Ocular infections and inflammation Flashcards
What is preseptal (periorbital) cellulitis, and what is the general treatment?
- Infection of the eyelid and periocular tissues that is anterior to the orbital septum
- PO abx and f/u
What is the treatment for postseptal (orbital) cellulitis?
Admit with IV abx and consult
What is endophthalmitis?
Infection of the globe
What is the only test that definitively distinguishes between periorbital and orbital cellulitis?
head CT
What is the ddx for preseptal and postseptal cellulitis? (8)
- Preseptal/postseptalcellulitis
- Subperiosteal/orbital
- Cavernous sinus thrombosis
- Dacryoadenitis/Dacryocystitis
- Hordoleum
- Bacterial/viral conjunctivitis
- Contact dermatitis
- Herpes zoster/Herpes simplex
What sort of infection is preseptal cellulitis usually associated with?
URI
What is epiphora?
Excessive tearing
What is the most common precipitating illness leading to postseptal cellulitis?
Sinusitis
What are the s/sx that are present in orbital cellulitis, that are not usually found with preseptal cellulitis?
- Pain on EOMs
- Decreased visual acuity
- Chemosis
- Proptosis
- Abnormal pupillary response
Orbital cellulitis + CN palsy = ?
Cavernous sinus thrombosis
What is the treatment for emergently increased IOP in a patient with orbital cellulitis?
Lateral canthotomy
What is a stye (external hordeolum)? What does it look like?
- Acute bacterial infection of the sebaceous glands along the eyelid
- Appears as a pustule along the eyelid margi
What is an internal hordeolum?
Acute bacterial infection of the meibomian gland
What is the difference between a style (external hordeolum) and an internal hordeolum?
Internal occurs on the inner surface of the tarsal plate
What are the s/sx of a hordeolum?
pain
Edema
Erythema
What is the treatment for a hordeolum?
Erythromycin abx and warm compresses for 7-10 days.
What is a chalazion?
Acute/chronic inflammation of a Zeis oil gland in the tarsal plate
What is blepharitis?
Inflammation of the eyelash follicles along the edge of the eyelash 2/2 bacterial infx
What are the s/sx of blepharitis? When are symptoms usually their worst?
Burning sensation
photophobia
Blurred vision
Conjunctival injection
Worst in the mornings
What is the treatment for blepharitis?
Daily cleansing of eyelash edges
What are the two major diagnoses that need to be distinguished from viral conjunctivitis?
Herpes
serious bacterial infx
What is keratoconjunctivitis?
Conjunctivitis that includes corneal involvement
What is chemosis?
Edema of the conjunctiva
What is the abx of choice for treating conjunctivitis in contact lens wearers?
Fluoroquinolone
What is epidemic keratoconjunctivitis?
Severe adenovirus that usually causes epidemics. More severe s/sx, with associated URI s/sx
Viral conjunctivitis is usually preceded by what sort of infection?
URI
True or false: follicles in the inferior fornix are common in viral conjunctivitis
True
What will fluorescein staining reveal with epidemic keratoconjunctivitis?
Punctate staining
What is the treatment for viral conjunctivitis?
Symptomatic, with nasal decongestants and warm compresses
How long can viral conjunctivitis last for?
1-3 weeks
When should you consult an ophthalmologist regarding the use of ocular steroids?
Always
Does herpetic conjunctivitis tend to be unilateral or bilateral?
Unilateral
Which cause of conjunctivitis usually has palpable LAD?
herpetic
What is the general treatment for herpes conjunctivitis?
Oral antivirals and topical antivirals
What is herpes zoster ophthalmicus?
Shingles affecting the V1 (rarely V2, V3) distribution, and eventually the eye
What is the treatment for herpes zoster ophthalmicus?
Admission and IV antivirals
What causes a corneal ulcer?
breaks in the epithelial barrier allows infection of the underlying corneal stroma
What is dacryocystitis?
Infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of the lacrimal sac
What are the common causes of a corneal ulcer? (4)
Contact lenses
Trauma/surgery
Herpes
Bells palsy
What are the s/sx of uveitis?
- Irregular pupil
- Scleral injection
- Blurred vision
- HA
- Floaters
What is synechia?
When iris adheres to the cornea, usually from trauma, iritis, or inflammation.
What condition can synechia lead to?
Closed angle gluacoma
What is the treatment for synechia?
Mydriatics/cycloplegic agents, to keep synechia from forming
Why should you never patch an eye to treat a corneal ulcer?
Increases risk of Pseudomonas infection, which can cause rapid, aggressive ulceration with corneal melting and perforation
What is the presentation of ultraviolet keratitis?
Slow onset of FB sensation and photophobia after UV exposure, progressing to severe pain
What will slit lamp exam show with UV keratitis? Wood’s lamp?
Diffuse punctate corneal edema and corneal abrasions
What is the treatment and prognosis of UV keratitis?
- Pain control with topical cycloplegics/oral analgesic
- Healing occurs in 24-36 hours
What causes the photophobia with uveitis?
Ciliary muscle spasm irritates CN V
What can be seen on slit lamp exam with uveitis?
Flare and cells
True or false: discharge is common with uveitis?
False
What is the classic PE finding of iritis?
Consensual photophobia
What is the most common cause of endophthalmitis?
Trauma or surgery to the globe
What are the symptoms of endophthalmitis?
- HA
- Eye pain
- Photophobia
- Vision loss
What are the signs of endophthalmitis?
- Erythema and edema of lids
- Conjunctival and scleral injection
- Chemosis
- Hypopyon
What is the treatment for endophthalmitis?
- Call ophtho
- Intravitreal abx and steroids
- Admit
What is the most common cause of vitreous hemorrhage?
Diabetic retinopathy
What are the symptoms of vitreous detachment/hemorrhage?
Sudden painless vision loss and sudden appearance of cobwebs or black spots
