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56 Cards in this Set
- Front
- Back
staph aureus
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bleph
ulcer blurred margins perforation in 7 days |
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strep pneumo
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acute bact conj
marginal infiltrates to ulcers central snakelike ulcer that has hypopyon |
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moraxella lacunata
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angular blepharoconj
with or without hypopyon |
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neisseria gonorrhea
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lusterless cornea
34 hour progression to ulceration, perforation, or panophthalmitis |
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haemophilus influ
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in fall
petechial hemorrhages progression to preseptal cellulitis or metastatic meningitis |
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atopic keratitis
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anterior subcap cataract
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marginal infiltrates/ulcers
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differentiate from herpes
hypersensitivity rxn oval and linear infiltrates separated from limbus by interval of clear cornea pain photophobia |
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dellen
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corneal thinning d/t dehydration
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epithelial defect and ulcers
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pathogens can access stroma
inflammatory response to stromal infiltration promotion of ulceration |
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bacterial corneal ulcer pathogens
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staph aureus, strp pneumo, moraxella, pseudomas
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s/s bacterial corn ulcer
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overlying epithelial defect
infiltrate extends beyond border of defect hypopyon |
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staph ulcer
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mucopurulent discharge
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strep ulcer
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serpiginous nature with undermined borders
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moraxella ulcer
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alcoholics and institutionalized pts
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psudomonas ulcers
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EW SCL pts
greenish mucopurulent discharge--GREEN GOO! endothelial plaque progress rapidly (perforate w/in 24 hours) |
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tx of bacterial ulcer
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fortified tobra q1h alternated with fortified cefazolin q1h OR
ciprofloxacin 2gtt q15min x 6 hours, 2gtt q 30 min rest of day, 2gtt q1h on 2nd day, 2gtt q4h on days 3-14. continue past day 14 if reepithelialization hasn't occurred. |
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4 main forms of hsv keratitis
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1. epithelial
2. disciform 3. necrotizing interstitial keratitis 4. indolent |
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punctate epithelial keratitis from HSV
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precursor to dendritic or ameboid. may not progress
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dendritic epithelial HSV
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arborized ulcer
true terminal end bulbs raised edges |
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ameboid epithelial HSV
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large amoeba0-shaped ulcer with dendritic edge of elevated mounds
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disciform (stromal) HSV
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stromal edema with intact overlying epithelium
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necrotizing interstitial keratitis (stromal)
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multiple/diffuse stromal infiltrates often with neo
bacterial superinfection must be r/o |
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indolent (neurotrophic) ulceration HSV
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sterile ulcer with smooth margins over area of stromal dixease persisting depspite antiviral therapy
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hallmark sign of HSV keratitis
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cornal hypoesthesia
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mngmt of HSF ocular dz
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debridement, topical antiviral
cycloyplegic, etc |
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mngmt of HSV epithelial keratitis
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mechanical debridement, topical antiviral (viroptic q2h while awake for no longer than 21 days)
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varicella zoster keratitis types
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spk, pseudodendrites, immune stromal keratitis, neurotrophic keratitis
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pseudodendrite zoster keratitis
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periph cornea elevated
medusa-like lesions that stain vividly with rose bengal chornic epi keratitis: corneal mucous plaque keratitis: accompanied by ciliary & tarsal conj injetion, mild anterior uveitis, fine keratic precipitattes, and corneal hypoesthesia |
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mngmt of herp zoster ophthal
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oral acyclovir within 72 hrs
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fungal corneal ulcer causative agents
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FACC: Fusarium, Aspergillus, Candida, Cephalosporium
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filamentous fungal infection fungal ulcer
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fusarium, aspergillus
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yeast infection fungal ulcer
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candida
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fungal ulcers
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satellite lesions
immune ring |
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protozoan corneal ulcers agents
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acanthamoeba
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s/s acanthamoeba keratitis
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severe ocular pain disproportionate to clinical signs
upper lid edema stromal infiltrate in shape of ring |
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mngmt acanthamoeba keratitis
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hosp admission?
cornal transplant often required eventually |
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interstitial keratitis
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most commonly associated with syphilis
binocular: congenital monocular: acquired |
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s/s old and acute
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old: deep corneal haze, stromal thinning, ghost vessels
new: pain, conj injection, ant uveitis |
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stromal edema 2nd to:
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endothelial dysfunction
apithelial dysfunction (less common) signs: folds in descemet's membrane |
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epithelial edema
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more effect on comfort and vision than stromal edema
may be 2nd to endothelial dysfunction or increased IOP reducted by hyperosmotics signs: microcystic edema, bullous keratopathy |
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verticillata
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Fabry's disease, differentiate from drugs like miodarone, plaquenil, indomethacin, etc
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fabry's dz lens findings
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granular ant capsular cat with radial pattern
unusual post subcap cat with spoke-like deposits of granular material radiating from central part of post cortex |
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marginal corneal melting/ulceration
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collagen vascular dx like RA SLE, sjogren's
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mgmt of marg corneal ulceration/melting
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bandage SCL-best
ocular lubrication caution with steroids r/o underlying dz |
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alkaptonuria
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missign enzyme: homogentisic acid oxidase
ochronosis: pigmentation of cartilage and other connective tissues ocular ochronosis: patches or particles of pigment in sclera conj andlimbic cornea sclerosis of cardiac valves degen. arthritis |
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Wilson's dz
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copper
liver, kidney, brain descemet's membrane of periph. cornea leading to kayser-fleischer ring |
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mngmt of wilson's dz
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d-penicillamine (cuprimine): mobilizes copper from tissues
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leprosy cornea
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thick, prominent corneal nerves with beading
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when does epithelial regen begin and do peripheral or central defects heal faster?
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w/in one hour
peripheral heal faster b/c closer to limbal vascular supply |
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scar with Bowman's
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no scar if Bowman's is intact
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when to resume CL wear after corneal abrasion?
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no sooner than 2 days after resolution
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corneal laceration
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r/o foreign body
r/o thickness laceration: ant chamber flattening, prolapse of IO contents, seidel's sign |
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burns: better prognosis with white or red conj?
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red: the whiter the worse the prognosis
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radiation burns: UV radiation
wavelength? |
rarely results in ant segment damage b/c of imediagte discomfort caused by heat
lag of 6 hrs b/w exposure and s/s shorter the wavelength, greater the tendency for keratoconj. severe keratoconj may result in mucin deficiency |
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thermal burns
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debride, remove FB, cycloplege, abx, patch, reexamine in 24 hrs
can result in: ant uveitis, corneal scars, corneal pannus, 2ndary infection, cictricial conj changes, cictricial dermal changes, ocular penetration |
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chemical burns
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copius irrigation
may result in: ant uveitis, ischemic necrosis of conj, corneal scrring and pannus, etc etc |