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79 Cards in this Set

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Condition accompanied by edema & neo which lead to scarring= blindness
corneal ulcers
Infectious corneal ulcers tend to progress ________ cornea and are made BETTER OR WORSE? with corneal patching
toward central
WORSE due to cause warmer environment for growth
Sterile ulcers damage tissue due to ?
Autoimmune response TOO MUCH
Cycloplegia is used to ________aqueous/blood barrier, _________ to help with pain, and ________ cell flare.
strengthen
paralyze ciliary muscle- result in elimating spasm/pain
decrease
Pilocarpine would __________aqueous/blood barrier and __________ cell flare
weaken
increase
Steroid use after pathogens are dead helps _____WBC and ____ scarring
decrease
decrease
Corneal infections are usually UNILATERAL or BILATERAL?
UNILATERAL
unless immunocompromised since most are opportunistic pathogens
Pathogens that can invade healthy intact corneas
C. diptheriae
N. gonorrhoeae
Listeria
H. aegyptius
Assumed to be bacterial initially for treatment
infectious corneal ulcers
Hypopyon almost always sterile. Example when not.
Leakage causing endophthalmus
Condition in which laboratory eval is indicated.
organic trauma
atypical ulceration
severe ulceration
immunocompromised or hospitalized
nonresponsive ulcer
Corneal ulcer. Culture preparation pre-anesthetic
(1) moiston calcium alginate swab
(2) conj and lid cultures
(3) agars:
blood
chocolate
thioglycollate broth
Corneal ulcer culture preparation post-anesthetic
(1) scrape with Kimura platinum spatula for smears for gram and Giemsa
(2) Kimura or calcium alginate swab for:
blood
chocolate
thioglycollate broth
sabouraud's dextrose agar
Sabouraud's dextrose agar should be swabbed last due to ________.
Ab that kills bacteria since want fungal growth on this agar.
Pathogen that causes significant mucopurulent discharge
S. aureus
Pathogen often serpiginous with undermined borders with hypopyon
S. pneumoniae
Pathogen more common in alcoholics, debilitated and institutionalized pts.
Moraxella
Pathogen common in EW SCL pts,greenish mucopurulent dischg, endothelial plaque, hypopyon, FAST perforation possible in 24 hrs
P. aeruginosa
FDA approved ulcer treatments. topical fluoroquinolones
ciprofloxacin (Ciloxan)
ofloxacin (Ocuflox)
Non-approved ulcer treatment that provides better gram + coverage.
3rd gen-levofloxacin (Quixin)
4th gen- moxifloxacin & gatifloxacin
Severe ulcer treatment or suspect resistance treatment.
fluoroquinolone and cefazolin or vancomycin. Alternating the above.
Tobramycin is the best option for corneal ulcers?
T or F
FALSE!!!
fluoroquinolone!!!!
Treatment for corneal ulcers can contain a systemic tetracycline?
T or F
TRUE!
slow destruction of corneal tissue by inhibiting collagenase and PMNs
In severe cases of corneal ulcers where topical antibiotics cannot be started within a short period, ______________ should be started.
subconjunctival antibiotics
examples of subconjunctival antibiotics
gentamicin and cefazolin
for corneal ulcers, __________ evaluation are done with evaluation based on?
DAILY
(1)degree pain
(2)size epi. defect
(3)size & depth infiltrate
(4)grade AC rxn
Impending or completed corneal perforation treatments.
(1) corneal transplant
(2) patch graft
(3) cyanoacrylate adhesive
Reactivation of latent herpes virus can be cause by?
(1) UV exposure
(2) stress
(3) immunocompromise
Recurrent ocular herpes is usually ___________.
keratitis
Primary infection of ocular herpes is usually ________ and can cause _________.
blepharoconjunctivitis
dermatitis
Characterized by acute follicular conjunctivitis with regional lymphadenopathy and 1 or 2 forms of bleph
Herpes simplex blepharoconjunctivitis
2 forms of bleph
(1) classical
(2) erosice-ulcerative
2 forms of herpes simplex keratitis
(1) epithelial
(2) stromal
Epithelial herpes simplex keratitis features
(1) punctate (may be only sign or percursor to the following)
(2) dendritic
(3) ameboid
Stromal herpes simplex keratitis features
(1)disciform
(2) necrotizing
dendritic and ameboid edges stain with _________ and center stains with __________
rose bengal/lissamine green
fluorescein
For stromal herpes simplex keratitis, the immune response is to _________.
the antigen NOT the infection
Disc shape stromal edema with intact epi and associated with anterior uveitis and uveitic glaucoma.
disciform stromal herpes simplex keratitis
Multiple or diffuse whitish gray corneal stromal infiltrates accompanied by neo, anterior uveitis, uveitic glaucoma and hypopyon
necrotizing stromal herpes simplex keratitis
Bacterial superinfection must be ruled out for this form of herpes simplex
Necrotizing Stromal
Sterile ulcer with smooth margins over an areas of stromal disease persisting despite antiviral treatment.
indolent (neurotrophic) ulceration
Hallmark sign of herpes simplex keratitis
corneal hypoesthesia
Study indicates _________ has no clinical benefit for stromal HSK for patients treated with trifluridine but shows efficacy at low doses as a prophylaxis
oral acyclovir
Replication of HSV requires a cell to synthesize proteins high in ______. ________ is an antimetabolite that acts as an analogue of (1st answer).
arginine
lysine
Treatment for blepharoconjunctivitis
(1) warm saline compresses
(2) good hygiene
(3) optional drying agents
(4) antibiotic ung if secondary infection
self-limiting and resolves without scarring within 2 weeks
_____% have recurrent ocular herpes within 2 years of primary ocular herpes
50%
You can use drying agents for blepharoconjunctivtis and herpes zoster?
T or F
FALSE
yes with blepharoconjunctivtis but NOOOO with herpes zoster since would make crusting worse and scarring worse!!!
Treatment for epithelial keratitis
(1) mechanical debridement
(2) topical antiviral- trifluridine sol (viroptic)
(3) cycloplegia
(4) analgesic if needed
(5) topical antibiotic if bacterial infection also
Why do we have to be careful during debridement of epithelial keratitis?
Don't want to push into stroma and cause an antigen/antibody response
For epithelial keratitis we should use a topical steriod?
T or F
FALSE!!!
promotes ameboid ulceration
For stromal keratitis and keratouveitis, we should use a topical steriod?
T or F
TRUE
cautious and slow tapering
It is very important to taper topical steriod in stromal keratitis and keratouveitis due to ___________.
REBOUND stromal infiltration
Severe keratitis or central corneal scarring from previous keratitis can be treated with_________ but may have ___________.
keratoplasty
rejection= haze
Varicella zoster of one or all nerves of ophthalmic (first) division of V
herpes zoster ophthalmicus
Usually involvement of the side and tip of nose indicated varicella zoster. This is called___________.
Hutchinson's sign
The first division of V includes:
Frontal nerve
nasociliary nerve
Signs of headache, malaise, fever & chills, followed in 1 to 2 days by neuralgic pain & 2 to 3 days with hot, flushed hyperesthesia and edema of dermatones.
herpes zoster ophthalmicus
herpes zoster ophthalmicus acute phase lasts?
1 to 2 weeks
For herpes zoster ophthalmicus, clear vesicles erupt over __________ and become yellow and pitted with scarring possible.
dermatones on 1 side of face.
Herpes Simplex Dermatitis results in scarring?
T or F
FALSE
Small dendrites without terminal end bulbs.
varicella zoster keratitis
___number of pts with herpes zoster Opht. develop ocular lesions with conjunctivitis being most common.
1/3
Conjunctivitis occurs in herpes zoster opht. The pustules & follicles are located on the __________ palpebral conj. & at the _________.
superior
limbus
For Herpes zoster oph. you should expect follicular conj. involvement
T of F
TRUE!!!!
viral
Herpes zoster opht. leads to conjuncitivitis then to __________ which resolves in 4 to 6 days.
acute epith. keratitis
The acute epith. keratitis due to herpes zoster opht. forms _____ and ________
SPK
pseudodendrites
The pseudodendrites in acute epith. keratitis is more ___________in the cornea.
peripheral
Chronic epithelial keratitis of herpes zoster ophthalmicus onset.
3 to 4months after onset of skin rash or 2 YEARS later.
Secondary to decreased corneal sensation___________. Typically located _______, and is a horizontally oval defect with ROLLED under edges.
Neurotrophic keratitis
inferior
List ocular conditions that can occur with herpes zoster opht.
(1) conjunctivities
(2) keratitis
(3) anterior uveitis
(4) SECTORAL iris atrophy
(5) glaucoma
(6) scleritis
(7) retinitis
(8) choroiditis
(9) optic neuritis
(10)other CN palsies
Scarring due to herpes zoster opht can cause:
(1) lid retraction
(2) cicatricial ectropion
(3) ptosis
(4) madarosis
(5) postherpetic neuralgia (due scar nerves)
For herpes zoster opht., treatment (acyclovir) begun within _______of onset of skin lesion reduces period of active infection and reduces incidence & severity of ocular complications.
72 hours
Consider ___________infection if persistent corneal ulcer not responding to antibiotic therapy.
Fungal
Fungal infections occur in the __________ and have __________ borders and loss of overlying epi. with ________lesion surrounding the primary infiltrate. Sterile hypopyon with severe anterior chamber rxn.
stroma
feathery; hyphate
satellite
Response to treatment for fungal infections are SLOWER than for bacterial infections?
T of F
TRUE
Treatment for ocular infection with Candida
Amphotericin B 0.15%
Treatment for ocular infection with Aspergillus
Miconzaole or clotrimazole 1%
Epithelial and subepithelial infiltrates along corneal nerves and produce a radial pattern (perineuritis)indicates: _____________.
acanthamoeba
Causes severe ocular pain that is initially disproportionate to clinical signs.
acathamoeba