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Anterior Segment > Inflammatory Corneal Disorders > Flashcards

Inflammatory Corneal Disorders Flashcards

1
Q

what disorder is caused by a hypersensitivity reaction to staphylococcal exotoxins & cell wall proteins

A

marginal keratitis

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2
Q

marginal keratitis is frequently associated with what two conditions

A

blepharitis & ocular rosacea

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3
Q

sign:
subepithelial infiltrate w/ adjacent conjunctival hyperemia
infiltrates are usually separated from limbus by a clear zone

A

marginal keratitis

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4
Q

what do you use to treat marginal keratitis to stop the toxins

A

antibiotic-steroid combo for 1-2 weeks

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5
Q

what corneal disorder has an acute & rapid onset of a subepithelial inflammatory nodule

A

phlyctenulosis

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6
Q

what are the implicated organisms in phlyctenulosis

A

staph aureus – in US
active mycobacterium tuberculosis – in developing countries
chlamydia trachomatis – in adults

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7
Q

sign:

small white limbal or conjunctival nodule w/ adjacent redness & hyperemia

A

phlyctenulosis

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8
Q

if the phlyctenulosis nodule extends past the limbus, what will occur

A

corneal haze & formation of superficial vessels

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9
Q

phlyctenulosis is common in

A

children (usually staph) & adolescents

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10
Q

what is the associated findings in phlyctenulosis

A

blepharitis

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11
Q

why do we still need to treat phlyctenulosis if it can self-resolve

A

because we don’t know which ones will self-resolve & which ones won’t

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12
Q

prognosis:

upon resolution → a wedge-shaped fibrovascular scar may remain on the cornea

A

phlyctenulosis

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13
Q

what steroid-antibiotic combinations can we use to treat phlyctenulosis

A

tobradex, zylet

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14
Q

when phlctenulosis has significant corneal involvment, how do we treat it & what medication

A

aggressive steroid therapy w/ slow taper

prednisone acetate 1% ophth susp q2h

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15
Q

what underlying etiology should be managed to prevent phlyctenulosis from recurring

A

blepharitis

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16
Q

what condition is a localized non-infectious type IV reaction to a bacterial antigen

A

phlyctenulosis

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17
Q

a rare autoimmune reaction against corneal stromal tissue

A

Mooren’s ulcer

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18
Q

which corneal disorder is a diagnosis of exclusion (no underlying systemic disease present)

A

Mooren’s ulcer

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19
Q

which corneal disorder may be associated with Hep. C infection

A

Mooren’s ulcer

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20
Q

these complications are related to which corneal disorder –
severe astigmatism
perforation after minor tumors; not likely on its on
secondary bacterial infections

A

Mooren’s ulcer

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21
Q

these signs can help you differentiate which corneal disorder from others:

  • infiltrated WBC’s on leading edge
  • no scleritis present
A

Mooren’s ulcer

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22
Q

peripheral corneal ulceration & thinning which then spreads centrally is a clinical finding in which corneal disorder

A

Mooren’s ulcer

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23
Q

why are topical steroids used to treat Mooren’s ulcers

A

to control inflammation (may need frequent dosage)

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24
Q

what treatment would you use for immunosuppression of a Mooren ulcer

it should be used especially when

A

topical cyclosporine (Restasis)

especially when there’s an IOP spike

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25
Q

when a Mooren’s ulcer has significant epithelium compromise, what would you use to treat it

A

prophylactic topical antibiotic

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26
Q

using doxycycline to treat a Mooren’s ulcer inhibits what

A

collagenase

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27
Q

what corneal disorder can precede or follow onset of systemic collegen-vascular autoimmune disease

A

peripheral ulcerative keratitis (PUK)

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28
Q

what is the most common underlying systemic etiology of PUK

A

rheumatoid arthritis

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29
Q

pathophysiology:
- immune complex deposition in peripheral cornea
- cytokine release & inflammatory cell recruitment
- upregulation of collagenases
→ causing destruction of peripheral stroma

A

peripheral ulcerative keratitis (PUK)

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30
Q

signs:
- crescentic ulceration with epithelial defect
- thinning & stromal infiltration at limbus
- limbitis, episcleritis, or scleritis can be present

A

peripheral ulcerative keratitis (PUK)

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31
Q

what specialists would you refer someone with PUK to & why

A
  • rheumatology → requires systemic immunosuppression

- corneal specialist → may need surgery to prevent perforation

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32
Q

what kind of topical lubricant is used to treat PUK aggressively

A

preservative-free

33
Q

if PUK has a large epithelial defect, what would you treat it with

A

prophylactic topical antibiotic

34
Q

what medication has anti-collagenase effect that is used to treat PUK

A

doxycycline

35
Q

why can’t you use topical steroids to treat PUK

A

promotes corneal melting

36
Q

PUK vs. Mooren’s ulcer:

which is rapidly progressive & which is slowly progressive

A

PUK - rapidly progressive

Mooren’s - slowly progressive

37
Q

PUK vs. Mooren’s ulcer:

which has trauma-induced perforation & which has spontaneous perforation

A

PUK - spontaneous

Mooren’s - trauma-induced

38
Q

PUK vs. Mooren’s ulcer:

which one can you treat with topical steroids

A

Mooren’s ulcer

39
Q

PUK vs. Mooren’s ulcer:

which is a diagnosis of exclusion & which has an underlying systemic disease

A

Mooren’s - diagnosis of exclusion

PUK - underlying systemic disease

40
Q

what are other ways CL-related corneal sequelae can be called & which one is a misnomer

A
  • tight lens syndrome
  • CLARE: contact lens acute red eye
  • CLPU: contact lens peripheral ulcer → misnomer
41
Q

what is a non-infectious corneal inflammatory consequence of CL wear

A

CL-related corneal sequelae

42
Q

what are the causes of CL-related corneal sequelae

A
  • hypoxia (usually after sleeping in CLs)
  • hypersensitivity reaction to cleaning solutions
  • CL deposits from overwear
  • tight lens
43
Q

clinical findings:

  • superficial punctate w/ NaFl staining
  • circumlimbal hyperemia
  • peripheral infiltrates (aka marginal keratitis)
  • corneal neovascularization
A

CL-related corneal sequelae

44
Q

what topical antibiotics would you treat CLARE (CL-related corneal sequelae with & why

A

4th gen fluoroquinolone → broad-spectrum

45
Q

if significant inflammation is present after treating CLARE with a topical antibiotic, what would you give the patient & when should they apply it

A

topical steroid → after 24h of antibiotic use

46
Q

an antibiotic/steroid combo can be used to treat CLARE when

A

there is mild/no epithelial staining is present

47
Q

if significant photophobia is present in CLARE, what should you consider

A

a cycloplegic

48
Q

we have to monitor CLARE daily for development of what

A

infectious keratitis

49
Q

a non-ulcerating inflammation of the stroma leading to neovascularization caused by an immune-mediated process triggered by an antigen

A

interstitial keratits (IK)

50
Q

what is the most common etiology of interstitial keratitis

A

congenital syphilis in chronic phase

51
Q

acquired syphilis, Cogan’s syndrome, HSV/HZV & tuberculosis are etiologies for what corneal disorder

A

interstitial keratitis (IK)

52
Q

which form of syphilis is bilateral

A

congenital syphilis

53
Q

which two causes of IK is presents typically as unilateral

A

acquired syphilis & tuberculosis

54
Q

a rare autoimmune vasculitis that targets inner ear & cornea

A

Cogan’s syndrome

55
Q

in Cogan’s, how does intraocular inflammation & neurosensory hearing loss present

A

they are often separated by a long period of time

56
Q

what intraocular inflammations present in Cogan’s

A
  • active IK
  • uveitis
  • scleritis
  • retinal vasculitis
57
Q

what are the symptoms of Cogan’s that involves the ear

A
  • vertigo
  • tinnitus
  • profound deafness
58
Q

does IK affect the epi & endo

A

no

59
Q

bloodwork that may reveal elevated ESR & CRP is associated with what condition

A

Cogan’s syndrome

60
Q

who would you refer a patient with IK to & why

A
  • immediate to rheumatology → for systemic steroids to prevent deafness & rule out vasculitis
  • audiology → evaluate the level of hearing loss
61
Q

which phase of IK has these signs:

  • pain & photophobia
  • stromal infiltrates & edema → leading to decreased VA
  • anterior chamber inflammation
  • conjunctival hyperemia
A

acute phase → active inflammation is occurring

62
Q

which phase of IK has these signs:

  • deep corneal haze/scarring
  • corneal ghost vessels
A

chronic phase → occurs when active phase is not accurately & rapidly treated

63
Q

IK bilateral signs indicate which etiology -

  • deafness
  • salt & pepper retinopathy
  • anterior uveitis
  • Argyll Robertson pupils
  • cataract
A

congenital syphilis

64
Q

which type of IK are these treatments used for:

  • topical steroid
  • cycloplegic
  • urgent infectious disease referral for systemic antibiotic treatment
A

active syphilitic IK

65
Q

what is the management for chronic syphilitic IK

A
  • blood work to rule out current systemic infection

- monitor for any corneal changes

66
Q

an ingrowth of tissue from the limbus into the peripheral cornea

A

pannus

67
Q

in pannus, where does the ingrowth of tissue penetrate

A

between epithelium & Bowman’s layer

68
Q

in pannus, what does the ingrowth consist of?

A

collagen & vessels into the superficial cornea

69
Q

these all cause what corneal disorder

  • hypoxia from CL wear
  • chemical burns
  • ocular rosacea
  • chronic blepharitis
A

pannus

70
Q

superior pannus is indicative of what

A

trachoma

71
Q

cellular deposits on corneal endothelium seen in anterior segment inflammation

A

keratic precipitates (KPs)

72
Q

what is Arlt’s triangle & how is it caused

A
  • typical distrubution of KPs in inferior 1/3 of cornea
  • apex of triangle points up
  • caused by gravity & aqueous humor currents
73
Q

an immunologic response of host to donor corneal tissue after keratoplasty (corneal graft)

A

corneal graft rejection

74
Q

when does corneal graft rejection usually occur

A

most common in the first 6 months after transplantation

75
Q

what can significantly increase the risk of a corneal graft rejection & why

A

corneal vascularization → blood vessels have immune cells & the cornea is avascular

76
Q

how can a corneal graft rejection decrease vision

A

graft becomes opacified

77
Q

clinical findings:

  • corneal edema
  • KPs on corneal graft but not on peripheral recipient cornea
  • stromal infiltrates
  • anterior chamber inflammation
A

corneal graft inflammation

78
Q

how can corneal graft rejections be reversed

A

topical & systemic steroids

Anterior Segment (37 decks)

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