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Disease 1 > Exam 2 Lecture 1 - Conjunctiva > Flashcards

Exam 2 Lecture 1 - Conjunctiva Flashcards

1
Q

transparent mucous membrane lining inner surface of eye lids and globe surface up to limbus, firmly attached to tarsal plates, plica semilunaris has caruncle that has cutaneous tissue containing hair follicles, sweat glands, and oil glands, epiethelium, adenoid, fibrous layer. 5 layers.

A

Conjunctiva

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2
Q

Arteries supplying blood to conjunctiva

A

Anterior ciliary and palpebral arteries

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3
Q

Tissue consisting of lymphocytes within epiethelial and stromal layers, associated blood vessels, and follicular aggregates. Critical for the initiation and regulation of ocular surface immune responses

A

Conjunctiva-Assocaited Lymphoid Tissue

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4
Q

secretion associated with white color, chronic allergic conjunctivits and dry eye

A

Mucoid secretion

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5
Q

secretion with serous exudate and tears, seen in allergic and viral conditions

A

Water secretion

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6
Q

Diffuse meaty red conjunctiva can indicate what

A

bacterial conjunctivitis

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7
Q

Purple red conjunctiva can indicate what

A

Viral conjunctivitis

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8
Q

Pinky- red conjunctiva can indicate what

A

Allergic Conjunctivitis

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9
Q

sign in conj of viral conj or sometimes bacterial conj such as H influenza, N meningiditis, S Pneumoniae, Enterovirus and cozsackievirus, can be subconjunctival in cases like valsalva maneuver, trauma, high BP, blood thinners like coumadin, warfarin, heparin, aspirin

A

Hemmorhages

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10
Q

Translucent swelling of conjunctiva - exudation from permeable capillaries - rubbing eyes excessively in allergic conj, chronic can mean orbital outflow constriction

A

Chemosis

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11
Q

Coagulated exudate adherent to inflamed tarsal conjuctival epithelium, PEELED EASILY, gonococcal conj, steven-johnson, severe adenoviral infection

A

Pseudomembrane

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12
Q

Inflammed exudate permeates the superficial layer of conj epithelium, tear with removal and cause bleeding- beta hemolytic infections and diphtheria

A

True Membrane

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13
Q

Cellular recruitment to the site of chronic inflammation and typically accompanies papillary response, recognized by loss of detail of the tarsal vessels, look whiteish - myeloid sarcoma for example

A

Infiltration

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14
Q

cicatricial entropion causing loss of goblet cells and accessory lacrimal glands can be a result of what?

A

Subconjunctival scarring - chalazion removal leaves scar on inner side of eyelid

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15
Q

Multiple discrete slightly elevated lesions, looks like translucent grains of rice or soldiers in a row - VIRAL CONJUNTIVITIS, more prominent at fornices. Blood veseels are AROUND not within. use red free filter to view better. Sub - epithelial lymphoid germinal centers with central immature lymphocytes and mature cells, clusters of lymphocytes. Caused by VIRAL and chlamydial conjunctivitis - Parinaud oculoglandular syndrome, hypersensitivity. Normal finding in children

A

FOLLICLES - LYMPHOCYTES/VIRUS

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16
Q

Elevated lesions in tarsal conjunctiva and limbal conjunctiva with vessels going THROUGH not around. TRANTA DOTS when in limbus area. Folds of hyperplasctic con with fibrovascular core and subepithelial stromal infiltration with inflammatory changes. Late changes - superficial stromal hyalinization, scarring, crypts. Caused by alergic/bac/ conj. CL wear, SLK, floppy eyelid syndrome

A

PAPILLAE- ALLERGIES/FOREIGN BODIES

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17
Q

Way to detect viral infection, occurs in chlamydial and severe bacterial conjunctivitis, such as gonoccocal and parinaud oculoglandular syndrome.

A

Lymphadenopathy

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18
Q

Conjunctivitis classifications

  1. al of a sudden
  2. onset within 12 hours
  3. between acute and chronic
  4. Longer than 4 weeks
A
  1. Acute - SPK, red eye, sticky eyelids
  2. Hyperacute - gonococcal - severe mucopurulent discharge
  3. Subacute -
  4. Chronic - follicular reaction - chlamydial disease, drug toxicity
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19
Q

general Type of conjunctivitis usually bacterial or HSV - viral, allergic - vernal/atopic, pediculosis

A

Acute Onset Conjunctivitis

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20
Q

general type of conjunctivitis with chlamydial inclusion, trachoma, molluscum contagiosum, toxicity, parinauds, neonatal

A

Chronic conjunctivitis

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21
Q

Common and self limiting conjunctivitis with infected secretions, not usually severe unless N gonorrhea which can invade the cornea. Meningitis can cause it but is rare and typically in children. Meaty red conj, may spread to other eye, matted shut eyelids when waking up

A

Acute BACTERIAL conjunctivitis

22
Q

DIscharge due to gonococcal or meningococcal conjunctivitis

A

Hyperacute Purulent discharge

23
Q

What can occur in the cornea as a result of gonococcal or meningococcal conj - acute bacterial conj.

A

Peripheral corneal ulcer

24
Q

Acute bacterial conj is - PAN unless what

A

gonococcal or meningococcal- swabs and scrapings for gram staining to rule out gram negative diplococci - kidney shaped

25
Q

PCR is done to rule out what etiology for acute bacterial conjunctivitis

A

chlamydia or viral infection

26
Q

Chocolate Agar and thayer martin are used to rule out what etiology

A

N. Gonorrhea

27
Q

2 common gram positive and 3 common gram negative causes of Acute bacterial conj. which can lead to corneal ulcers in compromised patients and is common in alcoholics?

A
  1. Staph and strep - strep can have petechias or pseudomembranes
  2. Haemophylus aegyptus, influenzae - URI or ear infection common, resembles preseptal cellulitis and can lead to meningitis
    Morax-Axenfeld- common in alcoholics, lead to ulcer. Chlamydia trichomatis - needs Oral AB
28
Q

How to treat acute blepharitis caused by gram negative chlamydia

A

no topicals - ORAL azithromycin or doxy, erythro, tetra

29
Q

Treatment for Acute Bacterial conjunctivitis by bacteria

A

Polytrim or tobradex, EEM or Bacitracin, Ciprofloxacin.

30
Q

Are most acute conj cases bacterial or viral?

A

VIRAL

31
Q

What treatment should be used for Acute bacterial conjunctivitis caused by

  1. H influenza
  2. Meningococcal
  3. gonococcal
  4. Preseptal/orbital cellulitis
A

SYSTEMIC ABs

  1. H influenza - augmentin - amox/clanulanate
  2. meningococcal - doctor - life saving
  3. Gonococcal - ceftriazone, quinolone, macrolide, azythro
  4. systemic
32
Q

Would you use topical steroids in Acute bacterial conj?

A

Yes, to reduce scarring in membranous and pseudomembranous conj.

33
Q

type of bacterial conjunctivitis seen in children, young adults, and parents of young children, bilateral, rapidly develops, copius mucopurulent secretion, petechias, psuedo or true membrane, follicles and PAN, rule of 5, follow up 24 to 48 hrs, monitor cornea

A

Hyperacute Bacterial Conjunctivitis

34
Q

Rule of 5: Age range

  1. 0-5 days
  2. 5 days to 5 weeks
  3. 5 weeks to 5 years
  4. 5 years or older
A
  1. Gonococcus
  2. Chlamydia
  3. Streptococcus/ H. Influenzae
  4. Staphylococcus
35
Q

Bacterial conj with severe purulent discharge, papillae, marked chemosis, PAN, to cultures, history of man to man sex, initiate treatment if highly suspicious.

  1. Name
  2. Treatment
A
  1. Gonococcal Conjunctivitis
  2. Ceftriazone 1 gm single dose, if cornea is involved HOSPITALIZE - will be given ceftriaxone, allergic to penicillin - fluoroquinolone - ciprofloxacin, bacitracin EEM topical, Fluoroguinolong topical - cipro, Treat possible chlamydial co infection - azithro or doxy or TTC or EEM for 7 days
36
Q

Conjuntivitis frequently caused by a virus - common cold, sporadic or epidemic,

  1. subtype that is most common, mild, accompanies cold or sore throat
  2. subtype with serotypes 3,4,7, spreads w URI, keratitis in 30%
  3. subtype with ADV serotypes 8,19, 37, most severe type, keratitis in 80%
  4. Subtype with follicular papillary lesions for years, rare
A

Adenovirus - Viral Conjunctivitis

  1. Nonspecific follicular conjunctivitis
  2. Pharyngoconjunctival fever
  3. Epidemic Keratoconjunctivitis
  4. Epidemic keratoconjunctivitis
  5. Chronic/relapsing adenoviral conjunctivits
37
Q

What conjunctivitis is often seen with epithelial microcysts, punctate epithelial keratitis, focal white subepithelial, anterior stromal infiltrates, eye lid edema, hyperemia, pseudomembranes more than membranes

A

ADV conjunctivitis

38
Q

3 conditions differential DX for ADV Conjunctivitis

  1. tropical areas, enterovirus, coxsackievirus, rapid onset, conj heme
  2. Follicular rx, unilateral, skin lesions
  3. common in children - varicella, measles, mumps, HIV conj
A
  1. Acute hemorrhagic conjunctivitis
  2. Herpes simplex virus
  3. Systemic viral infection
39
Q

How to treat ADV conjunctivitis

  1. progression
  2. for inflammation
  3. for comfort after membrane removed
  4. Under trial for ADV treatment
  5. Off label treatment
A

1.spontaneous resolution,
Prednisolone topical steroid for psuedo membranous, or symptomatic keratitis. but steroids may enhance viral replication, so monitor progress and IOP,
3. artifical tears, no CLS
4. gancyclovir gel - Zirgan
5. povidone-iodine - Betadine - tetracaine first

40
Q

Type 1 immdeiate hypersenstivitiy reacton in conjunctivities mediated by mast cell degranulation in response to action of igE. type 4 could be present tho.

A

Allergic Conjunctivitis - hay fever, allergies, asthma, eczema

41
Q

Allergic conjunctivitis type, common condition as reaction to alergen in environment like pollen, young patients playing outside, itching, burning, redness, tearing. Chemosis, red lid, hyperemia, papillae

  1. name
  2. Treatment
A
  1. Acute Allergic Conjunctivitis

2. Cold compress and single drop of naphcon A, Lastacaft -antihistamines and vasoconstriction

42
Q

hypersensitivity reaction to airborne antigens, associated with NASAL symptoms, can be seasonal ( Hay fever symptoms in summer, usually from grass and tree pollen) or perennial

A

Allergic Rhinoconjunctivitis

43
Q

allergic rhinoconj type that causes symptoms ALL YEAR long, worst in autumn, mast cell mediated response with a lot of eosinophil involvement.

A

Perennial Allergic Rhinoconjunctivitis

44
Q

Conjuntivitis with transient acute attacks of redness, watery itchy eyes with sneezing and nose discharge, mild papillary reaction.
1, name
2. Treatment - MCSs, Antihistamines, Dual action mast cell/antihistamine, topical steroids, oral antihistamines

A
  1. seasonal/perennial allergic (rhino) conjunctivitis
  2. Mast cel stabilizers- cromolyn sodium, nedocromil, lodoxamide, Antihistamines, combo antihistamine and vasoconstrictor - naphcon A, dual action antihistamine and mast cell stabilizers - ketotifen, olopatadine, azelastine, topical steroids - alrex, loteprednol, dexamethasone, oral antiistamine - loratidine claritin, diphenhydramine benadryl,, fexofenadine allegra, cetirizine zyrtec-
45
Q

best treatment for mild allergic conj

A

Artificial tears 4 - 8 times per day

46
Q

treatment for moderate severity allergic conj

A

Olopatadine, epinastine, nedocromil, ketotifen for itching, ketorolac, lodoxamide, pemirolast NSAID for reduce symptoms

47
Q

inflammed conj in patients usually children or young adults, men, age of 5, resolves around puberty, rarely after 25, IgE mediated, develop asthma and eczema, worse on a seasonal basis - april to august. Itchy, lacrimation, thick mucus discharge, burning, FB, photophobia.

  1. general name
  2. if it involves primairly the upper tarsal conj, associated with corneal disease
  3. if affects dark skinned and asian patients typically
  4. Featres of both 2 and 3
A
  1. Vernal Keratoconjunctivitis
  2. Palpebral VKC
  3. Limbal VKC
  4. Mixed VKC
48
Q

Type of VKC with SUPERIOR TARSAL diffues papillary hypertrophy. diffuse papillae when mild, flat top cobblestone pailillae when mild, or Giant papillae with mucus deposits when more progressed.

A

Palpebral VKC

49
Q

Type of VKC with TRANTA DOTS ( degenerated eosinophils) at limbus and tarsal signs, more common in dark skinned patients - in tropical regions, corneal complication signs more common in lighter skinned.

A

Limbal Vernal Keratoconjunctivitis

50
Q

Rare bilateral disease that develops in adulthook - 30-50, following long hx of eczema. Athma is common. tends to be perennial, sensitive to many airborne allergens, visual morbidity. dry scaly thickened, fissuring, itchy eye lids. lid margin keratinization, Absence of lateral eyebrow - Hertoghe sign - lower lid ectropion/epiphora, more inferior palpebral involvement, watery stringy discharge, small papillae,

A

Atopic Keratoconjunctivitis

51
Q

How to treat VKC/AKC

  1. general measures
  2. local treatment
  3. prophylactic
  4. for acute exacerbation
  5. for severe exacerbation and significant keratopathy
  6. If steroid treatment is ineffective
  7. to prevent infection in keratopathy in cases of shield ulcers
  8. Mucolytic agent to dissolve mucus filaments and prevent plaque formation
  9. Follow up
A
  1. avoid allergen, cold compress, lid hygiene
  2. Mast cell stabilizer or NSAID but check allergy
  3. mast cell stabilizer - lodozamide pemirolast, or antihistamine - nedocromil, oplopatadine, ketotifen, 2-3 weeks before season starts
  4. antihistamine - combined antihistamine and mast cell stabilizer
  5. Steroids - fluoromethalone, rimexolone, prednisolone, loteprednol, in short intensive courses, aiming for prompt tapering
  6. Immune modulators - cyclosporin or Tacrolimus (prefferred for severe AKC
  7. Antibiotics
  8. Acetylcysteine
  9. every 1-3 days if shield ulcer, otherwise, every few weeks, slowly taper steroid meds, maintain anti allergy drops throughout the season
52
Q

Mechanically induced conjunctivitis, seen in CL patients, prosthesis, exposed sutures, scleral buckles. greater risk if asthma, animal allergies, hay fever. immune overreaction, not seasonal. Copious mucus discharge - caused by rupture of connective tissue septa. Itchy after cls removal, white mucus in the morning, photophobia, lens deposits. giant papillae in superior tarsal, focal ulceration and white scarring, CL coating, high riding lens, possible ptosis.

  1. Name
  2. Treatment - remove stimulus
  3. Treatment - ensure effective cleaning of CL
  4. treatment - topical
A
  1. Giant Papillae Conjunctivitis
  2. Stop CL wear for several weeks, remove suture/scleral buckle, assess prosthesis,
  3. Change material, schedule, solution, cleaning
    4 - mast cell stabilizers, antihistamines, NSAID, dual action antihistamine/mcs, topical steroids for acute resistant cases or stiulus cant be removed like filtering bleb

Disease 1 (8 decks)

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