Diagnosis & Treatment Flashcards
CC: possibly trauma, transient FB sensation, mild photophobia, discomfort
Findings: Mild VA reduction, moderate bulbar injection, possible circumcorneal flush (w/ or w/o AC rxn), Corneal epithelium staining, Topical anesthetic relieves pain entirely (dull-ache is a sign of a AC rxn)
Superficial Epithelial Abrasion
Tx:
1. Eliminate direct/indirect cause such as removing FB, epilation of lash, refit of RGP, management of epitheliopathies.
2. Irrigate in office and apply AB ung (gentamicin or tobramycin)
3. If mild - AB gtt is optional; If moderate - severe then AB gtts QID for 2-3 days or until resolution.
4. Lubricating gtts q3-4 hours starting 2 hours after leaving office
5. Apply Heating pack q2-4 hours for the first day
6. Hypertonic gtts q3-4hrs for 2-3 days if corneal edema is present
7. Aspirin or Ibuprofen for pain relief
*Advise patient that discomfort will probably get worse before it gets better
The 4 Morning Syndromes
- Marginal Keratitis (toxic staph)
- Epithelial Basement Membrane Dystrophy
- Recurrent Corneal Erosion (RCE)
- Fuch’s Endothelial Dystrophy
What type of Burn (Thermal vs. Radiation vs. Acid vs. Alkali) creates more complications?
Alkali - because it continues to penetrate through the cornea (collagenolytic response) for hours - days after initial contact. May cause ulceration, melting, permanent stromal scarring or perforation. Reaction is directly proportional to pH (greater pH equals greater tissue reaction)
Hemosiderosis (Rust Ring formation) occurs how many hours after initial injury?
2 - 48 hours after embedding. All hemosiderotic epithelial cells must be removed to avoid chronic weakening, irritation re-erosion of epithelium and risk of infection.
How long does it take for the Basal Epithelial Cells to regenerate or repair EBM?
at least 6-8 weeks
Which type of Iris Nodule appears away from the pupillary border?
Busacca - whitish-yellow lumps representing iris stroma and always associated with granulomatous uveitis.
Koeppe - most common, round or oval masses located at the pupil border.
Describe the 4 types of hypersensitivity reactions
- Type I - Immediate or Anaphylactic which is mediated by IgE and the primary cell is the Mast Cell/Basophil
- Type II - Cytotoxicity - the antigens are typically endogenous and are mediate by IgM + IgG + complement
- Type III - Immune Complex - mediated by IgG and some IgM - antigen may be exogenous or endogenous and Neutrophils cause the damage
- Type IV - Cell Mediated or Delayed - damage occurs via sensitized T lymphocytes. Example - Tuberculin (PPD test)
Are males or Females more affected by Behcet’s Disease?
Globally = Males USA = Females
HLA associated with Behcet’s?
HLA-B5
Still’s Triad?
- Iridocyclitis
- Band Keratopathy
- Cataract
What is the diagnosis?
Etiology: Unknown
Clinical: dermatological disease in children
Diagnosed via: Biopsy
Ocular: AAU, Epibulbar Mass, Spontaneous Hyphema
Juvenile Xanthogranuloma (JXG)
Reiter’s Triad?
- Arthritis - especially the knee joint
- Nongonococcal urethritis
- Conjunctivitis/Uveitis
- Post venereal exposure usually chlamydial
Hutchinson’s Triad? - seen in congenital syphilis
- Interstitial Keratitis
- Notched Incisor Teeth
- Eighth nerve deafness
Aniridia may be associated with what systemic problem?
Wilms’ Tumor - nephroblastoma typically seen in children.
Whats the diagnosis?
- Usually white females 30-40 years old
- Unilateral
- Development of iris holes (pseudopolycoria)
- Progresses over 1-3 years
- Pupil distortion/displacement caused by PAS
- Complications: secondary glaucoma, corneal edema, pain, reduced VA
- Mimics Chandler’s syndrome (corneal endothelial changes, iris atrophy, mild glaucoma)
Essential Iris Atrophy
