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OPT 533-Ocular Disease > Final Material > Flashcards

Final Material Flashcards

1
Q

Dennie Morgan Folds

A

Folds under the lower eyelid due to edema from allergic dermatitis

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2
Q

Contact Dermatitis

A

Can be I or IV. Due to direct contact with allergens.

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3
Q

Dermatitis

A

Any inflammation of the dermis

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4
Q

Irritant Dermatitis

A

May or may not be itching. DX: based on exclusion. Patch test negative. TX: moisturizer, soaps.

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5
Q

What dermatitis do you NOT use steroids with?

A

Irritant dermatitis.

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6
Q

Allergic Dermatitis

A

There is itching. Type IV. Can have chemises, keratitis, vesicles. DX:patch skin test. TX: cold compress, topical steroids, lubricants, immunomodulators

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7
Q

Atopic Dermatitis

A

AKA Eczema. Inflammed, ITCHY patches on the skin. Inherited condition. Infancy: face, knees. Later: hyper or hypo-pigmentation. Dermatitis. Prone to staph or strep. DX: test not necessary if there are clear clinical markers. TX: damp compress, topical steroids, topical antihistamine, cool temperature, humid.

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8
Q

Urticaria

A

Hives, itchy welts. Cutaneous eruption. Multiple pathogenic mechanisms. Acute: immunological Chornic: unknown. Intense itching. Raised wheels. May be transient.

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9
Q

Angioedema

A

When the inflammation involve deeper layers of the skin. Little pruritus. Involves face, lips, eyelid, tongue, thread, hands, feet. May have respiratory distress.

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10
Q

TX for angioedema and urticaria

A

Cold compress, antihistamine, systemic steroids, epinephrine for acture pharyngeal or laryngeal edema.

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11
Q

Dermatitis where you use Systemic steroids!

A

Uritica and angioedema

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12
Q

Conjunctival hypermia

A

Conj. injection. Dilation of blood vessels. Due to unhappy conj. RX: lubricants and have the patient come back if the problem gets worse.

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13
Q

Subconjunctival hemorrhage

A

Diffuse of blood between conjunctival and episclera. Associated with anticoagulants, trauma, sneezing, coughing, straining, hypertension. If recurrence occurs do work up.

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14
Q

Conj. Chemosis

A

Conjuctival edema. Can have intense ballooning

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15
Q

Leading cause of conjunctival chemosis

A

Allergies!

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16
Q

Papillae

A

Elevation of the conjunctiva. Vascular core surrounded by edema and mixed inflammatory cells. Normal on the upper lid. Severe can be large or cobblestone.

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17
Q

Cause of papillae

A

Allergy, bacterial conjunctivis, chlamydial disease (trachoma or chlamydial conj).

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18
Q

Follicles

A

Discrete! Yellowish to gray white. Avascular but dilated blood vessels may surround. Made of plasma cells and lymphocytes. Normally on the bottom lid (fall to the floor)

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19
Q

Cause of follicles

A

Viral disease, chlamydial disease, cat-scratch (parinaud’s oculoglandular syndrome), toxic drug reaction.

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20
Q

Mucopurulent discharge

A

Discharge of mucus and puss. Pus=bacterial infection.

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21
Q

True Membrane

A

Fibrinous exudate firmly adherent to conjunctiva. Bleeds and scars when removed. You want to remove the membrane. Occurs with burns, steven-johnson, and bacterial conjunctivitis

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22
Q

Pseudomembrane

A

Fibrinous exudate loosely attached to conjunctiva. Avascular. Seen in mild allergic conjunctivitis, mild bacterial conjunctivitis.

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23
Q

Things that occur with conjunctival hyperemia

A

Corneal edema, anterior uveitis, posterior synechiae, hypopyon (collection of WBC), scleritis, sectoral involvement, episcleritis, blebitis, hyphema (RBC in anterior chamber)

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24
Q

Epithelial Melanosis

A

AKA Racial Pigmentation. Benign condition. Frequent in those with dark completion. Seen in first few years and then static. Both eyes have it but may be distributed differently. Pigmentation is in epithelium and moves freely.

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25
Q

Conjunctival Nevus

A

Discrete flat or slightly elevated pigmented lesion. Present usually during first two decades of life. Cystic spaces within the lesion are seen. Most common in juxtalimbal area. Amount of pigment is variable.

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26
Q

Conjunctival melanoma

A

Rare tumor. Solitary, black or grey nodule that is fixed to episclera or non pigmented lesion with a smooth surface. Often has blood vessels. Comes from unpigmented regions (10%), preexisting nevus (20%), or primary acquired melanosis (70%). Predominantly in whites. Metastasis to the lung most common.

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27
Q

Malignant Melanoma

A

All elevated or enlarged pigment lesions with a history of change should be biopsied or excised.

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28
Q

Primary Acquired Melanosis

A

Mobile, patchy, diffuse, flat lesion with indistinct margins. May grow. Occurs in white, middle aged or older adult. This is the top thing to lead to conjunctival melanoma.

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29
Q

PAM vs Melanoma

A

Melanoma is a sudden appearance of one or more nodules in otherwise flat lesions. PAM is not fixed to underlying tissue. PAM increases risk of Melanoma.

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30
Q

Ocular Melanocytosis

A

Multiple blue gray or slate gray patches of pigmentation in the episclera. Pigmentation cannot be moved over the surface of the globe.

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31
Q

Oculodermal Melanocytosis

A

Ocular melanocytosis plus hyper pigmentation of deep periorbital skin along first and second division of trigeminal nerve. Unilateral. Most common in Asian populations.

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32
Q

Ocular melanocytosis associated features

A

Ipsilateral iris hyperchromia, melanomas of the uveal tract, ipsilateral glaucoma.

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33
Q

Pinguecula

A

Conjuctival degeneration. Associated with environmental causes. Lubricants. Can become inflamed.

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34
Q

Pterygium

A

Triangular fibrovascular tissue. Trianglular base on conj. and apex on cornea. Often preceded by a pinguecula but can start on own. Will destroy bowman’s membrane and induce astigmatism.

35
Q

Stocker’s line

A

Iron line at leading edge of pterygium

36
Q

Pterygium Treatment

A

Lubricants, vasoconstrictors if inflamed. Excision if vision affected.

37
Q

Concretions

A

Hard yellow spots in palpebral conj. Debris from cellular degeneration trapped in conj. and calcify. Occur with elderly and those with chronic inflammation. Rarely any symptoms. Can remove with needle and fluroscene.

38
Q

Conjunctival cysts

A

Thin-walled cyst filled with clear water fluid. Usually no symptoms but can erupt if large.

39
Q

Bitot’s Spot

A

Drying and wrinkling of the conj. Due to vitamin A deficiency. Rarely seen in US.

40
Q

Eosinophils

A

Diagnosist cells for allergic reaction

41
Q

How does conjunctiva react with allergy?

A

Chemosis, hyperemia, papillae, lid edema, discharge.

42
Q

Seasonal Allergic Conjunctivitis

A

SAC is the component of hay fever. Triggered by airborne antigen. Type I response. Rhinitis may occur. For symptoms think of general things that occur with allergies

43
Q

Treatment for allergic conjunctivitis

A

Mild: cold compress. Ocular lub, vasoconstrictors. OTC topical decongestants with antihistamine. OTC topical combo drug
Moderate: Topical antihistamine or combo drug
Severe: mast cell stabilizer, topical antihistamine, oral antihistamine, topical steroid, topical NSAID, consider nasal steroid.

44
Q

Perennial Allergic Conjunctivitis

A

Clinically similar to SAC but persists throughout the year. TX: similar to sac

45
Q

Acute Allergic Conjunctivitis

A

Urticarial run caused by large amount of allergen reaching the conj. Symptoms similar to SAC. Sudden onset of severe chemises and swelling of lids. Will resolve within a few hours without treatment

46
Q

Giant Papillary Conjunctivitis

A

Specific conj. inflammatory rxn characterized by papillary hypertrophy in the superior tarsal conj. Due to chronic, physical trauma. Not a true allergic reaction. Caused by SCL overwear. Either no symptoms with signs or no signs without symptoms or both. Itching and irritation variable. Almost always bilateral.

47
Q

When does a papillae characterize as giant papillary conjunctivitis?

A

.3 mm or larger

48
Q

GPC treatment

A

Topical antihistamine, mast cell stabilizers, topical steroids, NSAIDS

49
Q

Vernal Keratoconjuctivitis AKA spring catarrh

A

Rare form of allergic disease (normal young boys). Bilateral inflammation affecting primarily upper palpebral conj. Self-limited. Extreme itch. Photophobia. Blepharospasm. Cobblestone papillae on superior tarsal plate-bilateral. Discharge. Trantas dots (WBC) sterile corneal ulcers. Increased keratoconus. SPK.

50
Q

Trantas’ Dots

A

Focal infiltrates that are elevated. Usually across limbus.

51
Q

Treatment of vernal keratoconjuctivitis

A

Cold compress, ocular lubes, mast cell stabilizer, topical and or oral antihistamines, topical steroids. Oral NSAIDS, immunotherapy.

52
Q

Vekacia

A

The first drug specifically for vernal keratoconjunctivitis.

53
Q

Atopic Keratoconjuncitivis

A

Rare condition that affects young men with contact dermatitis. Bilateral. Moderate to severe itching. Persists year round. Induration of soft tissue. Increased risk of keratoconus. Cataract formation.

54
Q

Atopic Keratoconjunctivitis Treatment

A

Cold compress, ocular lubricants, topical or oral antihistamines, mast cell stabilizer, topical steroids

55
Q

Topical vasoconstrictors

A

Binds to alpha receptors on blood vessels and stimulates them leading to vasoconstriction.

56
Q

Steroids

A

Don’t cure problems but stop the symptoms.

57
Q

Varicella/Zoster Virus

A

A herpes virus which infects the dorsal root ganglion. Latent in 90% of adults. Primary infection occurs with varicella (chickenpox). Transmission by skin papules and pustules.

58
Q

Chicken pox

A

Have skin lesions. Recover in 1-2 weeks. Ocular complications are rare. Virus becomes latent in dorsal root ganglion or with the sensory ganglia of the spinal cord.

59
Q

Shingles

A

Zoster virus reactivation. Virus undergoes active multiplication in ganglion cells. Have vesicle eruptions along dermatomes. Usually respects midline (unilateral)

60
Q

Herpes Zoster ophthalmicus (acute phase)

A

Virus reactivation and infects tissue innervated by the opthalmic division of the trigminal nerve. Normally unilateral. Most often in frontal branch. Can mimic or cause almost any ocular disease.

61
Q

Hutchinson’s sign

A

Occurs when herpes zoster opthalmicus also affect nasal branch and the nasocilliary nerve. Indicates increased risk of ocular involvement.

62
Q

Herpes zoster ophthalmicus ocular involement

A

Trichasis, entropion, ectropion, madarosis, poliosis. Conjunctivitis, pseudomembranes, puncttal stenosis, vesicles on lid margin.

63
Q

what would you see in the eyes with herpes zoster?

A

pseudodendrites.

64
Q

Treatment for herpes zoster ophthalmicus

A
  1. Acyclovir-standard.
  2. capsaicin
  3. antidepresents
  4. Treat each ocular complication
65
Q

Herpes zoster ophthalmicus prevention

A

Varivax for chickenpox. Zostavax for shingles.

66
Q

Variola (smallpox)

A

systemic viral disease characterized by skin lesions. Vaccination. Can cause blindness and conjunctivitis. No specific treatment.

67
Q

Monkeypox

A

Contact with ill animals or direct/respiratory contact with infected person. Leads to blindness. Treat with smallpox vaccination or cidofivir.

68
Q

Vaccinia (cowpox)

A

Virus used for smallpox vaccination. Eye can be involved through auto contamination from vaccination site. Have keratitis, lid pustules/ulcers, follicular conjunctivitis. Prevent with vaccinia immune globulin.

69
Q

Rubeola (measles)

A

Acute. Highly contagious. Maculopapular rash. Koplike spots on buccal mucosa (bright white spots). Conjunctivitis. Inflamm. of respiratory tract.

70
Q

Treatment for rubeola Measles

A

NO ASPRIN but other analgesic. Warm ocular compress. Low illumination if photophobic. MMR vaccination.

71
Q

Rubella (german measles)

A

Mild childhood disease with maculopapular rash

72
Q

Congenital rubella syndrome

A

Rubella transmited to the fetus via the placenta when a viremia occurs in the mother.

73
Q

Congenital rubella symptoms

A
  1. Heart defects-patent ductus arterioles
  2. Ear-nerve deafness
  3. Eye-cataracts, microphthalmos, anterior uveitis, salt and pepper retinopathy (hyperplasia and atrophy), glaucoma.
74
Q

Mumps

A

Acute viral disease characterized by fever, swelling, tenderness of one or more salivary glands. Ocular-dacryoadentitis. Prevent with vaccination

75
Q

Bacterial conjunctivitis

A

Infectious inflammation of conjunctiva with bacteria as the causative agent.

76
Q

Acute bacterial conjunctivitis causative agents

A

Most commonly caused by staph. aureus (from bleph, phlyctenules, marginal sterile infiltrates)
S. Pneumoniae and influenza more common in children

77
Q

Acute bacterial conjunctivitis timeline

A

Rapid onset 2-3 days

Duration less then 4 weeks.

78
Q

Spread of acute bacterial conjunctivitis

A

usually spread through touch.

79
Q

Symptoms of acute bacterial conjunctivitis

A

Red eye(more often nasally), FB sensation, unilateral initially, onset 2-3 days prior. Lids stuck shut in the morning. Unilateral tearing. Chemosis. Conjunctival papillae. Pseudomembrane or membrane may form. Corneal involvement.

80
Q

When do you get subconjunctival hemorrhages with acute bacterial conjunctivitis?

A

With S. Pneumoniae and H. flu

81
Q

Acute bacterial signs

A

Vas usually normal. Normal pupils. Usually no A/C reaction. Rule out corneal involvement.

82
Q

Treatment for acute bacterial conjunctivitis

A

Topical Broad spectrum AB. No less then QID unless approved for less.

83
Q

Fluoroquinolone

A

Broad spectrum AB that is developed only for the eye. Less resistance as there is only topical.

84
Q

Best opthalmic drugs to treat staph. aureus and epidermis

A
  1. Gentamicin
  2. Trimethoprim with polymixin
  3. Bessiflixacin
  4. Vancomycin

OPT 533-Ocular Disease (2 decks)

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