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OD2 (S1&2) > AED - Rarer Conjunctivis - Lid Disorders - Week 7 > Flashcards

AED - Rarer Conjunctivis - Lid Disorders - Week 7 Flashcards

1
Q

When does phthalmia neonatorum typically occur? Is it uni- or bilateral? What kind of infection is it? What is it mostly due to (2)?

A

A bilateral conjunctivitis which presents in the first four weeks of life
Most are due to pathogen/substance exposure at birth

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2
Q

What is the most common cause of ophthalia neonatorum and when does it usually manifest?

A

Chlamydial
-due to exposure to the pathogen during delivery
Usually manifests the second week after delivery

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3
Q

Aside from the most common cause, list 4 causes of ophthalmia neonatorum.

A

Gonococcal
Herpes simplex
Simple bacterial conjunctivitis
Chemical

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4
Q

What are silver nitrate drops typically used for in infants and what is a consequence of this?

A

A prophylaxis for gonococcal infection
Can result in chemical ophthalmia neonatorum

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5
Q

List a differential diagnosis for ophthalmia neonatorum.

A

Nasolacrimal duct obstruction

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6
Q

What is the treatment option for ophthalmia neonatorum (2)?

A

Irrigate with sterile saline and frequent use of sterile artificial tears

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7
Q

Should you refer for ophthalmia neonatorum?

A

Yes, for isolation of the pathogen and appropriate antibiotic treatment

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8
Q

List the two kinds of chlamydial conjunctivitis.

A

Adult inclusion conjunctivitis
Trachoma

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9
Q

Which species of chlamydia almost exclusively targets humans?

A

C. trachomatis

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10
Q

What are the agents of classic trachoma (4)?

A

C. trachomatis serotype A, B, Ba, C

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11
Q

What are the agents of inclusion conjunctivitis (7)?

A

C. trachomatis serotype D-K

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12
Q

What are serotypes L1. L2, and L3 responsible for (C. trachomatis) and what do they cause?

A

They infect tissues deeper to the epithelium and cause lymphogranuloma venereum

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13
Q

How is adult inclusion conjunctivitis typically transmitted and in which population are they most common?

A

Transmitted by infected genital secretions ( ͡° ͜ʖ ͡°)
Most common in young sexually active adults

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14
Q

Is ault inclusion conjunctivitis uni- or bilateral?

A

Can be either, but usually unilateral

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15
Q

How long does adult inclusion conjunctivitis typically last?

A

Many months

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16
Q

What is adult inclusion conjunctivitis associated with in women (3)?

A

Urethritis
Vaginitis
Cervicitis

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17
Q

Are chlamydial STDs typically symptomatic or asymptomatic?

A

High percentage asymptomatic

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18
Q

What kind of discharge is present in adult inclusion conjunctivitis (2)? what sensation is felt?

A

Mucopurulent (or watery)
Gritty FB sensation

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19
Q

Are follicles or papillae present with adult inclusion conjunctivitis? Particularly in which area?

A

Follicles, particularly in the upper tarsal conjunctiva - limbal follicles also possible

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20
Q

Is preauricular/submandibular lymphadenopathy common or rare with adult inclusion conjunctivitis?

A

Common

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21
Q

What can be seen in chronic prolonged cases of adult inclusion conjunctivitis (2)?

A

Marginal subepithelialcorneal infiltrate and superior pannus

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22
Q

List three differential diagnoses for adult inclusion conjunctivitis.

A

Adenoviral keratoconjunctivitis
Herpes simplex keratitis
Trachoma

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23
Q

What is the treatment option for adult inclusion conjunctivitis? What is recommended if chlamydia is confirmed?

A

Refer the patient and their sexual partner(s) to a GP or sexual health clinic for lab tests
Systemic macrolides or tetracyclines if chlamydia is confirmed

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24
Q

What antibiotic courses can be given for a chlamydial infection (name, dose and duration)?

A

Azithromycin 1g PO or
Erthromycin 250mg q.i.d for 2-6 weeks

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25
Q

What is a common risk factor for trachoma and what is it transmitted by?

A

Result of poor hygiene
Transmitted by the common fly

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26
Q

What disease is one of the leading causes of preventable blindness?

A

Trachoma

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27
Q

In what regions is trachoma most common?

A

Africa
India
Middle East
Asia
South America
Aboriginal communities in northern and northwestern Australia

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28
Q

Is trachoma usually uni- or bilateral?

A

Often unilateral initially

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29
Q

What kind of discharge is present with trachoma? What sensation is felt?

A

Mucopurulent
Gritty FB sensation

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30
Q

What can tracoma lead to, and what is a consequence of this?

A

Can lead to scarring, which can lead to trichiasis

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31
Q

What is the main sign of trachoma?

A

Superior bulbar and palpebral conjunctival follicular response

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32
Q

What does chronic inflammation over many years (or quicker) eventually lead to (5)?

A

Conjunctival scarring -> trichiasis -> ocular surface irritation -> corneal opacities -> vision loss

33
Q

What are herbert’s pits and in what disease can they be found?

A

Scarring of limbal follicles in trachoma

34
Q

What 5 aspects of a trachoma case are graded and under what kind of scale?

A

TF - trachomatous inflammation: follicular
TI - trachomatous inflammation: intense
TS - trachomatous scarring
TT - trachomatous trichiasis
CO - corneal opacity
0-3 scale

35
Q

List 4 differential diagnoses for trachoma.

A

Adult inclusion conjunctivitis
Other causes of conjunctival cicatrisation
Other causes of recurrent conjunctivitis
Other causes of superior corneal pannus

36
Q

What is the tratment option for trachoma (3)?

A

Refer for lab tests and surgery
Inactivate scarring using lubricants
Advise on prevention by improving hygiene and fly reduction programs

37
Q

Define the possible components of anterior blepharitis (2).

A

One or a combination of:
-staphylococcal anterior blepharitis
-seborrhoeic anterior blepharitis

38
Q

What is posterior blepharitis?

A

Meibomian gland dysfunction

39
Q

Is anterior blepharitis common or rare?

A

Common

40
Q

What part of the lid margin is inflammed in anterior blepharitis?

A

Anterior to the meibomian glands and includes the lashes

41
Q

Is anterior blepharitis usually uni- or bilateral? Is the onset symmetrical? Is it acute or chronic?

A

Usually bilateral, symmetrical, and cronic

42
Q

What does anterior belpharitis occur in conjunction with?

A

Seborrhoeic dermatitis

43
Q

What happens to the skin with seborrhoeic dermatitis? What does this promote?

A

Skin and lid margins become scaly and oily
Promotes excess growth of staph. colonies

44
Q

List three symptoms of anterior blepharitis.

A

Ocular surface burning FB sensation
Sticky crusting along the lid margins
Mild photophobia

45
Q

Can removl of lid crusting in anterior blepharitis cause bleeding or do they just fall off?

A

Can cause bleeding

46
Q

What is the tear flims like in anterior blepharitis?

A

Poor

47
Q

List three signs of anterior blepharitis.

A

Redness
Telangiectasia
Thickening of the anterior lid margin

48
Q

What 5 things may be observed in long-standing cases of anterior blepharitis?

A

Mild, chronic papillary conjunctivitis
Trachiasis
Recurrent bacterial conjunctivitis
External/internal hordeola
Lid/lash base ulceration
Bacterial keratitis

49
Q

Define madarosis.

A

Lash loss

50
Q

Define poliosis.

A

Lash pigment loss

51
Q

List 5 differential diagnoses for anterior blepharitis.

A

Posterior blepharitis
Basal, squamous, or sebaceous cell carcinoma
Dry eye

52
Q

List the four components of an anterior blepharitis workup.

A

Careful symptomatology
Slit lamp with fluorescein
Tear work up
Skin assessment

53
Q

What is the main treatment option for anterior blepharitis? List 3 additional options.

A

Lid therapy
-scrubbing the margins with a low irritant surfactant (baby shampoo) up to 4 times a day until under control
Lid supplements
Antibiotic ointment
Mild steroids

54
Q

Is posterior blepharitis common?

A

Yes

55
Q

Is posterior uni- or bilateral? Is onset symmetrical?

A

Bilateral and symmetrical

56
Q

How does posterior blepharitis affect the tear film?

A

Results in a poor/unstable tear film

57
Q

List 4 symptoms of posterior blepharitis.

A

Gritty/burning sensation
Crusting/redness on the lid margin
Symptoms worse in dry/air-conditioned environment
Photophobia (if corneal involvement - SPK)

58
Q

List three signs of posterior blepharitis.

A

Posterior lid margin thickened
Telangiectasia
PEE/SPK due to corneal irritation

59
Q

What are the seborrhoeic characteristics of posterior blepharitis and what do they result in?

A

Excess secretions appear as oil droplets capping meibomian glands
Creates oily or foaming tear film

60
Q

A high proportion of individuals with posterior blepharitis have what two diseases?

A

Acne rosacea or seborrhoeic dermatitis

61
Q

List 6 differential diagnoses for posterior blepharitis.

A

Anterior blepharitis
Posterior blepharitis
Basal, squamous, or sebaceous cell carcinoma
Dry eye

62
Q

List the five components of an posterior blepharitis workup.

A

Careful symptomatology
Slit lamp with fluorescein
Tear work up
Skin assessment
Gland expression

63
Q

What are the main treatment options for posterior blepharitis (2)? List 3 additional options.

A

Lid therapy
-scrubbing the margins with a low irritant surfactant (baby shampoo) up to 4 times a day until under control
Hot compresses and lid massage essential to improve gland function (4 times daily)
Lid supplements
Antibiotic ointment
Mild steroids

64
Q

How does intense pulse light work and what is it used for? How often is it used?

A

Good for blocked meibomian glands
Acts like a heat lamp, melts secretions and opens glands
Three or four treatments over several months

65
Q

Are demodex infestations a sign of poor hygiene?

A

Not necessarily

66
Q

What is used to kill demodex? Is it toxic to the cornea/conjunctiva? How should it be applied and how often?

A

TTO but is toxic
Weekly application of 50% TTO

67
Q

Is acne rocasea common or rare?

A

Common

68
Q

What is the cause of acne rocasea?

A

Unknown

69
Q

What is classic of acne rocasea?

A

Butterfly rash across the nose and cheeks

70
Q

List three signs of acne rocasea (aside from its characteristic sign).

A

Mild erythema with telangiectasia to nodular eruptions of cheeks and nose

71
Q

Does acne rocasea affect males or females more? What age group is it more common in?

A

Males > females, most commonly 30-40 years

72
Q

What two foods can exacerbate acne rocasea?

A

Alcohol and spicy food

73
Q

What may acne rosacea result in (2)?

A

Pustules and scarring

74
Q

In what percent of cases of acne rocasea is there ocular involvement?

A

5-10%

75
Q

List 5 symptoms of ocular rocasea.

A

Red eye
Recurrent styles and chalazia
Burning/gritty sensation
Photophobia
Facial flush

76
Q

List 5 signs of ocular rocasea.

A

Blepharitis (posterior)
Telangiectasis of the lid margin
Conjunctivitis
Chalazion/internal hordeolum
Keratitis

77
Q

What three things can ocular rocasea rarely cause?

A

Corneal scarring
Corneal neovascularisation
Corneal thinning/perforation

78
Q

List three differential diagnoses for ocular rocasea.

A

Blepharitis without rosacea
Other forms of non-infective conjunctivitis
Keratitis

79
Q

List 5 treatment options for ocular rosacea.

A

Topical antibiotic
Oral tetracycline/macrolide (mainstay)
Lid therapy as for anterior/posterior blepharitis
Tear supplements
Mild topical steroids

OD2 (S1&2) (174 decks)

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