AED - Rarer Conjunctivis - Lid Disorders - Week 7 Flashcards
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 bilateral conjunctivitis which presents in the first four weeks of life
Most are due to pathogen/substance exposure at birth
What is the most common cause of ophthalia neonatorum and when does it usually manifest?
Chlamydial
-due to exposure to the pathogen during delivery
Usually manifests the second week after delivery
Aside from the most common cause, list 4 causes of ophthalmia neonatorum.
Gonococcal
Herpes simplex
Simple bacterial conjunctivitis
Chemical
What are silver nitrate drops typically used for in infants and what is a consequence of this?
A prophylaxis for gonococcal infection
Can result in chemical ophthalmia neonatorum
List a differential diagnosis for ophthalmia neonatorum.
Nasolacrimal duct obstruction
What is the treatment option for ophthalmia neonatorum (2)?
Irrigate with sterile saline and frequent use of sterile artificial tears
Should you refer for ophthalmia neonatorum?
Yes, for isolation of the pathogen and appropriate antibiotic treatment
List the two kinds of chlamydial conjunctivitis.
Adult inclusion conjunctivitis
Trachoma
Which species of chlamydia almost exclusively targets humans?
C. trachomatis
What are the agents of classic trachoma (4)?
C. trachomatis serotype A, B, Ba, C
What are the agents of inclusion conjunctivitis (7)?
C. trachomatis serotype D-K
What are serotypes L1. L2, and L3 responsible for (C. trachomatis) and what do they cause?
They infect tissues deeper to the epithelium and cause lymphogranuloma venereum
How is adult inclusion conjunctivitis typically transmitted and in which population are they most common?
Transmitted by infected genital secretions ( ͡° ͜ʖ ͡°)
Most common in young sexually active adults
Is ault inclusion conjunctivitis uni- or bilateral?
Can be either, but usually unilateral
How long does adult inclusion conjunctivitis typically last?
Many months
What is adult inclusion conjunctivitis associated with in women (3)?
Urethritis
Vaginitis
Cervicitis
Are chlamydial STDs typically symptomatic or asymptomatic?
High percentage asymptomatic
What kind of discharge is present in adult inclusion conjunctivitis (2)? what sensation is felt?
Mucopurulent (or watery)
Gritty FB sensation
Are follicles or papillae present with adult inclusion conjunctivitis? Particularly in which area?
Follicles, particularly in the upper tarsal conjunctiva - limbal follicles also possible
Is preauricular/submandibular lymphadenopathy common or rare with adult inclusion conjunctivitis?
Common
What can be seen in chronic prolonged cases of adult inclusion conjunctivitis (2)?
Marginal subepithelialcorneal infiltrate and superior pannus
List three differential diagnoses for adult inclusion conjunctivitis.
Adenoviral keratoconjunctivitis
Herpes simplex keratitis
Trachoma
What is the treatment option for adult inclusion conjunctivitis? What is recommended if chlamydia is confirmed?
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
What antibiotic courses can be given for a chlamydial infection (name, dose and duration)?
Azithromycin 1g PO or
Erthromycin 250mg q.i.d for 2-6 weeks
What is a common risk factor for trachoma and what is it transmitted by?
Result of poor hygiene
Transmitted by the common fly
What disease is one of the leading causes of preventable blindness?
Trachoma
In what regions is trachoma most common?
Africa India Middle East Asia South America Aboriginal communities in northern and northwestern Australia
Is trachoma usually uni- or bilateral?
Often unilateral initially
What kind of discharge is present with trachoma? What sensation is felt?
Mucopurulent
Gritty FB sensation
What can tracoma lead to, and what is a consequence of this?
Can lead to scarring, which can lead to trichiasis
What is the main sign of trachoma?
Superior bulbar and palpebral conjunctival follicular response
What does chronic inflammation over many years (or quicker) eventually lead to (5)?
Conjunctival scarring -> trichiasis -> ocular surface irritation -> corneal opacities -> vision loss
What are herbert’s pits and in what disease can they be found?
Scarring of limbal follicles in trachoma
What 5 aspects of a trachoma case are graded and under what kind of scale?
TF - trachomatous inflammation: follicular TI - trachomatous inflammation: intense TS - trachomatous scarring TT - trachomatous trichiasis CO - corneal opacity 0-3 scale
List 4 differential diagnoses for trachoma.
Adult inclusion conjunctivitis
Other causes of conjunctival cicatrisation
Other causes of recurrent conjunctivitis
Other causes of superior corneal pannus
What is the tratment option for trachoma (3)?
Refer for lab tests and surgery
Inactivate scarring using lubricants
Advise on prevention by improving hygiene and fly reduction programs
Define the possible components of anterior blepharitis (2).
One or a combination of:
- staphylococcal anterior blepharitis
- seborrhoeic anterior blepharitis
What is posterior blepharitis?
Meibomian gland dysfunction
Is anterior blepharitis common or rare?
Common
What part of the lid margin is inflammed in anterior blepharitis?
Anterior to the meibomian glands and includes the lashes
Is anterior blepharitis usually uni- or bilateral? Is the onset symmetrical? Is it acute or chronic?
Usually bilateral, symmetrical, and cronic
What does anterior belpharitis occur in conjunction with?
Seborrhoeic dermatitis
What happens to the skin with seborrhoeic dermatitis? What does this promote?
Skin and lid margins become scaly and oily
Promotes excess growth of staph. colonies
List three symptoms of anterior blepharitis.
Ocular surface burning FB sensation
Sticky crusting along the lid margins
Mild photophobia
Can removl of lid crusting in anterior blepharitis cause bleeding or do they just fall off?
Can cause bleeding
What is the tear flims like in anterior blepharitis?
Poor
List three signs of anterior blepharitis.
Redness
Telangiectasia
Thickening of the anterior lid margin
What 5 things may be observed in long-standing cases of anterior blepharitis?
Mild, chronic papillary conjunctivitis Trachiasis Recurrent bacterial conjunctivitis External/internal hordeola Lid/lash base ulceration Bacterial keratitis
Define madarosis.
Lash loss
Define poliosis.
Lash pigment loss
List 5 differential diagnoses for anterior blepharitis.
Posterior blepharitis
Basal, squamous, or sebaceous cell carcinoma
Dry eye
List the four components of an anterior blepharitis workup.
Careful symptomatology
Slit lamp with fluorescein
Tear work up
Skin assessment
What is the main treatment option for anterior blepharitis? List 3 additional options.
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
Is posterior blepharitis common?
Yes
Is posterior uni- or bilateral? Is onset symmetrical?
Bilateral and symmetrical
How does posterior blepharitis affect the tear film?
Results in a poor/unstable tear film
List 4 symptoms of posterior blepharitis.
Gritty/burning sensation
Crusting/redness on the lid margin
Symptoms worse in dry/air-conditioned environment
Photophobia (if corneal involvement - SPK)
List three signs of posterior blepharitis.
Posterior lid margin thickened
Telangiectasia
PEE/SPK due to corneal irritation
What are the seborrhoeic characteristics of posterior blepharitis and what do they result in?
Excess secretions appear as oil droplets capping meibomian glands
Creates oily or foaming tear film
A high proportion of individuals with posterior blepharitis have what two diseases?
Acne rosacea or seborrhoeic dermatitis
List 6 differential diagnoses for posterior blepharitis.
Anterior blepharitis
Posterior blepharitis
Basal, squamous, or sebaceous cell carcinoma
Dry eye
List the five components of an posterior blepharitis workup.
Careful symptomatology Slit lamp with fluorescein Tear work up Skin assessment Gland expression
What are the main treatment options for posterior blepharitis (2)? List 3 additional options.
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
How does intense pulse light work and what is it used for? How often is it used?
Good for blocked meibomian glands
Acts like a heat lamp, melts secretions and opens glands
Three or four treatments over several months
Are demodex infestations a sign of poor hygiene?
Not necessarily
What is used to kill demodex? Is it toxic to the cornea/conjunctiva? How should it be applied and how often?
TTO but is toxic
Weekly application of 50% TTO
Is acne rocasea common or rare?
Common
What is the cause of acne rocasea?
Unknown
What is classic of acne rocasea?
Butterfly rash across the nose and cheeks
List three signs of acne rocasea (aside from its characteristic sign).
Mild erythema with telangiectasia to nodular eruptions of cheeks and nose
Does acne rocasea affect males or females more? What age group is it more common in?
Males > females, most commonly 30-40 years
What two foods can exacerbate acne rocasea?
Alcohol and spicy food
What may acne rosacea result in (2)?
Pustules and scarring
In what percent of cases of acne rocasea is there ocular involvement?
5-10%
List 5 symptoms of ocular rocasea.
Red eye Recurrent styles and chalazia Burning/gritty sensation Photophobia Facial flush
List 5 signs of ocular rocasea.
Blepharitis (posterior) Telangiectasis of the lid margin Conjunctivitis Chalazion/internal hordeolum Keratitis
What three things can ocular rocasea rarely cause?
Corneal scarring
Corneal neovascularisation
Corneal thinning/perforation
List three differential diagnoses for ocular rocasea.
Blepharitis without rosacea
Other forms of non-infective conjunctivitis
Keratitis
List 5 treatment options for ocular rosacea.
Topical antibiotic Oral tetracycline/macrolide (mainstay) Lid therapy as for anterior/posterior blepharitis Tear supplements Mild topical steroids
