8. Bacterial Keratoconjunctivitis

Front 1

what is conjunctivitis?

Back 1

inflammation of the conj

Front 2

what is keratitis?

Back 2

inflammation of the cornea

Front 3

similarity b/w conjunctivitis and keratitis?

Back 3

both are inflammation

Front 4

what is infiltration?

Back 4

WBCs entering tissue

Front 5

what is ulceration?

Back 5

loss of surface tissue

Front 6

T/F: the cornea is a thin mucous membrane that lines the eyelids, fornices, and anterior surface of the eye to the limbus

Back 6

FASLE;

CONJUNCTIVA

Front 7

the conj is a thin mucous membrane that lines the __, __, and __ of the eye to the __

Back 7

eyelids, fornices, anterior surface;

limbus

Front 8

regions of conj

Back 8

1) palpebral
2) fornices
3) bulbar

Front 9

what is the eye's 1st line of defense against invasion?

Back 9

epithelium

Front 10

T/F: the BM of the epithelium is tightly attached to bowman's

Back 10

true

Front 11

describe the type of cells in the corneal epithelium

Back 11

- flat, superficial SQUAMOUS
- then gradually become more COLUMNAR in deeper cell layers

Front 12

which corneal layer is acellular?

Back 12

bowman's

Front 13

__ layer contains collagen fibrils while __ contains collagen sheets that are regular in alignment

Back 13

bowman's;
stroma

Front 14

what happens if bowman's is involved in injury or infxn?

Back 14

scarring usually results

Front 15

what is the thickest corneal layer?

Back 15

stroma

Front 16

what types of cells does the stroma contain?

Back 16

keratocytes

(also has collagen)

Front 17

if infectious organism reaches the __ layer, corneal perforation is a real risk

Back 17

stromal

Front 18

__ is secreted by the corneal ENDOthelium

Back 18

descemet's membrane

Front 19

descemet's membrane is secreted by __

Back 19

corneal ENDOthelium

Front 20

how many cell layers does the corneal endothelium have?

Back 20

1 (it's a single cell layer)

Front 21

which layer is non-replicating and non-replacing?

Back 21

endothelium

Front 22

if the endothelium is lost/damaged, __ will result

Back 22

corneal edema

Front 23

function of endothelium?

Back 23

keeps cornea dehydrated (water pump)

Front 24

a corneal infiltrate is a collection of WBCs that have migrated from the __ and __ into the __

Back 24

limbal vasculature; tear film;
previously acellular/avascular cornea

Front 25

where do corneal infiltrates collect?

Back 25

in the subepithelial space

Front 26

MOA of infiltrates?

Back 26

WBCs break down collagen --> loss of epithelial cells OVERLYING the infiltrate

Front 27

T/F: WBCs always lead to loss of epithelial cells OVERLYING the infiltrate

Back 27

FALSE;

often, but not always

Front 28

what is an important rule of infiltration?

Back 28

the area of STAINING is always SMALLER than the area of infiltration

Front 29

describe the size of the area of staining due to infectious keratitis

Back 29

is same size or larger than infiltrate

Front 30

unlike sterile infiltrates, the area of staining is the same size or larger than the area of infiltration for __

Back 30

INFECTIOUS keratitis

Front 31

what's another word for sterile infiltrate?

Back 31

INFILTRATIVE keratitis

Front 32

what is infiltrative keratitis?

Back 32

sterile infiltrate

Front 33

differentiate b/w infiltrative and infectious keratitis

Back 33

1) area of staining
< infiltrate for INFILTRATIVE
> or = to infiltrate for INFECTIOUS
2) infiltrative are sterile while infectious are not

Front 34

name a few underlying causes of infiltrates

Back 34

1) chronic staph bleph
2) CL overwear
3) hypoxia
4) infectious keratitis of any etiology

Front 35

can infectious keratitis cause infiltrates?

Back 35

YES!!!

Front 36

how do infiltrates feel to the pt?

Back 36

1) usually NOT in acute pain
2) but may have mild-moderate discomfort w/ infiltrative keratitis

Front 37

T/F: infiltrative keratitis can not be caused by an infection since they are considered sterile

Back 37

FALSE;
although considered sterile, the underlying inciting event is often an infectious process

Front 38

when one says the world infiltrate, we are assuming that __

Back 38

it is sterile and referring to infiltrative keratitis

Front 39

___ typically form at the 4 and 8 o clock positions because...

Back 39

sterile infiltrates;
b/c that is where the lids contact the ocular surface most frequently (staph bleph)

Front 40

infiltrates at the 4 and 8 o clock positions are associated w/ __

Back 40

staph bleph

Front 41

how do you treat infiltrative keratitis?

Back 41

1) remove Ag (lid hygiene, remove CL, treat underlying condition
2) reduce inflamm w/ CC, Ab/steroid combo, or separate antibiotic and steroid regiments

Front 42

how do you reduce inflammation associated w/ infiltration?

Back 42

1) CC
2) antibiotic/steroid combo OR
3) separate antibiotic and steroid regimens

Front 43

what is a STERILE CORNEAL ULCER?

Back 43

ulceration or loss of epithelial layers of the cornea due to something other than an active infxn

Front 44

a shield ulcer (vernal disease) is an example of __

Back 44

sterile corneal ulcer

Front 45

a fingernail scratch or injury is an example of __

Back 45

sterile corneal ulcer

Front 46

T/F: neuropathic keratopathy is an example of a sterile corneal ulcer

Back 46

true

Front 47

T/F: recurrent corneal erosion is an ulceration caused by bacterial infxn

Back 47

FALSE;

it's a sterile corneal ulcer

Front 48

list the normal ocular defenses against microbial infxn

Back 48

1) corneal struc & conj epithelium
2) tear film
3) eyelids/blinking
4) normal flora of the eye

Front 49

name components of the tear film that provide defense against microbial infxn

Back 49

1) ceruloplasmin
2) C' components
3) lymphocytes
4) Ig
5) lysozyme
6) lactoferrin
7) betalysins
8) ceruloplasmin
9) C' components

Front 50

name some of the findings associated w/ acute inflammation

Back 50

1) Injection 2) Chemosis 3)Discharge 4) Corneal edema
5) Loss of corneal tissue Infiltration
6) Papillae and follicles
7) Preauricular node 8) Lid swelling

Front 51

why is cytology performed?

Back 51

to determine the patient’s cellular response to the infection or inflammation (DETERMINES WHAT CELLS ARE THERE)

Front 52

list the results of cytology

Back 52

1) PMN’s: bacterial infection
2) Lymphocytes: Viral infection
3) Eosinophils/basophils: allergic reaction

Front 53

what cells in cytology indicate bacterial infxn?

Back 53

PMNs

Front 54

what cells in cytology indicated allergic rxn?

Back 54

eosinophils and basophils

Front 55

why are cultures performed?

Back 55

to help identify what microbial organism is causing the infection

Front 56

what test helps identify what microbial organism is causing the infection?

Back 56

culture

Front 57

what test determines the patient’s cellular response to the infection or inflammation?

Back 57

cytology

Front 58

infections are least likely to be caused by..

bacteria, virus, or fungus?

Back 58

virus

(infxns are usually bacterial or fungal)

Front 59

what test helps identify which anti-infective agent(s) will be effective in treatment?

Back 59

sensitivity

Front 60

why are sensitivity tests performed

Back 60

to help identify which anti-infective agent(s) will be effective in treatment

Front 61

how long do cultures take?

Back 61

1) can be done on same day (gram stain)
2) bacteria - usually 24-48 hrs
3) fungi - 1-2 wks

Front 62

when are cultures "required" or strongly recommended?

Back 62

1) Sight-threatening (i.e. CENTRAL) or severe keratitis of microbial origin 2) Large, dense, deep infiltrate extending to mid-stroma
3) Corneal ulcers non-responsive to standard therapy
4) Clinical features suggestive of fungal or amoebic etiology
5) Neonatal conjunctivitis
6) Immunocompromised patients

Front 63

name the specific culture techniques

Back 63

1) swabbing of purulent material
2) corneal scraping

Front 64

describe this culture technique: swabbing of purulent material

Back 64

1) Gram stain on-site
2) Culture onto media plate
3) Deposit into transport media

Front 65

describe this culture technique: corneal scraping

Back 65

1) Ulcer margins
2) Ulcer bed

Front 66

list the culture media

Back 66

1) blood agar
2) chocolate agar
3) Thioglycollate broth
4) Sabouraud’s agar
5) transport media

Front 67

blood agar is useful for most __

Back 67

bacteria

Front 68

chocolate agar is the best medium for __

Back 68

Neisseria

Front 69

which culture medium is the Best for Neisseria?

Back 69

chocolate agar

Front 70

which culture medium is good for anaerobes

Back 70

Thioglycollate broth

Front 71

what is Thioglycollate broth good for?

Back 71

culturing anaerobes

Front 72

contents of transport media?

Back 72

nutrients, water, etc

Front 73

Sabouraud’s agar is good for ___ culture

Back 73

fugal

Front 74

which media is good for culturing fungus?

Back 74

Sabouraud’s agar

Front 75

what are the most common groups of pathogens responsible for bacterial keratitis and keratoconjunctivitis?

Back 75

1) Staph (G+)
2) strep (G+)
3) pseudomonas (G-)
4) enterobacteria (G-)

Front 76

what is the #1 cause of bacterial keratitis and keratoconjunctivitis? (which bacteria)

Back 76

Staph (G+)

Front 77

which enterobacteria are the most likely to be responsible for bacterial keratitis and keratoconjunctivitis?

Back 77

1) KLEBSIELLA
2) enterobacter
3) serratia
4) proteus

Front 78

moth common pathogen in children?

Back 78

Haemophlus influenzae

Front 79

which culture medium is the Best for Neisseria?

Back 79

chocolate agar

Front 80

which culture medium is good for anaerobes

Back 80

Thioglycollate broth

Front 81

what is Thioglycollate broth good for?

Back 81

culturing anaerobes

Front 82

contents of transport media?

Back 82

nutrients, water, etc

Front 83

Sabouraud’s agar is good for ___ culture

Back 83

fugal

Front 84

which media is good for culturing fungus?

Back 84

Sabouraud’s agar

Front 85

what are the most common groups of pathogens responsible for bacterial keratitis and keratoconjunctivitis?

Back 85

1) Staph (G+)
2) strep (G+)
3) pseudomonas (G-)
4) enterobacteria (G-)

Front 86

what is the #1 cause of bacterial keratitis and keratoconjunctivitis? (which bacteria)

Back 86

Staph (G+)

Front 87

which enterobacteria are the most likely to be responsible for bacterial keratitis and keratoconjunctivitis?

Back 87

1) KLEBSIELLA
2) enterobacter
3) serratia
4) proteus

Front 88

moth common pathogen in children?

Back 88

Haemophilus influenzae

Front 89

the surface tissues of the eye and the ocular adnexa are colonized by normal flora. what type of bacteria predominantly make up the normal flora?

Back 89

1) strep
2) staph
3) corynebacterium

Front 90

when does clinical infection occur?

Back 90

when the host defenses are disrupted, or when the normal flora of the eye is disrupted

Front 91

what can cause the flora to be altered?

Back 91

1) external contamination
2) spread from adjacent sites
3) via a blood-borne pathway

Front 92

Host immune response generally takes care of ____ in the flora

Back 92

low-grade fluctuations

Front 93

Is it easier to contract conjunctivitis or bacterial keratitis w/ ulceration? Why?

Back 93

- conjunctivitis
- b/c bacterial keratitis w/ ulceration USUALLY requires an interruption of the intact corneal epithelium
- while conjunctivitis can occur by simply altering the host defense or flora

Front 94

bacterial keratitis w/ ulceration usually requires an interruption of the intact corneal epithelium, allowing the microbe to enter the corneal __ where proliferation occurs

Back 94

stroma

Front 95

what is virulence?

Back 95

organism's ability to induce chemotaxis and release proteolytic enzymes

Front 96

what is pathogenicity?

Back 96

Organism’s ability to adhere to the edge of the epithelial defect and initiate infection

Front 97

what is an Organism’s ability to adhere to the edge of the epithelial defect and initiate infection?

Back 97

pathogenicity

Front 98

what is an organism's ability to induce chemotaxis and release proteolytic enzymes?

Back 98

virulence

Front 99

describe the process of keratitis w/ ulceration

Back 99

1) the epi and stroma swell and undergo necrosis
2) acute inflamm cells (PMNs) surround the beginning lesion and contribute to corneal breakdown
3) bacterial enzymes contribute to further tissue destruction

Front 100

w/ antimicrobial therapy, the host defenses can ...

Back 100

contribute w/ phagocytosis of the organism and cellular debris

Front 101

what are some negative effects that the immune response can have on the cornea?

Back 101

1) vascularization of the cornea
2) damaged stroma and bowman's replaced by scar and fibrous tissue that can interfere w/ vision

Front 102

what are the classifications of bacterial conjunctivitis?

Back 102

1) acute
2) chronic
3) hyperacute
4) neonatal

Front 103

Tx for staph bleph?

Back 103

1) lid scrubs - WC using clean cloth or gauze pads. vertical massage if any meibomian or seborrheic component. lid scrub
2) topical Ab ung and gel (if needed)
3) topical Ab/steroid combo if inflamed
4) rarely need oral antibiotics

Front 104

for staph bleph, what type of antibiotics are USUALLY prescribed?

Back 104

topical Ab UNG OR GEL

(or topical Ab/steroid combo)

Front 105

what type of Ab/steroid combo should you use if
a. ocular surface inflamm is present
b. inflamm is confined to lids

Back 105

a. ocular inflamm - drops
b. lids - ung

Front 106

lid scrub instructions for staph bleph?

Back 106

1) Warm compress first! Use clean cloth or gauze pads
2) Vertical massage if any meibomian or seborrheic component is present
3) Lid scrub

Front 107

is it safe to use steroids when the staining is trace?

Back 107

yes

Front 108

What do you do if there is severe staining that is infectious in origin?

(treat infxn b4 adding steroid!)

Back 108

conjunctivitis dosing of an antibiotic, but with very close follow up and possibly additional antimicrobial therapy

Front 109

1) acute onset of red eye, tearing, FBS, & MUCOPURULENT discharge
2) papilla
3) DIFFUSE injection
4) chemosis but not profound

Dx?

Back 109

acute bacterial conjunctivitis

Front 110

what's in mucopurulent discharge?

Back 110

WBCs and bacteria

Front 111

in acute bacterial conjunctivitis, what effect does contact w/ the ocular surface have?

Back 111

it prolongs/worsens the clinical picture

Front 112

in acute bacterial conjunctivitis, what does contact w/ the cornea result in?

Back 112

staining/PEK esp INFERIORLY

Front 113

what's the severity of acute bacterial conjunctivitis?

Back 113

ranges from moderate to severe in S/S

Front 114

is there any pain associated w/ acute bacterial conjunctivitis?

Back 114

usually not painful, but may be UNCOMFORTABLE

Front 115

What condition might you expect if your pt's lids are matted shut in the morning? why?

Back 115

acute bacterial conjunctivitis (b/c of the mucopurulent discharge)

Front 116

is PAN present in acute bacterial conjunctivitis? why or why not?

Back 116

NO PAN b/c most infectious material drains thru the nasolacrimal duct

Front 117

T/F: most cases of acute bacterial conjunctivitis start in 1 eye, then spread to the other

Back 117

true

Front 118

would many cases of acute bacterial conjunctivitis resolve on their own will w/o Tx?

Back 118

probably

Front 119

which is more painful, acute bacterial conjunctivitis or acute bacterial keratoconjunctivitis? why?

Back 119

acute bacterial keratoconjunctivitis b/c it involves the cornea

Front 120

acute bacterial conjunctivitis + ???? =

acute bacterial keratoconjunctivitis

Back 120

significant corneal staining/PEK

Front 121

Tx for acute bacterial conjunctivitis?

Back 121

1) minimal stain --> Ab/steroid combo
2) moderate/severe stain --> BROAD spectrum Ab in the CONJUNCTIVAL/prophylactic dose

Front 122

what is chronic bacterial conjunctivitis?

Back 122

conjunctivitis lasting 4 or more wks

Front 123

most common organism involved in
chronic bacterial conjunctivitis?

Back 123

staph aureus

Front 124

what are some additional chronic infectious/inflammatory signs that may be present in pts w/ chronic bacterial conjunctivitis?

Back 124

1) phlyctenules
2) infiltrates
3) bleph

Front 125

Tx for chronic bacterial conjunctivitis?

Back 125

1) treat associated disorders (bleph)
2) Ab w/ G+ coverage (polytrim, bacitracin)
3) rule out CHLAMYDIA!
4) Ab/steroid combo if inflamm & cornea not at risk

Front 126

for what type of conjunctivitis must you rule out chlamydia?

Back 126

chronic bacterial conjunctivitis

Front 127

hyperacute conjunctivitis is nearly always caused by ___ although other organisms can be implicated

Back 127

neisseria gonorrheae

Front 128

characteristics of neisseria gonorrheae?

Back 128

1) G -
2) diplococci
3) results from GENITAL-HAND-EYE contamination

Front 129

cause of hyperacute conjunctivitis?

Back 129

genital-hand-eye contamination (neisseria gonorrheae)

Front 130

S/S of hyperacute conjunctivitis?

Back 130

1) AC rxn w/ HYPOPYON
2) PAN
3) severe, copious mucopurulent discharge
4) significant chemosis
5) injection often w/ hemorrhages
6) lid edema
7) hot eye

Front 131

Name an organism with high virulence and pathogenicity

Back 131

neisseria gonorrheae

Front 132

PAN + AC rxn + mucopurulent d/c + hypopyon

Dx?

Back 132

hyperacute conjunctivitis

Front 133

which type of bacterial conjunctivitis requires Tx w/ CEFTRIAXONE 125 mg IM single dose?

Back 133

hyperacute conjunctivitis

Front 134

Tx for hyperacute conjunctivitis?

Back 134

1) CEFTRIAXONE 125 mg IM single dose
2) if penicllin-allergic --> SPECTINOMYCIN 1g IM
3) co treat for chlamydia (Azithromycin - single 1g dose)
and test for other STDs
4) Topical treatment to prophylax against coinfection (conjunctivitis dosing of broad spectrum antibiotic)

Front 135

why are topical antibiotics used for hyperacute conjunctivitis?

Back 135

- they are only used to prophylax against coinfection
- they are not effective against the gonococcus (need ceftriaxone)

Front 136

what is ophthalmia neonatorium?

Back 136

conjunctivitis in the newborn

Front 137

what is conjunctivitis in the newborn called?

Back 137

ophthalmia neonatorium OR
neonatal conjunctivitis

Front 138

causes of ophthalmia neonatorium?

Back 138

many... bacterial, viral, fungal, etc
1) most common: chlamydia
2) gonorrhea
3) herpes simplex

Front 139

most common cause of neonatal conjunctivitis?

Back 139

CHLAMYDIAL infxn acquired from passing thru birth canal

Front 140

T/F: dead bacteria promote just as much (if not more) of an immune response as live bacteria

Back 140

true

Front 141

why is conjunctivitis more problematic in infants?

Back 141

b/c they have an immature immune system (no lymph/follicles) and immature tear film

Front 142

another name for corneal ulcers?

Back 142

bacterial keratitis w/ ulceration

Front 143

Discharge is toxic to cornea, leading to _____

Back 143

PEK/keratitis/ulceration

Front 144

___ is a bacteria mix with WBC’s to form purulent discharge

Back 144

conjunctivitis

Front 145

clinical disease is seen when host immune system is not sufficient to ___

Back 145

offset disruption in flora

Front 146

there are __ cases of microbial (infectious) keratitis in the US each year, _____ of which are bacterial

Back 146

30,000;
25,000

Front 147

organisms that cause microbial (infectious) keratitis?

Back 147

bacterial, fungal, acanthamoeba

Front 148

most cases of corneal ulcers are the result of ___

Back 148

extended wear CL

Front 149

besides extended wear CL, what are some other risk factors for infectious keratitis?

Back 149

1) hospital/healthcare workers
2) dec'd immunologic defenses from malnutrition, alcoholism, moraxella, HIV
3) aq tear def/DES
4) recurrent/chronic corneal dis (HSV)
5) chronic infectious ds (dacryocystitis, canaliculitis, bleph)
6) TOPICAL STEROIDS
7) surgery/trauma to eye/adnexa
8) trichiasis
9) corneal exposure
10) corneal edema/bullous keratopathy
11) collagen-vascular ds, other mucous membrane disorders
12) vit A def

Front 150

S/S of corneal ulcer?

Back 150

1) epithelial defect w/ a THICK stromal INFILTRATE w/ surrounding edema
2) A/C
3) photophobia
4) significant PAIN/discomfort
5) blurred vision, tearing
6) ALL findings for bacterial conjunctivitis (papilla, mucopurulent, chemosis...)

Front 151

staph aureus and staph epidermidis are ___

(bacilli, cocci..?)

Back 151

cocci

Front 152

characteristics of moraxella?

Back 152

G - coccobacilli

Front 153

characteristics of pseudomonas?

Back 153

G - bacilli

Front 154

which is more severe, a corneal ulcer caused by staph aureus or by staph epidermidis?

Back 154

staph aureus

Front 155

S/S of staph aureus and staph epidermidis ulcers?

Back 155

YELLOW-WHITE round/oval infiltrates w/ DISTINCT borders; tissue surrounding the ulcer may be blurred by infiltrate and edema

Front 156

YELLOW-WHITE round/oval infiltrates w/ DISTINCT borders

Dx?

Back 156

staph aureus and staph epidermidis ulcers

Front 157

S/S of streptococcus ulcers?

Back 157

serpiginous (creeping as they spread to the central cornea)

Front 158

serpiginous ulcers are cause by __

Back 158

streptococcus

Front 159

can neisseria cause corneal ulcers?
explain

Back 159

1) yes, but not typical in CL wearers
2) results from extension of hyperacute conjunctivitis
3) can PERFORATE THE CORNEA w/in 48 hrs

Front 160

which organism that causes corneal ulcers can perforate the cornea w/in 48 hrs?

Back 160

neisseria

Front 161

which bacteria is most commonly seen in alcoholics and HIV pts?

Back 161

moraxella

Front 162

moraxella is most commonly seen in __ pts

Back 162

alcoholic and HIV

Front 163

characteristics of ulcers caused by moraxella?

Back 163

1) HYPOPYON
2) responds SLOWLY TO Ab
3) central or inf location --> less painful

Front 164

which bacteria can cause corneal ulcers w/ hypopyon?

Back 164

moraxella

Front 165

which bacterial species usually results in the least painful form of bacterial keratitis w/ ulceration? why?

Back 165

moraxella b/c in central or inferior location

Front 166

which bacteria responds slowly to antibiotics?

Back 166

moraxella

Front 167

which bacteria is most commonly associated w/ CL-related ulcers?

Back 167

pseudomonas

Front 168

S/S of pseudomonas ulcers?

Back 168

1) YELLOWISH-GREEN exudate that is difficult to remove w/ lavage
2) corneal edema --> GROUND GLASS
3) central or paracentral, broad, shallow ulceration

Front 169

what does it mean to "treat empirically"

Back 169

based on clinical findings, not laboratory studies

Front 170

what are the mandatory treatments for keratitis w/ ulceration that is treated empirically?

Back 170

1) remove CL, tell pt to "DC CL" until infxn completely resolved
2) lavage purulent material from eye
3) broad-spectrum Ab
4) CC
5) cycloplegic agent

Front 171

what does lavage mean?

Back 171

to rinse w/ sterile saline

Front 172

what are the most commonly used antibiotic agents for corneal ulcers?

Back 172

4th gen fluoroquinolones (FLQ)
1) Moxifloxacin (Vigamox, Moxeza)
2) Gatifloxacin (Zymar, Zymaxid)
3) Besifloxacin (Besivance)

Front 173

which agents are arguably the most effective topical antibiotics for empirical use in most corneal disease?

Back 173

4th gen FLQ

(moxi, gati, besifloxacin)

Front 174

what must you do if you want to prescribe a drug that is not FDA approved for the use you desire?

Back 174

must get pt's INFORMED CONSENT

Front 175

T/F: No standard doing regimen has been established for 4th gen FLQ

Back 175

TRUE

Front 176

LD for NON-VISCOUS 4th gen FLQ?

Back 176

1 gt q 5 mins x 1 hour then 1 gt q 1 h x 24 h

Front 177

LD for VISCOUS 4th gen FLQ?

Back 177

1 drop every 15-20 minutes for first hour-2 hours then 1 drop every 2 hours, once or twice overnight

Front 178

which agents are FDA approved for bacterial keratitis the 1st 24 hrs?

Back 178

1) ciloxan
2) iquix
3) ocuflox

Front 179

what historically effective meds are often still used w/ DIFFICULT/RECALCITRANT CASES of corneal ulcers?

Back 179

1) fortified tobramycin 14 mg/mL, 1 gt qh ALTERNATING WITH

2) Fortified cefazolin (50 mg/mL), 1 gt qh , around the clock for 24 hours. This means the patient is getting a drop every 30 minutes.

Front 180

what can you use as bonus (optional) antibiotic therapy?

Back 180

1) Azasite BID
2) Ab UNG for overnight coverage

Front 181

why is Azasite used for corneal ulcers?

Back 181

as anti-inflammatory for overnight coverage

Front 182

Azasite is used as __, NOT as primary antibiotic therapy for keratitis w/ ulceration

Back 182

adjunctive

Front 183

T/F: Antibiotic dosing is generally tapered as the condition improves, but antibiotics should nvr be tapered below the recommended dosing for conjunctivitis?

Back 183

true

Front 184

what is used to reduce inflammation associated w/ corneal ulcers on the first day?

Back 184

CC BID-QID for no more than 15 min at a time

and cycloplegic BID-TID

Front 185

effects of cycloplegic?

Back 185

1) reduce pain
2) reduce potential for iris-lens adhesions (posterior synechiae)
3) help seal up the leaky iris vessels (reduce permeability)

Front 186

follow up schedule for pts w/ corneal ulcers?

Back 186

daily (initially)

Front 187

additional Tx for corneal ulcer?

Back 187

doxycycline TO REDUCE COLLAGEN DESTRUCTION

Front 188

what are the signs of improvement (signs to taper)?

Back 188

1) blunting of perimeter of stromal infiltrate
2) dec'd density of stromal infiltrate
3) dec'd cornea edema
4) dec'd AC rxn
5) REEPITHELIALIZATION
6) Improvement in pain
7) reduced discharge
8) reduced edema/injection

Front 189

at follow up visits 24-48 hrs later, the judicious use of __ is often necessary to reduce the __ and avoid the __

Back 189

corticosteroids;
immune response;
adverse outcome of corneal scarring

Front 190

__ are nvr used the 1st day of Tx of any infectious keratitis w/ ulceration

Back 190

steroids

Front 191

benefit of introducing steroids after improvement is seen?

Back 191

1) hastens healing
2) reduces scarring
3) significantly reduces pt symptoms

Front 192

day 2 or 3 of Tx for corneal ulcer?

Back 192

1) taper Ab
2) add steroid
3) re-instill cycloplegic
4) remain out of CL
5) RTC 24 h (return)

Front 193

sterile infiltrate =

Back 193

infiltrative keratophy = marginal infiltrates