random dobies info

Question 1

when do you not use steroids alone

Answer 1

epithelial herpes simplex keratitis (no exceptions), active bacterial or fungal infection, large corneal epithelial defects, when you are unsure of diagnosis

Question 2

what does phlyctenular keratoconjunctivities result from

Answer 2

TB, GI parasites or Type IV reaction to staphylococcal antigens. thus, must treat agressively!

Question 3

if the condition is mild, how do you treat phlyctenular keratoconjunctivities?

Answer 3

OTC vasoconstrictors

Question 4

signs of marginal corneal infiltrates

Answer 4

lid disease, collarettes, madarosis, trichiasis, plugged meibomian gland, clear zone between infiltrate and limbus, 4 to 8 arc where lids cross limbus

Question 5

what would you give pt to decrease risk of corneal breakdown due to poor tear film

Answer 5

artificial tears (do this for pt with marginal corneal infiltrates)

Question 6

when treating marginal corneal infiltrates what should you remember for treatment?

Answer 6

don’t use steroid more frequently than the antibiotic

Question 7

symptoms to look for in bacterial keratitis

Answer 7

R red eye
S sensitive to light
V vision change
P pain

Question 8

abnormal signs in bacterial keratitis

Answer 8

AC cells and flare (hypopyon)

focal stromal infiltration surrounding excavation

Question 9

what would you use to treat secondary iritis

Answer 9

cycloplegia, DO NOT USE steroids!

Question 10

name an antibiotic-steroid drug and what it is used for

Answer 10

TobraDex or TobraDex ST; used for cases when you shouldn’t use steroids alone

Question 11

exceptions to steroid guidelines- using antibiotic + steroid (combo or separate)

Answer 11

epithelial Herpes Simplex Keratitis (NO EXCEPTIONS)

bacterial infections if significant concurrent secondary inflammation peresent

Question 12

what do steroids do?

Answer 12

speed the healing and reduce corneal scarring by decreasing inflammatory response

Question 13

for steroids to be useful they must be used while….

Answer 13

ulcer bed is open

Question 14

signs of ulcer getting better

Answer 14

infiltrate shrinks, epithelium fills in, pt feels better (decrease RSVP), any AC reaction cell and flare is reduced); this is when you taper off drops

Question 15

primary herpes simplex

Answer 15

aquired from enviornment. treat with warm saline soaks, drying agents (Burow’s solution), and no steroids

Question 16

for primary herpes simplex, take NO action with antivirals when

Answer 16

pt has conjunctivitis only without keratitis

Question 17

herpes simplex keratitis primary symptoms and abnormal signs

Answer 17

RSVP, decreased corneal sensation, dendritiform/dendritic, conjunctivitis, chemosis, +RB stain at edges, central +NaFl pooling

Question 18

ghost dendrites

Answer 18

seen in HSK. Term given to SEIs which have similar shape to that of epithelial lesions. SEIs develop beneath epithelial dendrites. Pt may have decreased sensitization where the ghost dendrites are located

Question 19

treatment for HSK

Answer 19

acyclovir and other PO antivirals, topical ophthalmic trifluridine or ganciclovir, or observation alone `

Question 20

treatment for mild keratitis SPK only

Answer 20

without dendrites use Viroptic QID, Zirgan TID as prophylactic agent. can use vasoconstrictors, lubricants, cool compresses. NO STEROIDS

Question 21

treatment for HSK dendritic keratitis

Answer 21

Zirgan: 1gtt 5x/day until decrease in RB staining and re-epithelialization occurs, then 1gtt 3x/day for 7 days longer consider the dose change!
Viroptic: 9gtt/day for 3-4 days; start taper slowly with decreased RB staining and start of re-epithelialization in 5-6 days. continue taper QID 3 days, TID 3 days, BID 3 days

Question 22

when using Zirgan for therapy…

Answer 22

pt should not wear contact lenses

Question 23

HSV interstitial keratitis

Answer 23

syndrome of three corneal findings: stromal infiltration, thinning, neovascularization associated with recurring HSK (sign is most often associated with systemic syphilis)

Question 24

recurrent Herpes Simplex Keratitis

Answer 24

can damage the epithelial BM and anterior stroma. pt may develop a post infectious keratopathy known as a trophic, indolent or metaherpetic ulcer

Question 25

treatment plans for recurrent HSK

Answer 25

gangciclovir (Zirgan gel)
trifluridine (Viroptic sol)
vidarabine (Vira-A ung): continued 5-7 days after complete resolution
idoxuridine (Herplex sol, Stoxil ung): continued 5-7 days after complete resolution –> most toxic, least effective
oral acyclovir 400mg BIDx12 months

Question 26

for HSK stroma scarring when are steroids ok?

Answer 26

stromal scarring, edema (make sure to pre-sterilize before)

if iritis presents with keratic percipitates

Question 27

HSK interstitial keratitis ok to use steroids if

Answer 27

iritis is progressing in severity or visual axis is threatened AND steroids have been previously used

Question 28

HSK trophic ulcers treatment

Answer 28

occurs from damaged BM and poor healing. protect cornea from lid abrasion with bandage soft lens. broad spectrum antibiotic drops BID while lens is in place, artificial tears QID

Question 29

Chickenpox/Herpes zoster virus symptoms

Answer 29

fever, malaise, severely itchy skin rash

Question 30

related symptoms/signs for herpes zoster virus

Answer 30

generalized nondermatomal distribution, infection by human herpesvirus 3, highly contagious and generally a childhood disease, distinguish primary varicella

Question 31

Reye’s syndrome and aspirin

Answer 31

rare and severe complication of flu and other viral diseases. 30% fatality rate. thus not recommended for chicken pox

Question 32

distinction between varicella zoster (shingles) and herpes simplex disease

Answer 32

varicella zoster virus infection is the prime target disease of antivirals. simplex requires less antiviral to achieve virucidal levels