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Anterior Segment 2 > Infectious Corneal Conditions > Flashcards

Infectious Corneal Conditions Flashcards

1
Q

What type of agar is gonoccocal keratoconjunctivitis cultured on?

A
  1. Chocolate Agar

2. Thayer-Martin Medium

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2
Q

WIT: Hyperacute conjunctivitis w/ alot of purulent discharge. Eyelid edema, conj hyperemia/chemosis, lymphadenopathy, peri corneal ulceration w/ central extension

A

Gono Keratoconjunc.

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3
Q

How do you treat gonoccocal keratoconjunctivitis?

A
  1. Topical FQ (moxi or gati)(q1h)
  2. IM Ceftriaxone
  3. Tx underlying infection & screen for chlamydia
  4. Erythro, Tetra, Doxy
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4
Q

When would you send a patient to the hospital w/ gonoc. kerato. ?

A

If their cornea perforates

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5
Q

This bacteria is found in soil, vegetation, moist environments in hospitals, GI tract. Gram (-)

A

Pseudomonas Aeruginosa

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6
Q

This bacteria has been linked to 60% of bacterial keratitis and known to be commonly found in CL wearers

A

Pseudomonas Aeruginosa

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7
Q

Corneas are made more susceptible to pseudomonas by what 3 things?

A
  1. Hypoxia
  2. Trauma
  3. Surface Disease
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8
Q

What type of bacteria is pseudomonas aeruginosa?

A

Gram (-) bacillus (rod)

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9
Q

What is the main risk factor for Acanthamoaeba? Where is it mainly found?

A

Soft contact lens wear

Water

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10
Q

Pt presents with paracentral ring-like stromal infiltrate, epithelial haze w/ defects, dendritiform ulcers, uveitis and the beginning of scleritis. What is it?

A

Acanthamoeba infection

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11
Q

What’s the first thing you should do to an acanthamoeba patient to help with drug penetration in the eye?

A

Debride epithelium to help w/ drug penetration

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12
Q

What’s contraindicated in acanthamoeba patients?

A

Steroids

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13
Q

WIT: Allergic, cell-mediated response; often hypersensitivity to staph. exotoxin; found mainly in young patients

A

Phylctenular Keratoconjunctivitis

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14
Q

What is phlyctenular kerato. caused by?

A
  1. Staph Blepharitis
  2. Tuberculosis
  3. Helminth (worm)
  4. Rosacea
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15
Q

What are the main signs of Phlyctenular Keratoconjunctivitis?

A
  1. Small white nodule at limbus
  2. Conj. injection
  3. Corneal ulceration or neo
  4. Scar of healed phlycten
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16
Q

How do we treat Phlyctenular Keratoconj.?

A
  1. Treat specific etiology

2. Topical steroid/antibiotic combo (helps w/ healing)

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17
Q

How long does it take for phlyctenular kerato. to resolve?

A

2-3 weeks

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18
Q

What is the incubation period for inclusion conjunctivitis?

A

1 week

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19
Q

How is inclusion conjunctivitis transmitted?

A
  • Systemic chlamydial infection is transmitted by autoinoculation
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20
Q

Chlamydia cells cannot ___ extracellularly; they depend on host cells.

A

replicate

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21
Q

Inclusion Conjunctivitis presents how?

A
  1. Subacute onset
  2. Uni or Bilateral Redness
  3. Watering
  4. Discharge
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22
Q

Inclusion Conjunctivitis Signs:

A
  1. Watering/Mucopurulent Discharge
  2. Large Follicles in Inf. Fornix & Tarsal Conj
  3. Peripheral Infiltrates (2-3 wks after onset)
  4. PAN swelling
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23
Q

Established inclusion conjunctivitis will have what signs?

A
  1. Less follicles, some papillae
  2. mild conj. scarring
  3. Superior pannus
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24
Q

What disease is the leading cause of preventable blindness in the world assoc. with poverty, overcrowding and poor hygiene?

A

Trachoma

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25
Q

WIT: Chronic, conjunctival inflammation caused by C.Trachomatis (chlamydial family)

A

Trachoma

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26
Q

What is the most important vector in Trachoma?

A

Flies

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27
Q

How can trachoma be directly transmitted?

A

From eye or nasal discharge

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28
Q

What are the signs of the active Trachoma disease?

A
  1. Mixed follicular/papillary rxn
  2. Mucopurulent discharge
  3. Herbert Pitts
  4. Sup. epithelial keratitis & pannus
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29
Q

What are the signs of the chronic Trachoma disease?

A
  1. Linear conj. scars (mild)
  2. Arlt’s LIne
  3. Upper Tarsus involvement
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30
Q

WIT: Superior conjunctival follicles at the upper limbus that may resolve and leave shallow depressions

A

Herbert’s Pitts

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31
Q

WIT: Thick band of scar tissue in the conjunctiva of the eye, near the lid margin, that is associated with eye infections

A

Arlt’s Line

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32
Q

What are the complications of Trachoma?

A
  1. Trichiasis/Distichiasis
  2. Corneal vascularization
  3. Entropion
  4. Dry Eye
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33
Q

How can we PREVENT trachoma?

A

Regular face washing and control of flies

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34
Q

How can we TREAT trachoma?

A
  1. Single dose Azithromycin 1g
  2. Z-Pak (if 1g is too strong)
  3. Erythromycin (for preg)
35
Q

What’s the purpose of surgery in trachoma?

A

Relieving trichiasis and maintaining complete lid closure

36
Q

WIT: Inflammation of the corneal stroma without primary involvement of the epithelium or endothelium

A

Interstitial Keratitis

37
Q

Interstitial keratitis is most commonly associated with what disease?

A

Congenital Syphillis

38
Q

What are the other causes of interstitial keratitis?

A
  1. Lyme Disease
  2. TB
  3. Leprosy
  4. Parasitic/Viral infection
39
Q

When/How does interstitial keratitis present from congenital symphillis?

A

Between the ages of 5-25 years w/ acute bilateral pain and severe blurred vision

40
Q

All patients w/ IK should have ___ ___ to determine is syphilis is involved.

A

Treponemal Serology

41
Q

What are the signs of IK?

A

Limbitis, Anterior Uveitis, Keratitis

42
Q

What is the treatment for IK?

A
  1. Systemic PCN (if active)
  2. Topical Steroids
  3. Cycloplegic
43
Q

What is the most common external ocular viral infection found in hospitals, schools and factories?

A

Viral Keratoconjunctivitis

44
Q

Viral keratoconjuncitivitis is from ___ types of adenoviral infection found on dry surfaces.

A

51 types

45
Q

Viral shedding may occur __-__ days before clinical disease is apparent and about ___ days after that.

A

4-10 days

12 days

46
Q

What is the #1 type of viral keratoconjunctivitis?

A

EKC

47
Q

What are the adenovirus serotypes for EKC?

A

8, 19, 37

48
Q

What are 3 ways EKC is transmitted?

A
  1. Hand to Eye
  2. Instruments
  3. Solutions
49
Q

Keratitis develops in what percent of EKC patients?

A

80%

50
Q

What are the clinical signs of EKC?

A
  1. Eyelid Edema
  2. PAN Swelling
  3. Follicles
  4. Pseudomembranes w/ subconj hemorrhage
51
Q

Stage 1 of EKC is how many days from onset? What ocular effect is found?

A

7-10 days from onset
PEK (resolves in 2 wks)
- contagious stage

52
Q

Stage 2 of EKC; What ocular effect is found?

A

Subepithelial Opacities (corneal infiltrates) ,, Centrally

53
Q

Stage 3 of EKC; What ocular effect is found?

A

Anterior Stromal Infiltrates (takes a long time to go away)(not contagious)

54
Q

What’s the rule of 8 for EKC:

A
  1. Adenovirus 8
  2. 8 day latency between exposure & onset
  3. 8 days of PEK (contagious)
  4. 8 days of SEIs (not contagious)
55
Q

Pharyngeal conj fever is adenoviral serotypes __ and __.

A

3 and 7

56
Q

PCF is found in patients who have had a ____ recently?

A

Upper respiratory tract infection

57
Q

What is the major cause of unilateral corneal scarring worldwide?

A

HSV (mainly HSV-1 = more common)

58
Q

What is the most common infectious cause of corneal blindness in developed countries?

A

HSV

59
Q

Reactivation of HSV is due to?

A
  1. Fever
  2. Hormonal change
  3. UV radiation
  4. Trauma
  5. Trigeminal Injury
60
Q

What are the risk factors for HSV?

A
  1. Atopic eye disease
  2. Children
  3. AIDs
  4. Malnutrition
  5. Measles
  6. Malaria
  7. Abuse of steroids
61
Q

What are the signs of HSV?

A

Central dendrite
Terminal Bulbs
Decreased corneal sensation

62
Q

How do you treat HSV even though it spontaneously heals?

A
  • Topical Antivirals (Zirgan)
  • Oral Antivirals
  • Debridement of dendrite
63
Q

What is contraindicated in HSV?

A

Steroid use

64
Q

What is the goal of treating HSV?

A

Heal with scarring of cornea

65
Q

What are the 2 etiologies of disciform keratitis?

A
  1. HSV infection of keratocytes or endothelium

2. Hypersensitivity to viral antigen in the cornea

66
Q

WIT: A patient presents with gradual onset of blurred vision with halos around lights.

A

Disciform keratitis

67
Q

What are the signs of disciform keratitis?

A
  1. Central stromal edema
  2. KPs
  3. Wessley Ring
  4. Uveitis
68
Q

How do we tx disciform keratitis?

A

If near visual axis, topical steroids w/ antiviral cover for at least 4 weeks… after 1 month topical steroid daily

69
Q

HZV are found in patients of what age?

A

6th-7th decade

70
Q

HZV affects what percentage of adults in the US population?

A

> 95%

71
Q

What is the tx for HZV?

A

high dose of oral antivirals (acyclovir, famciclovir, valacyclovir)

72
Q

What antiviral medication is best for HZV? Why?

A

Famciclovir = better bioavailability

73
Q

Prodromal phase last how many days before the rash starts?

A

3-5 days

74
Q

How does a HZV rash appear?

A

Red, maculopapular vescicles

75
Q

When do the vesicles appear?

A

within 24 hours and come together over 2-4 days

76
Q

When does the vesicles become pustular and dry up?

A

2-3 weeks

77
Q

WIT: Enterovirus 70 infection. Seen in the tropics and warm climates. Rare in US. Pt presents w/ unilateral or bilateral acute red eye, tearing FBS, highly contagious

A

Acute Hemorrhagic Conjunctivitis

78
Q

How do we treat acute hemorrhagic conjunctivitis?

A

Self-limiting, runs 2-3 weeks

Cold compresses

79
Q

What is contraindicated in acute hemorrhagic conjunctivitis?

A

Steroids

80
Q

What are the 6 bacteria that can penetrate an intact epithelium?

A
  1. N. Gonorrhea
  2. H. Influenzae
  3. N. Meningitis
  4. C. diphtheriae
  5. Listeria
  6. Shigella
81
Q

How do we treat a bacterial ulcer?

A

4th gen FQ and add broad spectrum coverage (Tobramycin)

82
Q

What is the major cause of vision loss in tropical and developing countries?

A

Fungal Keratits

83
Q

What are the 2 types of fungi?

A

Filamentous

Yeast

84
Q

Which type of fungi can penetrate the intact descemet’s membrane and perforation is common?

A

Filamentous fungi

Anterior Segment 2 (14 decks)

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