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Micro - Clinical Neuro > Infections of Eye > Flashcards

Infections of Eye Flashcards

1
Q

blepharitis

A
  • inflammation of eyelid margins
  • redness, swelling, no bump
  • caused by Staph aureus
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2
Q

stye

A
  • inflammation of eyelid glands or follicles
  • usually benign; small tender painful bumps on inside or outside of eyelid
  • caused by Staph aureus
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3
Q

conjunctivitis aka “pink eye”

A
  • can be caused by viruses, bacteria, fungi, parasites, chemicals, allergies
  • viral most common in late fall and early spring
  • redness, watery eyes, irritation, occasional photophobia
  • most commonly caused by adenovirus
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4
Q

bacterial conjunctivitis

A
  • stringy discharge; could cause eyelids to stick together
  • swelling, redness, tearing, irritation/gritty feeling
  • usually starts in one eye; could spread to the other
  • could be caused by staph, strep, haemophilus (not common - vaccine), chlamydia trachomatis (triad of NGU, arthritis & conjunctivitis = Ritter’s syndrome; usually neonates), N. gonorrhoeae
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5
Q

viral conjunctivitis

A
  • watery discharge; irritation, redness
  • starts in one eye, spreads to the other
  • adenovirus (most common), HSV (most serious - rarely goes to eyes though), CMV (AIDS pts)
  • less common but possible: VZV, Coxsackie, measles, rubella
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6
Q

allergic conjunctivitis

A
  • itching, tearing, swollen eyelids

- usually affects both eyes simultaneously

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7
Q

most common cause of infectious blindness?

A

Chlamydia trachomatis

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8
Q

cause of bacterial conjunctivitis in kids/adults v. neonates

A
  • children and adults = S. aureus, S. pneumonia, H influenza

- neonates: S. aureus, Pseudomonas, Chlamydia trachomatis, N. gonorrhoeae

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9
Q

Chlamydia trachomatis

A
  • # 1 cause of infectious blindness worldwide
  • serotype A-C; not the STD (sero D-K)
  • repeated infection by direct contact = 3Fs = fomites, flies, fingers; formation of scar tissue –> corneal abrasions –> blindness
  • neonates can be infected in eye and urogenital tract (serotypes D-K)
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10
Q

C. trachomatis: dx, tx, prevention

A
  • no gram stain; Giemsa stain = inclusion bodies (neonates); IFA detection of IgG or IgM
  • tx w/ oral azithromycin; can be combined w/ topical doxycycline
  • for neonates: tx = oral erythromycin
  • prevention = SAFE - surgery, antibiotics, facial cleanliness, environmental improvement
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11
Q

N. gonorrhoeae

A
  • severe purulent conjunctivitis in neonates; transmitted during birth
  • eye pain, redness, discharge; can go blind if not treated
  • dx: gram (-) diplococcic, culture on Thayer-Martin agar
  • tx = IV penicillin G, ceftriaxone if resistant strain
  • prevention: topical silver nitrate, erythromycin, tetracycline
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12
Q

Brazilian purpuric fever

A
  • in peds caused by H. flu aegyptius
  • purulent conjunctivitis then several weeks of fever, purpura, vascular collapse
  • rapidly fatal
  • probably distractor; don’t pick it
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13
Q

adenovirus

A
  • enveloped double-stranded DNA virus
  • school-aged kids –> swimming pools!
  • fever, sore throat, conjunctivitis
  • respiratory spread; ocular secretions
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14
Q

keratoconjunctivitis

A
  • caused by adenovirus
  • no pharyngitis (diff serotypes of adenovirus)
  • transmission by hands and fomites; highly contagious in households
  • classical “pink eye”
  • redness, photophobia, tearing, pain
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15
Q

to dx adenovirus? tx?

A
  • could run PCR but more practical to r/o other causes
  • rapid Strep tests, cultures for respiratory viruses, etc.
  • tx: most infections self-limited = supportive and symptomatic tx
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16
Q

herpes simplex virus

A
  • neonates: HSV-2; transmission during birth; causes red eye, watery discharge
  • keratoconjunctivitis = HSV-1 in adults; acute onset pain, red eye, watery discharge, itching, blurred vision, lid swells
  • dx: MULTINUCLEATED GIANT CELLS (synctitia) on Tzank smear
  • tx: IV acyclovir
17
Q

CMV

A
  • most common in AIDS pts
  • decreased VA, floaters, loss of visual fields, retinal necrosis = retinal detachment; associated w/ intraretinal hemorrhages
  • dx: owl’s eye inclusions; IgM serology; PCR
  • tx = IV ganciclovir; use foscarnet for AIDS pts
18
Q

herpes zoster ophthalmicus

A
  • caused by reactivation of VZV
  • eye pain, red eye (unilateral), decreased vision, skin/lid rash and pain, fever, malaise
  • typical zoster lesions around nose
  • dx: Tzank smear and Wright stain; IFA
  • tx = oral acyclovir
19
Q

Coxsackie A24 & Enterovirus E70

A
  • acute hemorrhagic conjunctivitis seen in undeveloped countries
  • rapid onset painful conjunctivitis; petechiae that become subconjunctival hemorrhages; almost always resolves in 5-7d
  • dx w/ PCR
  • tx: symptomatic w/ topical steroids
20
Q

measles

A
  • seen in unvaccinated people; usually kids
  • high fever, cough, coryza, CONJUNCTIVITIS, photophobia
  • buzzword = koplik spots = red bump w/ blue dot in the middle
21
Q

rubella

A
  • fetal infection: 1-8 wk gestation
  • cataract, glaucoma, microphthalmia
  • salt and pepper change in retina
22
Q

bacterial keratitis

A
  • infection of cornea; rapid progression
  • risk factors = contact lenses, trauma, surgery, immunocompromised
  • symptoms: pain, redness, swelling, impaired vision
  • dx: gram stain, culture corneal scraping
  • tx: depends on causative organism; topical fluoroquinolones, ciprofloxacin
23
Q

ocular fungal infections

A
  • Fusarioum species in southern states
  • Candida albicans (yeast) and Aspergillus (mold) in norther states
  • Fusarium & Aspergillus = filamentous fungi
  • spread through blood to eye or direct inoculation
  • not common but will lead to blindness
24
Q

Fusarium species

A
  • more common in southern states
  • causes keratitis: hx of trauma (contact lenses, foreign body)
  • symptoms: foreign body sensation, pain, discomfort, decreased vision, hypersensitivity to light
  • filamentous fungi
  • dx: KOH prep of eye scrapings cultured on Sabouraud dextrose agar
  • tx = topical natamycin
25
Q

Candida albicans

A
  • causes endophthalmitis
  • exogenous (accidental or post-op inoculation) or endogenous (hematogenous seeding of eye) spread
  • ocular pain, photophobia, floaters, fever
  • budding yeast w/ pseudohyphae and germ tubes
  • dx w/ funduscopic exam
  • tx = amphotericin B
26
Q

causes of ocular parasitic infections

A
  • protozoa: acanthamoeba, toxoplasma

- metazoan (worms): Trichinella spiralis, Taenia solium, Onchocerca volvulus, Loa loa

27
Q

Acanthamoeba species

A
  • parasitic; causes amebic keratitis
  • associated w/ contact lens use: contaminated solution, improper cleaning/storage, swimming in FRESH water w/ contacts
  • photophobia, blurred vision, foreign body sensation, severe pain
  • can cause cataracts and vision loss
  • dx w/ Giemsa stain; culture contact solution; will see motile amoeba on wet prep
  • tx = topical propamidine, micronazole, neomycin
28
Q

ocular toxoplasmosis-

A
  • Toxoplasma gondii = cause
  • AIDS pts but could be congenital (one of the TORCH bugs that crosses placenta)
  • can cause spontaneous abortions; if kid born w/ it you won’t see symptoms until teen yrs (means mom got it late in pregnancy)
  • severe scarring = irreversible vision loss
  • tx = pyrimethamin, sulfonamide drugs
29
Q

Trichinella spiralis

A
  • worm infections; larvae can be cyst in eye
  • periorbital edema
  • no good tx for larvae: corticosteroids and mebendazole
30
Q

Ocular cysticercosis

A
  • caused by Taenia solium
  • cysticerci lodge in the eye = loss of visual acuity and visual field defects
  • dx: you can see the cyst in the eye
  • tx = praziquantel or albendazole
  • surgically remove ocular cysts; if it’s in your eye it’s probably other places (brain)
31
Q

African River Blindness

A
  • Onchocerca volvulus; transmitted by black fly
  • early signs: itching, redness, photophobia, blurred vision
  • late disease = vision loss and blindness
  • tx = ivermectin
32
Q

Loa loa

A
  • transmitted by Chrysops fly (W. Africa)
  • DOES NOT CAUSE BLINDNESS
  • tx = diethylcarbamazine

Micro - Clinical Neuro (4 decks)

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