Eye 1.5 Flashcards
KERATOCONJUNCTIVITIS SICCA
general
multifactorial disease of the ocular surface with loss of the tear film
Pathophysiology
➤ Decreased tear production
➤ Abnormal meibomian gland physiology
KERATOCONJUNCTIVITIS SICCA
Risk Factors
➤ Females > Males, Increasing age
➤ Diabetes, Sjogrens, Parkinson disease
➤ Hormonal changes
➤ Nutritional deficiencies - vitamin A
➤ Contact lens use
KERATOCONJUNCTIVITIS SICCA
Clin man
➤ Dryness, irritation, bilateral conjunctival injection, foreign body sensation,
paradoxical excessive tearing, photophobia, blurred vision
➤ Can see corneal scarring, entropion, ectropion, blepharitis
➤ Reduced blink rate
KERATOCONJUNCTIVITIS SICCA
Tx
Management
➤ Artificial tears, gels or ointments
➤ Ophthalmology referral
ORBITAL/SEPTAL CELLULITIS
general
General: infection of the orbit posterior
to the orbital septum
➤ Often polymicrobial – S. aureus,
streptococci, GABHS, H. influenzae
➤ Typically secondary to sinus
infections (ethmoid sinusitis)
➤ Most common in children
ORBITAL/SEPTAL CELLULITIS
Dx and Tx
CT head
➤ Hospital admission for IV antibiotics - vancomycin followed by ceftriaxone, ampicillin-sulbactam,
piperacillin-tazobactam
➤ May need prompt surgical drainage
➤ Recommend follow up with ENT
Orbital/septal cellulitis
Clin man
(5)
Clinical Manifestations
➤ Ocular pain, especially with eye movements
➤ Ophthalmoplegia - extraocular muscle weakness with limited eye movements
➤ Diplopia
➤ Proptosis
➤ Visual changes may be present
PRESEPTAL/PERIORBITAL CELLULITIS
general
General: infection of the eyelid and
periocular tissue anterior to the orbital
septum
➤ Commonly due to sinusitis or
contagious infection of the soft tissues
of the eyelid/face
➤ Think insect bites
➤ Causative agents: S. aureus (MRSA),
streptococci, and anaerobes
PRESEPTAL/PERIORBITAL CELLULITIS
Dx and Tx
Clinical (if uncertain order CT)
Antibiotics: trimethoprim-sulfamethoxazole or clindamycin + (amoxicillin,
amoxicillin-clavulanic acid, or cefdinir)
➤ If younger than 1 year old, consider inpatient treatment
PRESEPTAL/PERIORBITAL CELLULITIS
Clin man
Clinical Manifestations
➤ Unilateral ocular pain, eyelid erythema, and edema
➤Absence of proptosis, chemosis, ophthalmoplegia, pain with eye movements
BACTERIAL KERATITIS
general
General: corneal ulceration and inflammation
➤ May rapidly progress
➤ Can cause vision loss because of the risk of corneal
clouding, scarring, or perforation
Causative Agents
➤ S. aureus, streptococci
➤ Contact lens use: pseudomonas aeruginosa
Bacterial keratitis
RF
Risk Factors
➤ Greatest risk – improper contact lens wear
➤ Dry ocular surfaces
➤ Topical corticosteroid use and immunosuppression
BACTERIAL KERATITIS
Clin Man and slit lamp results
Clinical Manifestations
➤ Typically unilateral ocular pain, photophobia, redness, vision changes, foreign
body sensation, difficulty keeping the affected eye open
➤ Conjunctival erythema, ciliary injection, hazy cornea, hypopyon
➤ Slit lamp: increased fluorescein uptake
BACTERIAL KERATITIS
Tx
Referral to ophthalmology – will likely need corneal culture
➤ Topical fluoroquinolone – moxifloxacin
➤ Do not patch eye
HERPES SIMPLEX KERATITIS
General
General: corneal infection and
inflammation usually due to reactivation
of herpes simplex virus in the trigeminal
ganglion
➤ Major cause of blindness in the US
herpes simplex keratitis
Dx and Tx
Diagnosis: fluorescein staining
➤ Dendritic corneal ulceration
Management
➤ Topical antiviral - acyclovir ointment
➤ Oral antiviral - valacyclovir
Herpes SImplex keratitis
Clin Man
Clinical Manifestations
➤ Acute onset, typically unilateral ocular pain, photophobia, conjunctival
erythema, blurred vision, ciliary flush(limbic injection)
➤ Pre-auricular lymphadenopathy
HERPES ZOSTER KERATITIS/OPHTHALMICUS
general
General: potentially sight-threatening
disorder that is a variant of varicella zoster
reactivation
➤ Pathophysiology
➤ After initial infection, varicella zoster
becomes latent in the dorsal root ganglia
or trigeminal ganglia where it can
reactivate, involving the ophthalmic
division of the trigeminal nerve
HERPES ZOSTER KERATITIS/OPHTHALMICUS
Clin man
Clinical Manifestations
➤ Prodrome: headache, malaise, fever, unilateral pain or hyperesthesia in the affected eye
➤ Vesicular rash: grouped vesicles on erythematous base
➤Hutchinson sign
➤ Ocular involvement – hyperemic conjunctivitis, uveitis, episcleritis
➤ Slit Lamp: dendritic uptake of fluoroscein
HERPES ZOSTER KERATITIS/OPHTHALMICUS
Dx
Diagnosis: clinical + fluoroscein staining
➤ PCR if testing is needed
HERPES ZOSTER KERATITIS/OPHTHALMICUS
Tx (4)
Management
➤ Urgent ophthalmology referral
➤ Analgesics for severe pain
➤ Atropine
➤ Oral antiviral
FUNGAL KERATITIS
general
General: fungal infection of the cornea
➤ Typically occurs after an eye injury with
veg active matter, corticosteroid use, or
contact lens use
➤ Can be a cause of blindness if left
untreated
➤ Causative Agent – fusarium, aspergillus, or
candida
FUNGAL KERATITIS
clin man
Clinical Manifestations
➤ Blurry vision, sudden ocular pain, photosensitivity, eye erythema, tearing,
blepharospasm
FUNGAL KERATITIS
Dx and Tx
Diagnosis : clinical
➤ Corneal biopsy
Management
➤ Ophthalmology referral
➤ Topical antifungal x months - natamycin, voriconazole
➤ May require corneal transplant
ACANTHAMOEBA KERATITIS
general
General: rare corneal infection with
acanthamoeba species
➤ Potentially sight threatening, often
carries a poor prognosis due to
significant delays to diagnosis.
➤ Most often occurs in contact lens
wearers
ACANTHAMOEBA KERATITIS
Clin man and slit lamp findings
Clinical Manifestations
➤ Typically unilateral, pain out of proportion to clinical findings, decreased vision,
ocular erythema, foreign body sensation, photophobia, tearing, mucopurulent
discharge
➤ Slit Lamp: radial or ring-like infiltrate, perineural infiltrates
ACANTHAMOEBA KERATITIS
Dx and Tx
➤ Diagnosis: corneal biopsy, PCR
Management
➤ Ophthalmology referral
➤ Medical therapy - biguanide + diamidine
➤ Miltefosine - recently obtain FDA approval for the treatment of a K
