 7

NaFl, rose bengal and lissamine green.

Front 8

PEK is seen as what with out staining

Back 8

grayish white opacities in epithelium with accumulation of epithelial cells that are surrounded by a focal inflammatory infiltrate.

Front 9

what does PEK stain best/worse with?

Back 9

stains poorly with NaFl but stains wel with rose bengal and lissamine green.

Front 10

SPK is commonly associated with what type of background?

Back 10

usually with a bacterial orgin that is usually blepharitis.

Front 11

diffuse SPK is seen with what kind of origins?

Back 11

bacterial conjunctivitis, adenoviral conjunctivitis, medicamentosa (tosicity from meds), allergic conjunctivitis, dry eye

Front 12

upper 1/3 SPK is associated with what?

Back 12

superior limbic conjunctivitis, vernal conjunctivitis (VKC), and trachoma.

Front 13

lower 2/3 SPK is associated with what?

Back 13

staph bleph, ectropion, entropion, lagopthamos, exposure keratopathy

Front 14

interpalpebral SPK is associated with what?

Back 14

keratoconjunctivitis, exposure keratopathy, and UV keratopathy (skiers keratopathy).

Front 15

you see a cluster of SPK that appears with a little edema what do you call this type of Spk?

Back 15

confluent SPK

Front 16

you see a cluster of SPK that is a little deeper at the center what type of SPK is this? is there scarring with this?

Back 16

focal no scarring b/c it is not in to bowmans layer.

Front 17

what is the most common staph, ocular pathogen, in patients of all ages?

Back 17

staph aureus

Front 18

what type of bacteria is staph bleph? pos. neg. cocci, rod,....

Back 18

gram pos. cocci

Front 19

what antibiotic ointment therapy is FDA approved for use with kids?

Back 19

polysporin ung

Front 20

what is the dosing of polytrim drops for staph bleph

Back 20

q3h

Front 21

gentamicin, tobramycin and polytrim are all in what family of antibiotics? and do they have any SE

Back 21

aminolycosides and they are toxic to the cornea.

Front 22

what is the normal dosage of antibiotic treatment for bleph

Back 22

gtt qid

Front 23

what fluroquinolone used to treat superficial bacterial keratitis (staph) can be administered tid x 7 days. what is the typical dosage for fluroquinolones?

Back 23

besfloxacin 1.5%
typical is qid/ q2-3h

Front 24

if you are expecting an infecting pathogen to be strep what drug family should you stay away from?

Back 24

aminoglycocides

Front 25

how long should you continue an antibiotic therapy in general?

Back 25

7-14 days

Front 26

keratitis is usually associated with what? -hint - related to the conj.

Back 26

conjunctivitis

Front 27

what are the most commonly involved species included in superficial bacterial keratitis (strep)

Back 27

pneumoniae and pygenes

Front 28

a pt comes in with acute conjunctivitis including petechial hemorrhages, pseudomembrane, mucopuulent discharge and diffuse punctate keratitis what could they have

Back 28

superficial bacterial keratitis strep. note that the pseudomembrane differentiates this from haemophilus

Front 29

what is the ointment treatment for superficial bacterial keratitis strep. what is approved for kids?

Back 29

same as for staph.
bacitracin, erythromycin. or polysporin (approved for kids)

Front 30

what is the treatment duration for fluroquinlones being used for the treatment of strep.

Back 30

7-14 days

Front 31

what is the only gram neg. (covered in class) pathogen that causes superficial bacterial keratitis

Back 31

Haemophilus

Front 32

a pt with acute conjunctivitis, petechial hemorrhages, mucopurulent discharge and matted eyes what could they have.

Back 32

superficial bacterial keratitis haemophilus.
note no pseudomembrane

Front 33

between infiltrates and ulcers what is more common?

Back 33

infiltrates

Front 34

between infiltrates and ulcers what is an antigen antibody reaction NOT due to a corneal infection?

Back 34

infiltrates

Front 35

corneal infiltrates usually occur where at on the cornea?

Back 35

where the lids meet the cornea.

Front 36

when does scarring become a problem with corneal infiltrates

Back 36

when it is deep. like in the anterior cornea

Front 37

another name for _______ is steril ulcer.

Back 37

corneal infiltrate

Front 38

true or false corneal infiltrates can be caused by contact wear?

Back 38

true

Front 39

corneal infiltrates are usually secondary to what? (not contact lens wear)

Back 39

chronic conjunctivitits (which is secondary to bleph)

Front 40

true or false corneal infiltrates are seperated from the limbus by a clear area

Back 40

true

Front 41

with corneal infiltrates is the epithelium is usually intact?

Back 41

true. there may be some damage but it will be smaller than the infiltrate

Front 42

symptoms with corneal infiltrates?

Back 42

pain, tearing, photophobia, FB

Front 43

what does CLARE stand for? and CLPU?

Back 43

contact lens related acute red eye
Contact lens peripheral ulcer

Front 44

what is the treatment for corneal infiltrates?

Back 44

treat the source of chronic conjunctivitis. ie bleph and discontinue contact lens wear or change soln.
you could also use a steroid or combo

Front 45

what is an infectious compromise in the epi of the cornea with the stroma infiltrated. (edema surrounds area infolved. can also see diffuse injection and chemosis

Back 45

this is a corneal ulcer

Front 46

extended wear of CL, poor tear film function, uncontrolled staph bleph, smoking, swimming with CL, under 22, and male are all risk factors for what

Back 46

corneal ulcer related to CL wear

Front 47

some bacteria like pseudomonas aeruginosa need compromised epi to get into the cornea what are some bacteria that dont need it to be compromised?

Back 47

neisseria gonorrhea, listeria monocytogenes, corynebacterium diphtheriae, haemophilus aegypticus

Front 48

what is the most common bacteria cultured from a bacterial ulcer?

Back 48

pseudomonas

Front 49

what are some signs of corneal ulceration that are posterior to the cornea?

Back 49

sever AC reaction, Hypopyon, synechiae, and increased IOP

Front 50

what bacteria that commonly causes a corneal ulcer usually has a minimal AC reaction, yellow white infiltrated, and has distinct boarders

Back 50

staph

Front 51

what bacteria that commonly causes a corneal ulcer usually has a gray yellow center, spreads centrally with the leading edge shaggy or indistinct and commonly has hypopyon?

Back 51

strep.

note there is also many resistant strains.

Front 52

what is the only gram neg bacteria that we talked about that can cause a corneal ulcer?

Back 52

pseudomonas

Front 53

what bacteria is capable of cause a rapidly progressing ulcer, located centally,has watery discharge, and is usually caused by trauma from a contact.

Back 53

pseudomonas

Front 54

until the organism is identified that is causing a corneal ulcer, what should you do?

Back 54

treat with a broad spectrum antibiotic such as a fluroquinolone

Front 55

what are the three avenues you could take to treat a corneal ulcer.

Back 55

1. monotherapy with fluoroquinolones
2. combination therapy with fortified cefazolin and fortified tobramycin
3. combination therapy with fluoroquinolones and fortified antibiotics.

Front 56

if a corneal ulcer is bigger than what you should refer

Back 56

>3mm

Front 57

when should you consider using a steroid on a corneal ulcer

Back 57

when the ulcer is threatening the visual axis so you can reduce scarring. this is very controversial and should only be done if epi is already starting to heal.

Front 58

if compliance is an issue with the pt having to add drops every hour what can be done?

Back 58

sub conj injection
hospitalization

Front 59

what is the follow up for a pt with a corneal ulcer?

Back 59

everyday

Front 60

what is worse a gram - or + corneal ulcer?

Back 60

-

Front 61

what is the difference with conj injection b/t an ulcer and infiltrate?

Back 61

ulcer it is diffuse
infiltrate it is sectoral