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212 Cards in this Set
- Front
- Back
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Lists 3 ways viruses can be transmitted
|
1. direct contact
2. bloodstream 3. droplet inhalation |
|
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How are most viral conjunctivitis cases tx?
|
supportive tx:
cool compresses AT vasoconstrictors(decongestants) |
|
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What is the most common causes of red eye?
|
simple adenovirus conjunctivitis
|
|
|
viral conjunctivitis typically present with what signs?
|
follicles
+ PAN serous discharge |
|
|
follicles in the lower lid fornix are typical of what viral conjunctivitis
|
simple adenoviral conjunctivitis
|
|
|
acute onset of pink eye, usually unilateral then rapidly bilateral
|
simple adenoviral conjunctivitis
|
|
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patients with simple adenovirus conjunctivitis have a hx of....
|
recent URTI or exposure to some with URTI or pink eye
|
|
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what off label drug has been used by doctors to tx viral eye disease?
|
betadine
|
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|
tx of simple adenoviral conjunctivitis
|
supportive tx
Pt ed on highly contagious nature of the condition --> proper hygeine |
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|
highly contagious variant of simple adenoviral conjunctivitis
|
epidemic keratoconjunctivitis
|
|
|
signs and symptoms of EKC
|
follicles
petechial hemes chemosis PAN pseudomembranes diffuse PEK and SEI's |
|
|
corneal involvement of EKC
|
diffuse PEK
SEI's |
|
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what does the rule of 8's refer to and what condition does it occur?
|
EKC
days 1-7 incubation periord day 8 - sx arise day 16- SEI, not contagious |
|
|
when is EKC no longer considered contagious?
|
when SEI develop usually on the 16th day
|
|
|
TX of EKC
|
AT
cool compresses vasoconstrictors prophlactic AB |
|
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adenoviral infection accompanied by fever and sore throat
|
pharygnoconjunctival fever (PCF)
|
|
|
what are outbreaks of PCF related to?
|
swimming in contaminated pools - AKA swimming pool conjunctivitis
|
|
|
highly contagious bilateral follicular conjunctivitis with prominent subconj hemes - eye looks blood
|
acute hemorrhagic follicular conjunctivitis
|
|
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what causes acute hemorhagic follicular conjunctivitis?
|
enterovirus
coxsachkievirus |
|
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secondary follicular conjunctivitis due to lid lesion with cheesy core
|
molloscum contagiousm
|
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|
cause of molloscum contagiosum
|
pox virus
|
|
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what group is suscepible to molloscum contagiosum?
|
immunocompromised --> AIDS and HIV
|
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follicular conjunctivitis caused by paramyxovirus seen in poultry workers
|
newcastle dz
|
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|
bacterial cause of follicular conjunctivitis seen in young girls who share eye makeup
|
moraxella
|
|
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tx of moraxella conjunctivitis
|
zincfrin - OTC decongestant
|
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unilateral conjunctivitis with ipsilateral lymphadenopathy, fever, and conjunctival ulcerations/granulomas associated with many diseases
|
Parinaud's oculoglandular conjunctivitis
|
|
|
systemic causes of parinaud's oculoglandular conjunctivitis
|
CAT SCRATCH DZ
tularemia TB syphillis |
|
|
tx of parinaud's ocular glandular conjunctivitis
|
hot compresses for lymph nodes
gentamicin/bacitracin ung for conj analgesic PRN |
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|
mild asymptomatic chronic conjunctivitivits with large palpebral follicles
|
axenfeld's conjunctivitis
|
|
|
inferior conjunctival follicles asymptomatic seen in pre-adolescents
|
chronic folliculosis
|
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|
HSV-1 occurs
|
above the belt
|
|
|
HSV 2 occurs
|
below the belt
|
|
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what is more common HSV 1 or HSV 2?
|
80/20
1 = 80% 2= 20% |
|
|
where does the first exposure/infxn of HSV manifest?
|
peripheral end organ --> lids
|
|
|
where does HSV become latent in?
|
ganglia --> trigeminal and cervical
|
|
|
when does the primary/1st infx of HSV occur?
|
age 6 months to 5 yrs old
|
|
|
in what % of patients does relapse of HSV occur?
|
25-50%
|
|
|
what are causes of relapses of HSV?
|
steroids
immunocompromise UV stress fatigue irradiation fever |
|
|
what is the most common cause of corneal opacifications in developed countries?
|
HSV keratitis
|
|
|
what is the most common cause of corneal opacifications in underdeveloped countries?
|
Trachoma (chlamydia)
|
|
|
List 7 ocular and neurological manifestations of HSV?
|
1. bleph
2. canaliculitis 3. conjunctivitis 4. keratitis 5. uveitis 6. retinitis 7. encephalitis |
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|
when does blepharitis secondary to HSV occur?
|
during the primary infection
|
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|
vesicular lesions on an erythematous base which turn into pustules which later ulcerate and crust without scaring is characteristic of what type of herpes virus
|
HSV
|
|
|
how do you differentiate btw HSV and HZV blepharitis?
|
HSV - random distribution of lesions
HZV - along trigeminal ganglion |
|
|
what type of conjunctivitis does HSV cause?
|
follicular
|
|
|
what is the most common initial ocular manifestation of HSV?
|
corneal involvement
|
|
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how does HSV keratitis present?
|
PEK
small bulbous epithelial lesions dendritic ulcer geographic ulcer |
|
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what does a dendrite in HSV represent?
|
loss of epithelium
|
|
|
do dendrites stain with NaFl in HSV keratitis?
|
yes
|
|
|
describe the staining pattern of an HSV dendrite
|
percolation of NaFl around area surrounding dendrite
|
|
|
what do the end bulbs/edges of the HSV dendrite contain?
|
actively replicating virus cells in the epithelium
|
|
|
does an HSV dendrite stain with rose bengal?
|
yes, the end bulbs stain
|
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what type of corneal manifestation is most common in HSV?
|
PEK
|
|
|
what should be ruled out in follicular conjunctivitis that presents with PEK
|
HSV keratitis
|
|
|
large area of ulceration without a branching linear pattern with possible dendritic edges
|
geographic ulcer
|
|
|
ulcer that exists in absence of active viral replication that represents an area of non healing epithelium
|
metaherpetic (post-infectious) ulcer
|
|
|
name 3 types of stromal inflammation associated with HSV
|
1. superficial stromal scarring
2. necrotizing stromal keratitis 3. disciform edema |
|
|
faint superficial scars that develop under an ulcer secondary to chronic infection and delayed treatment
|
superficial stromal scarring due to HSV 1
|
|
|
what is the goal of tx in tx superficial stromal scarring secondary to HSV?
|
tx the epithelium
|
|
|
white necrotic infiltrated lesion that extend into stroma that can lead to corneal thinning or perforation seen in HSV
|
necrotizing stromal keratitis
|
|
|
tx for necrotizing stromal keratitis due to HSV
|
viroptic and steroid (to reduce inflammation)
|
|
|
disc of corneal edema with KP's and iritis seen in HSV
|
disciform edema
|
|
|
tx of disciform edema
|
topical steroids
|
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|
tx of HSV keratitis
|
topical viroptic 1% q2h up to 9X/day during acute infection, taper, continue QID 3-5 days after complete re-epithelialization
|
|
|
what is recommended in addition to viroptic in the tx of HSV keratitis?
|
debridement
oral acyclovir 400mg 5x/day |
|
|
what is the F/U schedule for HSV keratitis?
|
daily until re-epithelization occurs
|
|
|
what is absolutely contraindicated in active herpetic epithelial disease and why?
|
STEROIDS bc they decrease the immune response
|
|
|
tx of HSV conjunctivitis without corneal involvement
|
viroptic 1% QID propphylactically or vidarabine ung
supportive tx NSAIDs if severe |
|
|
what is the F/U schedule for HSV conjunctivitis?
|
every 2-3 days checking for corneal involvement
|
|
|
tx for lid lesions due to HSV
|
topical AB ung
viroptic QID prophylactic if assoc with conjunctivitis oral acyclovir in severe cases |
|
|
F/U for HSV blepharitis
|
low risk every 3-4 days
high risk every 1-3 days |
|
|
in what cases of HSV can steroids be used?
|
immune reactions due to HSV - not active epithelial infectious disease such as:
necrotizing stromal inflammation disciform corneal edema uveitis |
|
|
when using a steroid in treating non epithelial HSV, what must be used in conjunction?
|
viroptic 1% in equal dosing to the steroid
|
|
|
rule of thumb for HSV tx
|
epithelial - VIROPTIC ONLY
stromal/uveal - VIROPTIC & STEROID |
|
|
what does stromal HSV mean regarding the infection?
|
not infectious bc its not epithelial - IMMUNE related
|
|
|
when do you consider orals in HSV?
|
at risk pts
|
|
|
what is HZV in childhood called?
|
chicken pox
|
|
|
what does HZV called in adulthood?
|
shingles
|
|
|
what is HZV?
|
reactivation of chickenpox that was dormant in the trigeminal ganglion
|
|
|
when does HZV reactivate?
|
immunocompromised states
|
|
|
what is the most serious complication of HZV?
|
post-herpetic neuraligia
|
|
|
pain, itching, parethesisas along future site of skin eruption with decrease sensation and tenderness is the prodome for what condition
|
HZV
|
|
|
pustules that break and ulcerate that are seen along one side of the face that occur with prior pain, itching, and parathesia before appearance of pustules
|
herpes zoster ophthalmicus
|
|
|
tip of nose affected in patients with V1 infection of HZV
|
Hutchinson's sign
|
|
|
what does Hutchinson's sign indicate?
|
that the eye will become involved, poor prognosis
|
|
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what is the type of conjunctivitis seen with HZV?
|
follicular
|
|
|
HZV keratitis presents with what type of corneal findings
|
pseudo-dendrites
plaques diffuse PEK |
|
|
how do you differentiate dendrites from pseudodendrites?
|
not excavated as in HSV with end bulbs that stain less vivdly than HSV
|
|
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sequela of HZV that results due to damage of corneal nerves that cuases decrease sensitivity and subsequent sloughing off if the epithelium
|
neurotrophic keratitis (HZV)
|
|
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tx of neurotrophic HZV keratitis
|
lubrication & surgery
|
|
|
pain that persists beyond the course of active infection which is the most serious complication of HZV
|
post-herpetic neuralgia (PHN)
|
|
|
most common cause of suicide in elderly
|
PHN
|
|
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what is the source of pain in PHN/
|
scarring of nerve endings causes the nerve to be constantly stimulated due to skin eruptions
|
|
|
tx of HZ ophthalmicus
|
oral acyclovir 800mg 5x/day for 7-10 days OR oral Famvir or Valtrex
prophylactic AB ung for skin lesions/conj/keratitis cool compresses for skin lesions topical steroids supportive tx oral steroids & analgesics & antidepressants for PHN |
|
|
what drug is not effective against HZV?
|
VIROPTIC
|
|
|
can steroids be used to tx HZV regardless of corneal involvent/
|
YES BUT IN CONJUNCTION with AB
|
|
|
acute swelling rendess ITCHING and chemosis in response to topical meds and other sources characterizes what type of allergic conjunctivitis
|
type 1 IMMEDIATE
|
|
|
manifestation of allergic response usually to ocular meds aka contact dermatitis
|
type 4 DELAYED
|
|
|
itching watery discharge chemosis red swollen eyelids and papillae is characteristic of what type of conjunctivitis
|
simple allergic conjunctivitis
|
|
|
the signs and symptoms of allergic conjunctivitis are caused by what mechanism
|
mast cell degranulation and release of histamine
|
|
|
how long does simple allergic ocnjunctivitis last
|
1-2 weeks
|
|
|
allergic conjunctivitis that occurs in seasonal warm months that affects young males
|
vernal conjunctivitis
|
|
|
ropy discharge, intense itching, giant cobblestone papillae, ptosis, and Horner Tranta's dots at limbus or PC and a shield ulcer is characteristic of what
|
vernal conjunctivitis
|
|
|
vernal conjunctivitis signs
|
horner trantas's dots
ptosis giant cobblestone papillae shield ulcer ropy discharge |
|
|
what are Horner Tranta's dots?
|
papillae - degenerated eosinophils
|
|
|
how does a shield ulcer in vernal conjunctivitis form
|
from mechanical rubbing of papillae onto cornea
|
|
|
allergic conjunctivitis similar to vernal but occurs year round and affects males>females
|
atopic conjunctivitis
|
|
|
atopic conjunctivitis occurs in patients with a hx of?
|
atopy - allergies, hayfever, eczema
|
|
|
papillary reaction to any foreign material that comes into contact with the PC usually due to SCL
|
GPC
|
|
|
what are the patient's cc in GPC?
|
itching
FBS loose fitting CL CL intolerance transient blur mucus discharge LARGE PAPILLAE IN UPPER TARSAL CONJ injection chemosis |
|
|
where are giant papillae found
|
superior PC
|
|
|
tx of GPC
|
modify SCL wear - < hrs, enzyme tx, switch to dailies, change material, DC wear
acute - DC CL use; topical antihistamine/vasoconst combo or steroid |
|
|
tx of vernal conjunctivitis without shield ulcer
|
Crolom
Alomide MAST CELL INHIBITORS PATANOL follow every 2-3 weeks |
|
|
tx of vernal conjunctivitis with shield ulcer
|
topical steroid - Pred Forte
with prophylactic AB and cycloplege follow daily until resolved then in 1 week |
|
|
tx of atopic conjunctivitis
|
since its year round avoid steroids
MAST CELL INHIBITORS PATANOL |
|
|
general tx of allergic conjunctivitis
|
1. remove offending agent
2. cool compresses and AT 3. OTC vasoconstrictors 4. ANTIHISTAMINE - Emadine 5. ANTIHISTAMINE + MAST CELL COMBO - patanol, zaditor, optivar, elestat 8. steroids 9. NSAID - ACULAR only FDA approved 10. chronic - MAST CELL STABILIZER - alocril, alamast, alomide, crolom, opticrom |
|
|
what is the name of the only NSAID approved for the tx of allergic conjunctivitis
|
ACULAR
|
|
|
list some mast cell stabilizers
|
alamast
alomodie cromolom alocril opticrom |
|
|
list some mast cell stabilizer & antihistamine combos
|
patanol
zaditor optivar elestat |
|
|
what causes chlamydia
|
obligate intracellular chlamydia trachomatis
|
|
|
what is the most common STD in the US
|
chlamydia
|
|
|
what are 2 forms of Chlamydia infections
|
Adult Inclusion Conjunctivitis
Trachoma |
|
|
chlamydia infection common in industrialized countries
|
adult inclusion conjunctivitis
|
|
|
chlamydia infection common in underdeveloped countries
|
trachoma
|
|
|
what is the most common cause of preventable blindness in underdeveloped countries
|
trachoma
|
|
|
conjunctivitis characterized by mucopurulent discharge, follicles, and papillae
|
chlamydia
|
|
|
in adult inclusion conjunctivitis are genital lesions active as well
|
NO, females are asymptomatic genitially
|
|
|
what part of the PC is affected in adult inclusion conjunctivitis
|
lower PC
|
|
|
what part of the PC is affected in trachoma
|
upper PC
|
|
|
ddx for adult inclusion conjunctivitis
|
EKC due to the SEIs
|
|
|
when should you be suspicious of chlamydia
|
chronic red eyes not responsive to std tx
|
|
|
tx of adult inclusion conjunctivitis
|
Azithromycin (zithromax) 1 g QD X 1 dose
OR Doxycycline 100 mgg BID x 1 day then 100mg QD x 21 days (or tetracycline or erythromycin) |
|
|
when should doxycycline or tetracycline not be used in the tx of adult inclusion conjunctivitis
|
lactating mothers or children < 8
|
|
|
how is trachoma transmitted
|
eye to eye via fly infestations
"fly to eye" |
|
|
superior tarsal conjunctival scarring that leads to entropion, trichiasis, and mucin deficient DES is called what
|
ARLT's line
|
|
|
what is ARLTs line and in what dz does it occur
|
superior tarsal conj scarring
trachoma |
|
|
scarred limbal follicles are called
|
Herbert's pit
|
|
|
what is diagnostic of trachoma
|
Herbet's pits - scarred limbal follicles
|
|
|
what are signs of trachoma
|
Herberts pits
ARTLs line mucopurulent dischrg papillae and follicles superior SPK |
|
|
in healed trachoma, what may lead to blindness
|
secondary bacterial keratitis due to trichiasis and scarring
|
|
|
what is the main thing to happen with trachoma
|
scarring
|
|
|
tx of trachoma
|
same as for adult inclusion
zithromax doxy or tetra erothromycin |
|
|
long term use of meds (miotics), heavy makeup use, env, radiatio, or soap can cause what
|
toxic and irrittative follicular conjunctivitis - may see mild papillae
|
|
|
chronic and recurrent inflammation of the superior PC and BC and cornea at 10 and 2
|
superior limbic keratoconjunctivitis
|
|
|
what is a major diagnostic sign of superior limbic keratoconjunctivitis
|
rose bengal staining of the entire affected are
|
|
|
is superior limbic keratoconjunctivitis uni or bilateral
|
bilateral but asymetrical
|
|
|
what are the symptoms of superior limbic keratoconjunctivitis
|
FBS
phoophobia pain more severe than clinical picture |
|
|
what is the tx of superior limbic keratoconjunctivitis
|
AT, punctal occlusion, pulse steroids
acetycysteine cromolyn silver nitrate bandage SCL thermal cautering conjunctival resection |
|
|
what is the etiology of superior limbic keratoconjunctivitis
|
unknown, DES, thyroid
|
|
|
focal nodule of limbal tissue in response to staph exotoxins (bleph) which is inflammatory in nature
|
conjunctival phlyctenulosis
|
|
|
what are causes of phylctenulosis
|
staph exotoxins >>>TB
|
|
|
mechanism of phylctenulosis
|
inflammatory
|
|
|
whitish plaque on cornea seen in response to staph exotoxins which is inflammtory in nature
|
corneal phlyctenulosis
|
|
|
conjunctivitis in neonate that occurs 3-5 days postpartum
|
ophthalmia neonatorium
|
|
|
what are the main causes of neonatal conjunctivitis
|
bacterial --> staph, strep, gonnorhea, pseudomonas, chlamydia
viral --> HSV |
|
|
leading cause of infectious neonatal conjunctivitis in the US
|
chalmydia
|
|
|
what is seen in neonatal conjunctivitis due to chlamydia
|
PAPILLAE ONLY bc lymph system not fully developed thus NO FOLLICLES
mucupurulent exudate, lid edema, chemosis, pseudomembrane, pneumonia |
|
|
prophylactic tx of neonatal conjunctivits
|
erythromycin 0.5% ung for chlamydia and gonorrhea
silver nitrate 1% --> gonorrhea, not used anymore |
|
|
hyperacute conjunctivitis in neonates
|
gonorrhea
|
|
|
tx of neonatal chlamydia
|
oral erythromycin 10-14 days
|
|
|
tx of neonatal gonorrhea
|
IV CILLIN drugs x 7 days with topical AB
|
|
|
tx of non-gonoccal bacterial neonatal conjunctivitis
|
bacitracin ung with gentamicin drops TID-BID with taper
|
|
|
tx of HSV neonatal conjunctivitis
|
viroptic 1% BID up to 9 doses a day; taper; use only for 3 weeks
|
|
|
loss of innervation to corneal tissue causing epithelial defect
|
neurotrophic keratopathy
|
|
|
number 1 cause of neurotrophic keratopathy
|
s/p HZV
|
|
|
causes of neurotrophic keratopathy
|
HZV
stroke CN V complicated sx irradiation complication acuostic neuroma |
|
|
what tumor can cause neurotrophic keratopathy
|
acuostic neuroma
|
|
|
signs of neurotrophic keratopathy
|
loss or reduction of corneal sensation
epithelial defects perilimbal injxn possible ulcer & iritis - lower cornea, grayish, heaped up borders |
|
|
what is the WU for neurotrophic keratopathy
|
test corneal sensation
hx signs of corneal exposure CT/MRI |
|
|
tx of neurotrophic keratopathy
|
mild - lubricants
corneal defect/abrasion - AB ung, cycloplege, pressure patch, bandage CL |
|
|
damage to the cornea from thermal burn or UV exposure
|
thermal/UV keratopathy
|
|
|
when do the symptoms of thermal/UV keratopathy appear
|
8-12 hrs after exposure
|
|
|
signs of thermal/UV keratopathy
|
confluent SPK interpalpebral area
injxn lid edema min/neg corneal edema miotic pupils droplet keratopathy |
|
|
yellow oily deposit seen in subepithelial cornea and conj
|
droplet keratopathy
|
|
|
droplet keratopathy
|
UV/thermal keratopathy
|
|
|
tx of thermal/UV kerathopathy
|
tx as corneal abrasion - AB ung, cycloplege pressure patch, bandage CL
bilateral patching if severe |
|
|
coarse punctate epithelial keratopathy of unknown etiology
|
thygeson's SPK
|
|
|
what are the clinical signs of thygeson's SPK
|
faint gray coarse PEK that stain with RB
microerosions that stain with NaFl WHITE AND QUIET epithelial only chronic bilateral |
|
|
tx of thygeson's SPK
|
weak topical steroids
bandage CL and pressure patch D/C CL use |
|
|
vascularization and infiltration affecting stroma and associated with systemic dz
|
non-herpetic interstitial keratitis
|
|
|
ghost vessels are seen in what condition
|
non-herpetic interstial keratitis
|
|
|
causes of non-herpectic interstitial keratits
|
syphillis >>>> TB
congenital syphilis - 80% bilateral acquired syphilis - 60% unilateral |
|
|
signs of syphilitic interstitial keratitis
|
infiltrates
endothelial edema KPs miosis stromal opacities |
|
|
signs of TB interstial keratitis
|
inferior peripheral ring-shaped corneal involvement
|
|
|
tx of non-herpetic IK
|
keratoplasty
active - steroids, cycloplege tx underlying condition |
|
|
main signs of non-herpetic IK
|
stromal scarring
opacification ghost vessels |
|
|
chronic automimmune disease that causes scarring of mucuos membranes
|
OCP
|
|
|
chronic recurrent unilateral conjunctivitis seen in elderly females due to underlying autoimmune dz
|
OCP
|
|
|
complications of OCP
|
DES
loss of VA - keratopathy, neo, ulcers, sacarring |
|
|
mechanism of OCP
|
loss of goblet cells and scarring
|
|
|
tx of OCP
|
AT ung
retinoid (vit A) topical chemo for rapid/progressive - oral pred & cyclophosphamide less active/progressive - oral pred & dapsond |
|
|
disease that appears similar to OCP but is not progressive
|
Stevens-Johnson Syndrome
|
|
|
mucosal inflammation in response to drugs or after systemic dz
|
steven johnson syndrome
|
|
|
severe pseudomembranous conjunctivitis with fibrosis of conj
|
Steven johnson syndrome
|
|
|
tx of S-J syndrome
|
topical anti-inflammatory
|
|
|
conjunctivitis seen due to an increase in lipid secretion that causes recurrent chalazia
|
ocular rosacea
|
|
|
common skin disorder that causes non-specific inflmmation with eyelid margin involvement such as plaques, scaring
|
psoriasis
|
|
|
Connective tissue dz that cause conjunctivitis
|
SLE
polyarteritis nodosa relapsing polychronditis retier's syndrome |
|
|
SLE
|
females>males
|
|
|
polyarteritis nodoa
|
males>females
|
|
|
recurrent inflammation of cartilage
|
relapsing polychronditis
females>males |
|
|
triad of retiter's syndrome
|
conjunctivitis
urethritis arthritis males |
|
|
most common cause of bacterial conjunctivitis
|
staph
|
|
|
tx of bacterial conjunctivitis
|
gentamicin
tobramycin polytrim vigamox |
|
|
what causes hyperacute bacterial conjunctivitis
|
N. gonorrhea, N. meningitidis
|
|
|
copious mucopurulent discharge
|
gonorrhea
|
|
|
thayer martin agar
|
neiserria
|
|
|
chocolate agar
|
neiserria, haemophalous
|
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what is necessary in tx of hyperacute bacterial conjunctivitis (n. gonorrhea, n.menigitidis)
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prompt aggresive tx to prevent globe perforation
flouroquinolone, lavage, oral penicillin/cephalosporin/erythromycin |
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who should be refered out in cases of bilateral hyperacute conjunctivitis
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children bc possibilty of n. mengitidis
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what is a consequence of hyperacute conjunctivitis
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globe perforation bc neiserria can penetrate intact corneal epithelium
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what should be ruled out in superior limbic keratoconjunctivitis
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thyroid dz
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