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Contact Lenses > corneal infiltrative events > Flashcards

corneal infiltrative events Flashcards

1
Q

what is an infiltrate?

A

white blood cells in conreal tissue due to inflammatory response to bacterial toxins

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2
Q

what is a corneal ulcer?

A

epithelial defect with underlying inflammation

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3
Q

are corneal ulcers infective?

A

can be non-infective or infective

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4
Q

what are the 3 different ways to classify CIEs?

A

ulcerative vs non-ulcerative
suppurative vs non-suppurative
central vs peripheral keratitis

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5
Q

how does a corneal ulcer form?

A

too much colonising bacteria on the CL, causes build up of endotoxins, which are trapped between CL and epithelium, then go into the epithelium, which triggers WBC response

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6
Q

what is a disadvantage of describing a CIE as ulcerative vs non-ulcerative?

A

lack of agreement over definition of ‘ulcer’

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7
Q

what does suppurative mean?

A

produces discharge (pus)

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8
Q

what is a disadvantage of describing a CIE as suppurative vs non-suppurative?

A

not all MK cases have discharge

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9
Q

what is a disadvantage of describing a CIE as central vs peripheral?

A

not always reliable indicator of whether infiltrate is sterile or not

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10
Q

what are asymptomatic infiltrates?

A

infiltrates in patients without symptoms

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11
Q

are asymptomatic infiltrates only in CL wearers?

A

no - can be in non-CL wearers too

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12
Q

what are asymptomatic infiltrates usually caused by?

A

environmental factors e.g air pollution

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13
Q

signs of asymptomatic infiltrates?

A

1 or more small discrete grey-white patches usually in periphery

intraepithelial

formed from inflammatory cells

no other signs of inflammation

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14
Q

symptoms of asymptomatic infiltrates?

A

none you donut

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15
Q

management of asymptomatic infiltrates?

A

px lens care review
review is concern over compliance or a larger number of infiltrates

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16
Q

what does this image show?

A

asymptomatic infiltrates

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17
Q

signs of asymptomatic infiltrative keratitis (AIK)?

A

small focal infiltrates up to 0.4mm
sub-epithelial
may be small punctate staining
mild limbal and/or bulbar redness

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18
Q

how to differentiate between AIK and AI?

A

sub epithelial in AIK, intraepithelial in AI
-also size on infiltrates in AI (<0.2mm) and AIK (<0.4mm)

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19
Q

management of AIK?

A

review lens care
review fitting and advise against sleeping in lenses

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20
Q

symptoms of AIK?

A

NONE YOU FRESHY

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21
Q

what does this image show?

A

AIK

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22
Q

who is AIK more common in?

A

those wearing lenses for 12-14 hours +
or sleeping in lenses

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23
Q

what do you say to a px with AIK?

A

you have signs of an inflammatory reaction, this is common if you get build up of toxins on the lenses which usually occurs when we aren;t cleaning the lenses as much as needed …. then go on to talk about your management or whatever

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24
Q

what is infiltrative keratitis?

A

inflammatory reaction of the conrea charaacterised by anterior stromal infiltration, with or without epithelial involvement, in the midperiphery to periphery of the cornea

25
Q

what does this image show?

A

infiltrative keratitis

26
Q

signs of infiltrative keratitis

A

single (or multiple) small round infiltrates in epithelium or anterior stroma
may be unilateral or bilateral
sectoral bulbar and/or limbal hyperaemia
epithelium generally doesn’t stain

27
Q

symptoms of infiltrative keratitis

A

minor infiltrates = asymptomatic
discomfort
FB sensation
irritation
mild photophobia
lacrimation
symptoms reduce on lens removal

28
Q

management of infiltrative keratitis

A

remove the cause
cease lens wear
use of lubricants for symptomatic relief and to flush out any toxins in the eye
treat marginal disease
monitor progress

29
Q

what is CLARE?

A

cl induced acute red eye
inflammatory reaction of the cornea and conjunctiva immediately following a period of eye closure with CL wear due to endotoxins from gram negative bacteria

30
Q

signs of CLARE

A

acute, unilateral circumferential bulbar conjunctival hyperaemia
small mid-peripheral infiltrates
SEVERE = mild anterior chamber involvement

31
Q

symptoms of CLARE

A

wake up in middle of the night with painful red eye
lacrimation
photophobia
FB sensation

32
Q

management of CLARE

A

self-limiting
remove lens
monitor 12-24 hours to ensure correct diagnosis
ocular lubricants
address lens compliance and lid hygiene as appropriate
daily wear - possible refit
prognosis good

33
Q

cause of CLARE

A

usually sleeping in lenses

34
Q

what is CLPU

A

inflammatory reaction with focal excavation of the epithelium, infiltration and necrosis of the anterior stroma

35
Q

in CLPU which layer of the cornea remains intact>

A

bowmans layer

36
Q

signs of CLPU

A

unilateral
single (usually) small sterile infiltrate in the peripheral cornea (<1.5mm)
clear cornea between ulcer and limbus
epithelium may stain
defined margins
mild sectoral hyperaemia
no lid oedema
SEVERE = mild AC reaction

37
Q

symptoms of CLPU

A

50% = asymptomatic
possible FB sensation
mild photophobia
lacrimation
general lens intolerance

38
Q

management of CLPU

A

cease lens wear until resolves (~2weeks)
self-limiting byt careful monitoring over first 24-48 hours due to MK risk
ocular lubricants
possible prophylactic antibiotics???
treat any lid margin disease
address compliance regime - consider modality
good prognosis - corneal scar likely

39
Q

which modality of lens are you more likely to get a CLPU

A

extended wear lenses

40
Q

associations of CLPU

A

bacterial contamination
hypoxia
tight lens
poor hygiene

41
Q

why is extended wear associated with CLPU?

A

the longer you are wearing the lenses, the more the cornea is exposed to endotoxins on the lens = inflammatory reaction

42
Q

what is MK?

A

microbial keratitis
INFECTION of the cornea characterised by excavation of the corneal epithelium, BOWMANS LAYER and stroma with infiltration and necrosis of tissue

43
Q

which 2 bacterias are associated with microbial keratitis?

A

pseudomonas (gram -ve)
staphylococcus (gram +ve)

44
Q

other types of keratitis?

A

acanthameoba
viral
fungal

45
Q

does MK or CLPU have a larger infiltrate?

A

MK (>1.5mm)

46
Q

signs of MK

A

large infiltrate
central or paracentral
irregular appearance
ill-defined margins
unilateral
severe hyperaemia
lid oedema
mucopurulent discharge
AC flare often present

47
Q

symptoms of MK

A

pain, acute onset, rapid progression
very red
reduced vision
lacrimation
photophobia
mucopurulent discharge

48
Q

how do you differentiate between CLPU and MK???

A
49
Q

management of MK

A

cease lens wear
refer to A&E
- corneal scrapes
TAKE CL CASE TO A&E
px will require dialy follow up (possibly kept overnight) until condition resolves
topical antibiotics
dual therapy - combination of 2 antibiotics for gram +ve and -ve
no lens wear until resolved
consider dailies

50
Q

signs of acanthamoeba keratitis

A

begins as a nonspecific keratitis with infiltrates along the conreal nerves in a radial pattern
ring infiltrate typicaly appears later in the disease process

51
Q

symptoms on acanthamoeba keratits

A

SAME AS MK

pain, acute onset, rapid progression
very red
reduced vision
lacrimation
photophobia
mucopurulent discharge

52
Q

management of acanthamoeba keratits

A

immediate referral to HES
mistaken for HSK
culture maybe taken
treated with broad spectrum antibiotics

53
Q

what are the most common pathogens for fungal keratits

A

candida or fusarium

54
Q

who is most likley to get fingal keratits

A

immune disorder

55
Q

which has a slower onset:
bacterial or fungal keratitis

A

FUNGAL

56
Q

which keratitis is associated with trauma with vegatative material?

A

FUNGALs

57
Q

signs of fungal keratitis

A

unilateral
hyperaemia
lacrimation
hypopyon
lid oedema

58
Q

symptoms of fungal keratitis

A

pain
photophobia
vision reduction
FB sensation

59
Q

management of fungal keraittis

A

cease lens wear
emergency referral
topical anti-fungals
may require corneal graft
take lens case with you to A&E

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