Eye Infections - 5Qs Flashcards
Def. bacterial conjunctivitis
Inflammation of conjunctiva due to bacterial inf
List possible etiology of bacterial conjunctivitis (BC)
Mechanical / irritative/ toxic Allergic Infectious (bacterial and virus) Immune mediated Neoplastic
MAIIN
What are the most common bacterial pathogens resp 4 BC in neonates?
C. Trachomatis H. Influenzae Staphylococcus aureus Streptococcus Pnuemoniae N. gonorrhoeae
C HSSN
What are the most common bacterial pathogens resp 4 BC in children?
H. Influenzae
S. aureus
S. pneumoniae
What are the most common bacterial pathogens resp 4 BC in adults?
H. Influenzae
S. aureus
S. pneumoniae
Coagulase-negative staph org
Name risk factors for BC wrt
- eye
- inf
- sex
Disorders of the tear ducts, eyelids, or tear film
Adjacent inf e.g. Dacryocystitis
Sexual abuse and sex with multiple persons - gonococcal and chlamydia inf
What’s the clinical presentation of C. trachomatis in neonates?
Conjunctival inj (dilation of conjunctival vessels) and eyelid edema
Purulent unilateral or bilateral ocular discharge one week after delivery from a chlamydia-infected mother
50% of neonates have chlamydia pnuemoniae
What’s the clinical presentation of N. gonorrhea in neonates?
Hyperacute inf
Rapid onset of conjunctival inf and eyelid edema
Eyes glued shut
Corneal involvement and perforation
What’s the clinical presentation of H. influenzae in children?
Xtics by concurrent upper respiratory tract inf and conjunctivitis otitis syndrome
75% of children
What’s the clinical presentation of S. pneumoniae in children?
Xtics by conjunctivitis-otitis syndrome
What’s the clinical presentation of staphylococci aureus in adults?
Associated with chronic blepharo-conjunctivitis
List complications BC.
Corneal scarring and perforation
Loss of vision
List diagnosis for BC
Comprehensive medical eye exam (Main)
Conjunctival cultures
Smears for cytology and stains (gram, giemsa)
When is Conjunctival cultures indicated?
Suspected infectious neonatal conjunctivitis
Recurrent or severe purulent conjunctivitis
Non-responding conjunctivitis
When is Smears for cytology and stains (gram, giemsa) indicated?
Suspected infectious neonatal conjunctivitis
Chronic or recurrent conjunctivitis
Suspected gonococcal conjunctivitis
What pathogens cuz BC that need to be treated systematically?
N. gonorrhoeae
C. trachomatis
When is topical tx preferred in BC?
Non-chlamydial and non- gonorrhoeae causes of BC
What medication should be avoided in BC?
Corticosteroids - may worsen herpetic keratitis
What’s the 1st line for BC caused by N. gonorrhoeae in neonates, children and adults?
Ceftriaxone
What’s the 1st line for BC caused by C. trachomatis in neonates and children < 45kg?
Erythromycin/ ethylsuccinate (EES, Ery-Tab, Erythrocin)
What’s the 1st line for BC caused by C. trachomatis in children > 45kg but < 8yr, children >= 8yr and adults?
Azithromycin (Zithromax)
List topical tx options for BC.
Bacitracin ung
Ciprofloxacin ung
What pt education is applicable to BC?
No contact lenses
Avoid rubbing and touching eyes to spread inf
What is the etiology of Viral Conjunctivitis (VC)
Adenoviral
Herpes Simplex Virus (HSV)
Varicella Zoster Virus (VZV)
Molluscum contagiosum
Name risk factors for VC?
Blepharitis (eyelid inflammation)
Poor hand hygiene
Other causes of ocular surface inflammation
Dry eye
B- POD
What are the clinical presentations of Adenoviral?
ABRUPT onset
Lymphadenopathy, petechial, and subconjuntival hemorrhages
What are the clinical presentations of HSV?
Unilateral conjunctival inj, watery discharge
Vesicular rash or ulceration of eyelids
What are the clinical presentations of VZV?
Unilateral or bilateral conjunctival inj, watery discharge
Vesicular rash or ulceration of eyelids
What are the clinical presentation of Molluscum contagiosum?
Unilateral or bilateral
Shiny dome-shaped lesion of eyelid
What are the complications of VC?
Scarring, infiltrates and necrosis
Perforation
Uveitis
Keratitis
Loss of vision
How do you diagnose VC?
Comprehensive medical eye evaluation
Culture NOT routinely done in VC
What should be avoided in the treatment of VC?
Topical AB and topical corticosteroids
How do you treat VC caused by Adenoviral?
No effective tx
What may be considered in Adenoviral?
Sx control e.g.
Artificial tears
Topical antihistamine
Cold compresses
How do you treat VC caused by Molluscum contagiosum?
Req Surgical removal of lesions
How do you treat VC caused by HSV?
Trifluridine 1% solution (Viroptic)
Acyclovir (Zovirax)
How do you treat VC caused by VZV?
Acyclovir (Zovirax)
What’s the pt education for VC?
Same as BC
Define Blepharitis.
Sty in the eye (inflammation of eyelid)
What’s the etiology of Blepharitis?
Staphylococcus epidermidis
S. aureus
Seborrheic
Meibomian gland dysfunction (MGD).
Name risk factors for Blepharitis.
Rosacea (main RF)
Aqueous tear deficiency
Isotretinion (Accutane)
Contact lens associated conjunctivitis
What’s the clinical presentation of Blepahritis caused by staphylococcus?
Scaling crusting of the eyelid
Loss and misdirection of eyelashes, eyelid scarring
Conjunctival injection, tear deficiency, corneal involvement
What’s the main complication of Blepharitis?
Keratitis
How do you diagnose Blepharitis?
Same as VC.
When is culture indicated in Blepharitis?
Recurrent B with severe inflammation
Hx of non-response to AB
What’s the preferred tx for B?
Topical AB e.g.
Bacitracin or Erythromycin X 1 week
What’s the recommended tx for chronic MGD Blepharitis?
Doxycycline
Monocycline
When is the recommend tx for chronic MGD Blepharitis contra-indicated?
Pregnancy
Lactation
Children < 10yr
Name the 4 main pathogens responsible for Bacterial Keratitis.
Gram tve cocci
Gram tve bacilli
Gram - ve bacilli
Gram -ve coccobacilli
What’s the clinical presentation of Bacterial keratitis?
Eye redness, pain and swelling
Ocular tearing or discharge
Increased light sensitivity
Blurry vision
What the complication of BK?
Corneal scarring, irregularities, perforation
Endophthalmitis
Loss of vision
How’s BK diagnosed?
Comprehensive medical eye exam
When’s culture and smears needed for BK?
Large extensive corneal infiltrate
Chronic or non-responsiveness keratitis
Atypical clinical presentation
Unusual hx
Sight-threatening or severe keratitis
When’s corneal biopsy indicated?
Non-responsive and has negative cultures
What is the preferred route of tx for BK?
Topical AB eyedrops or ointment
What’s the preferred tx for BK caused by no m.o. Identified or multiple m.o. identified? And Gram tve cocci
Cefazolin
What’s the preferred tx for BK caused by gram tve bacilli - Mycobacterium species?
Amikacin
What’s the preferred tx for BK caused by gram - ve rods?
Tobramycin or Gentamicin
What’s the preferred tx for BK caused by gram -ve cocci?
Ceftriaxone
What AB is reserved for if all else fails in BK tx?
Topical corticosteroids
