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Ocular Disease part 2 > Conjunctiva > Flashcards

Conjunctiva Flashcards

1
Q

what is blepharoconjunctivitis?

A

secondary to lid disease = secondary bacterial conjunctivitis

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2
Q

if a non-pediatric or non-geriatric patient presents with true primary bacterial conjunctivitis in the absence of lid disease - what are some causes?

A

overstressed lifestyle, acquired immune dysfunction, acquired immune deficiency (HIV, AIDS) or an oddball unusual microbe

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3
Q

what are some symptoms of blepharoconjunctivitis?

A

burn, itch, red, watery/tearing, lids mattered shut in AM, scratchy, FB sensation and swollen

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4
Q

what are some signs of blepharoconjunctivitis?

A

red/edematous eyelids, interpalpebral injection, NaFl staining SPK near lid margins, papillae, chemosis, mucopurulent discharge, -PAN

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5
Q

what are some of the eye’s defenses to prevent bacterial invasion of conjunctiva from lid infections?

A

bacteriostatic lysozymes and immunoglobulins in tear film, blink force and immune system in general

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6
Q

what organism causes blepharoconjunctivitis and where do they colonize?

A

staphylococci lid margins, conjunctiva, and meibomian glands

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7
Q

what is the goal of blepharoconjunctivitis treatment?

A

complete eradication is impossible - need to control amount of staph but maintain its position in anterior segment’s normal flora **focus on lid disease**

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8
Q

what is the initial treatment for blepharoconjunctivitis?

A

aggressive initial therapy = lid hygiene at least daily, topical antibiotic (AzaSite) BID for several weeks then Besivance TID (Durasite) soaks/scrubs/massage/ATs

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9
Q

how do you alter the treatment for blepharoconjunctivitis after the lid disease is under control?

A

alternate antibiotic ointments to reduce the chance of resistance - Polysporin and erythromycin

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10
Q

what are some treatment options for blepharoconjunctivitis in resistant cases?

A

AzaSite and Doxycycline 50-100mg PO x 3 weeks or more, Dicloxacillin, erythromycin ethylsuccinate (EES if allergic to PCN)

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11
Q

when is Dicloxacillin contraindicated?

A

if patient is allergic to penicillin/cephalosporins or newborns (children are ok)

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12
Q

when is doxycycline contraindicated?

A

children under 8-12 years old, pregnant or lactating females

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13
Q

when is erythromycin ethylsuccinate (EES) contraindicated?

A

patient with impaired hepatic function - ok in children and pregnant/lactating females

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14
Q

how do you treat blepharoconjunctivitis when you suspect an oddball bacterial infection?

A

culture/sensitivity testing - strong antibiotic drop = Besifloxacin suspension

gentamicin, trimethoprim, vancomycin = MRSA

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15
Q

which two drugs are no longer the “big guns” and resistance has become a problem?

A

moxifloxacin (Vigamox) and gatifloxacin (Zymar)

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16
Q

what is the great antibiotic is too dangerous to legally prescribe?

A

chloramphenicol - a few premature infants have died from aplasitc enemia with topical use

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17
Q

what information should you provide another provider when referring a patient?

A

detailed documentation of your treatment and the lack of resolution of the patient’s symptoms and signs

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18
Q

who typically develops true primary bacterial conjunctivitis?

A

pediatric (immune system is still developing) and geriatric (immune system is in decline)

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19
Q

what organisms cause primary bacterial conjunctivitis?

A

staph aureus, staph epidermidis, strep pneumoniae, and haemophilus influenzae

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20
Q

what are the various topical antibiotics used to treat bacterial conjunctivitis?

A

*aminoglycosides are not first choice* fluoroquinolones, polymyxin B combinations, and others (AzaSite, Ilotycin, Bacitracin)

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21
Q

what does epidemic history, petechial hemorrhages with scant discharge suggest in bacterial conjunctivitis?

A

strep pneumoniae

22
Q

if a patient has copious discharge in bacterial conjunctivitis - what organism might they have?

A

haemophilus influenzae

23
Q

what type of treatment should you use in children with bacterial conjunctivitis?

A

amoxicillin/clavulanate (Augmentin) PO for H.flu and small children may respond better to ung than gtt - start with Polytrim gtt

24
Q

what are some additional treatments for bacterial conjunctivitis besides antibiotic drops?

A

warm compresses, irrigation, lid hygiene, no school or work

25
Q

what are some symptoms of viral conjunctivitis/epidemic keratoconjunctivitis (EKC)?

A

watery/tearing, scratchy, FB sensation, lids mattered shut in AM, itchy, red, swollen

26
Q

what are some signs of viral conjunctivitis/EKC?

A

follicles, watery/mucus discharge, red/edematous eyelids, +PAN, pinpoint subconjunctival hemorrhages, pesudomembrane, +URI, subepithelial infiltrates

27
Q

what is the pathophysiology for viral conjunctivitis/EKC?

A

adenovirus - search for memory B cells

28
Q

what is the typical course for viral conjunctivitis?

A

Hx of recent URI/red eye - starts with one eye and moves to other within days - begins with hyperemic and congestive conjunctival reaction, within days - follicles, serous discharge, +PAN, +SEI, fibrinous pseudomembrane

29
Q

what is the treatment for typical viral conjunctivitis?

A

cool compress and AT’s (PF), may need vasoconstrictor/antihistamine (Naphcon-A), low dose steroids (fluorometholone alcohol or prednisolone phosphate 0.125%) for pseudomembrane or SEI

30
Q

what else could any follicular conjunctivitis or keratoconjunctivitis also be?

A

EKC or herpes simplex keratitis (HSK) - rule out punctate epithelial lesions and avoid steroids

31
Q

why is EKC so contagious and how long is the patient contagious for?

A

the virus is shed in the tears and through nasopharynx - usually spreads during first week when patient is asymptomatic

contagious about 2 weeks - they are non-contagious when SEI’s appear

32
Q

what is the treatment for EKC?

A

no antivirals - not effective use cool compress, lubricant’s, vasoconstrictors (Naphcon-A QID), NSAID (aspirin), antibiotic, and possibly a steroid

33
Q

why would you prescribe an antibiotic for EKC and what would you give?

A

prophylaxis for bacterial conjunctivitis/keratitis Chlorofluoroquinolone, polytrim, fluoroquinolones QID or polysporin, ciloxan erythromycin ointment qhs

34
Q

why are steroids controversial in EKC treatment? What kind would you give?

A

if you are unsure if there is HSK use low concentration 0.125% prednisolone phosphate or Lotemax sol/gel for pseudomembranes or SEIs

35
Q

how do you treat secondary iritis that may occur with EKC?

A

cycloplegics - homatropine 2-5% BID or cyclopentolate 1% BID

36
Q

what is the purpose/goal of using Betadine to treat EKC?

A

rapid decrease or elimination of live virus from ocular surface - decreased time for viral particles to migrate into anterior stromal tissues and incite an immune response (SEI)

37
Q

what are some symptoms of allergic conjunctivitis?

A

itching, watering, tearing, redness, scratching, FB sensation, lids mattered shut in AM, swollen

38
Q

what are some signs of allergic conjunctivitis?

A

thin watery discharge, redness, AM crusting, papillae, injection, chemosis, red/edematous eyelids, -PAN

39
Q

what 2 responses does an allergen on the conjunctiva initiate?

A

release of pre-formed inflammatory mediators = histamine and bradykinin

production of arachidonic acid and its conversion to prostaglandins, thromboxanes, and leukotrienes

40
Q

what is the regimen of treatment for allergic conjunctivitis in increasing order?

A

cool compresses, OTC topical vasoconstrictors or OTC topical vasoconstrictors/antihistamines (Naphcon-A, Vasocon-A) QID, topical antihistamines, topical dual mechanism (anti-H and MCS), topical steroids TID-QID, oral antihistamines or combo with decongestant, mast cell stabilizers QID

41
Q

how do you reduce serous leakage in allergic conjunctivitis?

A

topical decongestants (can cause rebound hyperemia) = naphazoline (Naphcon, Vasocon, Albalon)

oral decongestants = pseudoephedrine 30, 60 mg/ 120, 240mg

oral anti-histamines + decongestant = loratadine 5mg + pseudoephedrine 120mg or chlorpheniramine 4mg + pseudoephedrine 60mg

42
Q

why would you prescribe topical steroids for allergic conjunctivitis and what are some examples for hayfever conjunctivitis?

A

indicated for severe conditions with symptoms and signs loteprednol 0.2%, medrysone 1%, prednisolone phosphate 0.125%, FML 0.1%

43
Q

what do you educate patients on for allergic conjunctivitis?

A

discover/prevent exposure to allergen

pre-treat seasonal allergies with mast cell stabilizers QID or OTC ketotifen (Zaditor) BID or Rx olopatadine (Patanol BID/Pataday QD)

44
Q

should patients who suffer significantly from allergies suspend CL wear?

A

need to look at superior palpebral conjunctiva - look for hyperemia, edema or papillae - if they are present then yes and treat with corticosteroid QID and an allergy drop

45
Q

which oral antihistamines are more sedating? which are less?

A

sedating = benadryl (diphenhydramine) and Chlor-Trimeton (chlorpheniramine)

non-sedating = claritin, clarinex, allergra, and zyrtec

46
Q

what type of conjunctivitis is seen here?

A

True bacterial conjunctivitis

47
Q

what type of conjunctivitis is seen here and what clinical sign do they have?

A

Viral conjunctivitis = ECK

pseudomembrane

48
Q

what type of conjunctivitis is seen here?

A

blepharoconjunctivitis (secondary bacterial conjunctivitis)

49
Q

what is seen is this photo?

A

Subepithelial infiltrates (EKC)

50
Q

what type of conjunctivitis is seen here?

A

Allergic conjunctivitis

51
Q

what type of conjunctivitis is seen here?

A

EKC

52
Q

what type of conjunctivitis is seen here?

A

allergic conjunctivitis

Ocular Disease part 2 (7 decks)

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