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Anterior Segment > Disorders of the Conjunctiva: General & Bacterial > Flashcards

Disorders of the Conjunctiva: General & Bacterial Flashcards

1
Q

what mucus membrane lines inner surface of eyelids

A

palpebral conjunctiva

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2
Q

what mucus membrane lines the anterior globe

A

bulbar conjunctiva

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3
Q

bulbar conjunctiva is continuous with & where

A

corneal epithelium at the limbus

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4
Q

list the layers of the conjunctiva from most superficial to deep

A

conjunctiva → anterior Tenon’s capsule → episclera → sclera

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5
Q

which conjunctival layer is the protective outer layer

A

epithelium

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6
Q

what does the epithelium contain

A

goblet cells & conjunctival associated lymphoid tissue (CALT)

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7
Q

which conjunctival layer is composed of loose vascularized tissue

A

stroma

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8
Q

what does the stroma contain

A
  • accessory lacrimal glands
  • sensory nerves
  • lymphatic vessels
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9
Q

what is a conjunctival fold that allows the globe to move without stretching the conjunctiva

A

plica semilunaris

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10
Q

what is a small, fleshy nodular prominence

A

caruncle

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11
Q

what does the caruncle contain

A
  • goblet cells
  • sweat glands
  • sebaceous glands
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12
Q

what is dilation of conjunctival vessels that leads to diffuse redness

A

hyperemia

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13
Q

how do hemorrhages appear on an inflamed conjunctiva

A

small “petechial” (pin-point)

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14
Q

what is translucent swelling of the conjunctiva

A

chemosis

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15
Q

which membrane is coagulated exudate that is adherent to inflamed conjunctival epithelium

A

pseudomembrane

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16
Q

which membrane is coagulated exudate & fibrin that is firmly attached to conjunctival epithelium

A

true membrane

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17
Q

do follicles or papillae appear translucent/whitish like “grains of rice”

A

follciles

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18
Q

are follicles or papillae associated with ipsilateral lymphadenopathy

A

follicles

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19
Q

are follicles or papillae caused by formation of a subepithelial lymphoid germinal center with lymphocytes

A

follicles

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20
Q

what are the typical causes of follicles

A
  • viral
  • chlamydial (inclusion)
  • toxic
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21
Q

do follicles or papillae mainly develop in palpebral conjunctiva & potentially bulbar limbal conjunctiva

A

papillae

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22
Q

do follicles or papillae contain a central vascular channel, making it look “red & beefy”

A

papillae

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23
Q

are follicles or papillae composed of folds of hyperplastic epithelium with a fibrovascular core & stromal infiltration with inflammatory cells

A

papillae

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24
Q

what are the typical causes of papillae

A
  • allergy
  • bacteria
  • CL wear
  • floppy eyelid syndrome
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25
Q

what type of discharge would you see in viral & allergic conjunctivitis

A

serous

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26
Q

what type of discharge would you see in VKC or bacterial conjunctivitis

A

mucoid (stringy/ropy)

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27
Q

what type of discharge would you see in bacterial conjunctivitis

A

mucopurulent (pus-like)

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28
Q

what type of discharge would you see in a gonococcal conjunctivitis

A

severe purulent

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29
Q

what is the most common cause of bacterial conjunctivitis

A

S. aureus

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30
Q

what are less common causes of bacterial conjunctivitis

A
  • S. pneumoniae
  • H. influenzae
  • Moraxella
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31
Q

what are rare causes of bacterial conjunctivitis

A
  • N. meningitidis

- N. gonorrhea

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32
Q

these signs are indicative of what type of bacterial conjunctivitis:

  • eyelid edema & erythema in a severe infection
  • conjunctival hyperemia/injection & chemosis
  • white-yellow mucopurulent discharge
  • SPK
  • conjunctival papillae
  • usually bilateral
  • absent preauricular lymphadenopathy
A

acute bacterial conjunctivitis

33
Q

which bacterial conjunctivitis will have an acute onset of redness

A

acute bacterial conjunctivitis

34
Q

what treatment will speed up recovery & prevent reinfection & transmission in acute bacterial conjunctivitis

A

topical antibiotic QID x 1 wk

35
Q

what are some examples of topical antibiotics to treat acute bacterial conjunctivitis

A
  • G+ ABX
  • bacitracin
  • vigamox (if severe)
36
Q

when are systemic antibiotics indicated in acute bacterial conjunctivitis

A

when N. gonorrhea, N. meningitidis, or H. influenzae suspected

37
Q

in acute bacterial conjunctivitis, does conjunctival hyperemia or injection & chemosis predominate

A

hyperemia

38
Q

these signs are indicative of which bacterial conjunctivitis:

  • 12-24hrs onset
  • copious green-gray mucus discharge
  • typically unilateral, but can be bilateral
  • significant eyelid edema & conjunctival hyperemia
  • lymphadenopathy
A

hyperacute bacterial conjunctivitis

39
Q

what are the sequelae of hyperacute bacterial conjunctivitis

A
  • corneal ulceration
  • corneal perforation
  • panophthalmitis
40
Q

what organisms cause hyperacute bacterial conjunctivitis

A
  • N. gonorrhea

- N. meningitidis

41
Q

when treating hyperacute bacterial conjunctivitis, topical antibiotics are used in conjunction with

A

oral/IM/IV antibiotics

42
Q

treatments are indicative of which type of bacterial conjunctivitis:

  • infectious disease consult
  • hospitalization may be required
  • topical ABX & oral/IM/IV ABX
  • continuous irrigation of discharge
  • must report to government health agency
A

hyperacute bacterial conjunctivitis

43
Q

which type of bacterial conjunctivitis is conjunctival inflammation that develops within the first month of life through transmission by mother during delivery

A

neonatal conjunctivitis (ophthalmia neonatorum)

44
Q

these causes cause which type of bacterial conjunctivitis:

  • chlamydia trachomatis
  • neisseria gonorrhea
  • herpes simplex virus 2
  • a toxic reaction to silve nitrate prophylaxis (Crede prophylaxis)
A

neonatal conjunctivitis

45
Q

what is the most common cause of neonatal conjunctivitis

A

chlamydia trachomatis

46
Q

which cause of neonatal conjunctivitis has an onset within the first few days

A

toxic reaction

47
Q

which cause of neonatal conjunctivitis has an onset during the 1st week

A

gonococcal

48
Q

which cause of neonatal conjunctivitis has an onset within 1-2 weeks

A

HSV

49
Q

which cause of neonatal conjunctivitis has an onset within 1-3 weeks

A

chlamydia

50
Q

how do you treat neonatal conjunctivitis caused by HSV 2

A

IV acyclovir

51
Q

how do you treat a chlamydial neonatal conjunctivitis

A

oral erythromycin

52
Q

how do you treat a gonococcal neonatal conjunctivitis

A

hospital admission; IM/IV cephalosporin

53
Q

which type of bacterial conjunctivitis is caused by chlamydia trachomatis

A

chronic bacterial conjunctivitis (inclusion conjunctivitis)

54
Q

asymptomatic urethritis is a systemic symptom of chronic conjunctivitis in males or females

A

males

55
Q

dysuria & discharge are systemic symptoms in chronic bacterial conjunctivitis in males or females

A

females

56
Q

urethritis in males with chronic bacterial conjunctivitis can trigger what

A

Reiter syndrome

57
Q

dysuria & discharge in females with chronic bacterial conjunctivitis can progress to what

A

pelvic inflammatory disease & risk of infertility

58
Q

these symptoms are indicative of which type of bacterial conjunctivitis:

  • typically unilateral chronic red eye, can be bilateral
  • mucopurulent discharge
  • chronic (3+ weeks)
A

chronic bacterial conjunctivitis (inclusion conjunctivitis)

59
Q

what sign is characteristic for chronic bacterial conjunctivitis

A

large follicles in inferior fornix & follicles on bulbar conjunctiva

60
Q

these signs are indicative of which type of bacterial conjunctivitis:

  • tender preauricular lymphadenopathy
  • large follicles in inferior fornix
  • bulbar conjunctiva follicles
  • SPK
  • perilimbal subepithelial infiltrates appearing after 2-3 weeks
  • improves with topical ABX, but returns once discontinued
A

chronic bacterial conjunctivitis

61
Q

what is the preferred systemic antibiotic therapy for chronic bacterial conjunctivitis

A

azithromycin 1g PO, single dose

62
Q

what systemic antibiotic therapies are used to manage chronic bacterial conjunctivitis

A
  • azithromycin 1g PO, single dose

- doxycycline 100mg PO BID x 10 days

63
Q

what is the leading cause of preventable blindness in the world that is associated with poverty, overcrowding & poor hygiene

A

trachoma

64
Q

in trachoma, recurrent infections results in what

A

chronic immune response (type IV hypersensitivity) to chlamydial antigen

65
Q

which stage of trachoma is most common in preschool children

A

active inflammatory stage

66
Q

which stage of trachoma is prevalent in middle age

A

cicatricial chronic stage

67
Q

which stage of trachoma has mixed follicular & papillary conjunctivitis & mucopurulent discharge

A

active inflammatory stage

68
Q

which stage of trachoma has scarring of superior palpebral conjunctiva (Arlt’s line)

A

cicatricial chronic stage

69
Q

which stage of trachoma has superior epithelial keratitis & pannus formation

A

active inflammatory stage

70
Q

which stage of trachoma has trichiasis & cicatricial entropion

A

cicatricial chronic stage

71
Q

which stage of trachoma has corneal opacification from continuous mechanical trauma

A

cicatricial chronic stage

72
Q

what strategy is used to manage trachoma

A

SAFE strategy

73
Q

in SAFE strategy, what does the S stand for

A

surgery for trichiasis

74
Q

in SAFE strategy, what does the A stand for

A

antibiotics for active diseases

75
Q

in SAFE strategy, what does the F stand for

A

facial hygiene

76
Q

in SAFE strategy, what does the E stand for

A

environmental improvement

77
Q

how can you improve the environment to manage trachoma

A
  • access to clean water
  • sanitation
  • reduction in fly population
78
Q

what is the vector for trachoma

A

flies

Anterior Segment (37 decks)

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