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Ophthalmology > Microbiology in Ophthalmology > Flashcards

Microbiology in Ophthalmology Flashcards

1
Q

What causes bacterial conjunctivitis in under 2’s?

A

Staph Aureus
Neisseria gonorrhoea
Chlamydia thrachomatis

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2
Q

What causes bacterial conjunctivitis in adults?

A

Staph aureus
Strep pneumonia
Haemophilus influenze

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3
Q

Describe the treatment of bacterial conjunctivitis

A

Swab- so you know what to do if it doesn’t respond to antibiotics

Topical antibiotics; chloramphenicol

  • ointment=thick and unpleasant
  • drops=kept in fridge
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4
Q

What should you be wary about regarding chloramphenicol?

A

Avoid if aplastic anaemia

Allergy- if patient describes worsening symptoms

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5
Q

Describe adenovirus conjunctivitis

A

Fairly common- ‘pink eye’

Most of the time- red watery eye

Self-limiting

Contagious

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6
Q

Describe herpes simplex conjunctivitis

A

Found in patients if they have vesicles around the eye

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7
Q

Describe herpes zoster conjunctivitis

A

Virus goes to nerve ganglion to dwell in it; trigeminal=infection

Unpleasant, needs treated quickly

Cellulitis changes, some conjunctivitis, fewer keratitis

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8
Q

What is keratitis?

A

Further back in the eye and less common than conjunctivitis

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9
Q

Describe the history of chlamydial conjunctivitis?

A

Often chronic history

Unresponsive to treatments

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10
Q

When should you suspect chlamydial conjunctivitis?

A

Bilateral conjunctivitis in young adults

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11
Q

What are the other features of chlamydial conjunctivitis?

A

urethritis, vaginitis

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12
Q

What features of the eyes suggest chlamydial conjunctivitis?

A

Follicular change, this can cause scarring

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13
Q

What is a hypopyon?

A

white cells in the cornea causing white deposit

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14
Q

How is bacterial keratitis with hypopyon treated?

A

Admission for hourly drops and daily review

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15
Q

How serious is bacterial keratitis with hypopyon?

A

Serious, sight threatening

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16
Q

What is bacterial keratitis with hypopyon associated with?

A

Co-morbid condition; rheumatoid, contact lenses

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17
Q

Which viruses cause keratitis?

A

Herpes

Adenovirus

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18
Q

Describe the symptoms in herpetic keratitis

A

Pain

Can’t open eye, no history of trauma

Reduced corneal sensation

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19
Q

How should herpetic keratitis be treated?

A

Anaesthetic drops and antiviral

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20
Q

How should herpetic keratitis NOT be treated?

A

Steroids- cause a corneal melt and perforation

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21
Q

Describe the symptoms in keratitis caused by adenovirus

A

Poor vision
Conjunctivitis too
Contagious
follows a URTI

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22
Q

How is keratitis caused by adenovirus treated?

A

With topical antibiotics to prevent secondary infection - topical stewards if chronic

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23
Q

What does a dendritic ulcer look like and when is it seen?

A

Branching tree

Herpetic viral keratitis

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24
Q

When is fungal keratitis seen?

A

Very rare

Contact lenses

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25
Q

What is acanthamoeba?

A

Lives in contact lenses that have been washed in tap water

Painful and difficult to resolve

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26
Q

What should you do if you suspect a contact lens is the cause of infection?

A

Send for culture

27
Q

What other fungi cause fungal keratitis?

A

Pseudomonas aeruginosa

28
Q

What is fungal keratitis with hypopyon?

A

Trauma associated with a piece of vegetation

Grumbles on and patient pays little attention

29
Q

How does the onset of fungal and microbial keratitis vary?

A

Fungal keratitis is much more indolent

Usually a trauma from vegetation in fungal

30
Q

What can be seen in orbital cellulitis?

A

Proptosis- caused by pus in orbit

31
Q

What is orbital cellulitis associated with?

A

Paranasal sinusitis; sinus infection goes through the bone of the orbit and spreads

32
Q

How will a patient with orbital cellulitis present?

A

Pain on eye movement
Pyrexial
Extension from focal orbital infection to mebomian/lacrimal gland
Post-op

33
Q

How should orbital cellulitis be investigated?

A

CT scan to identify orbital abscess

34
Q

How to differentiate between preseptal and orbital cellulitis?

A
  • pre-septal just in the outer surface of the skin, there is not an affect on the function of the eye
  • bear in mind the child will be sore and not move the eye; this doesn’t mean they can’t
35
Q

Which organisms cause orbital cellulitis?

A 
Staphylococci
Streptococci 
Coliform
Haemophilus influenzae
Anaerobes
36
Q

How should orbital cellulitis be managed?

A

If suggestion of restriction of muscles or optic nerve (loss of colour, follow a finger) then broad spectrum AB and monitor

Drainage of abscess

37
Q

What is endopthalmitis

A

Devastating infection inside the eye

Post-surgical or endogenous

38
Q

How will a patient with endopthalmitis present?

A

Painful +++
Decreasing vision
Very red eye

39
Q

What is the risk with endopthalmitis

A

Can extend into cranial cavity

40
Q

Which organisms are responsible for endopthalmitis?

A

Conjunctival organisms

Staph epidermidis

41
Q

How is endopthalmitis treated?

A

Intravitreal amikacin/ceftazidime/vancomycin and topical antibiotics

Potential systemic antibiotics

42
Q

What is chorioretinitis?

A

Inflammation of the choroid and retina

43
Q

What can cause chorioretinitis?

A

CMV in AIDS
Toxoplasma gondii
Toxocara canis (worm)

44
Q

What will be observes in chorioretinitis in patients with CMV in AIDS?

A

Low CD4+ Count

Huge areas of exudation and haemorrhage; these patients will go blind

45
Q

What will be observes in chorioretinitis in patients with toxoplasma gondii?

A

Mild flu-like illness

46
Q

Where is toxoplasma gondii acquired?

A

Cats and raw meat

47
Q

How is toxoplasma gondii acquired?

A

In immunocompromised patients it enters latent phase and causes cyst formation

48
Q

How is toxoplasma gondii treated?

A

Can be macular- no treatment

Systemic treatment if sight threatening

49
Q

What is toxocara canis?

A

Parasitic nematode

Affecting cats/dogs

50
Q

Why is toxocara canis self-limiting?

A

Cannot replicate in humans, remains immature larvae

51
Q

What does toxocara canis cause?

A

Formation of granulomas which can cause irreversible visual loss

52
Q

How should eye infections be diagnosed?

A

Swab for culture
-bacterial, chlamydial, viral (USE ANAESTHETIC)

Corneal scape in bacterial keratitis

Aqueous/vitreous culture in endopthalmitis

Microscopy/culture for acanthomoeba

Serology for toxoplasma and toxocara

53
Q

How does chloramphenicol work?

A

Inhibits peptidyl transferase enzyme (stops bacterial protein being made)

54
Q

What is chloramphenicol bactericidal against?

A

Strep and haemophilus

55
Q

What is grey baby syndrome?

A

Baby overdose of chloramphenicol

56
Q

Which antibiotics inhibit cell wall synthesis?

A

Penicillins and cephalosporins due to B lactam ring

57
Q

What are penicillin and cephalosporins active against?

A

Staph

58
Q

Which antibiotics inhibit nucleic acid synthesis?

A

Quinolones e.g. oflaxacin (inhibit DNA gyrase)

59
Q

What is a common contaminant in eye drop bottles?

A

Pseudomonas

60
Q

How does aciclovir work?

A

Inhibits viral DNA synthesis

61
Q

When are antivirals used?

A

Dendritic ulcers of the cornea

62
Q

How is chlamydial conjunctivitis treated?

A

Topical oxytetracycline

May also need azithromycin if other manifestations

63
Q

How should bacterial keratitis be treated?

A

A 4-quinolone
-ofloxacin
Treats most gram -ve including coliform, pseudomonas and influence but NOT step pneumoniae

Gentamicin and cefuroxime
-treats gram +ve and gram -ve

Ophthalmology (15 decks)

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