631 D - Bacterial Keratitis Fall 2010

Front 1

what are the 5 layers of the cornea

Back 1

Epithelium
Bowman's Layer
Stroma
Desemets Layer
Endothelium

Front 2

This layer is called ___
Squamous epithelium____ cell layers thick
Basal layer responsible for ___ activity
Below basal layer is the ___ membrane
Desmesomes and hemidesmosomes form ___ attachments

Back 2

Epithelium
5-10
mitotic activity
basement membrane
tight attachments

Front 3

Epithelium
Free nerve endings (branches of the ___ nerve) run between ___
cells
Disrupted epithelium heals in
___ days if basement membrane is not damaged
___ days if basement membrane is damaged

Back 3

Epithelium
(branches of the trigeminal) run between epithelial cells
2-3 days if basement membrane is not damaged
6-8 days if basement membrane is damaged

Front 4

Epithelium
Free nerve endings (branches of the ___ nerve) run between ___
cells
Disrupted epithelium heals in
___ days if basement membrane is not damaged
___ days if basement membrane is damaged

Back 4

Epithelium
(branches of the trigeminal) run between epithelial cells
2-3 days if basement membrane is not damaged
6-8 days if basement membrane is damaged

Front 5

this is ___ Layer
Site of attachment of the epithelial ___ membrane
Consists of interwoven ___ fibers which __ regenerate, so damage causes ___

Back 5

Bowman’s Layer
epithelial basement membrane
interwoven collagen fibers which cannot regenerate, so damage causes scarring

Front 6

this layer is ___
Composed mainly of collagen fibrils and ____which are secreted by ___
Accounts for approximately 90% of corneal thickness
Greatest concentration of nerve supply in anterior ___.

Back 6

Stroma
collagen fibrils and glycosaminoglycans which are secreted by keratocytes
Accounts for approximately 90% of corneal thickness
Greatest concentration of nerve supply in anterior stroma.

Front 7

this layer is the ___
___layer of cells
Serves as a fluid barrier and as a ___ which keeps the cornea clear
___ innervated
Inability to ___

Back 7

Endothelium
Single layer of cells
Serves as a fluid barrier and as a pump which keeps the cornea clear
Not innervated
Inability to regenerate

Front 8

what is this corneal abnormality called

Back 8

superficial punctate keratitis (SPK)

Front 9

Superficial Punctate Keratitis (SPK)
Describes superficial punctate corneal epithelial disruption
___ etiologies
Consists of two forms:
___
___

Back 9

Superficial Punctate Keratitis (SPK)
Describes superficial punctate corneal epithelial disruption
Multiple etiologies
Consists of two forms:
Punctate Epithelial Erosion (PEE)
Punctate Epithelial Keratopathy (PEK

Front 10

Punctate Epithelial Erosions (PEE)
___ areas of epithelial disruption or lesion
Slightly depressed
Stain well with ___,___ and ___

Back 10

Punctate Epithelial Erosions (PEE)
Focal areas of epithelial disruption or lesion
Slightly depressed
Stain well with NaFl, rose bengal and lissamine green

Front 11

what epithelial disruption or lesion is this drop commonly used to stain

Back 11

Punctate epithelial erosion (PEE)

Front 12

what epithelial disruption or lesion is this drop commonly used to stain

Back 12

Punctate epithelial erosion (PEE)

Front 13

what epithelial disruption or lesion is this product commonly used to stain

Back 13

punctate epithelial erosion (PEE)

Front 14

what epithelial disruption or lesion is this product frequently used to stain

Back 14

punctate epithelial erosion (PEE)

Front 15

what is this epithelial disorder called

Back 15

Punctate epithelial keratopathy (PEK)

Front 16

Punctuate Epithelial Keratopathy (PEK)
Accumulation of epithelial cells that are surrounded by a focal ___infiltrate
___- ___opacities in the epithelium
Seen ___ staining.
Stain:
Poorly with ___ but
Well with ___ and ___

Back 16

Punctuate Epithelial Keratopathy (PEK)
Accumulation of epithelial cells that are surrounded by a focal inflammatory infiltrate
Grayish-white opacities in the epithelium
Seen without staining.
Stain:
Poorly with NaFl but
Well with rose bengal and lissamine green.

Front 17

what is this corneal disorder caused by dry eye syndrome called

Back 17

SPK superficial punctate keratitis

Front 18

Superficial Punctate Keratitis (SPK)
Commonly used to refer generally to:Superficial punctate epithelial disruptions of multiple etiologies
Clinically, often used interchangeably with ___

Back 18

Superficial Punctate Keratitis (SPK)
Commonly used to refer generally to:
Superficial punctate epithelial disruptions of multiple etiologies
Clinically, often used interchangeably with PEE

Front 19

what is this corneal disorder, bacterial in origin called

Back 19

superficial punctate keratopathy (SPK)

Front 20

what is this corneal disorder, bacterial in origin called

Back 20

superficial punctate keratopathy (SPK)

Front 21

Superficial Punctate Keratopathy (SPK)
___ origin is usually associated with ___.
Distribution seen in a variety of patterns

Back 21

Superficial Punctate Keratopathy (SPK)
Bacterial origin is usually associated with blepharitis.
Distribution seen in a variety of patterns

Front 22

Superficial Punctate Keratopathy (SPK)
Sxs:
___sensation
___
___
___

Back 22

Superficial Punctate Keratopathy (SPK)
Sxs:
FB sensation
Redness
Tearing
Photophobia

Front 23

what type of staining would you expect for this corneal SPK disorder

Back 23

eye lash scrapes

Front 24

what type of staining would you expect for this SPK corneal disorder

Back 24

inferior 1/3

Front 25

what type of staining would you expect for this SPK corneal disorder

Back 25

superior corneal staining (not vernal)

Front 26

what and where would you expect to see staining w/ this drop for:
___
Bacterial conjunctivitis
Adenoviral conjunctivitis
Medicamentosa
Allergic conjunctivitis
Severe dry eye syndrome

Back 26

Diffuse SPK

Front 27

what disorder and where would you expect to see staining for:
Superior limbic keratoconjunctivitis SLK
Vernal keratoconjunctivitis VKC
Trachoma

Back 27

upper 1/3 SPK

Front 28

what and where would you expect these disorders to stain:
Staph. Blepharitis
Ectropion
Entropion
Lagophthalmos
Exposure keratopathy

Back 28

Superficial punctate keratitis
lower 2/3 SPK

Front 29

what and where would you expect these SPK's to stain:
Keratoconjunctivitis sicca KCS
Exposure keratopathy
UV keratopathy

Back 29

interpalpebral SPK

Front 30

what and where would you expect these SPKs to stain:
Mechanical abrasion
Trichiasis
Entropion
Foreign body

Back 30

Linear streak

Front 31

what and where would you expect this SPK to stain:
Trichiasis
Trauma

Back 31

sectoral

Front 32

what pattern of staining do you expect w/ each of these pt

Back 32

Diffuse SPK?

Front 33

what pattern of staining do you expect with this pt

Back 33

confluent SPK

Front 34

what type of SPK is this?

Back 34

Diffuse SPK

Front 35

what type of SPK is this

Back 35

confluent SPK

Front 36

In superficial Bacterial Keratitis:
what 3 common pathogens cause superficial keratitis?

Back 36

Staphylococcus
Streptococcus
Haemophilus
Others

Front 37

Gram ___ cocci
Staph. ___is the most common ocular pathogen in patients of all ages
Staph. ___, though part of normal ocular flora, can also be pathogenic
what is this picture of?
what will this cause?

Back 37

gram positive
aureus most common
epidermis also pathogenic
staphylococcus
Superficial Bacterial Keratitis

Front 38

what bacterial keratitis is this and what is it caused by

Back 38

superficial bacterial keratitis (staphylococcus)

Front 39

what bacterial keratitis is this and what is it cause by?

Back 39

superficial bacterial keratitis (staphylococcus)

Front 40

Signs and symptoms of Staph. Keratitis:
Usually associated with acute or chronic ___ or ____
Exotoxins from Staph. cause a band of ___ across ___cornea
If ___lid is primary sight of infection
May also cause ___ punctate keratitis, PEE and occasional subepithelial infiltrates (SEIs)

Back 40

Signs and symptoms of Staph. Keratitis:
Usually associated with acute or chronic Staph. blepharitis or blepharoconjunctivitis.
Exotoxins from Staph. cause a band of punctate epithelial keratitis across inferior cornea
If lower lid is primary sight of infection
May also cause diffuse punctate keratitis, PEE and occasional subepithelial infiltrates (SEIs)

Front 41

what is this bacterial keratitis disorder called and what causes it

Back 41

superficial bacterial keratities (staphylococcus)

Front 42

In Superficial Bacterial Keratitis Staphylococcus
Associated signs:
___and ___ around lashes
Conjunctival ____ and papillae
___ discharge
Lids sticking in ___
Symptoms include foreign body sensation, ___, tearing, redness

Back 42

Crusts and collarettes around lashes
Conjunctival hyperemia and papillae
Mucopurulent discharge
Lids sticking in AM
Symptoms include foreign body sensation, photophobia, tearing, redness

Front 43

what is the tx/managment for superficial bacterial keratitis (staphylococcus)

Back 43

Treatment / Management
Treat associated blepharitis or conjunctivitis
Lid Hygiene
Warm compresses
Scrubs
Massage
Meibomian Expression

Front 44

what are some antibiotic ointments used for superficial bacteral keratitis (staphylococcus)

Back 44

Antibiotic ointment therapy:
Bacitracin,
Erythromycin
Polysporin, ung.
bid-tid or qhs in mild cases

Front 45

what bacterial keratitis may this ointment be used for

Back 45

Superficial Bacterial keratitis (staphylococcus)

Front 46

what bacterial keratitis may this ointment be used for

Back 46

superficial bacterial keratitis (staphylococcus)

Front 47

what bacterial keratitis disorder might this ointment be used for (bid0-tid or qhs in mild cases)

Back 47

superficial bacterial keratitis (staphylococcus)

Front 48

what drug, last year did the CDC advise practitioners to reserve current supplies of for neonatal prophylaxis and use alternative drugs for the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin, as well as for treatment of post-surgical and posttraumatic events.”

Back 48

erythromycin

Front 49

what bacterial keratitis is this tobrex commonly used to tx

Back 49

Superficial bacterial keratitis

Front 50

what bacterial keratitis is polytrim use to treat

Back 50

superficial bacterial keratitis (staphylococcus)

Front 51

what is the antibiotic drop therapy for superficial bacterial keratitis (staphylococcus)
Antibiotic drop therapy:
___,
___ gtt qid
___– works best against mersa. (trimethoprim & Polymyxin B)
gtts q3h

Back 51

Antibiotic drop therapy:
Gentamicin,
Tobramycin
gtt qid
Polytrim – works best against mersa. (trimethoprim & Polymyxin B)
gtts q3h

Front 52

what type of drug is Ciprofloxacin 0.3% Ciloxan

Back 52

Antibiotic theraphy: Fluialoroquinolone for superficial bacterial keratitis (staphylococcu)

Front 53

what type of drug is this and what is it used for

Back 53

antibiotic therapy fluoroquinolone for superficial bacterial keratitis (staphylococcus)

Front 54

what is this drug and what is it used for. how should it be used

Back 54

antibiotic therapy fluoroquinolone for superficial bacterial keratitis (staphylococcus)
TID X 7 days 3 shaakes & a flip 5 ml bottle

Front 55

how should besifloxacin 0.6% oph susup (besivance) be used for moderate to severe cases

Back 55

drop qid/q2-3h

Front 56

what is Levoflaxacin 0.5% Quixin and how should it be used

Back 56

antibiotic therapy fluoroquinolone for superficial bacterial keratitis (staphylococcus)

Front 57

what is Gatifloxacin 0.5% Zymar and how should it be used

Back 57

antibiotic therapy fluoroquinolone for superficial bacterial keratitis (staphylococcus)

Front 58

what is Vigamox and how should it be used

Back 58

antibiotic therapy fluoroquinolone for superficial bacterial keratitis (staphylococcus)
-approve for tid

Front 59

what are three drugs used for corneal ulcers

Back 59

Ciprofloxacin 0.3% (Ciloxan)
Ofloxacin 0.3% (Ocuflox)
Levofloxacin 0.5% (Quixin)

Front 60

how should you used antibiotic tx for superficial bacterial keratitis (staphylococcus)?
why is sulfacetamide less effective?

Back 60

Continue antibiotic therapy 7-14 days
Sulfacetamide is less effective due to many resistant strains

Front 61

with Superficial Bacterial Keratitis Staphylococcus, how is the dry eye treated? what are 3 drops used?

Back 61

Artificial tears / lubricants gtts q2h-qid
Ung qhs
-Refresh Tears, Refresh PM, Refresh Celluvise

Front 62

what is this Unique fluoroquinolone?:
DuraSite vehicle (a mucoadhesice agent) allows longer ocular residency time
Allows tid dosing
This works well for school aged kids
An ophthalmic drug with no systemic counterpart reduces resistance
Appears to be effective against MARSA
Unlike other fluoroquinolones!!!
Has a similar or superior potency to other ocular drugs tested

NOTE:
A new drug and not widely clinically used yet
Only FDA approved for bacterial conjunctivitis
Most likely will be used off label for more serious infections

Back 62

Besifloxacin ophthalmic suspension, 0.6% (Besivence) B&L

Front 63

what is this a picture of?
General Information
Gram ___ cocci
Most commonly involved species include pneumoniae and pygenes
Keratitis is usually associated with ___

Back 63

streptococcus
gram positive
conjunctivitis

Front 64

what is this bacterial keretitis from

Back 64

streptococcus

Front 65

what is this bacterial keratis called and from:
Signs and Symptoms
Diffuse punctate keratitis
Associated signs: (see conjunctivitis notes)
Acute conjunctivitis (possibly including petechial hemorrhages)
Pseudomembrane formation
Mucopurulent discharge
Associated URI or otitis media, especially in children
Symptoms include foreign body sensation, photophobia, tearing, redness

Back 65

superficial bacterial keratitis caused by streptococcus

Front 66

what three products are used for superficial bacterial keratitis caused by streptococcus?

Back 66

Antibiotic ointment therapy:
Bacitracin,
Erythromycin
Polysporin, ung.
bid-tid or qhs in mild cases

Front 67

what superficial bacterial keratitis is this ointment used for?

Back 67

Streptococcus

Front 68

what superficial bacterial keratitis is this used for

Back 68

streptococcus

Front 69

what bacterial keratitis is this ointment used for

Back 69

streptococcus

Front 70

what bacterial keratitis is this ointment used for

Back 70

superficial bacterial keratitis (streptococcus)

Front 71

what is Besivance tid + 3 shakes & a fl drop qid/q2-3h (for moderate to severe cases) used to tx (also)

Back 71

Superficial Bacterial keratitis streptococcus

Front 72

what is the treatment duration for Superficial Bacterial Keratitis streptococcus?

Back 72

tx duration 7-14 days

Front 73

what is this antibiotic Polytrim 0.3% used to treat also

Back 73

Superficial Bacterial Keratitis streptococcus

Front 74

what is this fluroquinolone Levofloxacin1.5% Iquix used to treat

Back 74

Superficial Bacterial keratitis Streptococcus

Front 75

what is this fluroqinolone, Moxifloxacin 0.5% Vigamox used to treat (also)

Back 75

Superficial Bacterial keratitis streptococcus

Front 76

what is this fluroquinolone Ciprofloxacin 0.3% Ciloxan used to treat (also)

Back 76

Superficial Bacterial Keratititis streptococcus

Front 77

what is this and what does it cause?

Back 77

Haemophilus
Superficial Bacterial Keratitis Haemophilus

Front 78

what is this and what is it's general information

Back 78

Haemophilus
Gram negative
Corneal involvement is usually associated with conjunctivitis

Front 79

what is this bacterial keratitis called?

Back 79

superficial bacterial keratitits haemophilus

Front 80

what is this bacterial keratitis called

Back 80

Superficial bacterial keratitis haemophilus

Front 81

what is this bacterial keratitis described below?
Signs and Symptoms
Diffuse punctate keratitis
Associated signs:
Acute conjunctivitis (possibly including petechial hemorrhages)
Mucopurulent discharge
Matted eyes
Associated URI or otitis media, especially in children

Back 81

superficial bacterial keratitis haemophilus

Front 82

what is the treatment for superficial bacterial keratitis haemophilus

Back 82

Treatment
Treat associated conjunctivitis
Antibiotic ointment therapy:
Polysporin, ung.
bid-tid or qhs in mild cases
Treatment duration: 7-14 days

Front 83

what is the tx for superficial bacterial keratitis?

Back 83

Treatment with solution:
Polytrim
Aminoglycosides
Fluroquinolones:
Ciloxan (Ciprofloxacin 0.3%)
Ocuflox (Ofloxacin 0.3%)
Vigamox (moxifloxacin 0.5%)
Zymar (gatifloxacin 0.3%)
Zymaxid (gatifloxacin 0.5%)
Quixin (levofloxacin 0.5%)
Iquix (levofloxacin 1.5%)
Besifloxacin 0.6% ophth susp.
QID to q2-3h
Treatment duration: 7-14 days

Front 84

what is the tx summary for superficial bacterial keratitis

Back 84

Depends on suspected organism!
Treatment with ointment:
Polysporin,
Bacitracin,
Erythromycin
Treatment with solution:
Polytrim q3h
Aminoglycosides
Fluroquinolones
QID to q2-3h (with 2 exceptions)
Depending on severity
Treatment duration: 7-14 days

Front 85

With superficial Bacterial Keratitis we know that most currently available topical Abs can eradicate most bacterial infections if used ___.
start with _____ for ___
if improvement noted drop to ___ for ___ more days (at least a TOTAL of ___)

Back 85

FREQUENTLY!
Start with a high frequency (q1-2h) for at least 2 days
If improvement is noted then drop to qid for 4-6 more days (at least a total of a week)

Front 86

Polysporin is made of what two drugs

Back 86

polymyxin B and Bacitracin

Front 87

Polytrim is made of what two drugs

Back 87

Trimethoprim an dPolymixin B

Front 88

reference

Back 88

reference