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41 Cards in this Set

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What is a hordeolum?
What organism is it usually caused by?
Sty, or infection of eyelid glands (zeis, moll, meibomian)

Staph aureus
What is a Chalazion?
cronic granulomatous infection of meibomian gland.
Etiology unknown.
What is marginal blepharitis characterized by.
bilateral inflammation of lid margins, scales.
What are the two types of marginal blepharitis?
1. Staphylococcal blepharitis
2. Sebrrheic blepharitis
Describe Staphylococcal Blepharitis
ulcerative
dry scales, red lids
caused by staph aureus
predisposes pt to chalazions & hordeola
treat w/ topical AB
Describe Seborrheic Blepharitis
no ulceration
greasy scales
not microbial
complication of seborrheic dermatitis
describe meibomiantis
bilateral chronic inflammation of meibomian glands
what is dacryocysitis
Infection of lacrimal sac. Most often unilateral and always secondary to obstruction of the naso-lacrimal duct
Pathogenesis of dacryocystitis
Tear fluid collects in the lacrimal sac because of the obstruction and bacteria from the conjunctival surface that have washed into the sac find a stagnant pool of fluid in which they may multiply.
Chronic adult dacryocystitis:
What is the organism and treatment?
Etiology is usually Streptococcus pneumoniae, or occasionally Candida albicans

Control - relieve obstruction of the nasolacrimal duct usually via surgical means
Acute adult dacryocystitis: What is the organism?
Staphylococcus aureus
Infantile dacryocystitis: What a major cause and the organism?
Often due to failure to canalize of a nasolacrimal duct.

Etiology Haemophilus influenzae
Canaliculitis
Organisms
Actinomyces israelii, Candida albicans, or Aspergillus species

Occurs exclusively in adults.
Dacryoadenitis
rare acute inflammation of the lacrimal gland.

Occasional complication of mumps, measles, or influenza in children or in adults in association with gonococcal conjunctivitis.

May occur as a retrograde infection from a bacterial conjunctivitis
Orbital Cellulitis
Is it serious?
What is the portal of entry?
What are the organisms?
Sequelae if not treated
YES

Microorganisms have direct portal of entry through the sinuses

Organisms are:

Pneumococci, streptococci, staphylococci.

Haemophilus influenzae b in unvaccinatedchildren under three.

Fungi - in the immunocompromised.

Sequelae is meningitis, or brain abscess
conjunctiva
thin transparent mucous membrane that covers the posterior surface of the lids and the anterior surface of the sclera, continuous with skin at lid margin and with corneal epithelium at the limbus.
patient may report the following symptoms with conjunctivitis
1.Foreign body sensation – feel like they have something in eye
2. Scratching or burning sensation
3. Sensation of fullness around the eyes
4. Itching (usually means allergic)
5. If cornea involved, photophobia and pain
patient with conjunctivitis may show the following signs
1. Hyperemia (redness)
2. Tearing
3. Exudation
4. Edema sometimes
5. Papillary hypertrophy sometimes
6. Follicles sometimes
what are the three stains done when conjunctivitis is suspected and what are they for?
1)Gram stain to identify bacterial type.(G+,G-)

2)Giemsa stain to identify human cell type.(poly, lymphocytes, etc)

3)Wet mount for fungi.
EXPECTED RESULTS FROM STAINS OF CONJUNCTIVAL SCRAPING: Normal eye
epithelial cells and occasional goblet cells
EXPECTED RESULTS FROM STAINS OF CONJUNCTIVAL SCRAPING: Acute bacterial infection
large numbers of neutrophils, with bacteria inside or outside the cells.
EXPECTED RESULTS FROM STAINS OF CONJUNCTIVAL SCRAPING: Viral conjunctivitis
lymphocytes and monocytes are predominant. In herpes simplex infections, multinucleated epithelial cells may be seen. Intranuclear inclusion bodies in epithelial cells reflect DNA viruses
EXPECTED RESULTS FROM STAINS OF CONJUNCTIVAL SCRAPING: Chlamydial infections
basophilic intracytoplasmic inclusion bodies seen in epithelial cells
EXPECTED RESULTS FROM STAINS OF CONJUNCTIVAL SCRAPING: Allergic conjunctivitis
eosinophils.
Acute catarrhal conjunctivitis (Mucopurulent conjunctivitis) (pinkeye)

is caused by what in adults, children, newborns
Streptococcus pneumoniae (most common in adults & children)

Haemophilus (frequent cause in children).

Staphylococcus aureus (most common cause in the newborn; fairly rare otherwise)
Acute Purulent Conjunctivitis
Serious
Needs immediate treatment
Caused by Neisseria gonherrea & meningitis
Produce toxic products that can result in perforation of cornea and toxic iritis
Chronic Bacterial Conjunctivitis is most frequently caused by
Staphylococcus aureus
Moraxella lacunata
Chlamydial Conjunctivitis (trachoma) is caused by what organism?
Chlamydia trachomatis antigenic types A-C
Chlamydial Conjunctivitis (trachoma) complications are due to ______.
scarring -- most common cause of blindness in developing countries
Inclusion Conjunctivitis (Inclusion Blennorrhea) is caused by what organism?
In what ways?
Chlamydia trachomatis antigenic types D through K.

genital to eye contact (via fomites), inadequately chlorinated swimming pools, in newborns via birth
Viral Conjunctivitis
very common, may be part of a systemic infection or may be limited to epithelium of cornea and conjunctiva. Discharge usually watery rather than purulent. E.g. chicken pox & shingles
Epidemic Keratoconjunctivitis (EKC)
viral conjunctivitis that can cause pseudomembranes
Herpes simplex virus (HSV) Conjunctivitis
viral conjuntivitis that can also cause pseudomembranes
Allergic Conjunctivitis
Immediate hypersensitivity reactions - characterized by itching
Ophthalmia neonatorum
a conjunctival infection that follows contamination of the baby's eyes during its passage through the mother's cervix and vagina.

topical erythromycin is used
Keratitis
Inflammation of the cornea
Signs and Symptoms of Keratitis
Pain and photophobia

Blurred vision and/or iridescent vision (halos)

No discharge, since there are no blood vessels or mucous glands, but there will usually be tearing.

Circumcorneal vascular congestion (ciliary or limbal flush)

If corneal inflammation is severe, toxins produced by infectious agents may diffuse into the anterior chamber, and leukocytes may settle there, resulting in hypopyon.

Abnormal light reflex (reflection of light from cornea)
Predisposing factors which may lead to corneal ulcers.
Dry eye syndrome (caused by deficiency of mucin or total ocular secretions).

Exposure of cornea from inability to close the lids.

Trauma to the cornea.

Inappropriate use of glucocorticoids.

Preexisting infection of the eye.

Inappropriate use of contact lenses, especially extended wear.
Acute Serpiginous Ulcer (Pneumococcal Ulcer) is caused by what organism?
Where is it prominant?
What is it's prognosis?
Streptococcus pneumoniae

developing countries

developes rapidly, if untreated eye will be lost
Necrotizing keratitis (Pseudomonas ulcer) is caused by what organism?
Where is it prominant?
What is it's prognosis?
Pseudomonas Aruganosa

Common in US

Occurs following minor injury & contaminated lens solution or make up, cornea may perforate and eye may be lost in 48 hours or less
Herpes simplex keratitis (dendritic keratitis)
viral corneal ulcer -- Caused usually by Herpes simplex virus type 1, but occasionally by type 2 --Self-limited and usually produces minimal scarring unless corticosteroids are used, or unless the cornea or patient is otherwise immunocompromised