Final Material Flashcards
Dennie Morgan Folds
Folds under the lower eyelid due to edema from allergic dermatitis
Contact Dermatitis
Can be I or IV. Due to direct contact with allergens.
Dermatitis
Any inflammation of the dermis
Irritant Dermatitis
May or may not be itching. DX: based on exclusion. Patch test negative. TX: moisturizer, soaps.
What dermatitis do you NOT use steroids with?
Irritant dermatitis.
Allergic Dermatitis
There is itching. Type IV. Can have chemises, keratitis, vesicles. DX:patch skin test. TX: cold compress, topical steroids, lubricants, immunomodulators
Atopic Dermatitis
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.
Urticaria
Hives, itchy welts. Cutaneous eruption. Multiple pathogenic mechanisms. Acute: immunological Chornic: unknown. Intense itching. Raised wheels. May be transient.
Angioedema
When the inflammation involve deeper layers of the skin. Little pruritus. Involves face, lips, eyelid, tongue, thread, hands, feet. May have respiratory distress.
TX for angioedema and urticaria
Cold compress, antihistamine, systemic steroids, epinephrine for acture pharyngeal or laryngeal edema.
Dermatitis where you use Systemic steroids!
Uritica and angioedema
Conjunctival hypermia
Conj. injection. Dilation of blood vessels. Due to unhappy conj. RX: lubricants and have the patient come back if the problem gets worse.
Subconjunctival hemorrhage
Diffuse of blood between conjunctival and episclera. Associated with anticoagulants, trauma, sneezing, coughing, straining, hypertension. If recurrence occurs do work up.
Conj. Chemosis
Conjuctival edema. Can have intense ballooning
Leading cause of conjunctival chemosis
Allergies!
Papillae
Elevation of the conjunctiva. Vascular core surrounded by edema and mixed inflammatory cells. Normal on the upper lid. Severe can be large or cobblestone.
Cause of papillae
Allergy, bacterial conjunctivis, chlamydial disease (trachoma or chlamydial conj).
Follicles
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)
Cause of follicles
Viral disease, chlamydial disease, cat-scratch (parinaud’s oculoglandular syndrome), toxic drug reaction.
Mucopurulent discharge
Discharge of mucus and puss. Pus=bacterial infection.
True Membrane
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
Pseudomembrane
Fibrinous exudate loosely attached to conjunctiva. Avascular. Seen in mild allergic conjunctivitis, mild bacterial conjunctivitis.
Things that occur with conjunctival hyperemia
Corneal edema, anterior uveitis, posterior synechiae, hypopyon (collection of WBC), scleritis, sectoral involvement, episcleritis, blebitis, hyphema (RBC in anterior chamber)
Epithelial Melanosis
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.
Conjunctival Nevus
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.
Conjunctival melanoma
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.
Malignant Melanoma
All elevated or enlarged pigment lesions with a history of change should be biopsied or excised.
Primary Acquired Melanosis
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.
PAM vs Melanoma
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.
Ocular Melanocytosis
Multiple blue gray or slate gray patches of pigmentation in the episclera. Pigmentation cannot be moved over the surface of the globe.
Oculodermal Melanocytosis
Ocular melanocytosis plus hyper pigmentation of deep periorbital skin along first and second division of trigeminal nerve. Unilateral. Most common in Asian populations.
Ocular melanocytosis associated features
Ipsilateral iris hyperchromia, melanomas of the uveal tract, ipsilateral glaucoma.
Pinguecula
Conjuctival degeneration. Associated with environmental causes. Lubricants. Can become inflamed.
Pterygium
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.
Stocker’s line
Iron line at leading edge of pterygium
Pterygium Treatment
Lubricants, vasoconstrictors if inflamed. Excision if vision affected.
Concretions
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.
Conjunctival cysts
Thin-walled cyst filled with clear water fluid. Usually no symptoms but can erupt if large.
Bitot’s Spot
Drying and wrinkling of the conj. Due to vitamin A deficiency. Rarely seen in US.
Eosinophils
Diagnosist cells for allergic reaction
How does conjunctiva react with allergy?
Chemosis, hyperemia, papillae, lid edema, discharge.
Seasonal Allergic Conjunctivitis
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
Treatment for allergic conjunctivitis
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.
Perennial Allergic Conjunctivitis
Clinically similar to SAC but persists throughout the year. TX: similar to sac
Acute Allergic Conjunctivitis
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
Giant Papillary Conjunctivitis
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.
When does a papillae characterize as giant papillary conjunctivitis?
.3 mm or larger
GPC treatment
Topical antihistamine, mast cell stabilizers, topical steroids, NSAIDS
Vernal Keratoconjuctivitis AKA spring catarrh
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.
Trantas’ Dots
Focal infiltrates that are elevated. Usually across limbus.
Treatment of vernal keratoconjuctivitis
Cold compress, ocular lubes, mast cell stabilizer, topical and or oral antihistamines, topical steroids. Oral NSAIDS, immunotherapy.
Vekacia
The first drug specifically for vernal keratoconjunctivitis.
Atopic Keratoconjuncitivis
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.
Atopic Keratoconjunctivitis Treatment
Cold compress, ocular lubricants, topical or oral antihistamines, mast cell stabilizer, topical steroids
Topical vasoconstrictors
Binds to alpha receptors on blood vessels and stimulates them leading to vasoconstriction.
Steroids
Don’t cure problems but stop the symptoms.
Varicella/Zoster Virus
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.
Chicken pox
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.
Shingles
Zoster virus reactivation. Virus undergoes active multiplication in ganglion cells. Have vesicle eruptions along dermatomes. Usually respects midline (unilateral)
Herpes Zoster ophthalmicus (acute phase)
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.
Hutchinson’s sign
Occurs when herpes zoster opthalmicus also affect nasal branch and the nasocilliary nerve. Indicates increased risk of ocular involvement.
Herpes zoster ophthalmicus ocular involement
Trichasis, entropion, ectropion, madarosis, poliosis. Conjunctivitis, pseudomembranes, puncttal stenosis, vesicles on lid margin.
what would you see in the eyes with herpes zoster?
pseudodendrites.
Treatment for herpes zoster ophthalmicus
- Acyclovir-standard.
- capsaicin
- antidepresents
- Treat each ocular complication
Herpes zoster ophthalmicus prevention
Varivax for chickenpox. Zostavax for shingles.
Variola (smallpox)
systemic viral disease characterized by skin lesions. Vaccination. Can cause blindness and conjunctivitis. No specific treatment.
Monkeypox
Contact with ill animals or direct/respiratory contact with infected person. Leads to blindness. Treat with smallpox vaccination or cidofivir.
Vaccinia (cowpox)
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.
Rubeola (measles)
Acute. Highly contagious. Maculopapular rash. Koplike spots on buccal mucosa (bright white spots). Conjunctivitis. Inflamm. of respiratory tract.
Treatment for rubeola Measles
NO ASPRIN but other analgesic. Warm ocular compress. Low illumination if photophobic. MMR vaccination.
Rubella (german measles)
Mild childhood disease with maculopapular rash
Congenital rubella syndrome
Rubella transmited to the fetus via the placenta when a viremia occurs in the mother.
Congenital rubella symptoms
- Heart defects-patent ductus arterioles
- Ear-nerve deafness
- Eye-cataracts, microphthalmos, anterior uveitis, salt and pepper retinopathy (hyperplasia and atrophy), glaucoma.
Mumps
Acute viral disease characterized by fever, swelling, tenderness of one or more salivary glands. Ocular-dacryoadentitis. Prevent with vaccination
Bacterial conjunctivitis
Infectious inflammation of conjunctiva with bacteria as the causative agent.
Acute bacterial conjunctivitis causative agents
Most commonly caused by staph. aureus (from bleph, phlyctenules, marginal sterile infiltrates)
S. Pneumoniae and influenza more common in children
Acute bacterial conjunctivitis timeline
Rapid onset 2-3 days
Duration less then 4 weeks.
Spread of acute bacterial conjunctivitis
usually spread through touch.
Symptoms of acute bacterial conjunctivitis
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.
When do you get subconjunctival hemorrhages with acute bacterial conjunctivitis?
With S. Pneumoniae and H. flu
Acute bacterial signs
Vas usually normal. Normal pupils. Usually no A/C reaction. Rule out corneal involvement.
Treatment for acute bacterial conjunctivitis
Topical Broad spectrum AB. No less then QID unless approved for less.
Fluoroquinolone
Broad spectrum AB that is developed only for the eye. Less resistance as there is only topical.
Best opthalmic drugs to treat staph. aureus and epidermis
- Gentamicin
- Trimethoprim with polymixin
- Bessiflixacin
- Vancomycin
