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DTMH Block 4 > Tropical ophthalmology > Flashcards

Tropical ophthalmology Flashcards

1
Q

Name examples of HIV associated ocular conditions

A

HIV microangiopathy
OIs (HSV, VZV, CMV, TB)
Malignancies
- OSSN
- kaposi’s
- lymphoma
IRIS

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2
Q

What is OSSN?

A

Ocular surface squamous neoplasia

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3
Q

What are the characteristics of HIV microangiopathy and the treatment?

A

Retinal haemorrhages
Cotton wool spots
Microaneurysms

Treatment: ARVs

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4
Q

Why are OIs common in HIV?

A
  1. Increased susceptibility
  2. Increased reactivation of latent organisms
  3. Increased pathogenicity of organisms
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5
Q

What ocular manifestations can HSV cause?

A

Keratitis
Uveitis
Retinitis

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6
Q

What ocular manifestations can VZV cause?

A

HZ ophthalmicus
Keratitis
Uveitis
Retinitis

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7
Q

What ocular manifestations can CMV cause?

A

Uveitis
Retinitis

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8
Q

What is the clinical characteristic of HSV keratitis?

A

Dendritic appearance in cornea

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9
Q

What is significant regarding HSV keratitis in the HIV population?

A

Increased incidence
Increased severity
Can be bilateral

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10
Q

What is herpes zoster ophthalmicus?

A

Reactivation in the ophthalmic division of trigeminal nerve

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11
Q

Name risk factors for herpes zoster ophthalmicus

A

Older age
HIV

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12
Q

What is the clinical presentation of herpes zoster ophthalmicus?

A

Papules, vesicles, pustules, crusting
Hutchinson sign
Postherpetic neuralgia
Skin severity does not correspond with ocular severity

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13
Q

What is the chance of eye involvement if Hutchinson sign is observed?

A

80%

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14
Q

What is the management of herpes zoster ophthalmicus?

A

Oral acyclovir within 72h of rash
Oral steroids
Ophthalmologist referral for complications

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15
Q

Name long term complications of herpes zoster ophthalmicus

A

Neurotrophic keratopathy
Lid changes

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16
Q

At what CD4 is CMV retinitis most common?

A

Low Cd4

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17
Q

What is the characteristic appearance of CMV retinitis?

A

Characteristic margherita pizza appearance (vasculotrophic virus)

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18
Q

Discuss the management of CMV retinitis

A

ARVs
Ganciclovir (intravitreal or oral)

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19
Q

What is the spectrum of OSSN?

A

Conjunctival intraepithelial neoplasia
CiS (carcinoma in situ)
SCC (squamous cell carcinoma)

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20
Q

Name risk factors for OSSN and which has the highest pathogenecity?

A

UVB
HIV
HPV (highest pathogenicity)

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21
Q

Discuss treatment of OSSN

A

Excision
Tropical chemotherapy

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22
Q

Which virus is Kaposi’s associated with?

A

HH8

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23
Q

What is the management of Kaposi’s sarcoma?

A

ARVs

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24
Q

Which virus is lymphoma associated with?

A

EBV

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25
Q

What is the management of lymphoma?

A

Excision
Radiotherapy

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26
Q

Which virus causes molluscum contagiosum?

A

Poxvirus

27
Q

What can be the complication of molluscum contagiosum?

A

Follicular conjunctivitis

28
Q

Discuss the management of molluscum contagiosum

A

Conservative
Excision if non-resolving or conjunctivitis

29
Q

What is ophthalmia neonatorum?

A

Conjunctivitis within 1st month of life

30
Q

Name causes of ophthalmia neonatorum

A

C. trachomatis
N. gonorrhoea
HSV

31
Q

Discuss management of ophthalmia neonatorum

A

Topical chloramphenicol
Saline irrigation of conjunctiva
Systemic ABs
- n. gonorrhoea IV CTX
- c. trachomatis PO erythromycin
- HSV IV acyclovir

32
Q

What is the leading cause of preventable blindness?

A

Trachoma

33
Q

Which pathogen causes trachoma and how is trachoma transmitted?

A

C. trachomatis A, B, C transmitted by direct contact or flies

34
Q

What is the WHO grading of trachoma?

A

FIST
Follicular
Inflammation
Scarring
Trichiasis
Corneal opacity

35
Q

Discuss management of trachoma

A

WHO SAFE strategy
- surgery
- antibiotics
- face cleanliness
- environmental improvement

36
Q

Which antibiotics should be used for trachoma?

A

1g azithromycin stat to patient AND family
Repeat annually if endemic

37
Q

What is ophthalmomyasis?

A

Infestation with fly larva, mostly in summer months when female fly releases larvae into eye

38
Q

Discuss management of ophthalmomyasis

A

Removal
Ivermectin

39
Q

Name the causative organism of leprosy

A

M. leprae
M. lepromatosis

40
Q

What are the systemic features of leprosy?

A
  1. Tuberculoid
  2. Borderline (most common)
  3. Lepromatous
41
Q

Describe tuberculoid leprosy

A

Hypopigmented macules
Anaesthetic skin patches

42
Q

Describe borderline leprosy

A

Similar to tuberculoid but more numerous and extensive

43
Q

Describe lepromatous leprosy

A

Widespread cutaneous thickening
Leonine facies
Peripheral plaques and nodules
URTI
Loss of digits due to peripheral neuropathy

44
Q

Discuss the ocular features of leprosy

A

Anterior uveitis
Iris pearls
Keratitis
Pannus

45
Q

Which fly transmits onchocerciasis?

A

Simulium black fly

46
Q

What is onchocerciasis also called?

A

River blindness

47
Q

How is onchocerciasis caused?

A

Black fly bites human -> larvae in nodules migrate to eyes

48
Q

What is the maculopapular rash in onchocerciasis also called?

A

Leopard skin rash

49
Q

What are the ocular features of onchocerciasis

A

Microfilariae in cornea/anterior chamber
Anterior uveitis
Keratitis
Chorioretinitis
Optic neuritis

50
Q

Discuss management of onchocerciasis

A

Ivermectin

51
Q

What causes neurocysticercosis?

A

Taenia solium

52
Q

What are the ocular features of neurocysticercosis?

A

Cysts in conjunctiva, anterior chamber and vitreous

53
Q

Discuss management of neurocysticercosis

A

Cyst removal
Anti-helminths
Steroids

54
Q

What causes hydatid cysts?

A

Echinococcus species

55
Q

What is the management of hydatid cysts?

A

Excision
Praziquantel

56
Q

What is the function of vitamin A?

A

Maintain epithelial surfaces
Immune function
Retinal function

57
Q

What is xerophthalmia?

A

Spectrum of ocular disease due to vitamin A deficiency

58
Q

Name causes of xerophthalmia

A

Malnutrition
Malabsorption
Alcoholism
Diarrhoea
Measles

59
Q

How is xerophthalmia classified?

A

XN - night blindness
X1 - conjunctival xerosis with Bitot spots
X2 - corneal xerosis
X3 - corneal ulceration
Xs - corneal scar
XF - xerophthalmic fundus

60
Q

What is a bitot spot?

A

Keratinised triangular lesion seen with xerophthalmia

61
Q

Discuss management of xerophthalmia

A

Vitamin A supplementation
- 200 000IU oral
- diet
Ocular
- lubrication
- structural support in case of perforation

62
Q

What is ocular perforation in xerophthalmia also called?

A

Corneal melt

63
Q
A

DTMH Block 4 (14 decks)

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