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Opthalmology > Ocular Infections > Flashcards

Ocular Infections Flashcards

1
Q

what are the causes of bacterial conjunctivitis?

A

Adults – Staph Aureus, Strep Pneumoniae, Haemophilus influenzae
Neonates – staph aureus, Neisseria gonorrhoea, chlamydia trachomatitis

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2
Q

what are the causes of viral conjunctitis?

A

Adenovirus
Herpes Simplex
Herpes Zoster

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3
Q

what is the cause of chlamydia conjunctivits?

A

chlamydia (coming out of womb)

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4
Q

what are the clinical features of bacterial conjunctivitis?

A 
Mucopurulent discharge
Sticky eyelashes/eyelids matted
Gritty 
NOT periauricular enlargement
Eyelid oedema
Conjunctival redness
One eye then next
Skin around eye affected
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5
Q

what are the clinical features of viral conjunctivitis?

A 
Watery discharge 
Often bilateral 
Enlarged follicular bumps
Some papillary conjunctival reaction
Gritty/burning
Enlarged periauricular
Fine diffuse pinkness
Adenovirus – follows cold
Herpes – vesicles
Blood vessels arise near base of elevated vessels
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6
Q

what are the clinical features of chlamydia conjunctivitis?

A 
Often chronic history
Unresponsive
Suspect in bilateral young adults
\+/- urethritis vaginitis
Contact tracing 
Subtarsal scarring
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7
Q

how is vision affected in conjunctivitis?

A

normal or very mildly reduced – acuity will always improve with pinhole

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8
Q

how is conjunctivitis diagnosed?

A

swab

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9
Q

how is bacterial conjunctivitis managed?

A

Topical antibiotics
Chloramphenicol (treats most)
Fusidic Acid (staph aureus)
Gentamicin

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10
Q

how is viral conjunctivitis managed?

A

Supportive – cool compress and lubricants

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11
Q

how is chlamydia conjunctivitis managed?

A

Oxytetracycline

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12
Q

how is chloramphenicol?

A

antibiotic eye ointment

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13
Q

what is the action of chloramphenicol?

A

o Inhibits peptidyl transferase – inhibit protein synthase

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14
Q

what are the side effects of chloramphenicol?

A

allergy, anaemia, grey baby syndrome

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15
Q

what is the management of seasonal allergy conjunctivitis?

A

antazoline (anti histamine)

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16
Q

what is the physiology of seasonal allergy conjunctivitis?

A

acute IgE-mediated reaction to airborne allergens which interact with IgE primed conjunctival mast cells. Leads to mast cell degranulation with the release of preformed histamine, responsible for the acute phase response.

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17
Q

what is keratoconjunctivitis sicca?

A

tear film abnormalities and/or ocular surface inflammation

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18
Q

what is the management of keratoconjunctivitis sicca?

A

topical lubricants

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19
Q

what are the causes of bacterial keratitis?

A 
Streptococcus
Pseudomonas
Enterobacteriaceae
Staphylococcus
Risks: contact lenses, trauma, steroids
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20
Q

what are the causes of herpetic keratitis?

A

Herpes Simplex Type 1

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21
Q

what are the causes of adenovirus keratitis?

A

Usually follows URTI

Most commonly adenovirus serotype 8, 19, 37

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22
Q

what are the causes of fungal keratitis?

A

Aspergillus falvus
Aspergillus fumigates
Fusarium
Candida

23
Q

what is the pathophysiology of bacterial keratitis?

A

Corneal inflammation
Diffusion of inflame cells into AC settles as Hypopyon
Bacterial toxins and enzyme destroy cornea = CORNEAL ULCER

24
Q

what is the pathophysiology of herpetic keratitis?

A

After initial infection virus spreads from epithelial cells to sensory nerve endings to cell body of CNV
ganglion
Formation of DENDRITIC ulcer

25
Q

what is the pathophysiology of adenovirus keratitis?

A

Highly contagious – eye secretions, air droplets

26
Q

what is the pathophysiology of fungal keratitis?

A

Trauma with vege/organic matter

Grows slowly then proliferates and breaks into anterior chamber

27
Q

what are the clinical features of bacterial keratitis?

A 
Anterior chamber reaction +/- hypopyon
Painful red eye
Visual loss
Corneal inflam
Ciliary injection
Eyelid oedema 
Ulcer = opacity
28
Q

what are the clinical features of herpetic keratitis?

A 
Pain
Photophobia
Blurred vision
Tearing
Redness
Recurrent
Dendritic ulcer -branches/tree
Vesicular lid lesions
Follicular conjunctivitis, preauricular nodes
29
Q

what are the clinical features of adenovirus keratitis?

A

Bilateral
Blurring/photophobia
Subepithelial infiltrates – central ulceration with irregular border + grey dots
Redness of bulbar and palpebral conjunctiva
Preauricular lymphadenopathy
Conjunctivitis if severe

30
Q

what are the clinical features of fungal keratitis?

A 
Conjunctival injection
Epithelial defect
Suppuration
Stromal infiltrate
Redness
Hypopyon
Gray/brown pigmentation
31
Q

what is the management of bacterial keratitis?

A

Eye threatening
Hourly drops of topical steroids
Abx e.g luxacin

32
Q

what is the management of herpetic keratitis?

A

AVOID steroids

Gangcyclovir for ulcer

33
Q

what is the management of adenovirus keratitis?

A

Give topical AB to prevent secondary

Steroids to speed recovery if chronic

34
Q

what are the causes of orbital cellulitis?

A
  • Staphylococci
  • Streptococci
  • Coliforms
  • Haemophilus Influenzae
  • Anaerobic
35
Q

what is the route of infection in orbital cellulitis?

A

o Direct extension from sinus
o Extension from focal orbital infection
o Post-operative

36
Q

what is orbital cellulitis?

A

Infection of the soft tissues of the orbit posterior to the orbital septum

37
Q

what is preorbital cellulitis?

A

Infection of soft tissue of the eyelids + periocular region anterior to the orbital septum

38
Q

what are the clinical features of orbital cellulitis?

A
  • Painful – especially on eye movements – kids will move their heads
  • Proptosis – bulging of the eye
  • Dark red discolouration of the orbit, chemosis, hyperaemia of the conjunctiva
  • Resistance to opening
  • Often associated with paranasal sinus
  • Sight threatening
  • Pyrexial
39
Q

what is the management of orbital cellultitis?

A
  • Need to differentiate between pre-septal and orbital
  • If any suggestions restriction of muscle or optic nerve dysfunction then scan
  • Broad spectrum AB and monitor
  • Sometimes abscess will require drainage
  • CT scan
40
Q

what is endophtalmitis?

A

Extreme form of posterior uveitis

41
Q

what is the cause of endophtalmitis?

A
  • Often conjunctival “commensal”

* Most common staph epidermis – post surgery or penetrating injury

42
Q

what are the clinical features of Endophthalmitis?

A
  • Very red eye
  • Eyelid swelling
  • Vitreous is opacified – infiltration by (PMNs)
  • Injected conjunctiva and sclera
  • Hypopyon, white lesions, cotton wool spots
  • Cells + flare on silt lamp examination
  • Uveitis
43
Q

how is endophthalmitis diagnosed?

A

aqueous/vitreous for culture

44
Q

what is the management of endophthalmitis?

A
  • Intravitreal amikacin/ceftazidime/vancomycin
  • Topical antibiotics
  • EVS
45
Q

what is the pathophysiology of endophthalmitis?

A
  • Blood borne organisms permeate the blood ocular barrier either by direct invasion or by changes in vascular endothelium by substrates released during infection
  • Destruction of intraocular tissues may be due to direct invasion or from inflammatory mediators
46
Q

what is pan ophthalmitis?

A

inflammation of all coats of eye

47
Q

what is the chorioretinitis?

A

inflammation of the choroid

48
Q

what are the causes of chorioretinitis?

A
  • CMV in AIDs
  • Toxoplasma gondii – protoxin infection – cats + raw meat
  • Toxocara canis – parasitic nematode
49
Q

what are the clinical features of toxoplasmosis chorioretinitis?

A 
Mild flu like illness
Enters latent phase with cysts forming
Scarring of sclera
White fluffy thig
Can reactivate
50
Q

what are the clinical features of Toxocara chorioretinitis?

A

Worm cannot replicate – self limiting

Form granulomas

51
Q

what are the general clinical features of Chorioretinitis?

A 
Floating black spots
Blurred vision 
Redness
Excessive tearing
Sensitivity to light
52
Q

how is Chorioretinitis diagnosed?

A

serology

53
Q

how is Chorioretinitis managed?

A

combo of steroids + antibiotics

Opthalmology (15 decks)

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