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Opthalmology > Ophthalmology - Inflammatory eye disorders (all the -itis’) > Flashcards

Ophthalmology - Inflammatory eye disorders (all the -itis’) Flashcards

1
Q

define conjunctivitis.

A
  • Inflammation of conjunctiva (thin layer of tissue that covers inside of eyelids) and sclera.
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2
Q

Pathophysiology of conjunctivitis.

A

bacterial - staph, strep penuamoniae, chlamydia, gonorrhoea. - TAKE SEXUAL HX IS EYE INFECTION

viral - adenoviruses.

allergic - type 1 hypersensitivity reaction.

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3
Q

risk factors for conjunctivitis.

A
  • Contact with infected person/ item.
  • Swimming pool water
  • Young sexually active, < 25 yrs
  • Compromised tear production/ drainage
  • Atopy, PMHx of non-ocular allergic conditions.
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4
Q

Presentation of conjunctivitis (general symp).

A

unilateral or bilateral.

red eye.

inflammation and dilation of blood vessels supplying conjunctiva.

conjunctival chemosis

itchy

  • No pain, photophobia or reduced visual acuity (reduced vision when covered w/ discharge but when wiped acuity should be normal).
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5
Q

What does photophobia on conjunctivitis suggest?

A

Photophobia – suggests corneal involvement (keratoconjunctivitis)

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6
Q

Define conjunctival chemosis.

A

swelling of tissue lining eyelid and surface of eye.

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7
Q

Presentation of bacterial conjunctivitis.

A

o Purulent discharge
o Worse in morning – eye may be stuck together in morning.
o Starts in one eye and spread to other. V. Contagious

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8
Q

Presentation of viral conjunctivitis.

A

o Clear discharge
o Associated w/ symp of viral infection, e.g dry cough, sore throat, blocked nose, tender preauricular lymph nodes.
o More likely unilateral.
o V contagious

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9
Q

presentation of allergic conjunctivitis.

A

o Watery discharge
o V. itchy

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10
Q

Mx of bacterial conjunctivitis.

A

o Self limiting – 7-14 days, lubricating eye drops to relieve symp.
o Abx drops if doesn’t resolve on own – chloramphenicol and fuscidic acid.

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11
Q

Mx of neonatal conjunctivitis.

A

o usually bacterial

Neonatal conjunctivitis (> 1 month) – urgent opthal referral as can be associated w/ gonococcal infection – can cause loss of sight and pneumonia.

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12
Q

Mx of viral conjunctivitis.

A

o Self-limiting therefore Tx aimed at preventing spread.
o Topical/ oral antivirals – acyclovir, ganciclovir (HZV usually requires combination of antivirals and steroids).

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13
Q

Mx of allergic conjunctivitis.

A

o Antihistamines to relieve symp.
o Topical mast cell stabilizers (prevent histamine release, need to be used for several wks to see effect) – if chronic/ seasonal symp.

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14
Q

Define keratitis.

A
  • Inflammation of cornea.
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15
Q

Causes of keratitis.

A
  • Viral infection – HSV-1 = most common, can affect any part of eye but corneal epithelium most common. Recurrent or dormant (lies dormant in trigeminal ganglia).
    o Called herpes keratitis. If spreads to stroma (between ep and endothelium called stomal keratitis – can lead to blindness.
  • Bacterial infection - pseudomonas or staphylococcus
  • Fungal infection - candida or aspergillus
  • Contact lens acute red eye (CLARE)
  • Exposure keratitis - caused by inadequate eyelid coverage (e.g. eyelid ectropion)
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16
Q

RF for keratitis.

A
  • Contact lens – bacterial.
  • Trauma/ eye injury, e.g scratch
  • Chronic corneal diseases, e.g dry eye, surgical trauma.
  • Risks of reactivation of HSV – sunlight (photokeratitis), fever, heat, immunocompromised state etc.
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17
Q

Presentation of keratitis.

A

painful red eye

hypopyon - if bac.

photophobia

foreign body sensation

epiphora

reduced visual acuity (subtle to signif)

vesicles around - viral

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18
Q

Diagnosis of keratitis.

A

fluorescein - dendritic corneal ulcer -> pathognomonic.

  • slit lamp needed to Dx.

corneal swab and scarping - viral PCR

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19
Q

Mx of keratitis

A
  • Ptx w/ red eye and sight threatening – same day opthal referral.
  • Acyclovir (topical or oral) or Ganciclovir eye gel
  • Topical steroids may be used alongside antivirals.
  • Corneal transplant if infection causes corneal scaring.
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20
Q

Complication of keratitis.

A
  • Corneal scaring – leads to blindness.
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21
Q

Define dacryoadenitis.

A
  • Inflammation of one or both lacrimal glands (main or accessory), from which tears are secreted.
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22
Q

cause of dacryoadenitis.

A
  • Viral – EBV (most common), VZV, HSV, CMV, mumps, rhinovirus.
  • Bacteria – staph. Aureus, MRSA, TB.
  • Parasitic or fungal.
  • Others = thyroid eye disease, Sjogren’s syn, lymphoma, sarcoidosis.
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23
Q

RF of dacryoadenitis.

A
  • exposure to an infectious agents.
  • autoimmune disorders.
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24
Q

Presenation fo dacryoadenitis.

A
  • Pain in superolateral orbit
  • Pain w/ eye movement
  • Droopy upper eyelid/ difficulty opening affected eye
  • Red eye
  • Diplopia (occasionally).
  • Regional lymphadenopathy, erythema, fever.
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25
Q

Diagnosis of dacryoadenitis.

A
  • CT orbit – show enlarged affected lacrimal gland.

check for cause:
- viral - PCR swab
- sarcoidosis - CXR
- autoimmune - AutoAb
- recurrent/ persistent despite Tx - MRI orbit

26
Q

Mx of dacryoadenitis

A
  • Bacterial - systemic broad spectrum Abx
  • Abscess drainage where indicated.
  • If idiopathic - corticosteroids.
  • Severe cases – conjunctival biopsy to assess tissue for orbital inflammatory diseases, e.g sarcoidosis.
27
Q

Define darcrocystitsis.

A
  • Acute infection in lacrimal drainage system, e.g nasolacrimal duct.
28
Q

Causes of darcrocystitsis

A
  • bacterial - staph aureus
  • congenital
29
Q

RF for darcrocystitsis

A
  • Women, > 30 yrs
  • Infants shortly after birth
  • Can be congenital blockage of nasolacrimal duct.
  • Trauma to nasolacrimal area.
  • Lacrimal sac tumors
  • Sinusitis, nasal pus collections, SLE
30
Q

Presentation of dacryocystitis.

A

acute

pain

epiphora

pus from punctum

fever

pain, erythema in intermediate region

31
Q

Diagnosis of dacryocystitis.

A
  • crigler massage - collect discharge for MC+S

if visual change, fever or orbital cellulitis - CT orbit

  • Dacryocystography if structural abn
  • fluorescein dye disappearance test
32
Q

What is the fluorescein dye disappearance test?

A

test for dacryocystitis.

place dye on corner of eye – if dye remains in eye/ drained over lower eyelid and down check = obstruction of lacrimal duct.

33
Q

Mx of dacryocystitis.

A
  • Oral Abx (co-amoxiclav) for 7-10 days. Abx eye drops if mild. IV ciprofloxacin if severe.
  • After infection resolved – dacryocystorhinostomy (DCR) –
34
Q

Define uveitis.

A

aka iritis.

can be acute or chronic.

  • Inflammation on ant uvea (incl iris, ciliary bodies and choroid).
35
Q

Causes of uveitis.

A

autoimmune, due to infection, trauma, ischemic or malignancy

36
Q

RF for uveitis?

A
  • Acute ant uveitis associated w/ HLA B27 conditions, e.g IBD, reactive arthirits, ankylosing spondylitis.
  • Chronic – sarcoidosis, syphilis, TB, HSV, lyme disease.
  • 20-50 yrs
37
Q

Presenation of uveitis.

A

chronic - granulomas (more macrophages), less severe and long duration.

unilateral

Cillary flush

reduced visual acuity

floaters and flshaes

miosis

photophobia

lacrimation

  • Abnormally shaped pupil

hypopyon - yellowish

  • headache
  • keratic precipitates
  • ant chamber flare
38
Q

What are keratic precipitates?

A

visible as small white spots on the posterior side of the cornea, which are collections of inflammatory cells

seen in uveitis

39
Q

define ant chamber flare

A

cloudiness of the aqueous humour due to inflammatory proteins

seen in uveitis.

40
Q

Diagnosis of uveitis.

A

shine light in good eye - pain in other

talbots test

slit lamp - hypopyon and white precipitates

41
Q

Mx of uveitis?

A
  • Steroids.
  • Immunosuppressants, e.g DMARDs and TNF inhibitors.
  • Cycloplegic-mydriatic meds e.g cyclopentolate or atropine eye drops.
    laser therapy if severe
42
Q

How do Cycloplegic-mydriatic drugs work?

A
  • Cycloplegic means paralysing the ciliary muscles. Mydriatic means dilating the pupils.

antimuscarinic - block iris sphincter muscles and ciliary body - dilate the pupil and reduce pain caused by cillary spasm.

43
Q

Define episcleritis.

A
  • Inflammation of episcleral (outermost layer of sclera, just underneath the conjunctiva).
44
Q

RF for episcleritis.

A

young middle age adults

associated w/inflammatory diseases, e.g RA, IBD

45
Q

Presentation of episcleritis

A

no pain (or mild)

segmental redness in lateral sclera.

foregin body sensation

dilated episclera vessels

WATERY EYE, NO DISCHARGE

46
Q

Presentation of episcleritis

A

no pain (or mild)

segmental redness in lateral sclera.

foregin body sensation

dilated episclera vessels

WATERY EYE, NO DISCHARGE

47
Q

Mx of episcleritis

A
  • Self limiting, resolves in 1-4 wks,
  • if mild symp no Tx needed – lubricating eye drops to improve symp, analgesia, cold compression.
  • Severe – systemic NSAID
48
Q

define scleritis.

A
  • Inflammation of sclera.
  • More serious than episcleritis.
49
Q

RF for scleritis

A

systemic diseases - IBD, sarcoidosis etc

50
Q

Presentation of scleritis

A

50% bilateral

severe pain, worse at night, pain w/ eye movement.

photophobia

watery eye

reduced visual acuity

  • Abn pupil reaction to light.
51
Q

Presentation of necrotising scleritis

A

eye may have blue colour – BECAUSE scleral thinning allow blue choroid to be seen. In some cases eye may appear white due to vascular occlusion.

visual impairment but no pain – can lead to perforation of sclera.

52
Q

in clinical practice how can you diffn between scleritis and episcleritis (test)?

A

touch eye w/ cotton wool.

episcleral vessels branch out when touched.
scleral vessels don’t

53
Q

Diagnosis of scleritis.

A

ix for systemic disease associated with it.

urine dip

FBC, CRP, U+E, LF

autoimmune Abs

54
Q

Mx of scleritis

A
  • Red eye and potential sight threatening – same day opthal referral.
  • NSAIDs (fluriprofen) – if mild.
  • steroids (either daily oral prednisolone or pulsed IV methylprednisolone) – if severe/ necrotising.
  • Immunosuppression for underlying cause, e.g methotrexate for RA.
55
Q

Define optic neuritis

A
  • Inflammation of optic nerve (CN II).
56
Q

Causes of optic neuritis

A
  • Infectious causes – TB, syphilis, lyme disease MMR, HSV etc (viral cause in children)
  • nutritious ON - VB12 def

drugs - amiodarone, ethambutol, isoniazid.

  • inherited.
  • autoimmune
  • post vaccine or post infection
57
Q

RF for optic neuritis

A

women (adults)

high altitude

58
Q

Presentation of optic neuritis

A

o Visual loss (temp in one eye).
o Periocular pain (and pain w/ eye movement).
o Dyschromatopsia

59
Q

Define dyschromatopsia

A

type of colour-blindness where 2/3 primary colours cannot be distinguished.

60
Q

Diagnosis of Optic neuritis.

A
  • Fundoscopy show pale optic disc.
  • MRI brain - MS.
  • Bloods for autoaAB and syphilis serology.
  • CXR for suspected tB, sarcoidosis, malignancy,
61
Q

Mx of optic neuritis.

A
  • IV methyprednisolne (oral prednisolone contrai due to risk of 2nd ep).

Opthalmology (6 decks)

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