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Anterior Segment > Block 15: Lectures 1-3 > Flashcards

Block 15: Lectures 1-3 Flashcards

1
Q

Which type of herpes simplex virus commonly involves the eye?

A

Type 1

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2
Q

When does primary infection of HSV typically occur?

A

childhood

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3
Q

Is treatment more likely to be indicated in primary or secondary infection of HSV?

A

secondary

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4
Q

Where does the latent herpes simplex virus reside?

A

sensory ganglion for the dermatome that was infected by primary infection

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5
Q

What are 4 possible causes for reactivation of HSV?

A

Fever, hormonal change, UV radiation, trauma

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6
Q

For a patient who has had a large number of previous recurrent attacks of HSV, does their chance of future recurrences increase or decrease?

A

Increase

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7
Q

Which stage of HSV (primary or secondary) does the virus replicate?

A

Secondary

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8
Q

What portion of the corneal ulcer does Rose Bengal stain in HSV Epithelial Keratitis?

A

Virus-laden cells at margin of ulcer

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9
Q

What portion of the corneal ulcer does Fluorescein stain in HSV Epithelial Keratitis?

A

Bed of dendritic ulcer

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10
Q

Is corneal sensation increased or decreased in HSV Epithelial Keratitis?

A

Decreased

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11
Q

What specific affect may steroids have on an ulcer in HSV Epithelial Keratitis?

A

Ulcer to enlarge to geographical or amoeboid appearance

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12
Q

Does HSV Epithelial Keratitis occur with “active” or “inactive” viral replication of HSV?

A

Active

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13
Q

A corneal ulcer caused by HSV Epithelial Keratitis heals w/o treatment, what may result?

A

Increased scarring and vascularization

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14
Q

What is the most common treatment given for HSV Epithelial Keratitis?

A

Acyclovir ointment or ganciclovir gel 5x/day (anti-virals)

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15
Q

What are two alternatives for treating HSV Epithelial Keratitis if the patient does not respond to topical anti-virals?

A
  1. Debridement of ulcer

2. Oral anti-virals

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16
Q

What type of IOP-lowering medications should be avoided in HSV Epithelial Keratitis?

A

Prostaglandin derivatives

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17
Q

How long does it typically take for corneal ulcers to heal with anti-viral treatment in HSV Epithelial Keratitis?

A

99% heal within 2 weeks

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18
Q

What often lingers for weeks after the ulcer heals in HSV Epithelial Keratitis?

A

Sub epithelial haze

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19
Q

What can eventually threaten vision in HSV Epithelial Keratitis?

A

Persistent sub epithelial haze in recurrent cases

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20
Q

What type of medication (general) should be avoided in HSV Epithelial Keratitis?

A

Steroids

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21
Q

What is the most common cause of infectious corneal blindness in developed countries

A

Herpetic eye disease

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22
Q

What should be performed or considered on any unilateral red eye?

A

Corneal sensitivity test

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23
Q

What step of secondary infection/reactivation of HSV is Epithelial Keratitis associated with?

A

Active viral replication

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24
Q

What does the presence of HSV Stromal Keratitis indicate? 2 answers.

A
  1. Immune-Mediated response to the reactivation of HSV

2. Active viral replication within stroma

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25
Q

Diffuse or focal infiltration of stroma without a dendritic ulcer is a common sign of what?

A

HSV Stromal Keratitis

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26
Q

What is a common treatment regimen for HSV Stromal Keratitis?

A

Topical steroids + oral antiviral

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27
Q

List three potential signs seen in progressed HSV Stromal Keratitis?

A
  1. Scarring (opacification)
  2. Thinning
  3. Vascularization
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28
Q

A frequent form of recurrent HSV keratitis that is thought to be an immune reaction is known as ________?

A

Disciform endothelitis

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29
Q

Which form of Keratitis presents with a complaint of “haloes around lights?”

A

Disciform endothelitis

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30
Q

How can visual loss usually be reversed in Disciform Endothelitis?

A

Steroid drops

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31
Q

What sign is present before a dendritic ulcer in HSV Epithelial Keratitis?

A

Swollen and opaque epithelial cells arranged in punctate or stellate pattern

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32
Q

What is commonly used as initial treatment in Disciform Endothelitis?

A

Steroid drops + antiviral

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33
Q

What is thought to be the cause of Neurotrophic Keratopathy?

A

Persistent non-healing corneal epithelial defects due to damaged nerves and reduced corneal sensation (hypesthesia or complete anesthesia) in HSV Keratitis.

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34
Q

What would make oval defects in neurotrophic keratopathy worse?

A

Antiviral drops

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35
Q

Uveitis associated with HSV mandates a thorough funduscopic exam to exclude _______?

A

Acute retinal necrosis

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36
Q

What are 2 potential cause of an acute elevation in IOP in Iridocyclitis?

A
  1. Acute trabeculitis

2. Steroid-induced

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37
Q

How is an acute rise in IOP due to acute trabeculitis in Iridocyclitis treated?

A

Steroids and often antivirals

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38
Q

What can cut recurrence rate of HSV epithelial and stromal keratitis in half?

A

400 mg oral acyclovir bid taken for years prophylactically

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39
Q

When is prophylaxis treatment indicated in HSV keratitis?

A

Frequent, severe recurrences in monocular patients

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40
Q

What type of secondary infections (general) most often complicate HSV Keratitis?

A

bacterial

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41
Q

What are 2 risks associated with keratoplasty in HSV Keratitis?

A
  1. Rejection of the corneal graft is common

2. Recurrence of herpetic eye disease common

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42
Q

What is Hutchinson Sign and what does it signify?

A

Shingles involving skin supplied by external nasal nerve - tip, side, and root of nose.

Significance: Correlates strongly with ocular involvement

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43
Q

What nerve is most often affected in Herpes Zoster Ophthalmicus?

A

Ophthalmic division (V1) of trigeminal nerve (CN5)

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44
Q

A 3-5 day phase of tiredness, fever, malaise and headache followed by a unilateral painful rash is most likely ____?

A

Herpes Zoster Virus (Shingles)

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45
Q

What virus causes shingles?

A

Reactivation of varicella-zoster virus

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46
Q

What can protect against the development of shingles?

A

Re-esposure to VZV via contact with chickenpox or vaccination to reinforce immunity

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47
Q

If clinical observations in a patient with shingles are not clear, how can a diagnosis be determined?

A

Vesicular fluid sample sent for PCR

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48
Q

What is the best treatment option for most cases of Shingles?

A

Oral antivirals - 800 mg acyclovir 5x/day for 5-7 days

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49
Q

What is the best window of time to start treatment of shingles?

A

Within 72 hours

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50
Q

Who should a person infected with Shingles avoid?

Why?

A
  1. Pregnant women
  2. Immunodeficient individuals

Shingles is contagious and can spread chickenpox

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51
Q

A dendritic epithelial ulcer in herpes zoster ophthalmicus signifies what stage of the disease?

A

Early/Middle - occurs soon after rash

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52
Q

Only about 5% of patients infected with herpes zoster ophthalmicus develop ______ weeks after rash?

A

Stromal (interstitial) keratitis

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53
Q

What may be a cause of elevated IOP in Herpes Zoster Ophthalmicus?

A

Anterior uveitis

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54
Q

List 4 possible complications of Herpes Zoster Ophthalmicus?

A
  1. Neurotrophic keratitis
  2. Scleritis
  3. Lid scarring
  4. Post-herpetic neuralgia
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55
Q

What is post-herpetic neuralgia?

A

Pain more than a month after shingles rash heals

56
Q

Which form of Acanthamoeba Keratitis is highly resilient?

A

Cystic form

57
Q

What is a common association with Acanthamoeba Keratitis in USA?

A

Contact lenses rinsed with tap water

58
Q

What form of Acanhamoeba Keratitis can cause tissue penetration/destruction?

A

Cysts that have turned into trophozoites

59
Q

Perineural infiltrates or “Radial Keratoneuritis” is essentially pathognomonic for ______?

A

Acanthamoeba Keratitis

60
Q

Blurry vision and discomfort/pain that is more significant than the clinical signs may represent _______?

A

Acanthamoeba Keratitis

61
Q

What stage might corneal melting occur in Acanthamoeba Keratitis?

A

Any stage

62
Q

What are early stages of Acanthamoeba Keratitis often mistaken for?

A

Herpes simplex keratitis

63
Q

What corneal infection should be considered any time there is limited response to antibiotics?

A

Acanthamoeba Keratitis

64
Q

What can be done to facilitate penetration of drops to treat Acanthamoeba Keratitis?

A

Debridement of epithelium

65
Q

How often are topical amoebicides administered when treating Acanthamoeba Keratitis?

A

Initially hourly and then gradually decreased and continued for months

66
Q

How are Acanthamoeba cases involving either late scarring, perforation, or drug-resistant managed?

A

Penetrating keratoplasty

67
Q

How is pain controlled in Acanthamoeba keratitis?

A

Oral NSAID

68
Q

In Onchocerciasis, what is necessary within the adult worm for the production of microfilariae?

A

Wolbachia

69
Q

What is the role or microfilariea in an individual infected with Onchocerciasis?

A

Microfilariae produce an intense inflammatory reaction

70
Q

Snowflake opacities with infiltrates surrounding dead microfilariae might suggest what corneal infection?

A

Onchocerciasis (river blindness)

71
Q

What population is most affected by Onchocerciasis?

A

Africa - especially severe in savanna regions

72
Q

Which layer of the cornea are initial lesions most commonly found in Onchocerciasis?

A

Anterior 1/3 of stroma at 3:00 and 9:00

73
Q

What affect on the pupil could posterior synechiae due to Onchocerciasis have?

A

Pear-shaped pupillary dilation

74
Q

What annual vaccine is given in areas where Onchocerciasis is endemic to kill the microfilariea and reduce spread of the disease?

A

Ivermectin

75
Q

What medication can be given to target Wolbachia in Onchocerciasis?

A

Doxycycline

76
Q

How is anterior uveitis treated in Onchocerciasis?

A

Steroids

77
Q

What causes marginal keratitis?

A

Hypersensitivity reaction to staphylococcal exotoxins and cell wall proteins that causes a lymphocytic infiltration (not infectious)

78
Q

How is the region between peripheral corneal infiltrates and conjunctival hyperemia described in Marginal Keratitis?

A

“Clear zone”

79
Q

In what way/pattern do infiltrates tend to spread in marginal keratitis?

A

Multiple coalesce/enlarge and spread circumferentially

80
Q

How is the discomfort/pain described most often in marginal keratitis?

A

Mild

81
Q

In addition to the corneal involvement in Marginal Keratitis, what associated feature must always be treated if present?

A

Blepharitis

82
Q

What effect/sign can occasionally be seen after resolution of marginal keratitis?

A

Residual superficial scarring/pannus (vascularization)

83
Q

What is the name of a nodular inflammation of the cornea due to hypersensitivity reaction to a foreign antigen?

A

Phlyctenular Keratitis

84
Q

Which age group primarily shows the common symptoms in Phlyctenular Keratitis?

A

6 months to 16 years old

85
Q

Where is the nodule typically located in Phlyctenular Keratitis?

A

Limbus

86
Q

What non-corneal feature is commonly associated with Phlyctenular Keratitis?

A

Intense local conjunctival hyperemia

87
Q

What are 2 common systemic associations with Phlyctenular Keratitis in under-developed countries?

A
  1. TB

2. Helminthic infestation

88
Q

What can a nodule in Phlyctenular Keratitis lead to?

A

Ulceration

89
Q

After spontaneous healing of the nodule in Phlyctenular Keratitis, what can often be expected?

A

Scar, superficial vascularization, and thinning

90
Q

What can be prescribed to speed healing and decrease the inflammatory response in Phlyctenular Keratitis?

A

Topical steroids with or without topical antibiotic

91
Q

How can the source of antigens be decreased in Phlyctenular Keratitis?

A

Treat blepharitis or underlying infection

92
Q

What defect is suspected as part of the multifactorial cause of Rosacea?

A

Defects in the body’s immune response to common skin and GI pathogens and abnormal vasoregulatory processes

93
Q

What feature can distinguish Rosacea from Acne?

A

Comedones (blackheads or whiteheads) are absent in Rosacea

94
Q

Where are punctate epithelial erosions often located in Ocular Rosacea?

A

Inferiorly

95
Q

What are 2 common signs of Ocular Rosacea affecting eyelids?

A
  • Marginal telangiectasia

- Meibomian gland dysfunction

96
Q

What is typically used as a first step in treating mild signs of Ocular Rosacea?

A

Lid hygiene and preservative-free artificial tears

97
Q

What can be prescribed to improve meibomian gland secretions by decreasing bacterial lipase and also protect cornea from perforation by inhibiting collagenase?

A

Oral tetracyclines given at lower dose than used to achieve antibiotic effect

98
Q

If lid hygiene and artificial tears are not sufficient to manage Ocular Rosacea symptoms, what might the next step be?

A

Anti-inflammatory medications - Oral tetracyclines most common and effective

99
Q

What is the goal in management/treatment of Rosacea?

A

Managing symptoms and avoiding flare triggers since there is no cure

100
Q

What is the name of a focal autoimmune disorder isolated to the eye?

A

Mooren’s Ulcer

101
Q

Mooren’s Ulcer can be seen in both elderly and younger individuals, but the form of the disorder varies between the two. Which form may affect both eyes and is more aggressive?

A

Form that affects younger individuals

102
Q

What is a distinguishing ocular sign between Mooren’s Ulcer and Peripheral Ulcerative Keratitis with Systemic Autoimmune Disease?

A

Scleritis is not present in Mooren’s Ulcer, but can be present in PUK

103
Q

How may Mooren’s Ulcer be initially treated?

A

Frequent topical steroids (hourly)

104
Q

Where is the ulceration typically located in Mooren’s Ulcer?

A

Peripheral stromal and progresses circumferentially, sometimes towards center

105
Q

In Peripheral Ulcerative Keratitis associated with systemic autoimmune disease present ocular signs/symptoms before or after the systemic autoimmune symptoms have appeared?

A

PUK can present before or after systemic autoimmune symptoms

106
Q

A crescent shaped destructive lesion (ulceration) located at the juxtalimbal corneal stroma, usually with neighboring scleritis is most likely ______?

A

Peripheral Ulcerative Keratitis with associated systemic disease.

107
Q

Which associated systemic disease is most commonly seen in Peripheral Ulcerative Keratitis?

A 
#1 Rheumatoid arthritis
#2 Wegener's Granulomatosis
108
Q

What type of treatment is often needed to control ocular inflammation in Peripheral Ulcerative Keratitis with associated systemic disease?

A

Systemic immunosuppression from rheumatologist

109
Q

What other disease may look clinically similar to Terrien’s Marginal Degeneration?

A

Corneal Arcus (Arcus Senilis)

110
Q

Non-inflammatory peripheral thinning of cornea due to degeneration that results in a peripheral gutter

A

Terrier’s Marginal Degeneration

111
Q

What are 3 features of Terrien’s Marginal Degeneration that can help differentiate it from other corneal thinning disorders?

A
  1. Lack of both inflammation and epithelial defect
  2. Slow progressive course
  3. Linear deposition of lipid
112
Q

What type of treatment is most often needed for Terrien’s Marginal Degeneration?

A

Most often no treatment required

113
Q

What is it called when there is loss of trigeminal innervation to the cornea with epithelial breakdown and persistent ulceration, resulting in partial or complete anesthesia?

A

Neurotrophic Keratopathy

114
Q

Thickened and rolled edges around defects on cornea in Neurotrophic Keratopathy probably resemble what?

A

Non-healing epithelial defects

115
Q

Why does progressive stromal melting have minimal discomfort in Neurotrophic Keratopathy?

A

Due to loss of trigeminal innervation to cornea

116
Q

What should be discontinued, if possible, when attempting to treat Neurotrophic Keratopathy?

A

All eye drops, except preservative-free artificial tears

117
Q

What kind of medication could be prescribed to an individual with Neurotrophic Keratopathy and a high concern for perforation?

A

Anti-Collagenase medication

118
Q

What can result from lagophthalmos with drying of cornea, despite normal tear production?

A

Exposure Keratopathy

119
Q

Where are punctate epithelial changes most commonly seen in Exposure Keratopathy?

A

Inferior 1/3 of cornea

120
Q

If Exposure Keratopathy is not severe and is reversible, what are 3 treatment options?

A
  1. Lubricants
  2. Lid taping
  3. Bandage contact lens
121
Q

Bilateral disorder with episodic (on/off) appearance of corneal epithelial opacities causing irritation and blur is known as _______?

A

Thygeson’s SPK

122
Q

How frequent are steroids used for when managing Thygeson’s SPK?

A

Low potency twice a day initially. Then tapered to as few as once every 1-2 weeks.

123
Q

Weak attachments between basal cells of corneal epithelium and its basement membrane can cause what syndrome?

A

Recurrent corneal erosion syndrome

124
Q

When is Recurrent Corneal Erosion Syndrome unilateral vs bilateral?

A

Unilateral: when associated with prior trauma

bilateral: when associated with corneal dystrophies

125
Q

Why may epithelial defects not be seen on a slit lamp exam in an individual with Recurrent Corneal Erosion Syndrome?

A

Quick healing rate of epithelium

126
Q

What are 2 basement membrane disturbances that may be seen in Recurrent Corneal Erosion Syndrome?

A

Microcysts and swirls

127
Q

What treatment regimen has been shown to reduce the frequency of Recurrent Corneal Erosions?

A

50 mg Doxycycline twice a day + topical corticosteroid (Prednisolone acetate) 2-3 times per day for three weeks

128
Q

What 3 procedures may be considered for frequent recurrent cases or corneal erosion syndrome?

A
  1. Anterior stromal puncture
  2. Diamond bur polishing
  3. Phototherapeutic keratectomy
129
Q

What condition describes strands of mucus and cellular debris attached to the epithelial surface?

A

Filamentary Keratopathy

130
Q

What can be given in Filamentary Keratopathy to break up mucus strands on the eye and reduce their formation?

A

Acetylcysteine drops

131
Q

What is deficient in Xerophthalmia?

A

Vitamin A

132
Q

Nearly 50% of world’s population with Vitamin A deficiency and Xerophthalmia are from where?

A

South and Southeast Asia

133
Q

What role does Vitamin A play in the eye?

A

Maintains the integrity and proliferation of epithelium of conjunctiva and cornea

134
Q

What photoreceptor protein is vitamin A a precursor to?

A

Rhodopsin

135
Q

Which is more sensitive to deficient Vitamin A, rods or cones?

A

Rods - affecting night time vision first

136
Q

How is Xerophthalmia treated systemically?

A

Oral or injected Vitamin A supplementation

137
Q

How are the ocular components of Xerophthalmia treated?

A

Intense lubrication

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