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HEENT > Red Eye - Exam 3 > Flashcards

Red Eye - Exam 3 Flashcards

1
Q

**_____ COPIOUS PURULENT DISCHARGE ; eyes can be “stuck shut” in the morning. can be ___ or ____. How is it transmitted?

A

CONJUNCTIVITIS

unilateral or bilateral

TRANSMITTED VIA DIRECT CONTACT
FINGERS, TOWELS, HANDKERCHIEFS, CONTAMINATED EYE DROPS

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2
Q

**_____ is the MC cause of conjunctivitis in adults. ____ in children. ____ who wear contacts.

A

Staph Aureus in adults

S Pneu in children

Pseudomonas in those who wear contacts

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3
Q

What is the treatment of choice for conjunctivitis in NONcontact lense wearers? For severe infection/contact lens use ______

A

erythromycin ophthalmic ointment or trimethoprim-polymyxin B drops (POLYTRIM)

TOPICAL FLUOROQUINOLONE
VIGAMOX OR MOXEZA (MOXIFLOXACIN)
OFLOXACIN OPHTHALMIC (OCUFLOX / FLOXIN)
CIPROFLOXACIN OPHTHALMIC

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4
Q

gonococcal infections in the eye are treated with _____. Chlamydial infections are treated with _____.

A

ROCEPHIN (CEFTRIAXONE) 1G IM – SINGLE DOSE can add ERYTHROMYCIN OR BACITRACIN

1G AZITHROMYCIN PO – SINGLE DOSE

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5
Q

**____ is the MC infectious cause of blindness (preventable blindness)

A

chlamydial

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6
Q

_____ pulls the eyelid inside out

A

Trachoma

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7
Q

USUALLY BILATERAL
COPIOUS WATERY DISCHARGE
FOREIGN BODY SENSATION
TYPICALLY LASTS 10 DAYS
ASSOCIATED WITH PHARYNGITIS, FEVER, MALAISE, PREAURICULAR ADENOPATHY aka flu like s/s

What am I?
What is the MC?
What is the treatment?

A

viral conjunctivitis

MC: adenovirus

supportive care: cold compress to reduce discomfort
pt education on hygiene

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8
Q

ITCHING
TEARING
REDNESS
STRINGY DISCHARGE
OCCASIONALLY PHOTOPHOBIA AND VISUAL LOSS
COBBLESTONE PAPILLAE NOTED ON EXAM
HYPEREMIA (bloodshot look to eye) AND CHEMOSIS (conjunctiva looks bulgy coming out of eye)

What am I?
**What are the 2 slum dunk characteristics?

A

Allergic conjunctivitis

**stringy discharge and cobblestone papillae

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9
Q

What is the treatment for mild-moderate allergic conjunctivitis? Severe?

A

TOPICAL ANTIHISTAMINES
ALAWAY (KETOTIFEN), PATANOL OR PATADAY (OLOPATADINE)
or
topical NSAIDS: diclofenac, ketorolac

severe: topical corticosteroids: LOTEPREDNOL (Alrex, Lotemax)

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10
Q

When would you NOT want to give steroids on a case of allergic conjunctivitis?

A

NO CORTICOSTEROIDS IF H/O OR SUSPECTED HSV
MAY CAUSE EXACERBATION

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11
Q

What does the uvea consist of?

A

the layer and structures of the eye beneath the sclera.

(1) the iris (and pupil)
(2) the ciliary body (secretes the aqueous humor)
(3) the choroid

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12
Q

the _____ is the layer of blood vessels and CT between the sclera and retina

A

choroid

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13
Q

Uveitis: anterior portion consists of ___ and ____.

The posterior portion consists of _____

A

Anterior portion:
Iris
Ciliary Body

Posterior portion:
Choriod

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14
Q

What are the different types of INTRAOCULAR INFLAMMATION OF THE UVEA? **What is the MC type?

A

ACUTE OR CHRONIC

NON-GRANULOMATOUS VS. GRANULOMATOUS

ANTERIOR OR POSTERIOR

ACUTE NONGRANULOMATOUS ANTERIOR UVEITIS

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15
Q

Describe a non-granulomatous uveitis. What is the predominant cell type?

A

Inflammation with no epithelial or giant cells
PRESENTS ACUTELY
UNILATERAL PAIN
REDNESS
PHOTOPHOBIA
VISUAL LOSS

PMN cells

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16
Q

Describe a granulomatous uveitis. What is the predominant cell type?

A

inflammation noted with histiocytes
INDOLENT
SLOW GROWING
BLURRED VISION
MILDLY INFLAMED EYE
RECURRENT

macrophages

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17
Q

What are some causes of acute NON-GRANULOMATOUS ANTERIOR?

A

ACUTE = PRIMARILY IMMUNOLOGIC aka autoimmune causes

HLA-B27 RELATED CONDITIONS
ANKYLOSING SPONDYLITIS
REACTIVE ARTHRITIS
PSORIASIS
ULCERATIVE COLITIS
CROHN’S DISEASE

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18
Q

What are some causes of chronic NON-GRANULOMATOUS ANTERIOR?

A

JUVENILE IDIOPATHIC ARTHRITIS

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19
Q

What are some causes of GRANULOMATOUS ANTERIOR uveitis?

A

SARCOIDOSIS
TOXOPLASMOSIS
TUBERCULOSIS
HIV
SYPHILIS
“SALT AND PEPPER” FUNDUS
HERPES
OCULAR TRAUMA

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20
Q

**“INFLAMMATORY CELLS AND FLARE” (proteins) WITHIN THE AQUEOUS is classic _____. How do you dx it? What will you see in severe cases?

A

anterior uveitis

slit lamp exam

SEVERE CASES = HYPOPYON
PUS IN THE ANTERIOR CHAMBER

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21
Q

In uveitis, CELLS MAY ALSO BE SEEN ON THE CORNEAL ENDOTHELIUM, what are they known as? in granulomatous you see _____. In non-granulomatous you seen _____

A

KERATIC PRECIPITATES (KPS) aka inflammatory cellular deposits

GRANULOMATOUS = LARGE KPS
IRIS NODULES MAY BE SEEN

NON GRANULOMATOUS = KPS ARE SMALLER
NO IRIS NODULES

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22
Q

in posterior uveitis, INFLAMMATORY LESIONS MAY BE PRESENT IN THE ____ or ____. What will new lesions look like? old lesions?

A

RETINA OR CHOROID

NEW LESIONS:
YELLOW WITH INDISTINCT MARGINS
RETINAL HEMORRHAGES

OLD LESIONS:
DEFINITE MARGINS
COMMONLY PIGMENTED

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23
Q

GRADUAL VISUAL LOSS—-SLOWER IN ONSET
MAY BE DUE TO VITREOUS HAZE AND OPACITIES
CAN PRESENT WITH FLOATERS AS WELL
BILATERAL INVOLVEMENT COMMON

What am I?
What is the cause?

A

posterior uveitis

idiopathic
autoimmune
pars planitis
infectious causes

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24
Q

What is pars planitis?

A

disease of the eye between the iris and choroid

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25
Q

What is the treatment for anterior uveitis?

A

refer to ophthalmology
**topical corticosteroids
dilation of the pupil to relieve discomfort: reduces painful spasms of ciliary muscles

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26
Q

What is the treatment for posterior uveitis?

A

systemic steroids
pupil dilation NOT needed
if infectious, treat with appropriate abx

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27
Q

______ is inflammation of the cornea. What are the different types?

A

keratitis

bacterial
viral
acanthomoeba
fungal

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28
Q

**____ are at the highest risk of developing bacterial keratitis. What is an additional cause? What is the MC pathogens?

A

contact lens wearers (especially those who wear them overnights)

corneal trauma

**PSEUDOMONAS
MORAXELLA
STAPHYLOCOCCI (INCLUDING MRSA)
STREPTOCOCCI

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29
Q

PT WILL COMPLAIN OF FOREIGN BODY SENSATION
TROUBLE KEEPING EYE OPEN
CORNEA APPEARS HAZY WITH ULCER AND ADJACENT STROMAL ABSCESS
HYPOPYON OFTEN PRESENT

What am I?
How do you dx?
What is the treatment?

A

bacterial keratitis

ULCER IS SCRAPED TO RECOVER MATERIAL FOR GRAM STAIN AND CULTURE

refer to ophthalmology
EMPIRICALLY WITH FLUOROQUINOLONES DROPS: OFLOXACIN 0.3%, CIPROFLOXACIN 0.5%, VIGAMOX, MOXEZA
HOURLY (DAY AND NIGHT) FOR THE FIRST 48 HOURS

Then tailor tx based on culture results

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30
Q

What are some causes of viral keratitis? Why is it dangerous?

A

PRIMARY OCULAR HERPES SIMPLEX-> can cause blindness

can cause blindness->TRAVELS TO SENSORY GANGLIA WHERE LATENCY DEVELOPS, VIRUS CAN COLONIZE THE TRIGEMINAL GANGLION

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31
Q

RED EYE
PHOTOPHOBIA
FOREIGN BODY SENSATION
WATERY DISCHARGE
REACTIVATED VIRUS ENTERS CELLS OF CORNEA
PRIMARY INFECTION MAY MANIFEST AS EYELID, CONJUNCTIVAL, AND CORNEAL ULCERATION
DENDRITIC (BRANCHING) CORNEAL ULCER

What am I?
What is the slam dunk s/s? How do you dx it?

A

Herpes simplex keratitis

**DENDRITIC (BRANCHING) CORNEAL ULCER

CORNEAL ULCERS IDENTIFIED WITH FLUORESCEIN STAIN

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32
Q

What is the treatment for HERPES SIMPLEX keratitis?

A

URGENT REFERRAL TO OPHTHALMOLOGIST
TOPICAL AND/OR ORAL ANTIVIRALS: treat until 1 week after lesions heals
ACYCLOVIR 400MG FIVE TIMES DAILY
ACYCLOVIR 3% OINTMENT

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33
Q

MALAISE
FEVER
HEADACHE
PERIORBITAL BURNING AND ITCHING
Rash
hutchinson sign
involves the OPHTHALMIC DIVISION OF THE TRIGEMINAL NERVE

What am I?
What is the tx?

A

HERPES ZOSTER OPHTHALMICUS

urgent referral to ophthalmology
HIGH DOSE ORAL ANTIVIRAL
ACYCLOVIR 800 MG FIVE TIMES A DAY
VALACYCLOVIR 1G TID

34
Q

____ INVOLVEMENT OF THE TIP OF NOSE OR THE LID MARGINS PREDICTS INVOLVEMENT OF THE EYE

A

hutchinson sign

35
Q

WHEN TREATING VIRAL KERATITIS, AVOID PRESCRIBING ____ . Why? What happens if you stop abruptly?

A

CORTICOSTEROIDS

IT CAN WORSEN OR PROLONG VIRAL INFECTION

CAUSE AN ACUTE REBOUND INFLAMMATORY REACTION

36
Q

What are some causes of fungal keratitis?

A

AFTER CORNEAL INJURY WITH PLANT MATERIAL, OR IN AGRICULTURAL SETTING, AS WELL AS TRAUMA TO EYE

37
Q

Name some common pt populations that you might see fungal keratitis?

A

AGRICULTURAL SETTING

UNDERLYING EYE DISEASE/IMMUNOCOMPROMISE

CONTACTS

MULTIPLE STROMAL ABSCESSES

LITTLE EPITHELIAL LOSS: corneal infiltrate feathery edges with “satellite lesions”

38
Q

LITTLE EPITHELIAL LOSS: corneal infiltrate feathery edges with “satellite lesions”. Need to associate with ____. How do you dx? **What is the tx?

A

fungal keratitis

CORNEAL SCRAPING AND CULTURE FOR FUNGI

**NATAMYCIN 5%, AMPHOTERICIN 0.1-0.5%, VORICONAZOLE 1%
TREATMENT MAY LAST FOR 6 MONTHS

39
Q

CAUSED BY SINGLE CELLED ______
FOUND IN RIVERS, LAKES, STREAMS, AIR, SOIL
COOLING SYSTEMS, SEWAGE SYSTEMS
OTHERWISE HEALTHY PEOPLE
CONTACT LENS WEARERS
USUALLY SEVERE PAIN: RARE BUT SERIOUS
swimming, sitting in hot tub, NOT washing hands before changing contacts
RED EYE
TEARING
BLURRED VISION
SENSITIVITY TO LIGHT
can proceed to vision loss

What am I?
Where does it like to invade?
How do you dx?

A

ACANTHAMOEBA KERATITIS

INFILTRATES IN THE CORNEAL STROMA likely invade THROUGH CORNEAL OPENING

DIAGNOSED WITH CULTURE USING SPECIALIZED MEDIA

40
Q

What is the treatment for ACANTHAMOEBA keratitis?

A

TOPICAL BIGUANIDE (POLYHEXAMETHYLENE OR CHLORHEXIDINE) for 6 months to 1 year

41
Q

WELL-CIRCUMSCRIBED AREA OF HEMORRHAGE UNDERNEATH CONJUNCTIVA
NORMAL VISUAL ACUITY
NORMAL PUPIL RESPONSE

What am I?
What is the cause?
What is the treatment?

A

SUBCONJUNCTIVAL HEMORRHAGE

VALSALVA, COUGHING, SNEEZING
SYSTEMIC HTN
ANTICOAGULANT MEDICATIONS

**self limiting: should reabsorb within 2 weeks

42
Q

What is DACRYOADENITIS?

A

INFLAMMATION OR INFECTION WITHIN THE LACRIMAL GLAND

SWELLING, PAIN, REDNESS AT LACRIMAL GLAND

supratemporal region

43
Q

What is DACRYOCYSTITIS? What is it due to?

A

INFECTION OF THE LACRIMAL SAC / DUCT

USUALLY DUE TO OBSTRUCTION OF THE NASOLACRIMAL SYSTEM (CONGENITAL OR ACQUIRED: INFANTS/PEOPLE OVER 40)

inframedial region

44
Q

What does ACUTE DACRYOCYSTITIS
INFECTION PRESENT like? chronic?

A

Acute: PAIN, SWELLING, TENDERNESS, AND REDNESS IN TEAR SAC AREA
PURULENT MATERIAL MAY BE EXPRESSED

chronic: TEARING AND DISCHARGE
MAY HAVE SOME MUCUS OR PUS

45
Q

What is the primary cause of DACRYOADENITIS?

A

inflammatory: autoimmune disease: Sjogren

viral: mumps

can be bacterial

46
Q

**What are the causes of DACRYOCYSTITIS?

A

INFECTION IN LACRIMAL DUCT
generally d/t blocked tear duct

can be caused by organisms:
acute:STAPHYLOCOCCUS AUREUS

chronic: STAPHYLOCOCCUS EPIDERMIDIS
STREPTOCOCCI

47
Q

**What is the treatment for autoimmune DACRYOADENITIS? viral? bacterial?

A

Autoimmune: Tx underlying cause/steroids

VIRAL: SUPPORTIVE CARE

Bacterial: SYSTEMIC ANTIBIOTICS
I&D IF NECESSARY

48
Q

**What is the treatment for acute DACRYOCYSTITIS? What about is there is mucopurulent discharge WITHOUT other signs of infection? Purulent discharge WITH other signs of infection (erythema and/or swelling)

A

Lacrimal Sac Massage

without: topical abx: tobramycin sulfate 0.3% or moxifloxacin 0.5%

with: SYSTEMIC ANTIBIOTIC THERAPY: AMOXICILLIN/CLAVULANIC ACID (AUGMENTIN)

49
Q

What is the treatment for chronic dacryocystitis?

A

Sx: DACRYOCYSTORHINOSTOMY:
EXPLORATION OF LACRIMAL SAC AND FORMATION OF FISTULA INTO THE NASAL CAVITY

50
Q

_____ CHRONIC INFLAMMATORY CONDITION OF THE LID MARGINS. Can be ____ or _____

A

BLEPHARITIS

anterior or posterior

51
Q

**anterior blepharitis involves _____, _____ and ____. May be _____ or ______

A

EYELID SKIN
EYELASHES
ASSOCIATED GLANDS

ulcerative or seborrheic

52
Q

What is anterior ulcerative blepharitis associated with? seborrheic?

A

ulcerative: STAPHYLOCOCCI

seborrheic: ITCHY RASH WITH FLAKY SCALES

53
Q

posterior blepharitis is inflammation of the _____ AT INNER PORTION OF EYELID. Can be ____ or ____ or _____

A

MEIBOMIAN GLANDS

bacterial or PRIMARY GLANDULAR DYSFUNCTION or chronic skin conditions

54
Q

_____ are MODIFIED SEBACEOUS GLANDS
RESPONSIBLE FOR EYE LUBRICATION
SECRETES OILY LAYER FOR TEARS
THIS HELPS TO REDUCE EVAPORATION OF TEARS
HELPS SPREAD TEARS

A

meibomian glands

55
Q

What kind of blepharitis is “red rimmed” and scales are commonly seen in lashes?

A

anterior blepharitis

56
Q

What kind of blepharitis are the lid margins red with spider veins (LID MARGINS ARE HYPEREMIC WITH TELANGIECTASIA), meibomian glands are inflamed, lid margin are rolled inward and tears may be frothy or abnormally greasy?

A

posterior blepharitis

57
Q

RED, SWOLLEN, ITCHY EYELIDS
GRITTY OR BURNING SENSATION
RED EYES
EXCESSIVE TEARING (WHICH CAN BE A SIGN OF DRY EYE)
CRUSTING/MATTING OF EYELASHES IN THE MORNING
FLAKING OR SCALING OF THE EYELID SKIN
LIGHT SENSITIVITY
BLURRED VISION (TRANSIENT, USUALLY IMPROVES WITH BLINKING)

What am I?
What is the tx?

A

Blepharitis

anterior: good eye lid hygiene, wash with baby shampoo, can use BACITRACIN OR ERYTHROMYCIN (anti-staph) ointment with acute exacerbation

posterior: REGULAR MEIBOMIAN GLAND EXPRESSION
HOT WASH CLOTH WILL HELP WITH EXPRESSION
LID MASSAGE

58
Q

If there is blepharitis with inflammation of conjunctivia and cornea, what is the tx?

A

LONG TERM LOW DOSE ORAL ABX THERAPY (2-4 WEEKS):
TETRACYCLINE 250 MG BID, DOXYCYCLINE 100MG DAILY, MINOCYCLINE 50-100 MG DAILY
and
SHORT TERM TOPICAL CORTICOSTEROIDS
PREDNISOLONE 0.125% BID

59
Q

____ is an acute infection, that is localized, red, swollen and TENDER. can be on the upper or lower lid. What is the MC bacteria?

A

HORDEOLUM

STAPHYLOCOCCAL ABSCESS

60
Q

An _____ is smaller and on the margin vs ____ is a meibomian gland abscess, USUALLY POINTS ONTO THE CONJUNCTIVAL SURFACE OF THE LID and MAY LEAD TO GENERALIZED CELLULITIS OF THE LID

A

EXTERNAL HORDEOLUM

INTERNAL HORDEOLUM

61
Q

What is the tx for a HORDEOLUM?

A

WARM COMPRESS #1, massage and gentle wiping of the eyelid after compress may help with drainage

62
Q

______ COMMON GRANULOMATOUS INFLAMMATION OF A MEIBOMIAN GLAND, HARD, NON-TENDER SWELLING,PAINLESS, LOCALIZED EYELID SWELLING

What is the tx?

A

chalazion

will resolve on its own
warm compress and massage/lid scrubs

if refractory: refer to ophthalmology INCISION AND CURETTAGE
CORTICOSTEROID INJECTION

63
Q

What are the differences between a hordeolum and chalazion?

A
64
Q

______ INFECTION OF THE SOFT TISSUE AND FAT THAT HOLD THE EYE IN ITS SOCKET. Who is the MC pt population?

A

ORBITAL CELLULITIS

children

65
Q

What bacteria is the MC cause of orbital cellulitis? Where do most cases arise from?

A

STREP. PNEUMONIA, STAPH AUREUS (INCLUDING MRSA)

MOST CASES ARISE FROM EXTENSION OF ACUTE SINUSITIS THROUGH THE ETHMOID BONES

66
Q

If orbital cellulitis is present in adults where did it arise from? hx of trauma or animal bite?

A

OFTEN CHRONIC SINUSITIS
ANAEROBIC ORGANISMS MAY BE INVOLVED

S AUREUS OR GROUP A B-HEMOLYTIC STREP

67
Q

FEVER
PAIN
EYELID SWELLING AND ERYTHEMA, DECREASED VISION/DIPLOPIA
PROPTOSIS
PTOSIS
CHEMOSIS
PAIN WITH AND LIMITATION OF EXTRAOCULAR MOVEMENTS
SLUGGISH PUPILLARY REACTION TO LIGHT OR A RELATIVE AFFERENT PUPILLARY DEFECT INDICATES OPTIC NERVE INVOLVEMENT
double vision
decreased vision
RAPD

What am I?
Is it life threatening?

A

ORBITAL CELLULITIS

YES!!! can be sight and/or life threatening

68
Q

**What 3 things make orbital cellulites an emergency?

A

PROPTOSIS
PTOSIS
PAIN WITH AND LIMITATION OF EXTRAOCULAR MOVEMENTS

69
Q

**What is the immediate treatment for orbital cellulits? After improvement what abx regimen can you switch to?

A

immediate treatment with IV abx in the hospital

INITIAL EMPIRIC TREATMENT
IV VANCOMYCIN PLUS EITHER
CEFTRIAXONE OR CEFOTAXIME

IF ANAEROBIC COVERAGE IS NEEDED
POSSIBLY TOGETHER WITH METRONIDAZOLE OR CLINDAMYCIN

TRIMETHOPRIM - SULFAMETHOXAZOLE (BACTRIM)
PLUS AMOXICILLIN/CLAVULANIC ACID (AUGMENTIN)
FLUOROQUINOLONE WITH PENICILLIN ALLERGY

70
Q

_____ BACTERIAL INFECTION SUPERFICIAL TO THE ORBITAL SEPTUM, INFECTION OF THE ANTERIOR PORTION OF THE EYELID. What is is caused by? **What are the 2 MC organisms?

A

Preseptal cellulitis

HORDEOLUM
WOUND
ANIMAL BITE
CONJUNCTIVITIS

**STAPH. AUREUS AND STREP. PNEUMONIAE

71
Q

TYPICALLY NO FEVER
+ EYELID SWELLING
+ ERYTHEMA
NO PROPTOSIS
NO LIMITATION OF OR PAIN WITH EXTRAOCULAR MOVEMENTS
NO VISION IMPAIRMENT/ DIPLOPIA
More common

What am I?
When should you order imaging?

A

Preseptal/periorbital cellulitis

IMAGING ONLY NEEDED WITH TREATMENT FAILURE OR UNSURE OF DIAGNOSIS

72
Q

What is the treatment for preseptal cellulitis?

When do you need to send these pts to the hospital?

A

ORAL ANTIBIOTICS
AMOXICILLIN/CLAVULANIC ACID (AUGMENTIN) OR CEFDINIR (OMNICEF) if PCN allergy
PLUS
TRIMETHOPRIM-SULFAMETHOXAZOLE or Clindamycin if sulfa allergy

IF NO IMPROVEMENT AFTER 24-48 HOURS ADMIT

73
Q

What is the function of the cornea? If you have a corneal ulcer, what does it put you at a higher risk for? why?

A

CORNEA FUNCTIONS AS A PROTECTIVE BARRIER AND AS A “WINDOW” THROUGH WHICH LIGHT RAYS PASS TO THE RETINA

EPITHELIUM = BARRIER TO THE ENTRANCE OF MICROORGANISMS INTO THE CORNEA
IF EPITHELIUM IS DEFECTIVE = INFECTION DUE TO A VARIETY OF ORGANISMS

74
Q

**What is a ciliary flush associated with? What is it?

A

corneal ulcer

PATHOGNOMONIC FOR CORNEAL PATHOLOGY
RED OR VIOLACEOUS RING SPREADING OUT FROM THE CORNEA

75
Q

GRAY OR YELLOW INFILTRATE AT SITE OF BREAK IN CORNEAL EPITHELIUM
SEVERE PAIN
TENDS TO SPREAD RAPIDLY
BEGINS SUPERFICIAL BUT MAY QUICKLY AFFECT ENTIRE CORNEA
CORNEAL PERFORATION AND SEVERE INTRAOCULAR INFECTION
EXUDATE MAY HAVE BLUISH-GREEN COLOR

**What am I?
**What is the tx?
**What is the MC pt population?
How do you dx?

A

PSEUDOMONAS AERUGINOSA corneal ulcer

fluoroquinolones, aminoglycosides, cephalosporins, and carbapenems
MOXIFLOXACIN, GATIFLOXACIN, CIPROFLOXACIN, TOBRAMYCIN, OR GENTAMICI

CONTACT LENS WEARERS

SCRAPINGS FROM THE ULCER SHOW GRAM-NEGATIVE RODS

76
Q

NO SPECIFIC IDENTIFYING FEATURES
SURROUNDING CORNEAL STROMA IS OFTEN INFILTRATED AND EDEMATOUS
MODERATELY LARGE HYPOPYON

**What am I?
**What is the tx?
**How do you dx?

A

GROUP A STREPTOCOCCUS corneal ulcer

ANTIBIOTIC EYE DROPS
MOXIFLOXACIN (VIGAMOX OR MOXEZA), GATIFLOXACIN, OR CEFAZOLIN

SCRAPINGS CONTAIN GRAM-POSITIVE COCCI IN CHAINS

77
Q

HYPOPYON AND SOME SURROUNDING CORNEAL INFILTRATION
OFTEN SUPERFICIAL
ULCER BED FEELS FIRM WHEN SCRAPED

**What am I?
**What is the tx?
**How do you dx?

A

STAPHYLOCOCCUS AUREUS / STAPHYLOCOCCUS EPIDERMIDIS corneal ulcer

CEFAZOLIN, MOXIFLOXACIN, GATIFLOXACIN
MRSA
VANCOMYCIN

SCRAPINGS SHOW GRAM-POSITIVE COCCI – SINGLY, IN PAIRS, OR IN CHAINS

78
Q

INDOLENT
GRAY INFILTRATE WITH IRREGULAR EDGES
MARKED INFLAMMATION OF THE GLOBE
SUPERFICIAL ULCERATION
SATELLITE LESIONS

**What am I?
**What is the tx?
**What organisms?

A

fungal corneal ulcer

AMPHOTERICIN B, VORICONAZOLE, POSACONAZOLE

CANDIDA, FUSARIUM, ASPERGILLUS, ETC

79
Q

IRRITATION, PHOTOPHOBIA, TEARING, REDUCED VISION
HISTORY OF FEVER BLISTERS OR OTHER HERPETIC INFECTION
DENDRITIC ULCER IN THE CORNEAL EPITHELIUM
BRANCHING, LINEAR PATTERN WITH FEATHERY EDGES
TERMINAL BULBS AT ITS ENDS

What am I?
What is the slam dunk finding?
What is the tx?

A

Herpes simplex corneal ulcer

Dendritic ulcer in the corneal epithelium

ORAL ANTIVIRAL
ACYCLOVIR
TOPICAL ANTIVIRAL
IDOXURIDINE, GANCICLOVIR

80
Q

_____ is the M/C CAUSE OF CORNEAL ULCERATION AND CORNEAL BLINDNESS

A

herpes simplex

81
Q
A

HEENT (12 decks)

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