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opthalmology > the conjuctiva and sclera > Flashcards

the conjuctiva and sclera Flashcards

1
Q

what are the three anatomical parts of the conjunctiva ?

A

the palpebral conjuctiva
the forniceal conjuctiva
the bulbar conjuctiva

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2
Q

what are the components of the conjunctiva ?

A

non keratinizing stratified squamous cell epithelium
goblet cells
substantia propria

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3
Q

what is the junction between the conjunctiva and the sclera called ?

A

the cornoscleral limbus

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4
Q

what are the different types of conjunctival reactions ?

A

hyperemia - conjunctival injection
chemosis - conjunctival oedema
subconjuctival hemorrhage
follicles
papillae

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5
Q

what are the features of conjuctival injection ?

A

hyperemia that extends away from the limbus

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6
Q

what are the causes of chemosis ?

A

acute: allergic reactions
chronic : thyroid eye disease, right sided heart failure and nephrotic syndrome

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7
Q

what are the causes of subconjuctival haemorrhage ?

A

viral conjunctivitis
valsalva or trauma
hypertension and diabetes
idiopathic
bleeding disorders

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8
Q

what are the causes of membrane formatiion ?

A

adenovirus
steven johnson syndrome
gonococcal conjuctivitis

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9
Q

how can you differentiate between a pseudomembrane and a true membrane ?

A

pseudomembrane can be peeled leaving behind an intact epithelium
A true membrane if peeled will leave behind a torn epithelium

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10
Q

what are follicles ?

A

multiple, discrete and translucent slightly elevated lesions that resemble translucent grains of rice, most prominent in the fornices

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11
Q

what are the causes of follicles ?

A

viral or chlamydiayal conjuctivitis
hypersensitivity to topical medications

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12
Q

what are papillae ?

A

can develop only in the palpebral conjunctiva and limbal bulbar conjunctiva

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13
Q

what are the causes of papillae ?

A

bacterial or allergic components
contact lens wearers
floppy eye syndrome

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14
Q

what are the classifications of conjunctivitis ?

A

infective
allergic
iatrogenic

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15
Q

what are the causes of bacterial conjunctivitis ?

A

strep pneumoniae
h influenza

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16
Q

what are the symptoms of bacterial conjunctivitis ?

A

redness
foreign body sensation
discharge which is usually bilateral but one eye may precede the other ( mucopurulent discharge)
vision is usually normal

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17
Q

what must be done in cases of suspected meningococcal or gonococcal infection ?

A

conjunctival swab

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18
Q

what must be done in cases of chlamydia or viral infections ?

A

PCR

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19
Q

what is the treatment for bacterial conjunctivitis if thee causative organism is not h.influenza , or gonococcal infection ?

A

topical antibiotics 4 times a day
either chloramphenicol, aminoglycosides, quinolone or macrolides

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20
Q

what is thee treatment for bacterial conjunctivitis caused by
h.influenza
gonococcal infection
meniingococcal infection ?

A

h.influenza :amoxicillin / clavulanic acid
gonococcal : 3rd generation cephalosporins
meningococcal : benzyl penicillin , ceftriaxone or ceftraxime IM can be used

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21
Q

what type of transmission or type of infection is adult chlamydial conjunctivitis ?

A

occulogenital infection
transmission is auto inoculation from genital secretions

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22
Q

what are the serological variants associated with adult chlamydia infection ?

A

D-K

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23
Q

what is the incubatioin period for adult chlamydia infection ?

A

app one week

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24
Q

what is the most common causee of non gonococcal urethritis in males ?

A

chlamydia

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25
Q

what are the symptoms associated with adult chlamydial infection ?

A

subacute unilateral or bilateral redness
watering and or discharge

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26
Q

what are the signs associated with adult chlamydial infection ?

A

watery or mucopurulent discharge
tender pre auricular lymphadenopathy
large follicles most prominent in the inferior fornix
superficial punctate keratitis is common
superior corneal pannus
mild conjuctival scarring

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27
Q

what are the investigations for a case of suspected adult chlamydia conjunctivitis ?

A

tarsal conjuctival scraping for geimsa stain

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28
Q

what would a positive giemsa stain for adult chlamydial conjunctivitis show ?

A

basophilic inclusion bodies in epithelial cells
lymphocytes in newborns

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29
Q

what is the treatment for adult chlamydial infection ?

A

referral to a genitourinary specialist
systemic ab- azithromycin 1g repeated after 1 week is the treatment of choice , topical antibiotics are not enough
reduce risk of transmission - no sexual activity until treatment is over
re-test in 6-12 weeks

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30
Q

what are the alternatives to azithromycin in ACC ?

A

erythromycin
amoxicillin
ciprofloxacin

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31
Q

what are the associated factors with trachoma ?

A

overcrowding
poor hygiene
flies are an important factor

32
Q

what type of response is associated with a trachoma infection ?

A

delayed hypersensitivity type 4

33
Q

what is the causative organism in Trachoma ?

A

also chlamydia but strains A to C

34
Q

what are the stages of trachoma divided into ?

A

active stage ( acute)
cicatricial stage ( chronic )

35
Q

what are thee features associated with the active form and stage of trachoma ?

A

common in pre school children
presents with both papillae and follicles
associated with mucopurulent discharge
in children under the age of 2 - papillary + pannus formation

36
Q

what is pannus ?

A

vascular invasion that occurs on the periphery of the cornea

37
Q

what are the features of cicatricial trachoma ?

A

common in middle aged patients
linear conjunctival scars called Arlts line
superior limbal follicles - Herbert pit
trichiasis
cicatrization - formation of scar tissue
cicatricial entropion - eyelids turn toward the globe due to fibrosis
corneal opacification
dry eyes due to destruction of goblet cells

38
Q

what is the grading system for trachoma ?

A

TF - A few follicles in the superior tarsal plate
TI - follicles and papillae
TS - corneal scaring and Arlts lines
TT - Trichiasis
CO - reached corneal opacity

39
Q

what is the management for trachoma ?

A

SAFE
Surgery to relieve entropion and trichiasis for complete lid closure
Antibiotics for thosee affected and family members - azithromycin
Facial cleanliness
Environmental improvement

40
Q

what is the most frequent causative agent for viral conjunctiivitis ?

A

adenovirus

41
Q

how is adenoviral conjunctivitis transmitted ?

A

transmission generally by contact with respiratory or ocular secretions

42
Q

what is the most common clinical form of viral conjunctivitis ?

A

non-specific acute follicular conjunctivitis which is usually due to adenovirus

43
Q

history of URTI and then presents with viral conjunctivitis ?

A

pharyngoconjunctival fever

44
Q

most severe adenoviral conjunctivitis ?

A

epidemic keratoconjunctivitis

45
Q

what is the causative organism in acute haemorrhagic conjunctivitis ?

A

tropical areas
enterovirus
coxsackievirus

46
Q

what are the signs of viral conjunctiivitis ?

A

watery eye discharge
eyelid oedema
lymphadenopathy
conjunctival hyperemia
conjunctival follicles

47
Q

what sign is specific to adenoviral conjunctivitis ?

A

keratitis

48
Q

what signs are seen in molluscum contagiosum ?

A

pale waxy nodule on the lid of the margin
follicular conjunctivitis

49
Q

what is the treatment for viral conjunctivitisi ?

A

adenoviral is self limiting within 2-3 weeks
reduce transmission risk , hawi 3al 3ayan
discontinuation of CL

50
Q

what are the types of allergic conjunctivitis ?

A

acute allergic conjunctivitis
seasonal allergic conjunctivitis
perennial allergic conjunctivitis

51
Q

what is the hallmark of allergic conjunctivitis ?

A

chemosis

52
Q

what are the seasonal associations with allergic conjunctivitis ?

A

acute allergic - spring and summer
seasonal allergic - hay feever eyes - spring and summer - pollen
perinneal allergic conjunctivitis - autumn - but less severe - pets in the house

53
Q

what is the immune response associated with vernal keeratoconjunctivitis ?

A

IgE and cell mediated immunity

54
Q

what is the treatment for allergic conjunctivitis ?

A

avoidance of allergen first
if mildd - artificial tears
moderate - mast cell stabilizers or antihistamine
severe - topical steroids

55
Q

what are the classifications of VKC ?

A

palpebral VKC - upper tarsal conjunctiva with papillae
LImbal VKC - limbal conjunctival papillae
Mixed VKC

56
Q

what age group is associated with AKC ?

A

30-50 yr olds unlike VKCC 5 year old boys

57
Q

what are thee seasonal association with AKC vs VKC ?

A

VKC is seasonal and is worse in thee spring
AKC is perineeal and worse in the winter

58
Q

what other diseases are associatedd with AKC ?

A

history of atopic dermatitis
asthma

59
Q

what are the sympttoms of AKC and VKC ?

A

eyelid erythema and scaling
conjunctival discharge
hyperemia and papillae
cicatrization which may lead to symblepharon
corneal keratopathy , keratoconus

60
Q

what complications are more likely to happen to AKC and VKC patients ?

A

retinal detachement
presenile subcapsular cataract

61
Q

what are the general measures for VKC and AKC ?

A

ABC approach
Avoid allergen
Bandage contact lens
Cool compresses

62
Q

what is the medical management for VKC and AKC ?

A

mast cell stabilizers
topical antihistaminic
Topical NSAIDS
topical steroids
oral histamines

63
Q

what is the management for unresponsive cases of AKC and VKC ?

A

ciclosporin
tacrolimus ointment

64
Q

what surgeries can be performed for AKC and VKC ?

A

superficial keratectomy
surface restoration surgeries

65
Q

what iss the etiology of giant papillary conjunctivitis ?

A

mechanically induced papillary conjunctivitis

66
Q

what are thee causes of giant papillary conjunctivitis ?

A

contact lens wear
exposed sutures and scleral buckles
ocular prosthesis

67
Q

what are the symptoms of giant papillary conjunctivitis ?

A

foreign body sensation
itching
redness
increased mucus production
blurring and loss of CL tolerance
symptoms may worsen after lens removal

68
Q

what are the signs associated with giant papillary conjunctivitis ?

A

CL protein deposits may be present
mucous discharge
superior tarsal hyperemia
ptosis and tissue laxity may occur due to chronic irritation
variable size papillae up to giant

69
Q

what is the treatment for Giant papillary conjunctivitis ?

A

removal of the stimulus
ensure effective cleaning of CL
topical drops as antihistamines , NSAID, mast cell stabilizers

70
Q

what is pinguecula ?

A

asymptomatic elastotoic degeneration of the stroma
yellow mound found on the bulbar conjunctiva
found more on the nasal limbus rather than the temporal limbus
doesn’t grow over the cornea

71
Q

what is the treatment for pinguecula ?

A

no treatment required

72
Q

what is pterygium ?

A

triangular fibrovascular subepithelial growth
point of the triangle points towards the cornea
grows over the cornea

73
Q

what are the differential diagnosis of pterygium ?

A

pseudo-pterygium

74
Q

what are the parts of a pterygium ?

A

cap
head
body

75
Q

how can you tell the difference between episcleritis and scleritis ?

A

episcleritis - painless, foreign body sensation ,
vessels blanch with 10% phenylpherine drops
self limiting but recurring
scleritis - very painful , exaceerbbated by eye movements andd can wake the patient up from their sleep
conjuctival vessels do not blanch on 10% phenylpherine

76
Q

what is the management of episcleritis vs scleritis ?

A

episcleritis - avoid steroid drops, oral NSAIDs
scleritis - investigate for a systemic disease, oral NSAIDs

opthalmology (14 decks)

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