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(2) Introductory ocular disease > Infections > Flashcards

Infections Flashcards

1
Q

Conjunctivitis: Signs and Symptoms

A

Symptoms and signs
• sudden onset
• conjunctival redness
• discharge (type is important for differential diagnosis

Management
• Optometrist can usually treat by self or in conjunction with pharmacist/GP

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2
Q

Keratitis: Signs and Symptoms

A

Symptoms and signs
• similar to conjunctivitis
• pain
• photophobia
• reduced vision (depending upon location)
• Unilateral (not always)
• Corneal involvement (wide variation in appearance and severity)

Management
• Depends upon type (more detail to follow) • Likely managed by HES / IP Optom

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3
Q

When do Bacterial infections occur?

A

• barriers are compromised (opportunistic bacteria).
• disrupted tear film
• Immunosuppression
• injury
• surgery
• virulent pathogen is present & invades an uncompromised eye

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4
Q

Bacterial conjunctivitis: Risks and symptoms

A

Risks:
• Immunosuppression; elderly, young children, steroids, diabetes
• Infection; CL wear, trauma, systemic infection, blepharitis

Symptoms:
• Originally unilateral but can quickly become bilateral
• Redness
• Sticky discharge/pus; thick, white/yellow
• uncomfortable (gritty, burning)
• eyes stuck together on waking

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5
Q

Bacterial conjunctivitis: Signs

A

• Conjunctival injection/hyperaemia
• Crusted & oedematous lids
• Discharge
• purulent or mucopurulent
• Mild papillary reaction
• mild corneal involvement:
• superficial punctate epitheliopathy
• peripheral corneal infiltrates

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6
Q

Bacterial conjunctivitis: Management

A

• Self limiting 5-7says without treatment
• Bathe lids/hot compresses to remove crust
• Advise about contagious nature
- arvise px of red flags
• Antibiotics? - Stewardship guidelines
- Only consider if not better after 7 days

• Review
- if minor corneal involvement

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7
Q

Bacterial keratitis causes:

A

Causes
• Generally only caused by opportunistic bacteria if damaged ocular surface:
• contact lens wear
• injury
• dry eye
• Immune compromise
• blepharitis

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8
Q

Bacterial keratitis: Symptoms

A

Symptoms:
• Acute onset
• Usually unilateral
• Pain (moderate to severe)
• Redness
• Discharge
• Blurred vision

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9
Q

Bacterial keratitis: Signs

A

Signs
• Lid oedema
• Epiphora
• Discharge (purulent or mucopurulent)
• Conjunctival hyperaemia
• Central or mid peripheral corneal lesion
- Stromal infiltration & edema beneath lesion
• Anterior chamber activity; flare, cells, hypopyon

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10
Q

Bacterial keratitis: Management

A

• Emergency referral straight to HES
• CL wearers keep cases for culture

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11
Q

Fungal Infections: Describe

A

• Rare in healthy individuals
• Rare in UK (needs hot/humid climates)

• Compromised corneal epithelium
• Usually immune compromised
• Hx trauma organic material

• Usually only suspected if unresponsive to other treatment

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12
Q

Fungal Keratitis: Describe

A

• Similar signs to bacterial conjunctivitis, but slower
• Often misdiagnosed when not clear Hx

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13
Q

Non-Herpetic Viral conjunctivitis: Describe

A

• Most commonly Adenoviral
- spectrum of disease, mild - severe
• Less commonly enterovirus

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14
Q

Non-Herpetic Viral conjunctivitis: Causes and symptoms

A

Causes
• Recent cold/ upper respiratory infection
• Crowded conditions
• Eye clinics!

Symptoms
• Acute onset - red, watery, uncomfortable
• unilateral> bilateral
• Blurred vision
• Hx of cold type symptoms
• Tender pre-auricular lymphadenopathy

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15
Q

Non-Herpetic Viral conjunctivitis: Signs and Severe signs

A

• Watery discharge
• Eyelid oedema
• Conjunctival hyperaemia
• Follicles on palpebral conjunctiva
• Tender pre-auricular lymphadenopathy

If severe:
• Pin point Conjunctival haemorrhages
• Chemosis
• Pseudomembranes

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16
Q

Non-Herpetic Viral conjunctivitis: Management and referral

A

• Advise
- Highly contagious, self limiting 2-3weeks, should stay off school/work in this time, cold compresses for inflammation

• Pharmaological
- Artificial tears + lubricants, vasoconstrictors/antihistamines to prevent itching, antibacterials not effective, antivirals not affective

• Refer if:
- Pseudomembrane requiring removal
- Corneal involvement (IP may manage with mild steroid - FML)

17
Q

Herpes simplex conjunctivitis: Signs/symptoms

A

• Common during primary infection (usually children)

• Watery discharge
• Follicles on conjunctiva
• Herpetic vesicles on skin

18
Q

Follicles also appear with adevoviral, how to differentiate?

A

• Adenoviral usually bilateral
• HSV usually unilateral

19
Q

Herpes simplex conjunctivitis: Management

A

• Cold compresses
• Artificial tears and lubricants
• Advice on hygiene and recurrence

20
Q

Herpes Simplex Keratitis: Predisposing Factors

A

• Hx of herpes simplex infection
• Poor general health, immunodeficiency, fatigue
• Systemic or topical steroids, or other immunosuppressive drugs
• Possible aggravating factors; sunlight (UV), fever, extreme heat or cold, infection (systemic or ocular), trauma (ocular)
• Severe atopic disease

21
Q

Herpes Simplex Keratitis: Symptoms

A

• May have hx of recurrent attacks
• Usually unilateral (bilateral in atopic px)
• Pain, photophobia, reduced VA, redness
• Severity of symptoms variable

22
Q

Herpes Simplex Keratitis: Signs

A

• Reduced corneal sensitivity
• Most common is dendritic ulcer (in epithelium):
- initially a punctate or stellate pattern
- can develop into a linear branching ulcer
- larger geographic ulcer

• Can involve corneal stroma and endothelium (in more severe cases) and anterior chamber activity (heretic uveitis) and even the retina (viral retinitis)

23
Q

Herpes Simplex Keratitis: Management
ENTRY LEVEL

A

ENTRY LEVEL PRACTITIONERS:
• Determine severity (depth of corneal involvement, A/C activity and IOP)

• Assess posterior pole - dilated fundus exam
- To rule out viral retinitis (emergency referral)

• Call CDU / ARC - emergency / urgent referral

24
Q

Herpes Simplex Keratitis: Management
IP/ SHARE CARE

A

• Treatment with topical antivirals (aciclovir or ganciclovir gel) 5 times daily until resolved then 3x daily for further 7 days

• Only for epithelial defects. More severe cases involving deeper corneal layers require tx

• CL wearers must be referred to HES
• If px is contact lens wearer may be early acanthamoeba!!!

25
Q

Describe Varicella Zoster Virus (herpes zoster)

A

• Previous systemic viral infection
• Virus lies dormant in cranial nerve sensory nerve

• Reactivation leads to herpes zoster
• herpes zoster defined as linked to trigeminal nerve

26
Q

Herpes Zoster: GH symptoms

A

• Pain and altered sensation of the forehead on one side
• Rash affecting forehead and upper eyelid appears a day to a week later
• General malaise, headache, fever
Ocular symptoms

27
Q

Herpes Zoster: Ocular Symptoms

A

• discomfort
• discharge
• redness
• pain
•photophobia

28
Q

Herpes Zoster : GH Signs

A

• Skin rash; acute and painful
- occurs in dermatomal pattern (area that nerve supplies)
- does not cross midline
- eye more likely to be affected if skin lesions on tip of nose (Hutchinson’s sign) or forehead

• Periorbital edema

29
Q

Herpes Zoster: Ocular involvement;
Conjunctivitis, corneal and other ocular lesions

A

Ocular Involvement - can vary in structure involved and severity

Conjunctivitis:
• mucopurulent discharge (associated with vesicle rash)

Keratitis:
• Most common are small fine dendritic or stellate lesions in epithelium
• Does not have end bulbs - pseudodendrites (unlike Herpes Simplex Keratitis
• Reduced corneal sensation

Other ocular lesions:
• Episcleritis
• Scleritis
• Anterior uveitis
• Secondary glaucoma
• Choroiditis, Optic Neuritis, retinitis

30
Q

Herpes Zoster: Management and referral

A

Management
• Assess posterior pole- rule out posterior involvement
• Liaise with GP - systemic antivirals (oral aciclovir) if recent (72hr rash) and no ocular involvement
• Liaise with GP with systemic antivirals if epithelial involvement

• Refer to ophthalmologist:
- No improvement from above after 1/52
- If other ocular signs present

31
Q

Describe Acanthamoeba Keratitis:

A

• Protozoal microorganism:

• High association with contact lens wear
- water contamination Cl or case, poor lens hygiene (grow on case)
• Cysts are resistant to most cleaning solutions, need hydrogen peroxide overnight or heat treatment
• uncommon with daily disposable lenses

• Can occur WITHOUT contact lens use:
- contact with water e.g. swimming
- immunocompromised

32
Q

Acanthamoeba Keratitis: Symptoms

A

•severe pain and reduced vision that are disproportionate to signs
- BUT not always pain in early stages!

• Epiphora, photophobia
• Slow course
• Frequently not diagnosed until late stage

33
Q

Acanthamoeba Keratitis: Signs

A

Signs:
• punctate keratitis
• pseudo-dendrites
• infiltrates
• ring abscess with hypopyon and satellite lesions

(2) Introductory ocular disease (16 decks)

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