M: Ocular disease table (study) Flashcards by Alexander Bowden

Name 7 ocular conditions that affect the eyelids and tissue surrounding the eyes

Blepharitis
Hordeolum
Chalazion
Preseptal Cellulitis
Dacryoadentis
Canaliculitis
Dacryocystitis

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Name 3 ocular conditions that affect the conjunctiva

conjunctivitis
trachoma
inclusion conjunctivitis (adults)

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Name 1 ocular condition that affects the cornea

keratitis

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Name 2 ocular conditions that affect the intraocular area

orbital cellulitis

- endophthalmitis

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In regards to Blepharitis:
A: Describe the condition (1)
B: List the pathogens that can cause it (3)
C: Describe management of this condition (3)

A: infection of the eyelid follicles along the edge of the eyelid
B: (Anterior Blepharitis): Mite infection, Staph. aureus, or a mixed infection of S. aureus + S. epidermidis and proprionibacterium acnes
C: eyelid hygeine, antibiotic ointment, condition may never be cured

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In regards to Blepharitis:
A: bilateral or unilateral?
B: List 9 symptoms

A: Can be either
B: burning, flaking, crusting, tearing, irritation, itching, redness in eyelid margins, FB sensation, scales at base of eyelashes

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In regards to Blepharitis:
A: state the long term effects of Anterior blepharitis without treatment, if severe
B: Describe Posterior blepharitis

A: ectropion, trichiasis, entropion
B: involves meibomianitis - excess oil production by the gland

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In regards to Blepharitis:

A: How do we maintain good eyelid hygeine? List what we can use (4)

baby shampoo
dilute sodium bicarbonate
warm compress
artificial tears

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In regards to Blepharitis:

A: List 3 antibiotic ointments used to treat. How long do we use them for?

Framycetin, Tetracyclin, or Chloramphenicol. Treat until clinically resolved

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In regards to Hordeolum:
A: Describe the condition (2) (External vs Internal)
B: List the pathogens that can cause it (2)
C: Describe management of this condition (6)

A: External = acute localized swelling of eyelid (typically due to obstruction or infection of eyelash follicle). Internal = Infection of meibomian gland
B: External: usually staph species. Internal: also usually staph species
C: External: hot compress; sometimes drainage. Internal: warm compress, Oral anti-staph. antibiotics, surgery if persistent

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In regards to Chalazion:
A: Describe the condition (1)
B: List the pathogens that can cause it (1)
C: Describe management of this condition (4)

A: inflammation of a blocked meibomian gland, usually on upper eyelid
B: Not an infection
C: Warm compress (to soften hard oil), don’t squeeze, often disappear without tx, may need corticosteroid

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In regards to Preseptal Cellulitis:
A: Describe its onset, which eye, and pain presence
B: How does it differ from orbital?
C: What does it typically involve?

A: Acute onset, unilateral, pain, fever (mild)
B: No proptosis or visual acuity disturbance
C: periocular swelling, may be difficult to open eye

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In regards to Preseptal Cellulitis:

- List the pathogens that can predispose to it (6)

Staph. Aureus, Strep. Pneum., Strep. pyog., Haemophilus influenzae type B, Peptostreptococcus, HSV 1 and 2 and VZV

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List the sources of the pathogens that cause preseptal cellulitis (5)

Upper resp. infection or Otitis Media: S. pneum., HaemB (if unvacc), S. aureus
Insect/Animal bites or lesions: S. aureus, S. pyogenes, peptostrep.
Skin infections: s. pyogenes, s. aureus
Ruptured dacryocoele (infants): s. aureus, s. pyogenes
Herpetic disease: HSV1/HSV2, VSV

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Describe the management of Preseptal Cellulitis (3)

essential to prevent spread to post-septal area (orbital cellulitis) or through to the meninges
oral therapy if child is otherwise well
IV antimicrobials if severely ill + blood cultures + CT scan of sinuses

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Are topical antimicrobial agents adequate to treat preseptal cellulitis?

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In regards to Dacryoadentis
A: Describe the condition (2)
B: List the pathogens that can cause it (2) (Kids vs Adults)
C: Describe management of this condition (2)

A: Inflammation of lacrimal gland (painful swelling in outer region of upper lid, with some degree of ptosis)
B: Children - viral infections (mumps, HSV). Adults - neisseria gonorrhoea
C: If viral: rest + warm compress. If other: specific treatment for microbe

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In regards to Canaliculitis:
A: Describe the condition (1)
B: List the pathogens that can cause it (7)

A: Inflammation of lacrimal (tear) duct
B: Actinomyces Israelii, “proprionibacterium” spp., Strep. spp., Staph. spp., Candida Albicans + other fungi, Pseudomonas aeruginosa

In regards to Canaliculitis:

- Describe the management of this condition (3)

remove concretions
antibiotics
surgery (possibly)

In regards to Canaliculitis, describe the following:
A: How rare and who does it typically affect?
B: Acute or chronic? Uni or Bilateral?
C: List 3 symptoms

A: Rare. Adults over 50yrs
B: Chronic unilatral
C: red eye, epiphora, and discharge

What does canaliculitis result in the formation of?

Dacryoliths: concretions that impede fluid drainage

Define epiphora

overflow of tears (and mucoid discharge) onto face

In regards to Dacryocystitis:
A: Describe the condition (2)
B: List the pathogens that can cause it (7) (congenital vs acquired)
C: Describe management of this condition (3)

A: Obstruction of nasolacrimal sac – stasis of lacrimal sac contents
B: Congenital: HaemB. Acquired: Psue.Aeruginosa, cutibacterium acnes, actino.israeilii . Both: S. aureus, S. pyogenes, S. pneumoniae
C: oral antibiotics and analgesia. Drainage

Compare the 2 types of Dacryocystitis

Congenital: rare, but potentially fatal

2. Acquired: (typically over 40yrs), can be acute or chronic

In regards to Conjunctivitis: A: Describe the condition (2) B: List the pathogens that can cause it (8)

A: inflammation of the conjunctiva and inner surface of eyelid B: S. aureus, pyogenes, pneumoniae, H. influenzae incl. biogroup aegypticus, moraxella spp., neisseria gonorrhea, c. trachomatis

In regards to Conjunctivitis: | - list 6 risk factors for developing the condition

- poor hygeine (body and CLs) - contaminated cosmetics - crowded living/social conditions - ocular diseases incl. dry eye, blepharitis, anatomic abnormalities of ocular surface and lids - recent ocular surgery - immune compromised

In regards to Conjunctivitis: | - describe management i.e. list 3 ways to prevent

Prevention: - good hygiene - don't share towels - exclude symptomatic people from childcare, school, work, etc.

What is the best way to treat acute conjunctivitis? What can we do to treat suspected bacterial infections?

Empirically, with "best guess" therapy. For suspected bacterial infections, can use framycetin or chloramphenicol eye drops or "delayed prescription" approach

List 7 symptoms of conjunctivitis

1. redness in white/corner of eye 2. increased amnt. of tears 3. thick yellow, green or white discharge (purulent suggests bacterial, serous suggests viral) 4. itchy + burning eyes 5. blurred vision 6. increased sensitivity to light 7. can spread to other eye

In regards to Trachoma | - describe the condition and state sequentially what happens in it (7)

- repeated infections of conjunctiva -- lymphoid follicles and inflammatory infiltration -- eyelid scarring --- trichiasis and entropion -- corneal abrasion -- scarring -- blindness

In regards to Inclusion Conjunctivitis, describe the following: A: Unilateral or bilateral? B: List 4 symptoms C: Describe the pathology found (3)

A: usually unilateral B: scanty mucopurulent discharge, epithelial keratitis, red eyes, small bumps on inside of lower eyelid C: marginal and central infiltrates, potential scarring of cornea + growth of new blood vessels

How would you describe seeing small bumps on the inside of the lower eyelid in someone with conjunctivitis?

Follicular conjunctivitis

In regards to Inclusion Conjunctivitis, describe the following: A: List the pathogen that causes it (1) B: List the sources of this pathogen (1 but sort of 4)

A: C. trachomatis serovars D-K B: exposure to infected genital secretions - transmitted to the eye via towel, fingers, etc., occasionally spread by water in swimming pools

What is neonatal conjunctivitis? When does it present?

A form of inclusion conjunctivitis that is seen in babies born vaginally to (asymptomatic) infected mothers, usually presenting 5-19 days after birth

What pathogens can cause neonatal conjunctivitis/ophthalmia neonatorum? (2)

- neisseria gonorrhea | - C trachomatis

List 4 symptoms of neonatal conjunctivitis

- swelling of lids - hyperaemia - conjunctival infiltration - discharge

What does neonatal conjunctivitis lead to if left untreated?

blenorrhoea (excess mucus)

In regards to keratitis: A: Describe the condition (1) B: list the pathogens that cause it (8)

A: inflammation of cornea (may or may not be assoc. with infection) B: S. aureus, pneumoniae, P. aeruginosa, Enterobacteriaciae, Moraxella, Fungi, Parasites (acanthamoeba), Viruses (HSV, VSV)

List 5 symptoms of keratitis

- red eye - eye discomfort - sensitivity to light - pain, vision loss and pus if more serious infection - may cause perforation of cornea, endophthalmitis and eye loss

List 3 risk factors for CL-assoc, keratitis

1. wearing CL too long 2. poor disinfection of lenses 3. wearing lenses while swimming

In regards to Orbital cellulitis: A: briefly describe the condition (1) B: List the pathogens that cause it (4) C: Describe how you manage the condition (2)

A: Infection of the soft tissues behind the orbital septum B: S. pneumoniae, aureus, pyogenes, HaemB C: medical/surgical emergency - urgent IV antimicrobial therapy and hospitalization needed

How is orbital cellulitis usually caused? List 4 ways

usually caused by infection of the sinuses (over 90% of cases), insect bites, injuries or dental infections

In regards to Endophthalmitis: A: Describe the condition. What causes it? (2) B: List the pathogens that cause it C: Describe source of these pathogens (4)

A: inflammation of the interior of the eye (inside the globe), typically caused by infection from eye surgery/trauma B: Everything, basically. C: Exogenous: direct inoculation of organism as result of ocular surgery (60% of cases), FBs and/or blunt/penetrating (4-13% of cases), ocular trauma. Endogenous: haemotogenous spread from a different source (e.g. endocarditis)

Describe the management of Endophthalmitis (4)

Acute endophthalmitis is a MEDICAL EMERGENCY. Intravitreal injection of antibiotics needed. Repeated injections used if no response to initial therapy. Systemic antimicrobials used in cases of endogenous endophthalmitis and exogenous fungal endophthalmitis