Lecture 2: Red Eye Flashcards
1
Q
How does bacterial conjuctivitis typically present?
A
Copious PURULENT discharge.
2
Q
What are the MC organisms for bacterial conjunctivitis?
A
S. Aureus (MC for adults)
Strep pneumo (MC for children, followed by mcat and hflu)
Pseudomonas (Contact wearers)
3
Q
How is bacterial conjunctivitis treated?
A
- Mild-moderate: Topical sulfonamide like polymixin B/trimethoprim.
- Severe OR pseudomonas: Moxifloxacin, Oculfox/floxin, cipro
4
Q
How is genital bacterial conjunctivitis treated?
A
- Gonococcal: rocephin IM. (corneal involvement = ER)
- Chlamydial: Azithromycin PO.
5
Q
How does gonococcal conjunctivitis present?
A
rip
6
Q
What is trachoma? What causes it?
A
Chlamydial infection of the eye. It is the MC infectious cause of blindness.
7
Q
How does viral conjunctivitis typically present?
A
Copious WATERY discharge.
Google says it is actually rarely bilateral, and her table on slide 18 also says that as well.
8
Q
What is the MCC of viral conjunctivitis? What environment?
A
Adenovirus, usually swimming pools.
9
Q
What condition is viral conjuctivitis associated with?
A
Preauricular adenopathy.
10
Q
How is viral conjuctivitis treated?
A
Supportive care and cold compresses.
11
Q
How does allergic conjunctivitis typically present?
A
Stringy discharge with cobblestone papillae on exam.
Hyperemia and chemosis
12
Q
How is allergic conjunctivitis treated?
A
- Mild-moderate: topical antihistamines, such as ketotifen or olopatadine. Can also use NSAIDs, mast cell stabilizers, or oral antihistamines.
- Severe: topical corticosteroids UNLESS h/o of suspected HSV.
13
Q
What is the uvea made of?
A
Anterior uvea: iris/pupil and ciliary body
Posterior uvea: Choroid
14
Q
What is the MC type of uveitis?
A
Acute nongranulomatous anterior uveitis
15
Q
How does ANTERIOR non-granulomatous uveitis usually present?
A
Unilateral pain with acute presentation.
* Redness
* Photophobia
* Visual loss
16
Q
How does ANTERIOR granulomatous uveitis present?
A
- Indolent
- Blurred vision
- Mildly inflamed
- Recurrent
17
Q
What is the MC of anterior non-granulomatous uveitis?
A
Immunologic, usually HLA-B27 conditions.
* Anklyosing spondylitis
* Reactive arthritis
* psoriasis
* ulcerative colitis
* crohn’s
18
Q
What usually causes granulamatous anterior uveitis?
A
- Sarcoidosis
- Toxoplasmosis
- TB
- Syphilis (salt and pepper fundus)
- Herpes
- Ocular trauma
19
Q
How is anterior uveitis/iritis diagnosed?
A
Slit-lamp examination
20
Q
What specific findings do you find in iritis?
A
Granulomatous: Large keratic precipitates.
Non-granulomatous: small keratic precipitates.
21
Q
What is a hypopyon?
A
Collection of inflamed epithelial cells.
Looks like pus in the anterior chamber of the eye.
22
Q
What exam findings would I expect in posterior uveitis?
A
New lesions: yellow with indistinct margins, retinal hemorrhages.
Old lesions: definite margins, commonly pigmented.
23
Q
What kind of symptoms would I expect in posterior uveitis?
A
Gradual vision loss
Floaters
Bilateral usually.
24
Q
What are the MCC of posterior uveitis?
A
Same as anterior + pars plantis or autoimmune retinal vasculitis.
25
How is anterior uveitis treated?
Referral.
Topical corticosteroids #1 + pupil dilation!
26
How is posterior uveitis treated?
Referral.
Special corticosteroid therapy.
27
What is the predominant cell in non-granulomatous anterior uveitis?
PMN cells.
28
What is the MC cell type in granulomatous anterior uveitis?
Macrophages and histiocytes
29
What is keratitis? 4 causes?
Inflammation of the cornea.
* Bacterial
* Viral (HSV, HZV)
* Acanthamoeba (parasite)
* Fungal
30
What is the biggest risk factor for keratitis?
Contact lens wear overnight.
31
What is the MC pathogen to cause bacterial keratitis?
Pseudomonas
32
How does bacterial keratitis typically present?
* Hazy cornea
* Hypopyon
* Stromal abscess
* Patients typically complain of a foreign body sensation and trouble keeping their eye open.
33
How is bacterial keratitis treated?
* Emergent referral
* Fluoroquinolone empiric tx.
* Tailor treatment once culture back.
34
How does HSV keratitis typically present?
* Red eye
* Photophobia
* Foreign body sensation
* Watery discharge
* Dendritic lesions on fluoroscein stain
35
How is HSV keratitis treated?
* Urgent referral
* Topical/oral antivirals
* Valacyclovir often used to prevent recurrence.
36
How does HZV keratitis typically present?
* Hutchinson's sign
* Malaise, fever, HA
37
How is HZV keratitis treated?
* Urgent referral
* High dose oral antiviral
* IV for immunocomped.
38
What do we generally avoid in viral keratitis treatment?
Corticosteroids
39
When does fungal keratitis usually occur?
Corneal trauma with plant material or agricultural settings.
Contacts
40
How does fungal keratitis typically present?
* Multiple stromal abscesses
* Satellite lesions
* Feathery edges
41
How is fungal keratitis treated?
* Natamycin 5%, amphotericin 0.1-0.5%, voriconazole 1% for up to 6 months.
42
How does acanthamoeba keratitis typically present?
Contact lens wearers usually have severe pain, infiltrates in corneal stroma.
Red eye, tearing, blurred vision
43
What kind of environments do people typically get acanthamoeba keratitis?
* Swimming
* Hot tub
* Not washing hands before changing contacts
44
How is acanthamoeba keratitis treated?
Topical antiseptic like polyhexamethylene or chlorhexidine for 6mo-1 year.
45
What is subconjunctival hemorrhage? What is the treatment?
Well-circumscribed area of hemorrhage under conjunctiva. Self-limiting.
46
What can cause a subconjunctival hemorrhage?
* Valsalva, coughing, sneezing
* Systemic HTN
* Anticoagulant meds.
47
What is dacryoadenitis?
Inflmmation of the temporal aspect of the upper eyelid. (Lacrimal gland)
48
What is dacryocystitis?
Infection of the lacrimal sac/duct.
Acute presentation: pain/swelling/redness in tear sac area. Possible purulent material.
Chronic presentation: tearing and discharge with some mucus or pus.
49
How do I tell dacryoadenitis from dacryocystitis?
Adenitis is a gland, so it is the temporal aspect of the upper eyelid.
Cystitis is central, so it is the nasal/inframedial aspect of the eye.
50
What typically causes dacryoadenitis? Dacryocystitis?
Adenitis: Usually autoimmune like sjogrens. Sometimes viral like mumps or bacterial.
Cystitis: Acute is staph aureus. Chronic is staph epidermidis
51
How is dacryoadenitis treated? Dacryocystitis?
Adenitis:
Autoimmune = underlying cause or steroids
Viral = supportive
Bacterial = systemic abx and maybe I&D
Cystitis:
Acute = lacrimal sac massage
Chronic = topical tobramycin or moxifloxacin if no other signs of infection
52
How do I treat dacryocystitis with signs of infection?
Amoxicillin/clavulanic acid
Possible surgery
Chronic: ABX. Definitive tx is a dacryocystorhinostomy (Making a fistula into nasal cavity to empty it consistently)
53
What does anterior blepharitis involve?
* Eyelid skin
* Eyelashes
* Associated glands
54
What are the two kinds of anterior blepharitis?
Ulcerative (staphylococci)
Seborrheic (itchy rash with flakes)
55
What does posterior blepharitis involve?
Meibomian glands at the inner portion of the eyelid.
56
What are the 2 kinds of posterior blepharitis?
Bacterial (staphylococci)
Primary glandular dysfunction
57
Where do I find meibomian glands and what are they for?
Inner part on the underside of your eyelids.
Eye lubrication, spread tears and preventing their evaporation.
58
How does anterior blepharitis typically present?
* Red-rimmed.
* Scales in eyelashes
59
How does posterior blepharitis typically present?
* Lid margins with hyperemic telangiectasia
* Inflamed meibomian glands
* Inward rolled lid margins
* Tears may be frothy or greasy.
60
What are the typical DDx for blepharitis?
* Conjunctivitis
* Hordeolum
* Chalazion
61
How is anterior blepharitis treated?
* Cleaning your eyelids
* Antistaphylococcal ointment for acute exacerbations (bacitracin or erythomycin)
62
How is posterior blepharitis treated?
Mild is treated with a hot wash cloth and lid massage.
Mild = regular meibomian gland expression.
63
How is moderate blepharitis treated when it involves the cornea and conjunctiva?
Long-term, low dose oral abx.
Short-term topical corticosteroids.
64
What is a hordeolum?
Acute infection caused by a staphylococcal abscess.
65
How does a hordeolum typically present?
* Localized, red, swollen, TENDER area. (either eyelid)
* External: Stye and smaller on margin.
* Internal: Meibomian gland abscess pointing on to the conjunctival surface of the lid.
66
How is a hordeolum treated?
Warm compress. Meds show little efficacy.
67
How does a chalazion typically present?
Hard, NONTENDER swelling.
Painless, localized eyelid swelling.
68
How is a chalazion treated?
Warm compress and massage.
Resolves on its own usually.
Refractory can involve a referral.
69
What differentiates preseptal cellulitis from orbital cellulitis?
Inflammatory proptosis.
If present, orbital cellulitis.
70
How does orbital cellulitis typically present?
Infection of the fat and tissue that hold the eye in its socket.
* Fever
* Pain
* Eyelid swelling/erythema
* Decreased vision/diplopia
* Proptosis
* ptosis
* Chemosis
* Pain and limitation of extraocular movements.
* leukocytosis
71
What are the MCC of orbital cellulitis?
Extension of acute sinusitis, so strep pneumo, H flu, Staph Aureus, and M Cat.
72
How is orbital cellulitis treated initially?
* Empiric abx with IV vanco + (ceftriaxone or cefotaxime)
* Can add metro or clinda if anaerobes are suspected.
* If trauma related, use cefazolin or ceftriaxone
73
How is orbital cellulitis treated after IV abx?
Oral abx if clinical improvement.
Usually bactrim + augmentin.
74
How does preseptal cellulitis typically present?
Minor inflammation/swelling of the superficial orbital septum.
* Afebrile
* Eyelid swelling and erythema
* NO proptosis
* NO limitation or pain of extraocular movements
* NO vision impairment/diplopia
75
What are the MCC organisms for preseptal cellulitis?
Staph Aureus
Strep Pneumo
76
How is preseptal cellulitis treated?
Oral ABX: (Augmentin or omnicef) + Bactrim
If not improved in 24-48 hrs, monitor closely for orbital cellulitis development.
77
What is ciliary flush and what does it indicate?
Red ring spreading out from cornea.
Highly suggestive of corneal ulcer.
Emergent referral if seen.
78
How does a pseudomonal corneal ulcer present? MC demographic?
Gray/yellow infilitrate at break.
Exudate may be bluish-green.
Culture: G- rod
MC: Contact lens wearers.
79
How do we treat a pseudomonal corneal ulcer?
ABX eye drops:
* Moxi
* Gatifloxacin
* Cipro
* Tobramycin
* Gentamicin
80
How does a GAS corneal ulcer present?
No specific identifying features.
Sometimes a large hypopyon or edematous corneal stroma.
Culture: G+ cocci (chains)
81
How is a GAS corneal ulcer treated?
ABX eye drops:
* Moxi
* Gatifloxacin
* Cefazolin
82
How does a staph corneal ulcer present?
* Hypopyon and corneal infiltration
* Superficial
* Firm ulcer bed when scraped
* Culture: G+ cocci (single, pair, or chains)
A firm staph
83
How is a staph corneal ulcer treated?
* ABX eye drops:
* Cefazolin
* Moxi
* Gatifloxacin
* Vanco if MRSA.
84
How does a fungal corneal ulcer present?
* Indolent
* Gray infiltrate with irregular edges
* Satellite lesions
* MCC: opportunists
85
How is a fungal corneal ulcer treated?
* Amphotericin B
* Voriconazole
* Posaconazole
86
What is the MCC of viral corneal ulcers?
HSV.
Dendritic lesion in corneal epithelium.
87
How is a viral corneal ulcer treated?
Oral acyclovir
Topical idoxuridine or ganciclovir
88
What eye conditions can be treated by a PCP?
* Stye
* Chalazion
* Blepharitis
* Subconjunctival hemorrhage
* Conjuctivitis
* Corneal abrasion/foreign body
* Contact lens overwear
* Dry eye syndrome
* Episcleritis
