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Anterior Segment > Disorders of the Conjunctiva: Viral & Allergic > Flashcards

Disorders of the Conjunctiva: Viral & Allergic Flashcards

1
Q

what is the most common organism to cause viral conjunctivitis

A

adenovirus

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2
Q

what viral conditions can cause viral conjunctivitis

A
  • HSV, molluscum contagiosum
  • mumps, measles
  • flu
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3
Q

how does HSV & molluscum contagiosum cause viral conjunctivitis

A

secondary conjunctivitis from viral shedding

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4
Q

what type of viral conjunctivitis is the most common form caused by different serotypes

A

nonspecific acute follicular conjunctivitis

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5
Q

which type of viral conjunctivitis is usually accompanied by other symptoms of common cold

A

nonspecific acute follicular conjunctivitis

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6
Q

which type of viral conjunctivitis has relatively mild ocular symptoms

A

nonspecific acute follicular conjunctivitis

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7
Q

which organism causes pharyngoconjunctival fever

A

adenovirus

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8
Q

how is pharyngoconjunctival fever spread

A

by droplets within families with upper respiratory infection

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9
Q

in pharyngoconjunctival fever what presents along with conjunctivitis

A

prominent sore throat & petechial hemorrhages

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10
Q

epidemic keratoconjunctivitis (EKC) is caused by what organism & which serotypes

A

adenovirus 8, 19, 37

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11
Q

which viral conjunctivitis has the most severe ocular response to the virus

A

epidemic keratoconjunctivitis (EKC)

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12
Q

in epidemic keratoconjunctivitis, conjunctivis is commonly present along with

A

keratitis

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13
Q

in EKC, when is the infection very contagious

A

10-12 days from symptom onset while eyes are still red

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14
Q

in EKC, what forms at 7-14 days

A

subepithelial infiltrates & SPK

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15
Q

this signs are indicative of which viral conjunctivitis progression:

  • pseudomembranes
  • petechial hemorrhages
  • significant palpebral & bulbar conjunctival injection
A

epidemic keratoconjunctivitis (EKC)

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16
Q

what is key for viral conjunctivitis

A

good hygiene

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17
Q

how do you treat the subepithelial infiltrates in EKC & give some examples

A

topical steroids:

  • PredForte
  • Durezol QID q2h if severe
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18
Q

what is used off-label to manage EKC

A

betadine protocol

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19
Q

what does betadine protocol do for EKC

A

shortens duration of virus replication & decrease severity of ocular sequelae

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20
Q

what is in Betadine protocol & what classification of medication is it

A

povidine iodine 5% (antiseptic)

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21
Q

what are the 3 instillations in Betadine protocol in order & what it does

A

1) instill 1 gtt proparacaine (topical anesthetic)
2) instill 1-2 gtt NSAID (for additional pain relief)
3) instill several gtts Betadine 5% solution

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22
Q

after 1 minute of instilling drops in Betadine protocol, what do you do

A

irrigate thoroughly with sterile saline solution

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23
Q

in EKC, if subepithelial infiltrates are present, what do you prescribe

A

topical steroid QID-6x/day

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24
Q

which type of viral conjunctivitis usually occurs in tropical areas

A

hemorrhagic conjunctivitis

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25
Q

what organisms frequently cause hemorrhagic conjunctivitis

A

enterovirus & coxsackle virus

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26
Q

these signs are indicative of which type of conjunctivitis:

  • eyelid edema
  • lymphadenopathy
  • palpebral conjunctival hyperemia & follicles
  • conjunctival hemorrhages & pseudomembrane formation if severe inflammation
  • SPK
  • subepithelial infiltrates
  • conjunctival chemosis
  • conjunctival injection
A

viral conjunctivitis

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27
Q

what is the prominent symptom in viral conjunctivitis

A

tearing (serous & some mucoid)

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28
Q

how do you manage viral conjunctivitis

A
  • palliative care
  • good hygiene
  • self-resolving in 2-3 weeks
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29
Q

allergic conjunctivitis is what type of hypersensitivity reaction

A

type I

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30
Q

which immunoglobulin is immediately release when triggered by an environmental allergen

A

IgE

31
Q

these signs are indicative of which type of conjunctivitis:

  • conjunctival chemosis & hyperemia
  • conjunctival papillae: tissue inflammation with eosinophils
  • eyelid edema
  • serous discharge
A

allergic conjunctivitis

32
Q

which signs predominate in allergic conjunctivitis

A

conjunctival chemosis & serous discharge

33
Q

what are the symptoms of allergic conjunctivitis, and which one predominates

A

itching (predominates), burning, tearing

34
Q

which type of allergic conjunctivitis has severe itching, chemosis, tearing, lid edema & hyperemia

A

acute allergic conjunctivitis

35
Q

which type of allergic conjunctivitis has an immediate onset after exposure to an environmental allergen

A

acute allergic conjunctivitis

36
Q

when is acute allergic conjunctivitis resolved

A

within 24 hours of removal of antigen

37
Q

what type of allergic conjunctivitis is more chronic & milder than acute allergic conjunctivitis

A

seasonal allergic conjunctivitis

38
Q

seasonal allergic conjunctivitis is usually associated with

A

pollen, weeds & grass

39
Q

which type of allergic conjunctivitis is chronic

A

perennial allergic conjunctivitis

40
Q

perennial allergic conjunctivitis is associated with

A

allergens that usually can’t be avoided within a home (ie, dust, mites, mold)

41
Q

what causes the immediate release of histamine

A

mast cell degranulation

42
Q

itching & burning in allergic conjunctivitis occurs with what mechanism of action

A

H1 binds to nerve endings

43
Q

vasodilation (hyperemia), increased vascular permeability, edema (chemosis) in allergic conjunctivitis occur with what mechanism of action

A

H2 binds to vessel walls

44
Q

what drug has a delayed response & is given before an allergy starts

A

mast cell stabilizers

45
Q

which type of allergic conjunctivitis can you use mast cell stabilizers to treat

A

seasonal allergic conjunctivitis

46
Q

what drug has an immediate response and is given in acute allergic response

A

antihistamines

47
Q

for severe symptoms in allergic conjunctivitis, what do you treat it with

A

topical steroids

48
Q

when would you use oral antihistamines with allergic conjunctivitis

A

if accompanied by allergic rhinitis

49
Q

what class of drugs are these & what do they treat:

  • Alocril (nedocromil)
  • Alomide (lodoxamide)
  • Crolom (generic comolyn sodium)

which one is fast-acting

A

mast cell stabilizers → treat allergic conjunctivitis

Alocril is fast acting

50
Q

what class of drugs are these & what do they treat:

  • Optivar (generic azelastine)
  • Patanol (olopatadine 0.1%)
  • Pataday (olopatadine 0.2%)
  • Pazeo (olopatadine 0.7%)
  • Bepreve (betastine)
  • Elestat (epinastine)
  • Lastacaft (alcaftadine)
  • Alaway, Zatidor (OTC ketotifen)

which ones are QD (vs. BID)

A

mast cell stabilizer + antihistamine combos → treat allergic conjunctivitis

Pataday, Pazeo, Alcaftadine

51
Q

what conjunctivitis is a recurrent bilateral allergic disorder that is a IgE & cell-mediated immune reaction

A

vernal keratoconjunctivitis (VKC)

52
Q

what type of hypersensitivity is vernal keratoconjunctivitis (VKC)

A

type I

53
Q

is VKC more frequent in males or females

A

males

54
Q

when is the onset & remission of VKC

A

onset at age 5 & remission in late teens (95% of pts)

55
Q

what kind of climate is VKC common in & where is it rare

A

warm & dry

rare in temperate regions

56
Q

when VKC present in temperate regions, what is it usually associated with

A

atopic conditions such as asthma or eczema

57
Q

these symptoms are indicative of which type of allergic conjunctivitis:

  • intense itching
  • burning
  • thick, ropy mucoid discharge
  • blepharospasm
  • photophobia

which symptom is the biggest symptom

A

VKC → intense itching is biggest symptom

58
Q

these signs are indicative of what type of allergic conjunctivitis:

  • superior tarsal papillae (“cobblestone”)
  • eyelid edema
  • ropy mucus deposition between giant papillae
  • shield ulcer
  • Horner-Trantas dots
  • epithelial erosions

which sign is characteristic

A

VKC → superior tarsal papillae (“cobblestone”) is characteristic sign

59
Q

what is an inflammatory cell plaque at the base of an epithelial defect

A

shield ulcer

60
Q

what is a gelatinous limbal conjunctival papillae (accumulation of eosinophils)

A

Horner-Trantas dots

61
Q

in VKC, what causes epithelial erosions

A

toxicity to inflammatory mediators & mechanical injury from giant papillae

62
Q

VKC with micropapillae & no corneal changes is considered mild, moderate, or severe & how would you treat it

A

mild

  • mast cell stabilizers
  • antihistamines
  • cool compresses
  • artificial tears
63
Q

VKC with macropapillae, mucus accumulation & corneal vascularization is considered mild, moderate, or severe & how do you treat it

A

moderate → topical steroids (pulse therapy)

- Durezol QID

64
Q

VKC with macropapillae, macroerosion, shield ulcer, persistent severe inflammation is mild, moderate, or severe & how do you treat it

A

severe → pulse therapy or immunomodulators when steroids aren’t working

65
Q

what type of allergic conjunctivitis is a rare bilateral disease that develops in adulthood

A

atopic keratoconjunctivitis

66
Q

atopic keratoconjunctivitis follows a long history of what & what is commonly found in these patients

A

follows long history of atopic dermatitis (eczema)

asthma is commonly found in these patients

67
Q

which type of allergic conjunctivitis is chronic & unremitting (perennial) that is usually worse in winter & has low expectation of resolution

A

atopic keratoconjunctivitis

68
Q

what type of allergic conjunctivitis is a genetic predisposition combined with antigen sensitization

A

atopic keratoconjunctivitis

69
Q

what type(s) of hypersensitivity is atopic keratoconjunctivitis

A

type I & IV

70
Q

symptoms of atopic keratoconjunctivitis

A

are similar to VKC, but more severe & unremitting

71
Q

these signs are associated with what type of allergic conjunctivitis:

  • erythema
  • dryness
  • scaliness
  • thickening of eyelid
  • disruption of epidermal integrity: fissuring, scratches
A

atopic keratoconjunctivitis

72
Q

these ocular findings are indicative of which type of allergic conjunctivitis:

  • chronic staphylococcal blepharitis
  • madarosis
  • keratinization of eyelids
  • conjunctival papillae (inferior palpebral > superior palpebral)
  • SPK → persistent epithelial defects
  • peripheral corneal vascularization & stromal scar formation
  • predisposition to bacterial, fungal & HSV keratitis
  • keratoconus in some patients
  • anterior/posterior subcapsular cataracts
A

atopic keratoconjunctivitis

73
Q

what class of medication can you use to treat atopic keratoconjunctivitis & give some examples

A

topical immunosuppressants → Restasis, Tacrolimus

Anterior Segment (37 decks)

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