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 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
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
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
