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NBEO step 2 > Conj/cornea/refractive surgery > Flashcards

Conj/cornea/refractive surgery Flashcards

1
Q

what is this?

A

pterygium

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2
Q

What layers does a pterygium affect?

A

Bowmans layer

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3
Q

what causes a pterygium?

A

Uv exposure
ocular irritation - ex. dry eye

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4
Q

What is a complication of pterygium?

A

induced astigmatism

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5
Q

What is this?

A

stocker’s line
- iron line at the edge of a pterygium
- sign of stability

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6
Q

what is this?

A

cicatricial pemphigoid: autoimmune disease bo f the mucous membranes of the body
- entire body!

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7
Q

who gets cicatricial pemphigoid?

A

females >60 yo

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8
Q

signs of cicatricial pemphigoid?

A

inferior symblepharon
ankyloblpeharon
tighter/shorter inf fornix
entropion
discharge
keratitis /keratinization
trichiasis

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9
Q

what is a systemic symptoms a patient with cicatricial pemphigoid might have?

A

dyspnea

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10
Q

what is dyspnea

A

trouble breathing

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11
Q

what is the treatment of cicatricial pemphigoid?

A

systemic condition so: systemic steroids / immunosuppressive
agents

treating complications like dry eye

corneal defects with antibiotics

surgery for symblepharon/ankyblepharon

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12
Q

what are erythema multiforme (EM) and SJS reactions ?

A

type 4 herpersensitivity reactions

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13
Q

which is the milder form ie. self-limiting?
SJS and EM ?

A

erythema multiforme

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14
Q

what causes erythema multiforme (EM) and SJS reactions ?

A

infection
poor rxn to medication

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15
Q

signs of erythema multiforme (EM) and SJS reactions ?

A

skin lesions
+ cicatrices pemphigoid signs

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16
Q

treatment of erythema multiforme (EM) and SJS reactions ?

A

dry eye treatment
corneal defects - antibiotics
inflammation - steroids
surgery

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17
Q

how long does it take for a subconj heme to heal?

A

2-3 weeks

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18
Q

what do you need to rule out if a patient has recurrent subconj hemes?

A

bleeding disorder

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19
Q

What causes superior limbic keratoconjunctivitis?

A

friction of the UP on the superior bulbar conj caused by:

TED
dry eye
RA
Sjogrens
cls wear

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20
Q

what is the treatment for superior limbic keratoconjunctivitis?

A
  1. ATs, punctal plugs for dry eye
  2. steroids/mast cell stabilizers for conj inflammation
  3. topical cyclosporine - if also have KCS (Keratoconjunctivits sicca)
  4. silver nitrate - no longer used for this
  5. surgery for severe symptoms of conj/ tenons cause
  6. if you see filaments/ mucous strands - topical aceylcysteine
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21
Q

What causes seasonal allergic conjunctivitis?

A

air-borne pathogens - pollens and hay fever

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22
Q

what causes perennial allergic conjunctivitis and when does it occur?

A

year round

cause: dust and dander

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23
Q

who gets atopic conjunctivitis?

A

hereditary predilection for allergic disease like dermatitis, eczema, allergic rhinitis, asthma

13-50yo

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24
Q

signs of atopic conjunctivitis?

A

itchy eyes + papillae + chemosis + possible pain

dermatitis, ectropion, trichiaisis, madarosis, corneal staining/erosisions, symblepharon, neo, keratoconus, cataracts

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25
Q

who gets vernal conjunctivitis ?

A

m < 10yo who live in hot climates

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26
Q

complaints of someone with vernal conjunctivitis ?

A

itchiness + pain

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27
Q

signs of vernal conjunctivitis ?

A

cobblestone papillae + chemosis
thick ropy discharge
tranta dots
shield ulcer

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28
Q

what is this and what cells are located in this?

A

tranta dots

eosinophils

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29
Q

what is this?

A

shield ulcer - superiorly located, sterile, well-delineated grey infiltrate

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30
Q

what are signs of bacterial conjunctivitis?

A

papillae + no lymphadenopathy
- mostly seen in kids

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31
Q

how do you treat bacterial conjunctivitis ?

A

antibiotics

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32
Q

what causes non-gonococcal bacterial conjunctivitis?

A

normal climates adults - s. aureus

adults in warmer climates - haemophilus influenza

adults in cooler climates - strep pneumonia

kids under 5 = H influenzae

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33
Q

what is the most common cause of conjunctivitis in kids under 3 ?

A

bacterial conjunctivitis non-gonococcal

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34
Q

what are symptoms of bacterial conjunctivitis non-gonococcal

A

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

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35
Q

signs of bacterial conjunctivitis non-gonococcal

A

mucopurulent discharge
redeness
chemosis (conj)
papillae
lid swelling
eyelids stick together in morning , maybe SPK

NO lymphadenopathy and NO corneal involvement

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36
Q

how is bacterial conjunctivitis non-gonococcal spread?

A

contact with secretions

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37
Q

treatment for bacterial conjunctivitis non-gonococcal

A

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

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38
Q

when do you follow up for bacterial conjunctivitis non-gonococcal

A

2 days post start of treatment

then every 3-5 days until resolution

39
Q

what is another conjunctival condition that can be associated with a pinguecula?

A

dellen

40
Q

what are the gonococcal conjunctivitis signs

A

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

41
Q

what is gonococcal conjunctivitis treatment ?

A

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

42
Q

fluroquinlone ending

A

floxacin

43
Q

what is ophthalmia neonatorum?

A

newborn gonococcal conjunctivitis - occurs within 4 days of birth

44
Q

how do you treat ophthalmia neonatorum?

A

if active infection - IM/IV ceftriaxone not exceeding 125 mg

prophylactically use erythromycin ointment / historically used silver nitrate

45
Q

What types of conjunctivitis does chlamydia cause?

A

adult inclusion conjunctivitis
trachoma

both are chronic - ie. can last up to 12 months without treatment

46
Q

what serotypes cause adult inclusion conjunctivitis ?

A

D-> K

47
Q

what serotypes cause trachoma?

A

A -> C

48
Q

what is the leading cause of preventable blindness in the world?

A

trachoma , but not really seen in developed countries

49
Q

What are signs of a chlamydial conjunctivitis ?

A

follicles
stringy mucous
tender pre auricular nodes on side of the involved eye

50
Q

where are the follicles located in adult inclusion conjunctivitis ?

A

inferior palpebral conj.

51
Q

what are signs of trachoma?

A

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

52
Q

what is this?

A

herbert’s pits

53
Q

what is this?

A

Arlt’s line

54
Q

how do you treat the 2 forms of chlamydial conjunctivitis?

A

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

55
Q

signs of viral conjunctivitis

A

follicles
+ lymphadenopathy

56
Q

treatment of viral conjunctivitis

A

self- limiting
only treat symptoms
ATs for comfort
steroids for inflammation

57
Q

what is adenovirus conjunctivitis?

A

the most common cause of pink eye/ viral conjunctivits

58
Q

how long is adenoconjunctivitis contagious for?

A

14 days - highly contagious

59
Q

symptoms of adenoconjunctivits

A

hx of recent illness
FBS , itching, burning

60
Q

what are the 3 types of adenoconjunctivits?

A

nonspecific

EKC

pharyngoconjunctival fever

61
Q

what is nonspecific Aadenoconjunctivits?

A

most common type of adenoconjunctivits

62
Q

what is Epidemic keratoconjunctivits

what are the signs/symptoms

A

EKC = sub epithelial infiltrates - see 2-3 weeks after infection

  • when you see these infiltrates mean no longer infectious
  • severe pain
63
Q

what are signs of SLK?

A

bilateral, chronic, recurrent
redundant, keratinized, thickened superior conj
filaments
micopannus
spk on cornea

64
Q

what is pharyjgoconjunctival fever?

A

swimming pool conjunctivitis

also has fever _ sore throat/pharyngitits

65
Q

what is the treatment of adenoviral conjunctivitis ?

A

followed for 2-3 weeks. avoid contact with people. clean bedsheets and towels

66
Q

what is this?

A

molluscum contagiosum

67
Q

what causes molluscum contagiosum?

A

dna pox virus

68
Q

what should you suspect if you see multiple lesions of molluscum contagiosum?

A

HIV

69
Q

what happens when one of the molluscum contagiosum nodules ruptures?

A

can lead to annus and chronic conjunctivitis !

70
Q

what is a pannus?

A

fibrous vascular tissue growth over the cornea

71
Q

how do you treat molluscum contagiosum?

A

remove nodules

72
Q

what is HIV testing?

A

western blot
ELISA

73
Q

What is conjunctival intraepithelial neoplasia?

A

CIN leads to squamous cell carcinoma

74
Q

what is this?

A

conjunctival intraepithelial neoplasia

75
Q

what is the most common conjunctival malignancy in the US?

A

conjunctival intraepithelial neoplasia

76
Q

what causes CIN and squamous cell carcinoma (SCC)?

A

smoking
UV
HPV

77
Q

what is this?

A

squamous cell carcinoma

78
Q

who gets conjunctival intraepithelial neoplasia and SCC?

A

old white males

if you see it under the age of 50 - suspect HIV

79
Q

how common is it for metastasis and orbital invasion for SCC?

A

rare!

80
Q

conjunctival intraepithelial neoplasia and SCC + malignant melanoma treatment?

A
  1. MRI and workup so see if orbital invasion
    - may need exenteration
  2. biopsy
  3. radiation

if recurrent - topical interferon, mitomycin C or 5-fluorouracil

81
Q

what is exenteration?

A

removal of globe and all the contents of the eye socket (muscles, fat, nerves, eyelids)

82
Q

what is mitomycin C?

A

DNA synthesis inhibitor - stops growth of cancer cells

83
Q

what does PAM lead to ?

A

primary acquired melanosis -> malignant melanoma

84
Q

what is this?

A

malignant melanoma

85
Q

what is malignant melanoma

A

slow growing, elevated, vascularized pigmented mass

86
Q

where is the first area of metastasis for malignant melanoma secondary to pam?

A

parotid/submandibular lymph nodes

87
Q

normal tear meniscus size?

A

0.20 mm or greater

88
Q

normal tear osmolarity

A

316 mOsm/L or less

89
Q

normal shirmers

A

> 15 mm without anesthesia (reflex + basal) after 5 mins

> 10 mm with anesthesia (basal only)

limited repeatability - not super useful

90
Q

individuals diagnosed with sjogrens have an increased risk of what?

A

lymphoma

91
Q

phenol red test

A

cotton thread is placed in the temporal fornix for 30 sec

> 10 mm = NORMAL

92
Q

vitamin A deficiency

A

can lead to dry eye

93
Q
A

NBEO step 2 (3 decks)

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