Conjunctiva/Cornea Flashcards
What are the associated conditions with superior limbic keratoconjunctivitis? How does it present? What is the Tx?
Thyroid disease, keratoconjunctivitis sicca, CLs
Thickened, red, superior bulbar conjunctiva with velvety appearance and keratitis.
Tx depends on etiology and severity: CL induced SLK is treated with topical steroids; mild SLK, use aggressive ATs q4-8x/day and pm ointment; moderate/severe SLK, use silver nitrate after instillation of proparacaine using a cotton-ip applicator for 20 seconds, then prescribe antibiotic ointment (erythromycin) qhs for 1 week. If no resolution, consider surgical resection.
Describe acute nonspecific follicular conjunctivitis. What is Tx?
Most common. Not EKC. Ask them if they have been recently sick.
Presents with diffuse red eye and follicles, tearing, chemises and discomfort. Corneal involvement is rare.
Caused by adenoviral serotypes 1-11
Runs self-limiting 10-14 day course - use supportive measures like cold compresses, mild vasoconstrictors and ATs. If infection is more severe, consider use mild steroid QID (lotemax) with taper for the acute phase (first 1-2 weeks)
Describe PCF. What is the Tx?
Pharygococcal fever? AKA swimming pool conjunctivitis caused by adenovirus serotypes 3-7. Affects children most frequently
Presents with triad of follicular conjunctivitis (may be hemorrhagic), low grade fever, and mild sore throat
Runs self-limiting 10-14 day course - use supportive measures like cold compresses, mild vasoconstrictors and ATs. If infection is more severe, consider use mild steroid QID (lotemax) with taper for the acute phase (first 1-2 weeks)
Describe EKC. What is Tx?
Most serious form of adenoviral infection and results from serotypes 9, 19, and 37. Causes PAIN and CORNEAL INVOLVEMENT with + PREAURICULAR LYMPHADENOPATHY in the first 1-2 weeks, sub epithelial infiltrates 3rd week (NO LONGER CONTAGIOUS), and may have pseudomembranes to be removed
Runs self-limiting 10-14 day course - use supportive measures like cold compresses, mild vasoconstrictors and ATs. If infection is more severe, consider use mild steroid QID (lotemax) with taper for the acute phase (first 1-2 weeks)
What is the rule of 8 with EKC?
Serotype 8 is most common
Symptoms start after 8 days
SEIs after 16 days - no longer contagious
Describe simple bacterial conjunctivitis. What is Tx?
Most common in kids
acute presentation of discharge that results in eyelids being stuck together upon awakening, redness, burning, FBS, NO PA nodes or corneal involvement.
Mostly gram + staph eli and aureus, other are gram - that are moraxella or haemophilus influenzae
Generally 5-7 days therapy of QID dosing:
Adults - fluoroquinolones, polymyxin B/trimethoprim (polytrim), tobramycin (never gentamycin, causes keratitis)
Children - Polytrim or polysporin ointment (great for crying children) (bacatracin/polymyxin B)
Describe gonoccal conjunctivitis. What is Tx?
Hyperacute with severe purulent discharge and marked PA lymphadenopathy (exception for lymphadenopathy), and peripheral corneal ulceration, pain upon urination
Most common in young adults with history of multiple sexual partners.
Tx depends on if the cornea is involved. All patients should be evaluated and treated for co-infection with chlamydia (Azithrymycin 1g 1 dose or 100mg doxy BID for 10 days). If cornea is involved, topical antibiotic q1h and Ceftriaxone IV 1g q12-24h for3-5 days. Cornea not involved, q2h topically and ceftriaxone 1g IM in the booty.
Describe adult inclusion conjunctivitis (chlamydia). What is Tx?
Serotypes D-K
Presents with SEVERE FOLLICLES on the inferior lid fornicies, chronic red eye that started weeks to months prior. Caused by sexual transmission that later results in ocular infection so topical therapy is not effective.
Azithromycin single dose 1g, or Z-pak in smaller doses
or
Doxycycline 100mg BID x 10 days
Use PF ATs q2-4h. Evaluate sexual partners
Describe trachoma
Serotypes A-C of chlamydia
Follicles in the form of Arlt lines (scarring that is white on superior tarsal conjunctiva) and Herbert’s pits (gimbal depressions of conjunctiva after resolution of follicles) that elands to entropion and corneal ulceration from trichiasis
What is the only drug for hormone replacement therapy that can cause severe aqueous deficient dry eye?
Premarin
How is gout usually associated with the cornea?
Band keratopathy
Describe disciform keratitis. What is Tx?
stromal edema seen in herpes simplex keratitis from endoheliitis. Characterized by focal, disc shaped stromal edema with underlying KPs on endo. Mild to moderate iritis is also seen.
Pred Forte QID and prophylactic tx with viroptic QID
Describe macular dystrophy. What is Tx?
Rare AR stromal dystrophy in the first decade of life. Mucopolysaccharide deposits causing corneal haze.
Tx is corneal transplant or PTK in 3rd decade of life.
Describe interstitial keratitis. What is Tx?
Stromal inflammation WITHOUT primary involvement of epithelium or endothelium. Seen in congenital syphilis most commonly (triad of syphilis is interstitial keratitis, hutchingson’s teeth, and deafness) and diagnosed at age 5-25. Stromal neovascularization and edema, conjunctival injection and AC reaction with keratic precipitates that can lead to stromal scarring, ghost vessels and irregular astigmatism.
Tx during active case is topical steroids. Refer for underlying systemic etiology. If keratouveitis is present, use topical steroids (PredForte q2-4h with taper), ccloplegics QID.
Describe Herpes Simplex. What is Tx?
May present with one or more of the following:
Blepharoconjunctivitis - vesicles and crusting on eyelid with acute conjunctivitis unilaterally, fallacies, water discharge and +PA lymphadenopathy
Infectious epithelial keratitis - SPK, dendritic ulcers (most common), corneal vesicles, geographic ulcers, or marginal ulcers. Rose Bengal stain edges with active virus particles. Tx for epithelial keratosis is Zirgan (Ganciclovir Gel) 1gtt 5x/day until ulcer heals then 1gtt 3x/day for 7 days OR Viroptic q2h 9x/day for 5-7 days then 5x/day for 7 days. Use cycloplegics for associated AC reaction. NEVER use corticosteroids unless it is stromal keratitis only.
Neurotrophic keratopathy from reduced corneal innervation (can result from other causes like LASIK, zoster, diabetes, CLs)
Stromal keratitis - immune mediated against virus -> neovascularization and scarring. PredForte QID and prophylactic Tx with Viroptic QID. Taper steroid and once taper reaches 2-3x/day, stop viroptic
Disciform keratitis - from endotheliitis and KPs causing stromal edema
Keratouveitis - corneal edema, AC reaction, KPs, hypopyon, rubeosis and elevated IOP
