Blepharitis & dry eye disease

Question 1

Classification of blepharitis

Answer 1

º Posterior blepharitis affects the meibomian glands.
º Anterior blepharitis affects the eyelid skin and the base of the eyelashes. Staphylococcal and seborrheic blepharitis can each be referred to as anterior Blepharitis.

Question 2

What’s the most common cause of evaporative dry eye disease?

Answer 2

Blepharitis

Question 3

What medications are related to an increase in DGM and blepharitis?

Answer 3

• Isotretinoin
  *Dupilumab

Question 4

What is the pattern of worsening symptoms in patients with blepharitis and dry eye?

Answer 4

• Worsening in the morning typical of blepharitis.
• Worsening later in the day, typical of aqueous deficiency dry eye.

Question 5

What are the clinical clasification of DED?

Answer 5

Dry eye can be divided into 2 major categories: aqueous tear deficiency (ATD) and evaporative
dry eye. Patients may have elements of both conditions.

Question 6

What are the mechanisms behind evaporative dry eye disease?

Answer 6

The primary abnormality in patients with evaporative dry eye is meibomian gland dysfunction (MGD). This leads to tear film instability, evaporation, and hyperosmolarity, initiating the inflammatory cycle.

Question 7

What are the Sjogren syndrome autoantibodies?

Answer 7

Autoantibodies
a. Antibodies to ro/SS- A antigens
b. Antibodies to La/SS- B antigens

Question 8

What’s the differential diagnosis in cases of chronic unilateral conjunctivitis?

Answer 8

Giant fornix syndrome
and mucus fishing syndrome could be included in the differential diagnosis
of chronic unilateral mucopurulent conjunctivitis, as could Chlamydial
conjunctivitis. Tumors (eg, sebaceous cell carcinoma) can masquerade as
unilateral conjunctivitis. Finally, molluscum contagiosum can cause unilateral
follicular conjunctivitis.

Question 9

What are the clinical manifestations of staphylococcal blepharoconjunctivitis?

Answer 9

Punctate epithelial keratopathy, marginal infiltrates, or phlyctenulosis.

Question 10

What are the etiologies associated with phlyctenulosis?

Answer 10

Phlyctenulosis is most frequently
associated with S aureus but can also be associated with Mycobacterium tuberculosis infection
affecting malnourished individuals in tuberculosis-endemic areas of the world.

Question 11

What agents can cause membranous conjunctivitis?

Answer 11

Severe conjunctivitis (Adenoviral), N. gonorrheae, Streptococcus Pyogenes.

Question 12

What’s the most common cause of viral conjunctivitis?

Answer 12

Adenovirus

Question 13

What diseases and serotypes are caused by Chlamydia trachomatis?

Answer 13

1. Trachoma: Serotypes A-C.
2. Adult inclusion conjunctivitis: Serotypes D-K.
3. Chlamydial ophthalmia neonatorumm: Serotypes D-K.

Question 14

What’s the most common cause of congenital conjunctivitis?

Answer 14

Chlamydia

Question 15

What’s the most common cause of preventable blindness in the world?

Answer 15

Trachoma

Question 16

What’s the Art’s line?

Answer 16

Arlt’s line is a characteristic finding of trachoma. Thick band of scar tissue in the conjunctiva of the eye, near the lid margin.

Question 17

What’s the Herbert pits?

Answer 17

Regression of the follicles leads to depressed, round thinned areas known clinically as Herbert’s pits at the limbus, are pathognomonic cicatrial scars.

Question 18

Grades os Trachoma according to the WHO?

Answer 18

º TF: Trachomatous folicular inflamation.
º TI: Trachomatous intense inflamation.
º TS: Trachomatous scaring.
º TT: Trachomatous trichiasis
º CO: Corneal opacity

Question 19

Management of trachoma according to the WHO?

Answer 19

The SAFE strategy:
S:urgery
A:ntibiotics
F:acial cleanliness
E:nviromental improvement

Question 20

Etiology of adult inclusion conjunctivitis?

Answer 20

C. Trahomatis serotypes D-K

Question 21

Treatment of adult inclusion conjunctivitis?

Answer 21

The treatment is systemic with 1gr azithromycin single dose + azithromycin ointment.

Question 22

Etiological causes of bacterial conjunctivitis?

Answer 22

S. Aureus, S. neumoniae and H. influenzae.

Question 23

What microorganisms can penetrate a healthy cornea?

Answer 23

Neisseria gonorrhoeae
Corynebacterium diphtheriae
Hemophilus aegyptius
Listeria
Shigella
* Pseudomonas aurigenosa CAN NOT penetrate a healthy cornea.

Question 24

What characteristics in a pterigium can make you suspicious of malignancy?

Answer 24

Calcifications, leukoplakia, atypical cal elevation, irregular feeder
vessels, and rapid growth are not typical of pterygia and may alert the clinician to the possibility of a malignancy.

Question 25

What is the stocker line?

Answer 25

The Stocker line is iron deposition at the head of the pterygium

Question 26

What are Hassall- Henle bodies?

Answer 26

With increasing age, occasional peripheral endothelial guttae, sometimes known as Hassall- Henle bodies, may form

Question 27

Whats a fleischer ring?

Answer 27

A Fleischer ring, or iron deposition in the basal epithelial cells of a cone in the eyes with keratoconus, becomes narrower and more prominent as the disease progresses. * Not to be confused with Kayser–Fleischer ring. Copper deposits cause Kayser-Fleischer rings in descemet's membrane of cornea, and are indicative of Wilson's disease, whereas Fleischer rings are caused by iron deposits in basal epithelial cells.

Question 28

Calcific band keratopathy involves mainly what layer?

Answer 28

Involves mainly Bowman's membrane layer.

Question 29

What is Salzmann nodular degeneration?

Answer 29

Is an idiopathic noninflammatory corneal condition that can be bilateral and is typically seen in middle-aged and older women. The subepithelial elevated nodules are gray- white or blue- white and often present in a roughly circular configuration involving the central or paracentral cornea.

Question 30

What do we need to suspect in a patient with a senile arcus less than 40?

Answer 30

In patients younger than 40 years, the presence of arcus may be indicative of a hyperlipoproteinemia with elevated serum cholesterol. An appropriate workup or referral is advised.

Question 31

What is Crocodile shagreen, or mosaic degeneration?

Answer 31

is a bilateral corneal opacity with a characteristic mosaic pattern reminiscent of a crocodile’s back, patients are often asymptomatic.

Question 32

Mention the main characteristics of Polymorphic amyloid degeneration?

Answer 32

* Is a bilateral, symmetric, primarily central, and slowly progressive corneal degeneration that appears later in life and is characterized by amyloid deposition. * Found primarily in the mid- to deep stroma. * Vision is usually minimally affected. * Recurrent erosions do not occur * Cataract surgery can be performed without added risk.

Question 33

What is Furrow degeneration?

Answer 33

Is characterized by corneal arcus associated with peripheral thinning within the lucid interval. * The corneal epithelium remains intact. * There is no associated inflammation, vascularization, or potential for perforation. * Vision is rarely affected * No treatment is required.

Question 34

What is Terrien marginal degeneration?

Answer 34

Is a noninflammatory, slowly progressive thinning disorder of the peripheral cornea. It is usually bilateral but can be asymmetric. * Spontaneous perforation is rare, although it can occur with minor trauma. * Lipid typically deposits at the central edge of the vascular pannus. * The corneal epithelium remains intact. * Patients often are asymptomatic until bothered by induced astigmatism.

Question 35

Differential diagnosis of the terien marginal degeneration?

Answer 35

TMD may be confused with peripheral ulcerative keratitis (PUK); however, in the latter, the epithelium typically is not intact and there is no lipid deposition. This distinction is important because PUK is often associated with an underlying systemic disease, and TMD is not.