Conj/cornea/refractive surgery Flashcards
what is this?
pterygium
What layers does a pterygium affect?
Bowmans layer
what causes a pterygium?
Uv exposure
ocular irritation - ex. dry eye
What is a complication of pterygium?
induced astigmatism
What is this?
stocker’s line
- iron line at the edge of a pterygium
- sign of stability
what is this?
cicatricial pemphigoid: autoimmune disease bo f the mucous membranes of the body
- entire body!
who gets cicatricial pemphigoid?
females >60 yo
signs of cicatricial pemphigoid?
inferior symblepharon
ankyloblpeharon
tighter/shorter inf fornix
entropion
discharge
keratitis /keratinization
trichiasis
what is a systemic symptoms a patient with cicatricial pemphigoid might have?
dyspnea
what is dyspnea
trouble breathing
what is the treatment of cicatricial pemphigoid?
systemic condition so: systemic steroids / immunosuppressive
agents
treating complications like dry eye
corneal defects with antibiotics
surgery for symblepharon/ankyblepharon
what are erythema multiforme (EM) and SJS reactions ?
type 4 herpersensitivity reactions
which is the milder form ie. self-limiting?
SJS and EM ?
erythema multiforme
what causes erythema multiforme (EM) and SJS reactions ?
infection
poor rxn to medication
signs of erythema multiforme (EM) and SJS reactions ?
skin lesions
+ cicatrices pemphigoid signs
treatment of erythema multiforme (EM) and SJS reactions ?
dry eye treatment
corneal defects - antibiotics
inflammation - steroids
surgery
how long does it take for a subconj heme to heal?
2-3 weeks
what do you need to rule out if a patient has recurrent subconj hemes?
bleeding disorder
What causes superior limbic keratoconjunctivitis?
friction of the UP on the superior bulbar conj caused by:
TED
dry eye
RA
Sjogrens
cls wear
what is the treatment for superior limbic keratoconjunctivitis?
- ATs, punctal plugs for dry eye
- steroids/mast cell stabilizers for conj inflammation
- topical cyclosporine - if also have KCS (Keratoconjunctivits sicca)
- silver nitrate - no longer used for this
- surgery for severe symptoms of conj/ tenons cause
- if you see filaments/ mucous strands - topical aceylcysteine
What causes seasonal allergic conjunctivitis?
air-borne pathogens - pollens and hay fever
what causes perennial allergic conjunctivitis and when does it occur?
year round
cause: dust and dander
who gets atopic conjunctivitis?
hereditary predilection for allergic disease like dermatitis, eczema, allergic rhinitis, asthma
13-50yo
signs of atopic conjunctivitis?
itchy eyes + papillae + chemosis + possible pain
dermatitis, ectropion, trichiaisis, madarosis, corneal staining/erosisions, symblepharon, neo, keratoconus, cataracts
who gets vernal conjunctivitis ?
m < 10yo who live in hot climates
complaints of someone with vernal conjunctivitis ?
itchiness + pain
signs of vernal conjunctivitis ?
cobblestone papillae + chemosis
thick ropy discharge
tranta dots
shield ulcer
what is this and what cells are located in this?
tranta dots
eosinophils
what is this?
shield ulcer - superiorly located, sterile, well-delineated grey infiltrate
what are signs of bacterial conjunctivitis?
papillae + no lymphadenopathy
- mostly seen in kids
how do you treat bacterial conjunctivitis ?
antibiotics
what causes non-gonococcal bacterial conjunctivitis?
normal climates adults - s. aureus
adults in warmer climates - haemophilus influenza
adults in cooler climates - strep pneumonia
kids under 5 = H influenzae
what is the most common cause of conjunctivitis in kids under 3 ?
bacterial conjunctivitis non-gonococcal
what are symptoms of bacterial conjunctivitis non-gonococcal
starts in 1 eye and then may spread to the other eye
will be able to tell you time of day it started, not exact moment
hx of recent illness/cold
FBS
signs of bacterial conjunctivitis non-gonococcal
mucopurulent discharge
redeness
chemosis (conj)
papillae
lid swelling
eyelids stick together in morning , maybe SPK
NO lymphadenopathy and NO corneal involvement
how is bacterial conjunctivitis non-gonococcal spread?
contact with secretions
treatment for bacterial conjunctivitis non-gonococcal
topical antibiotic - ocuflox (any fluroqoquinolone) qid for 5-7 days
polytrim - for kids because ointment is easier to put in and won’t remove it by crying
remove large mucous strands before installation
no cls wear
when do you follow up for bacterial conjunctivitis non-gonococcal
2 days post start of treatment
then every 3-5 days until resolution
what is another conjunctival condition that can be associated with a pinguecula?
dellen
what are the gonococcal conjunctivitis signs
hyper acute - ie. explosive symptoms, will be able to tell you exact second it happened
severe pus discharge
severe chemosis
papillae
prominent pre auricular lymphadenopathy
corneal ulcers - bacteria attacking the corneal epithelium = infectious keratitis
what is gonococcal conjunctivitis treatment ?
systemic therapy is mandatory!!
ceftriaxone IM if cornea not involved
- IV if cornea is involved
hospitalized if cornea involved
use fluroquinolones if allergic to pennicillins or cephalosporins
fluroquinlone ending
floxacin
what is ophthalmia neonatorum?
newborn gonococcal conjunctivitis - occurs within 4 days of birth
how do you treat ophthalmia neonatorum?
if active infection - IM/IV ceftriaxone not exceeding 125 mg
prophylactically use erythromycin ointment / historically used silver nitrate
What types of conjunctivitis does chlamydia cause?
adult inclusion conjunctivitis
trachoma
both are chronic - ie. can last up to 12 months without treatment
what serotypes cause adult inclusion conjunctivitis ?
D-> K
what serotypes cause trachoma?
A -> C
what is the leading cause of preventable blindness in the world?
trachoma , but not really seen in developed countries
What are signs of a chlamydial conjunctivitis ?
follicles
stringy mucous
tender pre auricular nodes on side of the involved eye
where are the follicles located in adult inclusion conjunctivitis ?
inferior palpebral conj.
what are signs of trachoma?
look for follicles in the superior palpebral conj
- they then can press along the globes and cause indentations along the superior limbus (Herbert’s pits)
after time the follicles can cause scarring along the superior palpebral conj = Arlt’s line
what is this?
herbert’s pits
what is this?
Arlt’s line
how do you treat the 2 forms of chlamydial conjunctivitis?
1) single dose of oral azithromycin
2) daily dose of doxycycline , erythromycin, or tetracycline for 1-2 weeks
3) can use topical antibiotics if cornea involved
f/u every 24 hours - few days
signs of viral conjunctivitis
follicles
+ lymphadenopathy
treatment of viral conjunctivitis
self- limiting
only treat symptoms
ATs for comfort
steroids for inflammation
what is adenovirus conjunctivitis?
the most common cause of pink eye/ viral conjunctivits
how long is adenoconjunctivitis contagious for?
14 days - highly contagious
symptoms of adenoconjunctivits
hx of recent illness
FBS , itching, burning
what are the 3 types of adenoconjunctivits?
nonspecific
EKC
pharyngoconjunctival fever
what is nonspecific Aadenoconjunctivits?
most common type of adenoconjunctivits
what is Epidemic keratoconjunctivits
what are the signs/symptoms
EKC = sub epithelial infiltrates - see 2-3 weeks after infection
- when you see these infiltrates mean no longer infectious
- severe pain
what are signs of SLK?
bilateral, chronic, recurrent
redundant, keratinized, thickened superior conj
filaments
micopannus
spk on cornea
what is pharyjgoconjunctival fever?
swimming pool conjunctivitis
also has fever _ sore throat/pharyngitits
what is the treatment of adenoviral conjunctivitis ?
followed for 2-3 weeks. avoid contact with people. clean bedsheets and towels
what is this?
molluscum contagiosum
what causes molluscum contagiosum?
dna pox virus
what should you suspect if you see multiple lesions of molluscum contagiosum?
HIV
what happens when one of the molluscum contagiosum nodules ruptures?
can lead to annus and chronic conjunctivitis !
what is a pannus?
fibrous vascular tissue growth over the cornea
how do you treat molluscum contagiosum?
remove nodules
what is HIV testing?
western blot
ELISA
What is conjunctival intraepithelial neoplasia?
CIN leads to squamous cell carcinoma
what is this?
conjunctival intraepithelial neoplasia
what is the most common conjunctival malignancy in the US?
conjunctival intraepithelial neoplasia
what causes CIN and squamous cell carcinoma (SCC)?
smoking
UV
HPV
what is this?
squamous cell carcinoma
who gets conjunctival intraepithelial neoplasia and SCC?
old white males
if you see it under the age of 50 - suspect HIV
how common is it for metastasis and orbital invasion for SCC?
rare!
conjunctival intraepithelial neoplasia and SCC + malignant melanoma treatment?
- MRI and workup so see if orbital invasion
- may need exenteration - biopsy
- radiation
if recurrent - topical interferon, mitomycin C or 5-fluorouracil
what is exenteration?
removal of globe and all the contents of the eye socket (muscles, fat, nerves, eyelids)
what is mitomycin C?
DNA synthesis inhibitor - stops growth of cancer cells
what does PAM lead to ?
primary acquired melanosis -> malignant melanoma
what is this?
malignant melanoma
what is malignant melanoma
slow growing, elevated, vascularized pigmented mass
where is the first area of metastasis for malignant melanoma secondary to pam?
parotid/submandibular lymph nodes
normal tear meniscus size?
0.20 mm or greater
normal tear osmolarity
316 mOsm/L or less
normal shirmers
> 15 mm without anesthesia (reflex + basal) after 5 mins
> 10 mm with anesthesia (basal only)
limited repeatability - not super useful
individuals diagnosed with sjogrens have an increased risk of what?
lymphoma
phenol red test
cotton thread is placed in the temporal fornix for 30 sec
> 10 mm = NORMAL
vitamin A deficiency
can lead to dry eye
