Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Repeating KHIO 1 > 6 Red eye/Conjunctivitis > Flashcards

6 Red eye/Conjunctivitis Flashcards

1
Q

Allergic conjunctivitis presentation:

A

Bilateral inflammation (lids/conj.)
Itching
Redness
Mucinous discharge
Photophobia
Pain/blur has cornea involvement
May associate with rhinitis/asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Classifications of allergic conjunctivitis

A

Seasonal allergic (SAC)
Vernal kerato- (VKC)
Atopic kerato-(AKC)
Perennial allergic (PAC)
Contact blepharo-
Giant papillary (GPC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Initial treatment of allergic conjunctivitis

A

Topical antihistamines
Mast cell stabilizers
Nonsteroidal anti-inflammatory drugs (NSAIDs) / short term steroids (ophthal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Seasonal Allergic conjunctivitis epidemiology/risk:

A

Hay fever (25-50% ocular allergy cases) most common.
Type 1 Hypersensitivity to allergens (tree/weed pollen, mold/grass)
Most severe in spring/summer when pollen high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SAC pathophysiology

A

Airborne allergen binding to IgE receptors in mast cells > degranulation of mast cells of MCt subtype > proinflammatory mediator release > eosinophil / basophil attraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SAC clinical presentation:

A

Bilateral, sudden onset, associated with airborn antigen variation.
Itching, tearing, photophobia, burning
Conj. Swelling (chemosis) greater than Conj. Hyperemia (injection)
Corneal punctate epithelial keratitis (spots) rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Perennial allergic conjunctivitis epidemiology:

A

Hypersensitivity to indoor antigens (mites, animal dander, mold)
No seasonal distribution, associated with DED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PAC pathophysiology

A

Airborne allergen binding to IgE receptors in mast cells > degranulation of mast cells of MCt subtype > proinflammatory mediator release > eosinophil / basophil attraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PAC clinical presentation:

A

Mild
Itching
Conj. Swelling (chemosis) greater than Conj. Hyperemia (injection)
Fine papilliary reaction (bumps on tarsal conj.)
DED increases symptoms
Corneal punctate only with DED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Vernal keratoconjunctivitis epidemiology / risk:

A

Serious allergic reaction
0.5% allergic ocular disease
Mainly 11-13 years
50% px have atopy (asthma/rhinitis/exzema)
More common in hot/dry climates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

VKC pathophysiology:

A

Type I/IV hypersensitivity reaction
Antigenic stimulation > lymphocyte activation (T-helper 2) with eosinophil infiltrate
Goblet cell increase > MUC5AC increase > abundant mucous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

VKC clinical presentation:

A

Bilateral itching, Sticky discharge, photophobia
Lid edema with conj. Injection (hyperemia)
5% corneal involvement, blur > scarring
Type 1 (palpebral): giant tarsal papillae (7mm), cobblestone look on eversion
Type 2 (limbal/bulbar): gelatinous eosinophilic mounds (Trantas dots) at limbus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

VKC Giant papillae corneal examination:

A

Corneal abrasion leads to:
Superficial punctate keratopathy, small fluorescein points upper cornea
Corneal macroerosions / shield ulcer: epithelial loss > large staining upper half
Superficial pannus: corneal opacification near limbus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Atopic keratoconjunctivitis epidemiology and pathophysiology:

A

Inflammatory disorder 20-50 years and male mainly
With atopic diseases 95% (dermatitis).
Type I/IV hypersensitivity, Reduction in MUC5AC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

AKC clinical presentation:

A

Itching, burning, tearing, eryhematous/swollen lids, eczema on lids, madarosis (lash loss) from scratching.
Lid edema > dennie-morgan fold in lower lid / Allergic shiner
Inferior tarsal small pappillae (<1mm)
Inflammtion > lower fornix adhesions
Inf. Corneal abrasions (punctate epithelial keratitis, pannus, ulceration
Increases suceptibility to herpetic keratitis (vision threatening)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Contact blepharoconjunctivitis epidemiology/risk:

A

Secondary to chemical/plant re-exposure
Cosmetics: nail varnish, eyeliner, mascara, soap
Preservatives: benzalkonium chloride, thimerosal (CL solution)
Antimicrobials: aminoglycosides, polymyxin
Ocular medications: atropine, tropicamide, scopolamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Contact blepharoconjunctivitis pathophysiology:

A

Type IV hypersensitivity
Partial antigen (hapten) binds proteins forming antigen > langerhans cells (type 2 MHC) present antigen to T helper 1 in lymph > T cells sensitize (week-months) > T cell present to ocular surface > cytokine/inflammatory cell accumulation
Unlike SAC/PAC, reaction to agent takes 2-3 days instead of 2-3 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Contact blepharoconjunctivitis clinical presentation:

A

Can be unilateral
Itching, burning of conj.
Lid exzema / erythematous (red) / lichenificated (leather) look
Conj. May form follicles
Inf. Cornea may form superficial puncatace keratitis from substance pooling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Giant papillary conjunctivitis epidemiology/risk:

A

CL wear
Risk with atopy, ocular prostheses / sutures / foreign bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

GPC pathophysiology:

A

Mechanical damage to conj. Epithelium > Th2 lymphocyte resonse
Allergic component from CL/prosthetic deposits
Protein deposits serving as haptens (partial allergens) > type IV hypersentitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

GPC clinical presentation:

A

Can be unilateral
CL/prosthetic may be present for years before symptoms
Iching, mucous discharge, photophobia
Giant papillae (>1mm) on tarsal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management of allergic conjunctivitis:

A

Avoidance of antigen
Artificial tears dilute agents
Topical drops;
Antihistamines
Mast cell stabilizers
NSAIDs (require ophthal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Topical medications for allergic conjunctivitis:

A

Antihistamines: 2nd generation (levocabastine / emedastine) > 1st generation (Antazoline / pheniramine)
Mast cell stabilizers: Lodoxamide > Cromoglycate
Multimodal agents: control H1 and mast cells
Avoid topical decongestants (phenylephrine), results in rebound hyperemia and CBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Antihistamine treatment of allergic conjunctivitis:

A

1st generation: sedative and anticholinergic activity
2nd generation: cause ADDE and may exacerbate symptoms, Used for rhinoconjunctivitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Adenoviral keratoconjunctivitis:

A

Many manifestations, commonly epidemic keratoconjunctivitis (EKC) > Pharyngoconjunctivitis (PCF) > isolated follicular conjunctivitis
Commonly causes epidemics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Adenoviral keratoconjunctivitis transmission:

A

Most common infectious conjunctivitis
Transmitted via eye contact, ocular secretion, respiratory droplets, ophthalmic tools.
Biphasic, infective phase > inflammatory phase 7-10 days after infection, infectious 2-3 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Adenovirus keratoconjunctivitis epidemiology:

A

Most common viral conj. Infection (75%), more common in adults
Epidemic KC mainly 20-40 years, involves whole ocular surface
Pharyngo-CF in children, involves pharyngitis/fever
Commonly unilateral, 70% bilateral 1-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Epidemic keratoconjunctivitis clinical presentation

A

Watery discharge, Hyperemia (pink eye), foreign body, photophobia
pain, chemosis, ipsilateral lymph adenopathy (swelling)
Pseudo/vascular membrane, symblephara (bulbar fuses lids), subepithelial infiltrates
Tarsal follicles, petechiae (blood spots), subconj. Hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Adenovirus contributing symptoms (other illnesses):

A

Can lead to; conjunctivitis, gastroenteritis, hepatitis, myocarditis, pneumonia.
Often preceded by Fever, nausea, diarrhea, myalgia (muscle pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Pharyngoconjunctival fever clinical presentation

A

Abrupt fever/rhinitis, pharyngitis (upper res. Infection), Preauricular (ear) lymph andenopathy (swelling), follicular/papilliary conjunctivitis (conj. Follicules)
Crusting, lid swelling, epiphora (watering), injection, chemosis, sub conj. Hemorrhage
Common in children

31
Q

Isolated follicular conjunctivitis:

A

Adenoviral conjunctivitis, without sore throat or lymph hyperplasia (adenopathy)
No corneal / systemic involvment

32
Q

Adenovirus structure:

A

Icosahedral, non-enveloped, ds DNA
From genus Mastadenovirus of Adenoviridae family
Classification from A-G, 65-80nm made of 252 capsomeres, with nucleoprotien core

33
Q

Adenovirus serotypes

A

EKC associated with serotypes 8, 19, 37 (species D)
Newly 53/54 found in japan
PCF associated with serotypes 3> (2, 4, 5, 7, 11, 14) (species B/C)
Serotypes 1-11 (B/C/E) cause isolated follicular conjunctivitis

34
Q

Complications of adenoviral infection (EKC):

A

Pseudo / vascular membrane formation in tarsal conj. Of fibrin exudate
Epithelial keratitis (infiltrates), immune reaction with viral antigens in corneal stroma, decreases corneal sensitivity, lasts weeks-years.
Bacterial superinfection of strep

35
Q

Adenoviral infection pathway

A

Lytic infection of epithelia > 10^4/6 virus release (5% are infective)
Latent infection of lymph > small viral release
95% replication rate (10 days) > 5% (16 days)

36
Q

Adenoviral immune response:

A

Inhibition of cellular apoptosis
Inhibition of interferon > tumour necrosis
Prevention of MHC-1 expression

37
Q

Adenovirus diagnosis:

A

Rapid antigen detection strip
PCR
Immunofluroescence assay

38
Q

Viral conjunctivitis DDX

A

Adenovirus > follicules/upper res. infection
HSV/HZV > unilateral / very painful, with dendritic keratitis
Varicella/zoster virus > fever
Picornavirus > hemorrhagic conjunctivitis in young Px
Molluscum contagiosum > follicular conjunctivitis / nodules at lid margin

39
Q

Adenovirus / allergic conjunctivitis DDX

A

Both are bilateral with itching
Adenoviral > forign body sensation, follicular tarsal reaction
Allergic > papillary conjunctival reaction

40
Q

Adenovirus treatment:

A

Self limiting resolution < 3 weeks, no effective treatment
Symptomatic relief via lubricants / cool packs
Topical antibiotics prevent bact. Infection
Topical antihistamine/vasoconstrictors reduce discomfort (risk toxicity)
Steroids restricted to pseudomembrane/infiltrates (severe)
Scarring > Keratectomy with mitomycin C.

41
Q

Adenovirus drug treatments:

A

Adenovirus drug treatments:
Rarely used for side effects
Virustatics: ganciclovir > mild efficicacy
Antiviral: cidofovir > decreased infiltrates
Cyclosporine > decreased pain
Never use antibiotics

42
Q

Adenovirus prevention:

A

Hygiene (hand/instrument disinfection)
Ethanol/bleach cleaning
Ensure cleaning for 2 weeks

43
Q

Herpes simplex virus conjuntivitis clinical presentation:

A

Unilateral
Watery, preauricular lymph adenopathy, pain, burning, foreign body sensation.
Decreased vision, dendritic corneal lesions

44
Q

HSV treatment:

A

Topical antiviral (trifluridine 1%) or (vidarabine 3%) 5/day
Dosage x2 and oral if corneal/skin involvement
Cool compress

45
Q

Herpes zoster ophthalmicus conjunctivitis clinical presentation:

A

unilateral
Nose ulcer, injection, conj. Edema, petechiae (blood spot)
Branching corneal lesions with bulbs

46
Q

HZO treatment:

A

Resolves in 1 week
Antibiotic for bacterial protection
Cool compress / lubricants

47
Q

Bacterial conjunctivitis causes

A

Gram-positive: streptococcus pneumoniae / Staphylococcus aureus (children)
Gram-negative: Haemophilus influenzae
Neisseria gonorrhoeae: hyperacute

48
Q

Bacterial conjunctivitis clinical presentation:

A

Unilateral > bilateral 2 days
^abrupt than viral
Tearing, irritation, crusting, injection (most at fornix)
Mucopurulent Yellow sticky discharge (mattes lids/lishes)
Corneal ulceration, chemosis

49
Q

Bacterial conjunctivitis treatment:

A

Self-limiting, Broard-spectrum antibiotics reduces course / spread / ulceration
Erythromycin and bacitracin/polymyxin B
Aminoglycosides have poor staph/strep coverage
CLs to be removed
Fluroquinolone for corneal ulcers

50
Q

Hyperacute bacterial conjunctivitis causes:

A

Gram negative Neisseria gonorrhoeae (STD) or uncommonly N meningitidis
Hand/genital/eye contact, neonates from birth canal.
Neonates present bilateral discharge in 5 days

51
Q

Hyperacute conjunctivitis clinical presentation:

A

Abrupt bilateral onset
Copius purulent (pus) discharge
Injection, chemosis, lid swelling, globe tenderness, preauricular lymph adenopathy
ulceration

52
Q

Hyperacute conjunctivitis treatment

A

Saline irrigation
Topical antibiotics
N gonorrhoea requires systemic antibiotics for concurrent diseases

53
Q

Chlamydial conjunctivitis:

A

STD
Serotypes A-C cause Trachoma > keratoconjunctivitis (common preventable blindness)
Serotypes D-K cause inclusion conjunctivitis

54
Q

Chlamydial conjunctivitis clinical presentation:

A

Common STD for newborns > adults
Uni/bilateral
Hyperemia, foreign body sensation, mucopurulent (mucus/pus) discharge, preauricular lymph adenopathy

55
Q

Chlamydial conjuntivitis treatment:

A

Oral azithromycin 1g/day or erythromycin 500mg 4/day
Topical erythromycin ointment reduces ocular infection

56
Q

Subconjunctival hemorrhage:

A

Conj. / episclera bleeding into sub conj. Space
Caused by trauma, systemic illness (diabetes/hypertension), anticoagulants, valsalva (cough/vomiting)
Dry eye > spontaneous

57
Q

Subconjuntival hemorrhage treatment:

A

Self resolving 10-14 days
Reassurance
Warm compress / lubrication may increase recovery

58
Q

Episcleritis:

A

Self resolving (2-3 weeks) inflammation of membrane between sclera and conj.
Idiopathic or from systemic disease
NSAIDs can help

59
Q

Episcleritis clinical presentation:

A

Abrupt redness, gritty feel, headache
Swelling, vessel displacement outward

60
Q

Scleritis:

A

Inflammation of sclera either Ant. / Pos.
Ant. Is either diffuse/nodular/necrotizing
Associated with RA, infection (viral/bac./fungal), women

61
Q

General scleritis presentation:

A

Uni/bilateral
Severe orbit pain, headache
Irregular vasculation, blue colour

62
Q

Scleritis treatment:

A

Testing / Treating underlying cause
NSAIDs, Corticosteroids, immunosupression

63
Q

Uveitis:

A

Ant. Iris/ciliary/choroid inflammation
Post. (iridocyclitis): retina/choroid/vitrious
Associated with MHC antigen HLA B-27
May relate to infection, parasitic (toxo), viral (herpes), bacterial (tuberc.)

64
Q

Uveitis clinical presentation:

A

Often unilateral
Limbal hyperemia, pain, photophobia, blur, tearing, Constricted pupil
Pos. No redness, floaters, photopsia.
Accumulation of inflammatory material in pos. Chamber (white spots)

65
Q

Uveitis treatment

A

Corticosteroids (topical prednisolone 1%)
Mydriatics (phenelephrine) protect iris from synechiae

66
Q

Acute angle glaucoma (AAGC):

A

Blockage of outflow ant. Chamber
Mydriasis / accomodative obstruction

67
Q

Acute angle glaucoma risk:

A

Elderly / hyperopic (large lenses)

68
Q

Acute angle glaucoma (AAGC) clinical presentation:

A

Global injection, Mid-dilation without light reaction, high IOP (>21), pain, blur
Headache, nausea (from light halo blur)
Corneal edema, ant. Chamber precipitates

69
Q

Acute angle glaucoma (AAGC) treatment:

A

Attacks can self resolve
Mydriatics (phenelephrine/pilocarpine 1%)
Beta blockers (timolol .5%)
Topical steroids (Prednisolone1%)
Apraclondine 1%, brimonidine .2%
Oral acetazolamide .5g (reduce fluid production)

70
Q

Conjunctivitis DDX:

A

Pain, Photophobia, blur > refferal
Hyperpurulent dis. > gonococca
Mucopurulent dis. > bacterial
Serous dis. > Allergic (itching) / Viral (no itch)

71
Q

Bacterial conjunctivitis ophthalmic treatment

A

Aminoglycoside (gentamicin)
Fluroquinolone (ciprofloxacin)
Macrolides (azithromycin)

72
Q

viral conjuntivitis ophthalmic treatments

A

Cold compress
Drops
Antihistamines

73
Q

Allergic conjunctivitis ophthalmic treatment

A

Antihistamine (Azelastine)
Mast cell inhibitor (Lodoxamide)
NSAIDs (Ketorolac)

Repeating KHIO 1 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions