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(C) CM 1B: ID/EENT > Lecture 2: Red Eye > Flashcards

Lecture 2: Red Eye Flashcards

1
Q

How does bacterial conjuctivitis typically present?

A

Copious PURULENT discharge.

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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)

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3
Q

How is bacterial conjunctivitis treated?

A
  • Mild-moderate: Topical sulfonamide like polymixin B/trimethoprim.
  • Severe OR pseudomonas: Moxifloxacin, Oculfox/floxin, cipro
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4
Q

How is genital bacterial conjunctivitis treated?

A
  • Gonococcal: rocephin IM. (corneal involvement = ER)
  • Chlamydial: Azithromycin PO.
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5
Q

How does gonococcal conjunctivitis present?

A

rip

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6
Q

What is trachoma? What causes it?

A

Chlamydial infection of the eye. It is the MC infectious cause of blindness.

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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.

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8
Q

What is the MCC of viral conjunctivitis? What environment?

A

Adenovirus, usually swimming pools.

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9
Q

What condition is viral conjuctivitis associated with?

A

Preauricular adenopathy.

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10
Q

How is viral conjuctivitis treated?

A

Supportive care and cold compresses.

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11
Q

How does allergic conjunctivitis typically present?

A

Stringy discharge with cobblestone papillae on exam.
Hyperemia and chemosis

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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.
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13
Q

What is the uvea made of?

A

Anterior uvea: iris/pupil and ciliary body
Posterior uvea: Choroid

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14
Q

What is the MC type of uveitis?

A

Acute nongranulomatous anterior uveitis

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15
Q

How does ANTERIOR non-granulomatous uveitis usually present?

A

Unilateral pain with acute presentation.
* Redness
* Photophobia
* Visual loss

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16
Q

How does ANTERIOR granulomatous uveitis present?

A
  • Indolent
  • Blurred vision
  • Mildly inflamed
  • Recurrent
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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

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18
Q

What usually causes granulamatous anterior uveitis?

A
  • Sarcoidosis
  • Toxoplasmosis
  • TB
  • Syphilis (salt and pepper fundus)
  • Herpes
  • Ocular trauma
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19
Q

How is anterior uveitis/iritis diagnosed?

A

Slit-lamp examination

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20
Q

What specific findings do you find in iritis?

A

Granulomatous: Large keratic precipitates.
Non-granulomatous: small keratic precipitates.

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21
Q

What is a hypopyon?

A

Collection of inflamed epithelial cells.
Looks like pus in the anterior chamber of the eye.

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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.

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23
Q

What kind of symptoms would I expect in posterior uveitis?

A

Gradual vision loss
Floaters
Bilateral usually.

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24
Q

What are the MCC of posterior uveitis?

A

Same as anterior + pars plantis or autoimmune retinal vasculitis.

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25
Q

How is anterior uveitis treated?

A

Referral.
Topical corticosteroids #1 + pupil dilation!

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26
Q

How is posterior uveitis treated?

A

Referral.
Special corticosteroid therapy.

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27
Q

What is the predominant cell in non-granulomatous anterior uveitis?

A

PMN cells.

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28
Q

What is the MC cell type in granulomatous anterior uveitis?

A

Macrophages and histiocytes

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29
Q

What is keratitis? 4 causes?

A

Inflammation of the cornea.
* Bacterial
* Viral (HSV, HZV)
* Acanthamoeba (parasite)
* Fungal

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30
Q

What is the biggest risk factor for keratitis?

A

Contact lens wear overnight.

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31
Q

What is the MC pathogen to cause bacterial keratitis?

A

Pseudomonas

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32
Q

How does bacterial keratitis typically present?

A
  • Hazy cornea
  • Hypopyon
  • Stromal abscess
  • Patients typically complain of a foreign body sensation and trouble keeping their eye open.
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33
Q

How is bacterial keratitis treated?

A
  • Emergent referral
  • Fluoroquinolone empiric tx.
  • Tailor treatment once culture back.
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34
Q

How does HSV keratitis typically present?

A
  • Red eye
  • Photophobia
  • Foreign body sensation
  • Watery discharge
  • Dendritic lesions on fluoroscein stain
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35
Q

How is HSV keratitis treated?

A
  • Urgent referral
  • Topical/oral antivirals
  • Valacyclovir often used to prevent recurrence.
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36
Q

How does HZV keratitis typically present?

A
  • Hutchinson’s sign
  • Malaise, fever, HA
37
Q

How is HZV keratitis treated?

A
  • Urgent referral
  • High dose oral antiviral
  • IV for immunocomped.
38
Q

What do we generally avoid in viral keratitis treatment?

A

Corticosteroids

39
Q

When does fungal keratitis usually occur?

A

Corneal trauma with plant material or agricultural settings.
Contacts

40
Q

How does fungal keratitis typically present?

A
  • Multiple stromal abscesses
  • Satellite lesions
  • Feathery edges
41
Q

How is fungal keratitis treated?

A
  • Natamycin 5%, amphotericin 0.1-0.5%, voriconazole 1% for up to 6 months.
42
Q

How does acanthamoeba keratitis typically present?

A

Contact lens wearers usually have severe pain, infiltrates in corneal stroma.
Red eye, tearing, blurred vision

43
Q

What kind of environments do people typically get acanthamoeba keratitis?

A
  • Swimming
  • Hot tub
  • Not washing hands before changing contacts
44
Q

How is acanthamoeba keratitis treated?

A

Topical antiseptic like polyhexamethylene or chlorhexidine for 6mo-1 year.

45
Q

What is subconjunctival hemorrhage? What is the treatment?

A

Well-circumscribed area of hemorrhage under conjunctiva. Self-limiting.

46
Q

What can cause a subconjunctival hemorrhage?

A
  • Valsalva, coughing, sneezing
  • Systemic HTN
  • Anticoagulant meds.
47
Q

What is dacryoadenitis?

A

Inflmmation of the temporal aspect of the upper eyelid. (Lacrimal gland)

48
Q

What is dacryocystitis?

A

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
Q

How do I tell dacryoadenitis from dacryocystitis?

A

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
Q

What typically causes dacryoadenitis? Dacryocystitis?

A

Adenitis: Usually autoimmune like sjogrens. Sometimes viral like mumps or bacterial.

Cystitis: Acute is staph aureus. Chronic is staph epidermidis

51
Q

How is dacryoadenitis treated? Dacryocystitis?

A

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
Q

How do I treat dacryocystitis with signs of infection?

A

Amoxicillin/clavulanic acid
Possible surgery

Chronic: ABX. Definitive tx is a dacryocystorhinostomy (Making a fistula into nasal cavity to empty it consistently)

53
Q

What does anterior blepharitis involve?

A
  • Eyelid skin
  • Eyelashes
  • Associated glands
54
Q

What are the two kinds of anterior blepharitis?

A

Ulcerative (staphylococci)
Seborrheic (itchy rash with flakes)

55
Q

What does posterior blepharitis involve?

A

Meibomian glands at the inner portion of the eyelid.

56
Q

What are the 2 kinds of posterior blepharitis?

A

Bacterial (staphylococci)
Primary glandular dysfunction

57
Q

Where do I find meibomian glands and what are they for?

A

Inner part on the underside of your eyelids.
Eye lubrication, spread tears and preventing their evaporation.

58
Q

How does anterior blepharitis typically present?

A
  • Red-rimmed.
  • Scales in eyelashes
59
Q

How does posterior blepharitis typically present?

A
  • Lid margins with hyperemic telangiectasia
  • Inflamed meibomian glands
  • Inward rolled lid margins
  • Tears may be frothy or greasy.
60
Q

What are the typical DDx for blepharitis?

A
  • Conjunctivitis
  • Hordeolum
  • Chalazion
61
Q

How is anterior blepharitis treated?

A
  • Cleaning your eyelids
  • Antistaphylococcal ointment for acute exacerbations (bacitracin or erythomycin)
62
Q

How is posterior blepharitis treated?

A

Mild is treated with a hot wash cloth and lid massage.
Mild = regular meibomian gland expression.

63
Q

How is moderate blepharitis treated when it involves the cornea and conjunctiva?

A

Long-term, low dose oral abx.
Short-term topical corticosteroids.

64
Q

What is a hordeolum?

A

Acute infection caused by a staphylococcal abscess.

65
Q

How does a hordeolum typically present?

A
  • 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
Q

How is a hordeolum treated?

A

Warm compress. Meds show little efficacy.

67
Q

How does a chalazion typically present?

A

Hard, NONTENDER swelling.
Painless, localized eyelid swelling.

68
Q

How is a chalazion treated?

A

Warm compress and massage.
Resolves on its own usually.
Refractory can involve a referral.

69
Q

What differentiates preseptal cellulitis from orbital cellulitis?

A

Inflammatory proptosis.
If present, orbital cellulitis.

70
Q

How does orbital cellulitis typically present?

A

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
Q

What are the MCC of orbital cellulitis?

A

Extension of acute sinusitis, so strep pneumo, H flu, Staph Aureus, and M Cat.

72
Q

How is orbital cellulitis treated initially?

A
  • 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
Q

How is orbital cellulitis treated after IV abx?

A

Oral abx if clinical improvement.
Usually bactrim + augmentin.

74
Q

How does preseptal cellulitis typically present?

A

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
Q

What are the MCC organisms for preseptal cellulitis?

A

Staph Aureus
Strep Pneumo

76
Q

How is preseptal cellulitis treated?

A

Oral ABX: (Augmentin or omnicef) + Bactrim
If not improved in 24-48 hrs, monitor closely for orbital cellulitis development.

77
Q

What is ciliary flush and what does it indicate?

A

Red ring spreading out from cornea.
Highly suggestive of corneal ulcer.
Emergent referral if seen.

78
Q

How does a pseudomonal corneal ulcer present? MC demographic?

A

Gray/yellow infilitrate at break.
Exudate may be bluish-green.
Culture: G- rod

MC: Contact lens wearers.

79
Q

How do we treat a pseudomonal corneal ulcer?

A

ABX eye drops:
* Moxi
* Gatifloxacin
* Cipro
* Tobramycin
* Gentamicin

80
Q

How does a GAS corneal ulcer present?

A

No specific identifying features.
Sometimes a large hypopyon or edematous corneal stroma.
Culture: G+ cocci (chains)

81
Q

How is a GAS corneal ulcer treated?

A

ABX eye drops:
* Moxi
* Gatifloxacin
* Cefazolin

82
Q

How does a staph corneal ulcer present?

A
  • Hypopyon and corneal infiltration
  • Superficial
  • Firm ulcer bed when scraped
  • Culture: G+ cocci (single, pair, or chains)

A firm staph

83
Q

How is a staph corneal ulcer treated?

A
  • ABX eye drops:
  • Cefazolin
  • Moxi
  • Gatifloxacin
  • Vanco if MRSA.
84
Q

How does a fungal corneal ulcer present?

A
  • Indolent
  • Gray infiltrate with irregular edges
  • Satellite lesions
  • MCC: opportunists
85
Q

How is a fungal corneal ulcer treated?

A
  • Amphotericin B
  • Voriconazole
  • Posaconazole
86
Q

What is the MCC of viral corneal ulcers?

A

HSV.
Dendritic lesion in corneal epithelium.

87
Q

How is a viral corneal ulcer treated?

A

Oral acyclovir
Topical idoxuridine or ganciclovir

88
Q

What eye conditions can be treated by a PCP?

A
  • Stye
  • Chalazion
  • Blepharitis
  • Subconjunctival hemorrhage
  • Conjuctivitis
  • Corneal abrasion/foreign body
  • Contact lens overwear
  • Dry eye syndrome
  • Episcleritis

(C) CM 1B: ID/EENT (27 decks)

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