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Eye Disease > Keratitis > Flashcards

Keratitis Flashcards

1
Q

Name three types of non-infective keratitis

A
  • CLPU
  • Marginal keratitis
  • Keratitis secondary to exposure
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2
Q

What is the pathogen that is responsible for protozoal keratitis?

A

Acanthamoeba

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3
Q

What are corneal signs of corneal disease (there are seven)?

A

-Punctate keratitis
- Superior limbic keratitis
- Corneal infiltrates
- Scaring (from trachoma)
- Corneal ulcer
- Vascularisation
- Hypopyon (accumulation of inflammatory material)

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4
Q

What are associated adnexal and conjunctival signs of corneal disease?

A

-Skin lesions (respects midline)
-Follicles (adenoviral)
-Conjunctival pseudo membrane (adenoviral)
-Conjunctival scaring (trachoma)

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5
Q

What are symptoms of corneal disease?

A
  • Pain/discomfort (due to lots of pain receptors)
  • Reduced VA
  • Photophobia
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6
Q

What are two corneal diseases that are similar?

A

CLPU and MK

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7
Q

What causes the ulcer in CLPU and infilt?

A

Staphylococcus produces toxins and the ocular surface responds to these toxins.

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8
Q

What are some symptoms of CIE?

A
  • Mild FB sensation
  • Can be asymptomatic
  • Mid pain
  • Mild photophobia
  • Mild epiphora
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9
Q

What does CIE stand or?

A

Contact lens infiltrative events this includes CLPU and CL-associated infiltrative keratitis- in these conditions bacteria does not cause progression to an infection (its an inflammatory response)

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10
Q

What are clinical signs of CIE?

A
  • Mild conjunctival hyperamia
  • Stromal infiltrate
  • No AC activity
  • Overlying epithelium may stain
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11
Q

What does flare represent ?

A

Breakdown of the blood aqueous barrier and there is protein in aqueous which leads to light scatter

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12
Q

Is microbial keratitis a sight threatening condition?

A

YES

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13
Q

Which contact lens wearers are at most risk of MK?

A

Extended contact lens wearers

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14
Q

Which is the most common bacteria to cause MK in contact lens wearers?

A

Gram negative psuedonomas

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15
Q

What are symptoms of MK?

A

Severe pain with a rapid onset, redness, photophobia, discharge, blurred vision, more pronounced photophobia

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16
Q

What are signs of MK?

A
  • Loss of epithelium
  • Stromal infiltrate + oedema (seen from a hazy cornea)
  • Reduced VA
  • AC activity (cells and flare)
  • Fungal lesions deeper and feathery edges
    BOWMANS MEMBRANE NOT INTACT
17
Q

How is MK managed?

A

Emergency referral to an ophthalmologist, contact lenses should not be discarded as they are required for culture, they will be given intensive day and night therapy

18
Q

Why is MK so serious?

A

It is sight threatening as they can penetrate the cornea which can lead to corneal scarring

19
Q

What is the 123 that ophthalmologists use after a referral of suspected MK?

A

If there is the presence of AC inflammation (6-15 cells in a 1mm by 1mm SL beam),
2mm> in size or adjacent lesions or
3mm> from centre of cornea then a corneal scrape is formed to see what organisms is causing this immediately

20
Q

What happens to patient who to no meet the 123 criteria from a suspect MK referral?

A

They are given antibiotic therapy straight away every hour

21
Q

Is an corneal infiltration an infection?

A

No it is an inflammatory response to a toxin

22
Q

What is another name for blepharitis?

A

Marginal keratitis

23
Q

What are some signs and symptoms of marginal keratitis?

A

Lacrimination, red eye, photophobia, stromal infiltrate where the lid margin is in contact with the cornea, Hypereamia of adjacent conjunctiva,

24
Q

What is a major RF of marginal keratitis?

A

Long standing conjunctivitis

25
Q

What is the treatment of marginal keratitis?

A

Combination of topical steroids and antibiotics are used (MAKE SURE IT IS AN INFLAMMATION AND NOT AN INFECTION)

26
Q

What is another name for inflammatory keratitis?

A

Sub-epithelial infiltrates in adenoviral conjunctivitis

27
Q

Describe what is seen in inflammatory keratitis.

A

Begins with small microcysts then to focal punctate epithelial lesions which can then progress into sub epithelial infiltrates which occurs after viral conjunctivitis

28
Q

What is the normal treatment for inflammatory conjunctivitis?

A

Let is self heal, if not then topical steroids can be used in some cases

29
Q

What is causes acanthamoeba keratitis?

A

Acanthamoeba in contact lens wearers mostly which can be caused by exposure to soil or contaminated water

30
Q

What are the early and late signs of acanthoemba infective keratitis?

A

Early= Epithelial or sub epithelial infiltrates, pseudodendrities, infiltrates along corneal nerves
Late= Central or paracentral ring infiltrate, stromal thinning

31
Q

What is the management of infective keratitis caused my acanthamoeba ?

A

Emergency referral to ophthalmologist where they will be on intensive topical disinfective treatment

32
Q

What can acanthamoeba infective keratitis be misdiagnosed for and why?

A

Herpes simplex infective keratitis because of the dendritic ulcer

33
Q

What are the symptoms of herpes simplex keratitis?

A
  • Pain
  • Burning
  • Irritation
  • Photophobia
  • Reduced VA - based on severity
  • Redness
34
Q

State the epithelial and stromal (sight threatening) signs of herpes simplex keratitis

A

Epithelial = initially punctate lesions which coalesce into a dendritic form which could lead to a geographic ulcer
Stromal= stromal infiltrate,vascularisation, necrosis, scarring

35
Q

What is the management of herpes simplex keratitis?

A

Emergency referral, topical antiviral given to epithelial level, combination of antiviral and steroidal for stromal level

36
Q

What causes exposure keratitis?

A

When corneal surface becomes dehydrated due to dry eye or inadequate lid closure

37
Q

What causes photokeratitis?

A

Exposure to UV radiation and no eye protection worn when exposed- mild irritation and severe pain

38
Q

How is photokeratitis managed?

A

Lubricant and/or prophylactic topical antibiotics

Eye Disease (48 decks)

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