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cornea and external eye diseases Flashcards

1
Q

4 RFs of subconjunctival haemorrhage

A
  1. trauma
  2. blood thinners
  3. HTN
  4. valsava manoeuvre
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2
Q

presentation of subconjunctival haemorrhage

A
  1. sudden onset red eye
  2. painless
  3. no BOV
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3
Q

mx of subconjunctival haemorrhage

A

conservative - reassure

if no RFs and recurrent, work up for haematological abnormalities

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4
Q

3 types of keratitis (corneal infection)

A

viral
bacterial
fungal

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5
Q

which types of keratitis should be referred

A

herpetic (dendritic ulcer)
bacterial keratitis
fungal keratitis

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6
Q

viral keratitis main features

A

vision affected (but not too bad), some pain

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7
Q

features of bacterial keratitis

A

contact lens, trauma
ulcer, abscess
pain ++, poor vision

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8
Q

features of fungal keratitis

A

immnocompromised
trauma

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9
Q

herpetic keratitis main causes

A

herpes simplex virus 1 more common than 2

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10
Q

symptoms of herpetic keratitis

A

red eye
pain
tearing
photophobia

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11
Q

clinical signs of herpetic keratitis

A

conjunctival injection
reduced corneal sensation
dendritic or geographic ulcers (stain with fluorescein) - epithelial keratitis
stromal infiltratino and corneal edema - stromal keratitis

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12
Q

3 RFs for herpetic keratitis

A
  1. reduced host immunity (eg HIV)
    OR long term immunosuppression
  2. recent ocular surgery
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13
Q

mx of herpetic keratitis

A

topical acyclovir (epithelial keratitis)
+/- topical steroids (stromal/endothelial keratitis)

immunocompromised or children: oral acyclovir

recurrent HK: oral acyclovir for prophylaxis

avoid topical steroids in epithelial keratitis

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14
Q

cx of herpetic keratitis

A
  1. recurrence
  2. neurotrophic keratopathy with persistent epithelial defect or ulcer
  3. stromal scarring –> high astig
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15
Q

herpes zoster ophthalmicus (HZO)

A

Caused by reactivation of varicella zoster virus

Manifests as a painful vesicular rash along the CN V1 nerve

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16
Q

clinical features of HZO

A
  1. painful vesicles or pustules (crust and heal within 2-6 weeks) along the V1 dermatome
  2. +/- corneal sensation, VA
  3. raised IOP
  4. conjunctival injection on slit lamp
  5. hutchinson’s sign
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17
Q

hutchinson’s sign

A

tip of nose rash: increased risk of corneal involvement (nasociliary branch affected)

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18
Q

3 RFs for HZO

A
  1. adv age
  2. psychological stress
  3. immunocompromised
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19
Q

mx for HZO

A
  1. isolate pt
  2. oral acyclovir
  3. acyclovir ointment if there is corneal involvement
  4. topical abx cream to skin lesions
  5. steroid eye drops if there is ocular inflammation
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20
Q

LT cx from HZO

A
  1. Neurotrophic keratopathy due to impaired corneal innervation
  2. Post-herpetic neuralgia (10–17%)
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21
Q

neurotrophic keratopathy

A

degenerative disease of the cornea caused by damage of the trigeminal nerve, which results in impairment of corneal sensitivity, spontaneous corneal epithelium breakdown, poor corneal healing and development of corneal ulceration, melting and perforation.

in herpetic keratitis and HZO

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22
Q

bacterial keratitis common organisms (4)

A
  1. Staph aureus
  2. Strep pyogenes
  3. Strep pneumoniae
  4. Psuedonomas aeruginosa
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23
Q

4 RFs for bacterial keratitis

A
  1. contact lens wear
  2. contaminated water contact with eye
  3. trauma
  4. prolonged use of topical steroids
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24
Q

hypopyon without corneal ulcers with clear cornea

A

anterior uveitis or endopthalmitis

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25
Q

hypopyon with hazy cornea

A

keratitis

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26
Q

hypopyon

A

accumulation of white blood cells that form a whitish layer of fluid in the lower portion of the eye’s anterior chamber –> severe inflammation or infection

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27
Q

clinical signs of bacterial keratitis

A

HCCCCEA
1. hypopyon
2. conjunctival injection
3. corneal infiltrate
4. corneal ulcer
5. corneal edema
6. epithelial defect
7. anterior chamber reaction

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28
Q

symptoms of bacterial keratitis

A
  1. pain
  2. watering and discharge
  3. decreased vision
  4. photophobia
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29
Q

inx of bacterial keratitis

A
  1. corneal scraping to send for gram stain, fungal smear and culture, aerobic and anerobic culture
  2. send contact lens solution for culture
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30
Q

abx and other meds for bacterial keratitis

A
  1. topical cefazolin and gentamicin
  2. topical cycloplegia
  3. systemic abx if sclera involved
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31
Q

what to avoid in bacterial keratitis?

A

topical steroids

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32
Q

specific gram stain and culture of cornea scrapings

A

blood agar - most fungi and bacteria except neisseria

choc agar - neisseria and moraxella

sabourand agar - fungi

33
Q

cx of bacterial keratitis

A
  1. corneal melt and perforation
  2. corneal scar
34
Q

common causes of fungal keratitis

A

yeast: candida sp
filamentous: fusarium

35
Q

RFs for fungal keratitis

A
  1. trauma especially organic matter
  2. immunocompromised
  3. prior topical steroid use
36
Q

signs of fungal keratitis

A
  1. subacute
  2. feathery margins
  3. endothelial plaques
  4. satellite lesions
  5. immune ring
37
Q

fungal keratitis: corneal scrapings to send for

A
  1. gram stain
  2. sabourad agar
38
Q

mx of fungal keratitis

A

topical and systemic antifungal therapy

39
Q

when should topical steroids be avoided

A
  1. epithelial keratitis in herpetic keratitis
  2. infective keratitis (bacterial, fungal)

indicated in
1. stromal or endothelial keratitis in herpetic keratitis - risk of scarring
2. HZO
3. psuedomembrane conjunc

40
Q

conjunctivitis - safe (treat and watch)

A
  1. typical hx (contact, URTI, tearing)
  2. little pain, good vision (6/12), bilateral, watery discharge, conjunctival injection
41
Q

conjunctivitis - not safe (refer early/immediately)

A

PPAC
1. atypical hx - contact lens users, trauma
2. pain, poor vision, purulent discharge (bacteria)
3. corneal involvement
4. prolonged course (>1 week)

42
Q

allergic conjunctivitis

A
  1. acute allergic conjunct
  2. seasonal/perennial conjunct
  3. atopic keratoconjunct (AKC)
  4. vernal keratoconjunct (VKC)
  5. contact lens related
43
Q

acute allergic conjunct sx

A
  1. lid edema/erythema
  2. conjunctival chemosis
  3. watery or mucoid discharge
  4. no papillae or corneal involvement (same for seasonal or perennial conjunc)
44
Q

seasonal allergic conjunct triggers

A

pollen during spring

45
Q

perennial allergic conjunct triggers

A

all year round, caused by animal dander, feathers or dust mites

46
Q

VKC features

A
  1. giant papillae or cobblestone papillae
  2. limbitis / Horner trantas dots
  3. shield ulcer

sight threatening

47
Q

AKC features

A
  1. papillary hypertrophy (seen on lid eversion) –> eyelid thickening and scarring
  2. periocular dermatitis
48
Q

AKC a/w

A
  1. atopic dermatitis and asthma
  2. anterior and posterior subcapsular cataracts
49
Q

AKC vs VKC epidemiology

A

AKC usually 5-20 yo males
VKC usually teenage to 50 year olds, chronic course with periodic acute exacerbations

50
Q

4 common sx for all allergic conjunctivitis

A
  1. intense itch
  2. intermittent red eyes (conjunctival injection) - chronic
  3. lid swelling
  4. thick ropy mucoid discharge
51
Q

cx from untreated VKC or AKC

A

KLCCCC

  1. keratoconus
  2. loss of eyelashes
  3. conjunc scarring
  4. corneal neovascularisation
  5. corneal ulcer
  6. corneal scarring
52
Q

shield ulcers

A

due to accumulation of fibrin and mucus, at upper 2/3 of cornea

Changes in tarsal Conjunctiva rubbing against cornea - shield ulcers

not infective in nature, can use topical steroids for mx

53
Q

RFs for allergic conjunc

A
  1. atopic hx of asthma, allergic rhinitis or eczema
  2. young male
54
Q

mx of allergic conjunct (systemic)

A
  1. allergen avoidance
  2. skin prick test
  3. control of other allergies
55
Q

mx of allergic conjunct (ocular)

A
  1. topical mast cell stabilisers, anti-histamines, immunomodulators
  2. topical lubricants
  3. topical steroids
  4. cold compress
56
Q

most common cause of viral conjunc

A

adenovirus

57
Q

sx of viral conjunc

A
  1. sequential red eyes
  2. sticky discharge
  3. tearing
  4. itch
  5. a/w recent URTI, lymphadenopathy, contact hx
58
Q

6 clinical findings for viral conjunc

A

CCCPPH
1. conjunc injection
2. conjunc follicular reaction
3. haemorrhage
4. pseudomembranes
5. preauricular lymphadenopathy
6. corneal involvement - epithelial defects, keratitis etc

59
Q

mx of viral conjunc

A
  1. topical lubricants
  2. self limiting 1-2 weeks
  3. good hand hygiene - viral conjunc is contagious
60
Q

cx from viral conjunc

A
  1. corneal epithelial defect
  2. dry eyes
  3. numular keratitis (presence of anterior stromal infiltrates) - treat with topical steroids if risk of scarring
61
Q

causes of psuedomembrane conjunc

A

herpes, strep, adenovirus

62
Q

mx of psuedomembrane conjunc

A
  1. Peel off membranes
  2. Lubricants
  3. Topical steroids +/- abx cover
  4. Contact and hygiene precautions
63
Q

common causes of bacterial conjunc

A
  1. Staph aureus
  2. Staph epidermis
  3. Strep pneumoniae
  4. Haemophilus influenzae

vs for bacterial keratitis
1. Staph aureus
2. Strep pyogenes
3. Strep pneumoniae
4. Psuedonomas aeruginosa

64
Q

symptoms of bacterial conjunc

A
  1. subacute onset
  2. redness
  3. mucopurulent discharge
  4. burning/grittiness
  5. bilateral
65
Q

signs of bacterial conjunc

A
  1. Crusty lids
  2. Conjunctival hyperaemia
  3. Mild papillary reaction
  4. Lids and conjunctiva may be edematous
66
Q

mx for bacterial conjunc

A

topical abx eg chloramphenicol

67
Q

chlamydial conjunctivitis

A
  1. follicular
  2. +/- keratitis
68
Q

gonococcal conjunctivitis

A
  1. purulent
  2. keratitis and corneal perforation in severe cases
69
Q

inx for chlamydial conjunc

A

conjunc scraping: direct IF stain or PCR

70
Q

inx for gonococcal conjunc

A

G stain and culture on choc agar or thayer-martin

71
Q

episcleritis vs scleritis

A

episcleritis: inflammation of superficial episcleral vessels of the eye, benign
scleritis: inflammation of deeper scleral vessels, sight threatening, systemic condition requiring systemic inx TRO autoimmune conditions

both have red eye

72
Q

symptoms of episcleritis

A
  1. asymptomatic
  2. lid tearing/irritation
  3. tender to touch
  4. vessels blanch with phenylephrine
    self limiting
73
Q

symptoms of scleritis

A

**1. eye pain **
2. watering and photophobia
3. appearance violaceous (localised, diffuse, nodular)
4. signs of previous ocular surgery (eg pterygium excision or corneal wound - surgically induced necrotising scleritis)

74
Q

inx for scleritis

A
  1. B scan ultrasonography - T sign
  2. systemic workup TRO infective and autoimmune conditions - FBC, ESR, RF, ANA, ANCA
75
Q

mx for episcleritis

A
  1. topical NSAIDs
  2. topical steroids (rare)
  3. lubricants
76
Q

mx for scleritis

A
  1. treat underlying condition (RA)
  2. NSAIDs
  3. corticosteroids
  4. immunosuppression
77
Q

scleritis most commonly a/w

A

RA

78
Q

cx of scleritis

A
  1. necrotising anterior scleritis - scleral thinning and perforation
  2. raised IOP
  3. serous retinal detachment

eye (7 decks)

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