2: Keratitis Flashcards
What is keratitis also known as
Corneal ulcer
What is keratitis
Inflammation of the cornea
What is the cornea
Transparent structure covers iris and pupil
What is trauma (scratch) to the cornea called
Corneal abrasion (Not a corneal ulcer)
What is the most common cause of keratitis
Bacterial (80%)
What bacterial organisms cause keratitis
More commonly gram negative
What viral organisms cause keratitis
HSV1
VZV
What are 3 risk factors for bacterial keratitis
Contact lenses
Recent eye surgery
Immunodeficiency
What are 5 symptoms of bacterial keratitis
Red-eye Purulent discharge Hypophyon Severe eye pain Photophobia Vision can be affected
What is a hypophyon
Collection of pus behind the cornea
Is viral conjunctivitis unilateral or bilateral
bilateral
How does viral keratitis present
Unilateral Red-eye Severe eye pain Photophobia Blurry vision
What is first-line investigation for keratitis
Slit lamp with fluroscein
In bacterial keratitis what will be seen on slit lamp with fluroscein
Round corneal ulcers
Hypophyon
How will HSV keratitis present on slit lamp with fluroroscein
Dendritic ulcers (superficial corneal ulcers)
What do dendritic ulcers indicate
Virus is replicating
What is performed on dendritic ulcers
Direct fluorescien antibody test or PCR
How soon should individuals with keratitis be referred to opthalmology
Same-day
What cranial nerve should be tested in keratitis
CN5
What is first line for herpes simplex or varicella zoster virus keratitis
Topical acyclovir
What is first Line for bacterial keratitis
Ciprofloxacin hourly for 48h. Then QDS for 5d
Explain regimen for giving ciprofloxacin
Hourly for 48h and then QDS for 5 days
What is a complication of HSV1 keratitis
Corneal scarring and subsequent blindness
What increases risk of scarring and blindness in HSV1 keratitis
Glucocorticoid drops are used without anti-viral cover
What is a complication of bacterial keratitis
Loss of vision
What are 4 main Ddx for red eye
- Acute glaucoma
- Keratitis
- Conjunctivitis
- Uveitis
What is subconjunctival haemorrhage
Pool of blood under conjunctiva
What are 3 causes of subconjunctival haemorrhage
High BP
Anticoagulant use
Leptospira in sewage
In which individuals does subconjunctival haemorrhage occur more often
Elderly frail females
What is scleritis
Inflammation of the sclera with oedema of the conjunctiva
What are the two types of scleritis
Anterior scleritis
Posterior scleritis
What is the most common type of scleritis
Anterior (90%)
What is 50% of scleritis associated with
Systemic disease such as RA
How does scleritis present clinically
Painful eye movements
Dull ache
Photophobia
Headache
Why does scleritis present with pain on eye-movements
As extra-ocular muscles attach onto the sclera
In what time frame should someone with scleritis be referred to opthalmology
Urgently
What is episcleritis
Inflammation of episclera, located just below the sclera
How will episcleritis present
Blue discolouration below a focal cone-shaped wedge of engorged vessels
In which gender is episcleritis more common
Females
How does episcleritis present
Acute onset
Dull ache
What is a corneal abrasion
Trauma to the eye
What may cause corneal abrasion
Contact lenses
Chemical injury
How do corneal abrasions present clinically
Pain
Photophobia
Decreased vision
What is used to investigate corneal abrasions
Blue slit lamp with fluoroscein
How will corneal abrasions appear on blue light slit lamp and fluoroscein
Green
