Clinical Approach to Ocular Surface Disorders Flashcards
Differential diagnosis for acute follicular conjunctivitis?
“Adeno hardly happens to careful nuns”
Adenovirus, HSV, hemorrhagic (coxsackievirus), Chlamydia, Newcastle’s (from chickens)
Differential diagnosis for chronic follicular conjunctivitis?
“Passing tough tests mostly means late cramming”
Parinaud’s (Bartonella and others), Trachoma, toxic (most common, esp from glaucoma gtts), Moraxella, Molluscum, Lyme, Chlamydia
What are papillae made of?
Dilated vessels surrounded by edema and a mixed inflammatory infiltrate and anchored down by fibrous septa
enlarged, non-inflammed follicles in inferotemporal and forniceal conj in asymptomatic children and adolescents?
benign lymphoid folliculosis
what are follicles comprised of?
lymphocytes
what cells comprise mutton-fat KP?
macrophages
name 4 common classes of systemic drugs which can cause with dry eyes?
beta-blockers, anticholinergics, antihistamines, diuretics
What is a normal tear meniscus height? What is considered pathologic?
1.0 mm; <0.3 mm
how long does it take for cyclosporine to work for aqueous tear deficiency? what percentage of patients with moderate to severe ATD benefit from this drug?
2-3 months. 50%
how should patients be instructed to take oral doxycycline?
without dairy products
what are common side effects of systemic tetracyclines?
GI upset and photosensitivity
what is the effect of punctal occlusion on MGD?
worsens MGD
what are the findings in ocular rosacea?
excessive sebum secretion, chronic blepharitis, recurrent chalazia, eyelid margin telangiectasias, chronic conjunctivitis, marginal corneal infiltrates, ulcerative keratitis, corneal neovascularization
mainstay of treatment of ocular rosacea?
systemic tetracyclines
anterior eyelid inflammation with crusting/scaling of anterior eyelid skin with greasy consistency? primary treatment?
seborrheic blepharitis; eyelid hygiene (lid scrubs, warm compresses if a/w MGD)
hard, brittle, fibrinous eyelid scales, matted eyelid crusting, varying degrees of madarosis, poliosis, trichiasis: diagnosis and treatment?
staphylococcal blepharitis; eyelid hygiene +/- topical bacitracin, erythromycin, azithromycin, +/- topical steroids
crusting and ulceration of lateral canthal eyelid skin?
Moraxella angular blepharoconjunctivitis
unilateral limbal nodular inflammation accompanied with engorged conjunctival vessels: diagnosis? immunology? causes in developed v. underdeveloped areas? treatment?
phlyctenule; type IV hypersensitivity reaction; S aureus; M tuberculosis; topical steroids
multiple marginal corneal infiltratres with clear intervening space between limbus?
staphylococcal marginal hypersensitivity reaction
difference between internal v external hordeola?
External: occur on anterior eyelid in gland of Zeis; Internal: posterior eyelid in meibomian gland.
difference between hordeolum and chalazion? treatment?
- Hordeolulm: infectious abcess of gland of Zeis or meibomian gland.
- Chalazion: chronic lipogranulomatous inflammation of meibomian gland or gland of Zeis
- conservative treatment with warm compresses for both. intralesional steroid or incision and drainage for chronic, persistent chalazion
systemic problems associated with floppy eyelid syndrome? ocular findings in addition to floppy eyelid?
obesity and sleep apnea. papillary conjunctivitis, keratoconus
what labs would you order in somebody diagnosed with superior limbic keratoconjunctivitis?
TSH and free T4
treatment of SLK?
topical anti-inflammatories, BCL, amniotic membrane graft, serum tears, thermocauterization or surgical resection of superior bulbar conj
what enzyme is upregulated in recurrent corneal erosion syndrome?
gelatinase (MMP-2 and MMP-9)
treatment for recurrent corneal erosion?
antibiotic ointments for acute phase; then topical steroids, doxycycline, BCL, anterior stromal micropuncture, epithelial debridement, PRK
topical drops associated with neurotrophic keratopathy?
anesthetics, NSAIDs, trifluridine, beta blockers, CAIs
trichiasis v distichiasis?
trichiasis is lash from normal location on eyelid margin oriented posteriorly with risk of corneal contact. distichiasis is a lash originating from an abnormal location such as a Meibomian gland orifice
well circumscribed pattern of lissamine green or rose bengal staining on inferior and inferior bulbar conj?
mucous fishing syndrome
what percentage of limbal stem cells are needed for normal ocular resurfacing?
25-33%
wavelike irregularity of the corneal surface emanating from the limbus seen with fluorescein staining?
limbal stem cell deficiency
primary and secondary causes of limbal stem cell deficiency?
primary: aniridia, sclerocornea, MEN syndrome, KID (keratitis-icthyosis-deafness syndrome), xeroderma pigmentosa, ectodermal dysplasia
secondary: chemical or thermal burn, Stevens-Johnson, MMP, ocular surgery or radiation, contact lens use, mitomycin C, conjunctival neoplasia, pterygium, herpes, trachoma
mechanism of aqueous tear deficiency in Sjogren syndrome?
T-cell mediated autoimmune destruction of lacrimal glands
lab tests used to diagnose Sjogrens?
anti-Ro (SS-A) or anti-La (SS-B) antibodies
prominent systemic finding in ichthyosis? treatment of corneal degeneration in ichthyosis?
diffuse skin scaling. lubrication. topical steroids are not helpful
heredity and genetics of xeroderma pigmentosum? ocular findings?
AR. defect in DNA repair, especially from UV-induced damage. basal, squamous (most common), or melanotic cancers of conj or eyelids, dry and inflamed conjunctiva, corneal decompensation
gastric bypass patient with severely dry eyes and foamy gray triangle on bulbar conj: diagnosis, pathophysiology, histology of lesion
xerosis; vitamin A deficiency leading to loss of mucous production by conjunctival goblet cells; keratinized epithelium, inflammatory cels, debris, and Corynebacterium xerosis
