Keys Flashcards

Question

What is the differential diagnosis of a conjunctival membrane and pseudomebrane?

Answer 1

MEMBRANE: Bacterial conj (strept, pneumococci, corynebacterium diphtheria); chemical burns, ligneous, adenovirus, HSV PSEUDOMEMBRANE: All of above + OCP, SJS, SLK, gonnococal and chlamydial infection in newborns

Answer 2

* Adenovirus (most common) * Herpes simplex virus (mainly type 1) * Molluscum Contagiosum (a poxvirus) * Varicella-zoster virus * Picornavirus (enterovirus 70, coxsackie A24)

Answer 3

``` (1) LUBRICANTS • Treat ocular surface dryness/blepharitis • Punctal plugs (if not closed by scarring (2) STEROIDS • Topical steroids (cautious for corneal melt) - (3) DAPSONE • Dapsone 50-100mg oral daily • SE: anaemia – FBC & G6PD prior to Rx (4) OTHER IMMUNOSUPPRESSANTS • MTX • MMP • Cyclophosphamide • Rituxumab (CD20 supression) (5) PLASMAPHORESIS PRINCIPLES: • Withdraw after disease quiescent for 3-6/12 • Surgery – entropion/keratoprosthesis ```

Answer 4

General: Azithromycin 1g oral If pregnant: erythromycin 500mg o BD for 14/7 If neonatal: erythromycin elixir 50mg/kg/day for 14/7 + Rx parents

Answer 5

(1) Antibiotics • If no corneal involvement: Ceftriaxone 1g im and ciprofloxacin q2h • If corneal involvement: ceftriaxone 1g iv BD (can perf rapidly) and moxifloxacin (1.0%) q1h (2) Saline irrigation (3) Screen/treat for concurrent Chlamydial infection (4) Treat all partners

Answer 6

(1) Urgent gram stain (2) Exclude dacrocystitis, NLD obstruction, congenital glaucoma (3) Use erythromcin ointment QID + erythromycin elixir 50mg/kg/day for 14/7

Answer 7

``` (1) TOPICAL ANTIFUNGALS • g. Amphotericin B 0.15% (Candida) q1h or • g. Natamycin 5% (filamentous) q1h • Can give g. voriconazole 1% q1h • Can debride epithelium for penetration (2) CYCLOPEGICS • Atropine 1% if hypopyon (3) CONSIDER SYSTEMICS • Consider voriconazole 200mg oral BD ```

Answer 8

After managing underlying cause – debride epithelium then wipe with EDTA 3%

Answer 9

(1) Polyhexamethyl biguanide 0.02% (PHMB) or chlorhexidine 0.02% q1h (2) Propamide 0.1% (brolene) q1h (needs to be treated for 2-6 months due to cysts) (3) Voriconazole 200mg BD (4) NSAIDs if scleritis (5) Topical steroids use once infection controlled controversial

Answer 10

(1) Lid hygiene / warm compress / Artificial tears (2) Use oc chlorsig to lids (3) Consider cyclosporine 0.05% BD (esp for meibomitis) (4) Doxycycline 50mg o D for 6/12 (CI in children; pregnant; breast-feeding – use erythromycin 200mg D)

Answer 11

(1) Lubricants always – BCL + chlorsig if acute – extended wear CL if not healing (2) Alcohol delamination (20% for 40s) Doxycycline 100mg BD; flarex QID (3) Anterior stromal puncture ( ~27G needle to ~ 100μm outside visual axis) ~ 45% symptom free at 5yrs (4) Epithelial debridement & diamond burr polishing of BM (will leave ~ 50% symptom free at 5yrs) (5) Transepithelial phototheurapeutic keratectomy – excimer laser ablation (1D of hyperopia; 80% symptom free at 20mths)

Answer 12

``` PRINCIPLE: 1. Always aim to identify the chemical 2. Exclude systemic burns (AIRWAY?) ACUTE TREATMENT: 1. Irrigate with Morgan Lens till pH 7.0-7.2 2. g maxidex q1h (if grade 2 or above BUT must taper by 10/7 if epithelium not healed) 3. g chlorsig QID 4. g citrate 10% q2h 5. g atropine 1% BD 6. g ascorbate 10% q2h 7. Ascorbate (Vit C) 2g o D 8. Ural sachet TDS / doxycycline CHRONIC TREATMENT: 1. Lubricants - preservative free 2. Debride necrotic epithelium 3. Tenon’s advance; AMT; LSCF; 4. Lids; PK (delay >6/12); keratoprosthesis ```

Answer 13

``` (1) Education • Avoid eye rubbing • Atopy management (2) Correct refractive errors • Glasses/SCL/RGP (3) Collagen Cross linking if: • Progressing K’s (documented before VA↓) • CCT>400μm • Young with progressive myopia (4) Intrastromal rings (intacts) • Need clear cornea + CCT>400 + K380: ALTK; DALK; FSALK • CCT <380: DALK; FSALK • Peripheral thinning: TILK (tuck in) • Hydrops/scarring: PK (urgent if vascularised) ```

Answer 14

``` PK: • Large wound "open sky" • Weaker structural strength • Longer recovery (1-1.5yrs) • Potential VA 6/6 • Rejection rate same • Complications higher (suture abscess; irregular astig, wound dehiscence) • Less difficult • Lens status phakic DSAEK: • Small wound • Stronger/ Intact globe • Quicker (3-6/12) • 1 line less than PK (hyperopic shift) • Rejection rate same • Less complications • Learning curve (5-10% dislocation rate) • Best if PCIOL ```

Answer 15

(1) Cut at the steep axis – ie the axis of the + cyl (or 90 away from – cyl (2) Can be removed after 6-12/52

Answer 16

1. Manage underlying condition – referral to rheumatologist etc for RA; Sarcoidosis; OCP. 2. Preservative free lubricants (cellufresh / refresh plus) q1h + ointment (GenTeal gel) 3. Cyclosporine 0.05% QID 4. Punctal plugs (collagen inserts – temporary; acrylic – reversible; cautery permanent) 5. Remove filaments – consider 10% acetylcysteine (Mucomyst) QID 6. Serum drops (20% QID) 7. Moisture chamber nocte 8. Surgical - Lateral tarsorrhaphy/Botox

Answer 17

- hypertonic saline 5% (Muro 128) – hairdryer at arms length - Reduce IOP if elevated - If ruptured bullae – give antibiotic / hydrophilic BCL - Graft – PK vs DSEK (if no ACIOL) vs Gunderson if no visual potential - remember the hyperopic shift with DSEK

Answer 18

``` FEATURES OF REJECTION: Definite: flare; cells KPs on donor endothelium; line Probable: no rejection line Possible: gradual graft edema nil else TREATMENT: (1) Epithelial • Double current dose of PF or PF QID (which ever is more) (2) Endothelial • PF q1h • Cyclosporine A 0.5% • Oral prednisolone • Homatropine BD • Control IOP ```

Answer 19

1. Eliminate agent 2. Cool compress 3. Lubricant 4. Olopatadine 0.1% BD 5. NSAID 6. g Steroid 7. o Antihist 8. CSA

Answer 20

(1) Rx underlying cause (50% associated with TED), blepharitis (2) As per dry eye - lubricants ++, punctal plugs, cyclosporine 0.05% BD (3) Silver nitrate 0.5% applied (4) Acetylcystein 10% if filaments (5) surgical resection /cautery

Answer 21

(1) Type I – classic, type AA amyloid, no systemic amyloid deposition; <10yrs old – TGFβ1 (5q31) (2) Type II – systemic amyloidosis, less lines & more peripheral, May have cranial & peripheral neuropathy (Meretoja’s syndrome); 30-40yrs old – Gelsolin (9q34)