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Y3 - Opthalmology > Infective keratitis > Flashcards

Infective keratitis Flashcards

1
Q

What is keratitis?

A

Inflammation of the cornea

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2
Q

What is the most common cause of keratitis?

A

infection (particularly viral and bacterial)

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3
Q

What is the corneal epithelium?

A

the corneal epithelium forms the primary barrier to microbes and the tear film on the corneal surface

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4
Q

What three groups of bacteria most commonly cause infective keratitis when the corneal epithelium is disrupted?

A
  1. Staphylococcus
  2. Streptococcus
  3. Pseudomonas
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5
Q

What are 3 bacteria that can penetrate intact corneal epithelium and can therefore cause keratitis without corneal obstruction?

A
  1. Neisseria gonorrhoea
  2. Neisseria meningitides
  3. Corynebacterium diphtheria
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6
Q

What are 4 risk factors for bacterial keratitis?

A
  1. Contact lenses
  2. Corneal trauma
  3. eyelid disease
  4. Immunosuppression
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7
Q

True or false: infective keratitis typically presents unilaterally

A

True

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8
Q

Give 5 general clinical presentations associated with infective keratitis:

A
  1. Ocular pain
  2. Photophobia
  3. Reduced visual acuity
  4. Diffuse conjunctival injection
  5. Eyelid oedema
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9
Q

Give 3 additional clinical presentations associated with bacterial keratitis?

A
  1. Purulent discharge
  2. area of yellow/white infiltrate with clearly defined margins
  3. hypopyon in the anterior chamber
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10
Q

What is hypopyon?

A

Hypopyon is a medical condition involving inflammatory cells in the anterior chamber of the eye

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11
Q

Give 3 important questions to ask when conducting a contact lens history:

A
  1. Duration of wear
  2. Type of contact lens (short/long wear)
  3. Have they ever slept, showered or swam with their lenses in?
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12
Q

Give 2 examinations used to investigate bacterial keratitis:

A

1) Snellen chart for visual acuity
2) anterior segment examination using slit lamp or fundoscope

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13
Q

What investigation may be used to gain insight into the causative organism in keratitis?

A

Corneal scrape/ conjunctival swab

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14
Q

What investigation should be carried out on contact lens wearers if infective keratitis is suspected?

A

send contact lenses and case off for culture

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15
Q

What guidance should be given to contact lens wearers if infective keratitis is suspected?

A

contact lens use should be discontinued IMMEDIATLY

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16
Q

What two topical antibiotic therapies are given for bacterial keratitis?

A
  1. Fluoroquinolone
  2. Cefuroxime with gentamicin
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17
Q

What are 5 complications of bacterial keratitis?

A
  1. Spread of infection
  2. Corneal perforation
  3. Residual dense corneal scarring
  4. Irregular astigmatism
  5. Formation of cataracts
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18
Q

What are the two most common viral causes of keratitis?

A

1) herpes simplex
2) varicella zoster

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19
Q

What type of herpes virus causes viral keratitis?

A

Herpes simplex virus-2 (HSV-2)

20
Q

In which structure does HSV establish latency following primary infection?

A

trigeminal ganglion

21
Q

Describe the aetiology of herpes simplex epithelial keratitis:

A

following primary infection, HSV establishes latency in the trigeminal ganglion which can reactivate and move to the corneal epithelium

22
Q

How can you tell viral and bacterial keratitis apart from examination?

A

viral keratitis causes epiphora while bacteria keratitis causes purulent discharge

23
Q

What is epiphora?

A

Excessive tearing from one or both the eyes without any specific reason.

24
Q

What is the key diagnostic sign of HSV keratitis?

A

dendritic ulcers

25
What are dendritic ulcers?
small green patches seen on fluorescein staining with linear branching morphology associated with HSV keratitis
26
What is the main treatment for viral keratitis?
topical antivirals (aciclovir ointment) and epithelial debridement
27
What is the name given to the varicella zoster infection of the ophthalmic branch of the trigeminal nerve?
herpes zoster ophthalmicus
28
What are 3 clinical presentations specifically associated with herpes zoster opthalmicus?
1. Rash in the V1 dermatomal distribution 2. Punctate keratitis 3. Psuedodendrites
29
What is punctate keratitis?
small dots caused by cell death when the eye is viewed under high magnification
30
What are pseudodendrites?
similar to dendritic ulcers but lack the terminal bulb seen in HSV
31
Name 3 typical symptoms of herpes simplex epithelial keratitis?
1. Discomfort, grittiness, red eye, reduced visual acuity and photophobia 2. Epiphora 3. A previous history of cold sores
32
Name 4 typical clinical findings on examination for herpes simplex epithelial keratitis?
1. Lids and lashes - mild erythema and oedema 2. Conjunctiva - diffuse or cicumlimbal injection 3. Cornea - dendritic ulcer 4. Reduced corneal sensation
33
What is the most common complication of herpes zoster ophthalmicus?
post-herpetic neuralgia
34
What is post-herpetic neuralgia?
A complication of shingles, painful, blistering skin rash, which is caused by reactivation of herpes zoster virus.
35
What are 4 risk factors for fungal keratitis?
1. Corneal trauma 2. Contact lens wear 3. Immunosuppression 4. Ocular surface disease
36
True or false: the visual prognosis of fungal keratitis is generally good
false (it is an aggressive infection)
37
What would the cornea look like under examination with fugal keratitis?
grey-white stromal infiltrate with fluffy margins. Satellite lesions may be seen. Rapid progression may occur with necrosis and corneal thinning
38
What treatment is used for fungal keratitis?
topical antifungals (hour installation) and analgesia
39
What protozoa commonly causes keratitis?
acanthamoeba
40
Where are acanthamoeba found?
Fresh water and soil
41
Give 3 clinical presentations specific to acanthamoeba keratitis:
1. Ring shaped infiltrate with radial perineural infiltrates 2. Epiphora 3. Severe pain that is often disproportionate to mild clinical findings
42
What type of investigation can be used to view acanthamoeba cysts in suspected acanthamoeba keratitis?
confocal microscopy
43
What antiamoebic agent is commonly used to treat acanthamoeba keratitis?
topical PHMB (polyhexamethylene biguanide)
44
What surgery can be used to treat very severe cases of infective keratitis?
penetrating keratoplasty (full thickness corneal transplant)
45
True or false: acanthamoeba keratitis has a poor prognosis relative to other forms of infective keratitis
True

Y3 - Opthalmology (16 decks)

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