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61 Cards in this Set

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how long does it take for the epithelium on the cornea to heal when the basement membrane is not damaged and when it is?
not damaged then 2-3 days
damaged then 6-8 days
can scarring occur in bowmans?
yes b/c it will never heal just scars
the greatest supply of nerves is in the anterior or posterior stroma
anterior
what is the fluid barrier of the stroma to keep out aquous? what is the semi permeable barrier?
endo is a non permeable but has pumps to keep cornea clear and descemets is the semi
is corneal endo able to regenerate
no
SPK consists of two forms, according to dr. erickson
PEE and PEK (puctate epithelial keratopathy)
PEE stains well with what?
NaFl, rose bengal and lissamine green.
PEK is seen as what with out staining
grayish white opacities in epithelium with accumulation of epithelial cells that are surrounded by a focal inflammatory infiltrate.
what does PEK stain best/worse with?
stains poorly with NaFl but stains wel with rose bengal and lissamine green.
SPK is commonly associated with what type of background?
usually with a bacterial orgin that is usually blepharitis.
diffuse SPK is seen with what kind of origins?
bacterial conjunctivitis, adenoviral conjunctivitis, medicamentosa (tosicity from meds), allergic conjunctivitis, dry eye
upper 1/3 SPK is associated with what?
superior limbic conjunctivitis, vernal conjunctivitis (VKC), and trachoma.
lower 2/3 SPK is associated with what?
staph bleph, ectropion, entropion, lagopthamos, exposure keratopathy
interpalpebral SPK is associated with what?
keratoconjunctivitis, exposure keratopathy, and UV keratopathy (skiers keratopathy).
you see a cluster of SPK that appears with a little edema what do you call this type of Spk?
confluent SPK
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?
focal no scarring b/c it is not in to bowmans layer.
what is the most common staph, ocular pathogen, in patients of all ages?
staph aureus
what type of bacteria is staph bleph? pos. neg. cocci, rod,....
gram pos. cocci
what antibiotic ointment therapy is FDA approved for use with kids?
polysporin ung
what is the dosing of polytrim drops for staph bleph
q3h
gentamicin, tobramycin and polytrim are all in what family of antibiotics? and do they have any SE
aminolycosides and they are toxic to the cornea.
what is the normal dosage of antibiotic treatment for bleph
gtt qid
what fluroquinolone used to treat superficial bacterial keratitis (staph) can be administered tid x 7 days. what is the typical dosage for fluroquinolones?
besfloxacin 1.5%
typical is qid/ q2-3h
if you are expecting an infecting pathogen to be strep what drug family should you stay away from?
aminoglycocides
how long should you continue an antibiotic therapy in general?
7-14 days
keratitis is usually associated with what? -hint - related to the conj.
conjunctivitis
what are the most commonly involved species included in superficial bacterial keratitis (strep)
pneumoniae and pygenes
a pt comes in with acute conjunctivitis including petechial hemorrhages, pseudomembrane, mucopuulent discharge and diffuse punctate keratitis what could they have
superficial bacterial keratitis strep. note that the pseudomembrane differentiates this from haemophilus
what is the ointment treatment for superficial bacterial keratitis strep. what is approved for kids?
same as for staph.
bacitracin, erythromycin. or polysporin (approved for kids)
what is the treatment duration for fluroquinlones being used for the treatment of strep.
7-14 days
what is the only gram neg. (covered in class) pathogen that causes superficial bacterial keratitis
Haemophilus
a pt with acute conjunctivitis, petechial hemorrhages, mucopurulent discharge and matted eyes what could they have.
superficial bacterial keratitis haemophilus.
note no pseudomembrane
between infiltrates and ulcers what is more common?
infiltrates
between infiltrates and ulcers what is an antigen antibody reaction NOT due to a corneal infection?
infiltrates
corneal infiltrates usually occur where at on the cornea?
where the lids meet the cornea.
when does scarring become a problem with corneal infiltrates
when it is deep. like in the anterior cornea
another name for _______ is steril ulcer.
corneal infiltrate
true or false corneal infiltrates can be caused by contact wear?
true
corneal infiltrates are usually secondary to what? (not contact lens wear)
chronic conjunctivitits (which is secondary to bleph)
true or false corneal infiltrates are seperated from the limbus by a clear area
true
with corneal infiltrates is the epithelium is usually intact?
true. there may be some damage but it will be smaller than the infiltrate
symptoms with corneal infiltrates?
pain, tearing, photophobia, FB
what does CLARE stand for? and CLPU?
contact lens related acute red eye
Contact lens peripheral ulcer
what is the treatment for corneal infiltrates?
treat the source of chronic conjunctivitis. ie bleph and discontinue contact lens wear or change soln.
you could also use a steroid or combo
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
this is a corneal ulcer
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
corneal ulcer related to CL wear
some bacteria like pseudomonas aeruginosa need compromised epi to get into the cornea what are some bacteria that dont need it to be compromised?
neisseria gonorrhea, listeria monocytogenes, corynebacterium diphtheriae, haemophilus aegypticus
what is the most common bacteria cultured from a bacterial ulcer?
pseudomonas
what are some signs of corneal ulceration that are posterior to the cornea?
sever AC reaction, Hypopyon, synechiae, and increased IOP
what bacteria that commonly causes a corneal ulcer usually has a minimal AC reaction, yellow white infiltrated, and has distinct boarders
staph
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?
strep.

note there is also many resistant strains.
what is the only gram neg bacteria that we talked about that can cause a corneal ulcer?
pseudomonas
what bacteria is capable of cause a rapidly progressing ulcer, located centally,has watery discharge, and is usually caused by trauma from a contact.
pseudomonas
until the organism is identified that is causing a corneal ulcer, what should you do?
treat with a broad spectrum antibiotic such as a fluroquinolone
what are the three avenues you could take to treat a corneal ulcer.
1. monotherapy with fluoroquinolones
2. combination therapy with fortified cefazolin and fortified tobramycin
3. combination therapy with fluoroquinolones and fortified antibiotics.
if a corneal ulcer is bigger than what you should refer
>3mm
when should you consider using a steroid on a corneal ulcer
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.
if compliance is an issue with the pt having to add drops every hour what can be done?
sub conj injection
hospitalization
what is the follow up for a pt with a corneal ulcer?
everyday
what is worse a gram - or + corneal ulcer?
-
what is the difference with conj injection b/t an ulcer and infiltrate?
ulcer it is diffuse
infiltrate it is sectoral