Disorders Of Conjunctiva & Disorders Of The Lacrimal Drainage System Flashcards
Signs and symptoms of conjunctival disease
Ocular discomfort
Burning sensation
Pain
Itching
Exudation
Hyperemia
2 types of bacterial conjunctival infections
Simple bacterial conjunctivitis
Gonococcal keratoconjunctivitis
3 types of viral conjunctival infections
Adenoviral keratoconjunctivitis
Molluscum Contagiosum conjunctivitis
Herpes Simplex conjunctivitis
3 types of chlamydial conjunctival infections
Adult chlamydial keratoconjunctivitis
Neonatal Chlamydial conjunctivitis
Trachoma
3 causative agents of simple bacterial conjunctivitis
Staphylococcus epidermidis
Staphylococcus aureus
Streptococcus pneumoniae
Common
Self limiting
Simple bacterial conjunctivitis
Crusted eyelids and conjunctival injection
Subacute onset of mucropurulent discharge
Simple bacterial conjunctivitis
Treatment for simple bacterial conjunctivitis
Broad spectrum topical antibiotics (chloramphenicols)
A sexually transmitted infection of epithelium and commonly manifests as cervicitis, urtheritis, and conjunctivitis
Gonorrhea
Causative agent of gonorrhea
Neisseria gonorrhoeae
Treatment for gonorrhea
Antibiotics
Acute profuse purulent discharge
Hyperaemia
Chemosis
Gonococcal keratoconjunctivitis
Corneal ulceration
Perforation
Endophthalmitis if severe
Gonococcal Keratoconjunctivitis
Signs of gonococcal keratoconjunctivitis
Acute
Profuse
Purulent discharge
Hyperaemia
Chemosis
Treatment for gonococcal keratoconjunctivitis
Topical gentamicin
Intravenous cefoxitin
Adenovirus types 3 and 7
Pharyngoconjunctival fever
Adenovirus type 8 and 19
Epidemic keratoconjunctivitis
Pharyngoconjunctival fever
Adenovirus type 3 and 7
Affects children
Upper respiratory tract infection
Keratitis 30%
Epidemic keratoconjunctivitis
Adenovirus type 8 and 19
Very contagious
No systemic symptoms
Keratitis in 80%
Signs of viral conjunctivitis
Usually bilateral
Acute watery discharge and follicles
Subconjunctival haemorrhages and pseudomembranes
Treatment for viral conjunctivitis
Symptomatic
Usually bilateral
Acute watery discharge and follicles
Subconjunctival haemorrhages
Viral conjunctivitis
Signs of keratitis
Transient- focal, epithelial keratitis
May persist for months- focal, subepithelial keratitis
Treatment for keratitis
Topical steroids
Topical steroids
Keratitis
Antibiotic
Gonorrhea
Broad spectrum topical antibiotics
Simple bacterial conjunctivitis
Infection caused by poxvirus
Molluscum contagiosum
Waxy umbilicated eyelid nodule
Ipsilatetal chronic mucoid discharge
Molluscum Contagiosum conjunctivitis
Unilateral eyelid vesicles
Acute follicular conjunctivitis
Herpes simplex conjunctivitis
Treatment for Molluscum Contagiosum
Destruction of eyelid lesion
Destruction of eyelid lesion
Molluscum Contagiosum conjunctivitis
Treatment for herpes simplex conjunctivitis
Topical antivirals to prevent keratitis
Topical antivirals to prevent keratitis
Herpes simplex conjunctivitis
2 types of herpes simplex
Type 1 and type 2 herpes simplex virus
Type 1 herpes simplex virus
Waistline and above
Type 2 herpes simplex virus
waistline and below
Risk factors of HSV-2
Having multiple sex partners
Having sex at young age
Being female
Having STI
Having weakened immune system
Simply known as chlamydia
Chlamydia infection
Chlamydia infection is caused by the bacterium
Chlamydia Trachomatis
Chlamydia symptoms in men
Discharge from penis
Burning with urination
Pain
Swelling
Chlamydia symptoms in women
Pelvic inflammatory disease
Future infertility
Ectopic pregnancy
Treatment for chlamydia infection
Azithromycin or doxycycline
Erythromycin
Infection with chlamydia trachomatis stereotypes D to K
Contaminant genital infection is common
Adult chlamydial keratoconjunctivitis
Subacute mucopurulent follicular conjunctivitis
Variable peripheral keratits
Adult chlamydial keratoconjunctivitis
Treatment for adult chlamydial keratoconjunctivitis
Topical tetracycline or oral tetracycline
Erythromycin
Present between 5-19 days after birth
neonatal chlamydial conjunctivitis
May be associated with otits, rhinitis, and pneumonitis
Neonatal chamydial conjunctivitis
Treatment for neonatal chlamydial conjunctivitis
Topical tetracycline and oral erythromycin
Infection with serotypes A, B, Ba, C of chlamydia trachomatis
Trachoma
Fly is a major vector in infection-reinforcement cycle
Trachoma
Is the leading cause of preventable irreversible blindness in the world
Trachoma
Is related to poverty, overcrowding, and poor hygiene
Trachoma
Progression of trachoma
Acute follicular conjunctivitis
Conjunctival scarring (arlt line)
Herbert pits
Pannus formation
Trichiasis
Cicatricial entropion
Treatment for trachoma
Systemic Azithromycin
Other term for neonatal conjunctivitis
Ophthalmia neonatorum
Conjunctival inflammation developing within the first month of life
Neonatal Conjunctivitis
Most common infection of any kind in neonates occuring in up to 10%
Neonatal Conjunctivitis
It is identified as a specific entity distinct from conjunctivitis in older infants because of its potentially serious nature (both ocular and systemic complications) and because it is often the result of infection transmitted from mother to infant during delivery
Neonatal Conjunctivitis
Causes of neonatal conjunctivitis
Chlamydial trachomatis
Neisseria gonorrhoea
Herpes simplex
Used as prophylaxis against infection, cause conjunctival irritation
Topical preparations
Despite poor neonatal tear production, a persistently mildly watery eye with recurrent mild bacterial conjunctivitis may be secondary to an as yet uncanalized tear duct
Congenital nasolacrimal obstruction
A common condition caused by an acute conjunctival reaction to an environmental allergen, usually pollen
Acute allergic conjunctivitis
Typically seen in younger children after playing outside in spring or summer
Acute allergic conjunctivitis
Acute itching and water are common, but the hallmark is ___
Chemosis
Treatment for acute allergic conjunctivitis
Treatment is not usually required
a recurrent bilateral disorder in which both IgE and cell mediated immune mechanism play important roles
Vernal keratoconjunctivitis
It primarily affects boys and onset is generally from about the age 5 years onwards
Vernal keratoconjunctivitis
Relatively common in warm dry climates such as the Mediterranean, Sub-saharan Africa and the middle east
Vernal keratoconjunctivitis
Over 90% of patients have other atopic conditions such as asthma and eczema and two-thirds have family history of atopy
Vernal keratoconjunctivitis
It often occurs on a seasonal basis
Vernal keratoconjunctivitis
Can occur due to a variety of mechanical stimuli of the tarsal conjunctiva
Giant Papillary Conjunctivitis
Most frequently encountered with contact lens wear, when it is termed ____
Contact lens-associated papillary conjunctivitis
The risk is increased by the build up of proteinaceous deposits and cellular debris on the contact lens surface
Giant Papillary Conjunctivitis
Ocular prosthesis, exposed sutures and scleral buckles, corneal surface irregularity and filtering blebs can be responsible
Giant Papillary Conjunctivitis
Is an innocuous but extremely common asymptomatic degeneration of the conjunctival stroma
Pinguecula
a yellow-white mound is seen on the bulbar conjunctiva adjacent to the limbus
Pinguecula
Is is more frequently located at the nasal than the temporal limbus, but its frequently present at both
Pinguecula
Cause is believed to be actinic damage
Pinguecula
is a triangular fibrovascular sub epithelial ingrowth of degenerative bulbar conjunctival tissue over the limbus onto the cornea
Pterygium
Typically develops in patients who have been living in hot climates
Pterygium
Historically similar to a pinguecula and shows elastotic degenerative changes in vascularised sub epithelial stromal collagen
Pterygium
Enrouch onto the cornea invading the Bowman’s layer
Pterygium
Parts of the Lacrimal Drainage System
Puncta
Vertical canaliculi (2mm)
Horizontal canaliculi (8mm)
Lacrimal sac (10mm)
Nasolacrimal duct (12mm)
Causes of excessive watering
Lacrimation
Epiphora
Lacrimal pump failure
Caused by reflex over-productuon of tears from stimulation of CNV by irritation of the cornea or conjunctiva
Lacrimation
Caused by mechanical obstruction of tear drainage
Epiphora
Due to lower lid laxity or weakness of the orbicularis muscles
Lacrimal pump failure
Evaluation of watering eye
External examination
Eyelids- malposition
Dynamics of eyelid closure
Puncta- malposition, stenosis, obstruction
Lacrimal sac
Marginal tear strip
Fluorescein disappearance test -2mins
Infections of lacrimal passages
Congenital nasolacrimal duct obstruction
Congenital Dacryocele
Chronic canaliculitis
Dacryocystitis
Caused by delayed canalization near valve of Hasner
Congenital nasolacrimal duct obstruction
On pressure reflux of purulent material from punctum
Congenital nasolacrimal duct obstruction
Signs of Congenital nasolacrimal duct obstruction
Epiphora
Matting of eyelashes
Infrequently acute dacryocystisis
Treatment for Congenital nasolacrimal duct obstruction
Massage of nasolacrimal duct and antibiotic drops 4 times daily
Improvement by age 12 months in 95% of cases
If no improvement- probe at 12-18 months
Results- 90% cure by first probing and 6% by second
Distension of lacrimal sac by trapped amniotic fluid (amniontocele) caused by imperforate valve of Hasner
Congenital Dacryocele
Bluish cystic swelling at or below medial canthus
Congenital Dacryocele
May become secondarily infected
Congenital Dacryocele
is pulsatile swelling above medial canthal tendon
Encephalocele
Treatment for Congenital Dacryocele
Initially massage
Probing if massage fails
Frequent caused by Actinomyces
Chronic canaliculitis
Unilateral epiphora and chronic mucropurulent discharge
Chronic canaliculitis
Signs of Chronic canaliculitis
Oedena of canaliculus and pouting punctum
Expressed concretions consisting of sulphur granules
Treatment for Chronic canaliculitis
Simple curettage or canaliculotomy
Infection of the lacrimal sac usually secondary to obstruction of the nasolacrimal duct. It may be acute and chronic and is most commonly staphylococcal or streptococcal
Dacryocystitis
2 types of Dacryocystitis
Acute Dacryocystitis
Chronic Dacryocystitis
Usually secondary to nasolacrimal duct obstruction
Acute Dacryocystitis
Signs of acute Dacryocystitis
Tender canthal swelling
Mild preseptal cellulitis
Treatment for acute Dacryocystitis
Systemic antibiotics and warm compresses
DCR after acute infection is controlled
Epiphora and chronic or recurrent unilatetal conjunctivitis
Chronic Dacryocystitis
Signs of chronic Dacryocystitis
Painless swelling at inner canthus
Expressed mucropurulent material
Treatment for chronic Dacryocystitis
Dacryocystorhinostomy (DCR)