Conjunctiva/Cornea Flashcards
Episcleritis
- diffuse
- nodular
- young adults, recurring
- benign, self-limiting, acute, unilateral, sectoral, mild pain
- blanches with 10% phenyl
Causes:
- idiopathic
- collagen vascular disease (CRAP)
- spirochetes (syphilis, Lyme)
- virus
- metabolic/gout
- vasculitis
Scleritis
a) non-necrotizing
b) necrotizing
c) granulomatous
- female 30-50 years old
- severe boring pain to side of head/face
a) Non-Necrotizing:
- diffuse (least severe systemic) vs nodular (immobile)
b) Necrotizing:
- with inflammation: deadly, 33% die within a few years due to SEVERE autoimmune disease
- without inflammation: scleromalacia perforans - due to chronic RA, minimal injection, large patches of blue-grey thinning, lack of symptoms
c) Granulomatous:
RA > Wegener’s
Differentials for epiphora with mild to no pain.
- blepharitis
- ectropion
- dry eye disease
- nasolacrimal duct obstruction
- conjunctivitis
Differentials for epiphora with moderate to severe pain.
- corneal pathology
- anterior uveitis
- dacrycosystitis
- entropion with trichiasis
Dacryocystitis
- unilateral, painful, crusting, epiphora and occasional fever
- below medial canthal tendon (if above, suspicious for lacrimal sac tumour)
Canaliculitis
- unilateral, epiphora, mild tenderness, swollen puncta (“pouting puncta”)
- mucopurulent discharge upon lacrimal sac expression
- smoldering red eye
- resistant to topical ophthalmic antibiotic
Caused by Actimoyces israelii
Most common cause of dacryocystitis
- Staphylococcus aureus
- Staphylococcus epidermis
- Pseudomonas
- Haemophilus influenzae in children
Jones I Test
- checks patency of the nasolacrimal system
- fluorescein on inferior fornix, drain in 5 minutes
Positive = patent nasolacrimal, fluorescein drains out Negative = no draingage
Jones II Test
- nasolacrimal irrigation with saline following negative test
- reflex of saline from same canaliculus and punctum indicates blockage within canaliculus
- reflex of saline from opposite canaliculus and punctum indicate nasolacrimal blockage
What condition gets “Trantas dots”? What is it?
- collections of epithelial cells and eosinophils near the limbus
- VKC
Causes of GPC
Immune mediated response:
- protein deposits
- mechanical trauma
Other causes:
- blebs
- prosthetics
- scleral buckles
- sutures
What is a giant papillae?
> 1mm in diameter; forms when neighbouring papillae break down septae and coalesce together after prolonged inflammation
Risks of GPC
- EW hydrogel contact lenses
- high water-ionic lenses
- higher modulus of elasticity
- poor replacement compliance
Ophthalmia neonatorum
Acute conjunctivitis within the first month of life. Can be caused by:
1) Gonoccocal - occurs within first 5 days
2) Chlamydia - 5 days - 2 weeks after.
What is “Bitot’s Spot”?
Keratin build-up in the epithelium due to Vitamin A deficiency and associated with dry eye.
