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BOARDS2: conjuntiva/cornea > Ocualr Pain And Irritation > Flashcards

Ocualr Pain And Irritation Flashcards

1
Q

Things that cause frequent blinking

A

SLK
DED
Filamentary K

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2
Q

Things that cause SLK

A

Thyroid
DED
CL

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3
Q

What does the course of SLK look like

A

Exacerbation and remission

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4
Q

What is SLK

A

Chronic inflammatory reaction associated with thyroid daises, DED, and/or CL wear. Most commonly in females with mean age of 50. Exact etiology unknown. Characterized by episodes of remission and exacerbation that eventually resolve over time

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5
Q

Signs of SLK

A

Bilateral, thickened, red, superior bulbar conjunctiva (most prominent at the limbus) and superior keratitis (SPK or filamentary). Tarsal conj has a velvety appearance secondary to diffuse papillary hypertrophy

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6
Q

Symptoms of SLK

A

Redness
FB sensation
Frequent blinking
Discharge is not common

Symptoms usually worse than signs

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7
Q

Types of adenovirus in eye

A

Acute non specific
PCF
EKC

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8
Q

Acute nonspecific adenovirus

A

Most common
Rare corneal involvement
Diffuse red eye, conj follicles in inferior fornices, tearing, chemosis, and mild discomfort.

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9
Q

PCF

A 
Kids
Swimming pool
Low grade fever, sore throat 
Follicular conjunctivitis + low grade fever + sore throat 
Corneal involvement uncommon
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10
Q

EKC

A

Serotypes 8, 19, 37
Pain and corneal involvement at day 8
8 days later (day 16)-SEI/SPK, no longer contagious at this point
Preauricular lymphadenopathy
Possible pseudomembrane (remove, anesthetize, pull with jewelers)

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11
Q

Simple bacterial conjunctivitis

A 
Children 
Acute onset 
Variable discharge
Eyelids stuck together upon awakening 
Redness, burning, and FB sensation
No PA or corneal involvement
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12
Q

Most common causes of bacterial conjunctivitis

A

Gram + (70% of cases)
Staph epi/aureus

Remaining cases typically from gram - rods including moraxella catarrhalis and H flu

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13
Q

Most common causative agents of bacterial conjunctivitis in kids

A

Strep pneumonia

H flu

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14
Q

Gonococcal conjunctivitis

A 
Hyperacute 
Severe purulent discharge 
Conjunctival chemosis 
Pseudomembrane 
Papillary reaction
Marked PA

Can invade and intact corneal epithelium

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15
Q

What is the only bacterial conjunctivitis that commonly presents with preauricular lymphadenopathy and pseudomembranes

A

N gonorrhea

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16
Q

Appearance of adult inclusion conjunctivitis

A 
Acute conjunctivitis 
Unilateral giant follicles most concentrated in inferior fornices
PA lymphadenopathy may be present 
Eyelids matted shut
Minimal mucopurulent discharge
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17
Q

Adult inclusion conjunctivitis

A

Chlamydia (D-K)
Direct inoculation
Ocualr probs 5-14 days after inoculation
Usually have active urogenital infection

18
Q

Symptoms of AIC

A

Chronic red eye that started several weeks to months prior

Can persist for 3-12 months if left untreated and eventually becomes bilateral

19
Q

Corneal involvement in AIC

A

30-85% of patients and includes punctate keratitis, pannus and SEI (more peripheral in location compared to EKC)

20
Q

Trachoma

A

Caused by chlamydia (A-C)
Most common preventable infectious blindness worldwide
Poor hygiene communities
Transmitted via direct contact of secretions but also through the common fly, fomites, or shared cosmetics
Most common in kids aged 1-5

21
Q

Appearance of trachoma

A

Presents in early childhood with a mixed and often bialtera, follicular and papillary conjunctivitis of the superior tarsal conjunctiva
Mucopurulent discharge, PAL, and superior pannus

Progression through early adulthood resutls in Arlt lines (superior scarring), and herberts pits (depressions at the limbus). Progressive scarring of the tarsal conjunctiva leads to distortion of the eyelids and subsequent corneal ulceration due to trichiasis

22
Q

What percent of cases of SLK are due to thyroid

A

50%

23
Q

What tests should you order in someone with SLK

A

T3, T4, TSH

24
Q

Most common etiologic agent for simple bacterial conjunctivitis

A

Staph aureus

25
Q

A histroy of what is common in someone with adenovirus

A

URTI

26
Q

What does SLK NOT respond to

A

Steroids

27
Q

Treatment for mild SLK

A

Heavy lubrication

  • AT 4-8x/day
  • ung qhs
  • punctal occlusion of LL
28
Q

Treatment for mod-severe SLK

A

Silver nitrate 0.5-1.0% with CTA 10-20s

  • irrigate
  • Rx topical abx qhs x 1 week

Surgery/cautery if 2-3 tries of silver nitrate doesnt work

Acetylcysteine 10% 3-5x/day for filaments

29
Q

Treatment of mild adenovirus

A

Cool compresses

Cool AT

30
Q

Treatment of severe adenovirus with SEIs

A

Mild topical steroids
-lotEmax QID 1-2 weeks, taper

5% betadine
-not needed if they have SEI

31
Q

Treatment of simple bacterial conjunctivitis

A

Adult
-FQ, polytrim, tobramycin QID 5-7x/day

Kid

  • polytrim, polysporin QID x 7 days
  • ointment is good because they could cry out the drops
32
Q

What medications should be avoided in similar bacterial conjunctivitis with SPK

A

Topical aminoglycosides bc of corneal toxicity

33
Q

Treatment for gonococcal conjunctivitis without corneal involvement

A

Abx drops q2hrs

Systemic ceftriaxone 1g IM

34
Q

Treatment of gonococcal conjunctivitis if there is corneal involvement

A

Abx drops q1hr

Ceftriaxone 1g IV every 12-24 hours for 3-5 days

35
Q

What should everyone with gonococcal conjunctivitis be evaluated for

A

Chlamydia

36
Q

Treatment for AIC

A

Oral azithromycin 1000mg as four 250mg capsules or two 500mg
Oral doxy 100mg BID 7-10 days
Erythromycin 500mg QID x 7 days or
Augmentin 500mg TIDx 7 days if pregnant

Eval sexual partners
PFAT q2-4h

37
Q

Treatment for trachoma

A

SAFE

  • surgery for trichiasis
  • systemic abx (Azithromycin/doxy)
  • facial/environmental hygiene
38
Q

Most common infectious cause of neonatal conjunctivitis

A

Chlamydia

AKA ophthalmia neonatorum

39
Q

What is given to babies when they are born as prophylaxis against ophthalmia neonatorum

A

Topical ophthalmic erythromycin ointment

40
Q

Tetracyclines and kids

A

Contraindicated in kids under 7, pregnant women, and breastfeeding women

41
Q

What conditions typically have worse symptoms than signs

A

SLK and acanthamoeba

42
Q

What has severe signs but not symptoms

A

Neurotrophic keratitis

BOARDS2: conjuntiva/cornea (7 decks)

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