Week 2 - B - Ophthalmology 1 - Conjunctivitis and Keratitis

Question 1

How does bacterial conjunctivitis present?

Answer 1

Presents with redness of the eye

Purulent discharge

Itching of the eyes

May have a photophobia also

Question 2

How is bacterial and viral conjunctivitis differentiated? What can be taken due to the discharge?

Answer 2

Bacterial presents with purulent discharge - viral doesnt

Take swabs from the discharge to identify the organism

Question 3

Conjunctivitis tends to resolve within 14 days but if there it is severe or last longer (usually if bacterial) antibiotics can be given What is the 1st line choice of treatment for bacterial conjunctivitis (covers most organism)?

Answer 3

Chloramphenicol

Question 4

What are some potential side effects of chloamphenicol?

Answer 4

Some side effects are

Irreversible aplastic anaemia

Worsening symptoms if allergic

Grey baby syndrome

Question 5

What is aplastic anaemia?

Answer 5

An impairment of bone marrow function which causes failure to produce all three blood cell typess :

anaemia (low RBC),

leukopenia (Low WBC),

thrombocytopaenia (low platelets)

Question 6

What is given as treatment if the bacterial organism causing cojunctivitis is staph aureus?

Answer 6

Give fusidic acid eye drops

Question 7

If the organism causing conjunctivitis is pseudomonas aerguinosa, what eye drops are given?

Answer 7

Give gentamicin eye drops

Question 8

What is a key sign to remember in conjunctivitis that helps differentiate from other causes of red eye?

Answer 8

Vision is unaffected in conjunctivitis

Question 9

If a patient presents with allergic conjunctivitis, what is the usual treatment?

Answer 9

Application of cold compresses to the eyes (for 5–10 minutes once or twice daily) to relieve symptoms.

Application of ocular surface lubricants such as saline solution or artificial tears If non-pharmacological measures do not provide adequate relief:

* Consider prescribing a topical antihistamine or

dual action mast cell stabilizer and topical antihistamine

Question 10

What are the usual causes of follicular conjunctivitis?

Answer 10

Chlamydial infection

Viral infection eg HSV, Adenovirus

Question 11

What may follicular conjunctivitis be secondary to in children? Usually presents as small firm umbilicated papules

Answer 11

Molluscum contagiosum

Question 12

How are viral conjunctiivits treated?

Answer 12

Usually self limiting

Patients should be advised to take precautions to avoid spread to others ie. stay home from school while discharge and redness persist, frequent hand-washing, avoid sharing towels/cosmetics, avoid eye-rubbing.

ADVISE COOL COMPRESS / LUBRICANTS

Question 13

In patients presenting with vesicular crusting on the tip of the nose, what do you think is the cause of this and what is this known as?

Answer 13

Hutchison’s sign - causes vesicles on the tip of the nose - think herpes zoster virus

Eye involvement as the nasociliary branch of the opthalmic nerve supplies the tip of the nose

Question 14

What is the treatment of herpes zoster conjunctiviits?

Answer 14

Give the patient oral acyclovir

Question 15

What are causes of conjunctivitis in neonates?

Answer 15

Staph aureus, and STD related conjunctiviis - chalmydial trachomatis, neisseria gonorrhea

Question 16

How does chlamydial conjunctivits present?

Answer 16

Usually presents as bilateral conjunctivitis with eye pain and discharge coming from the eye

Also have follicles on the inner eyelid

Can get it via STDD transmission, eg birth canal or unprotected sex or from infected swimming areas in poor countries eg africa

Question 17

In adults, what other non-eye related symptoms can come with chlamydial conjunctivitis?

Answer 17

Burning sensation when peeing

Question 18

What is the treatment fro chlamdyial conjunctivitis? (what may also be given to adults if they have a genital infection?)

Answer 18

Topical oxytetracycline

Adults may also need oral azithromycin for genital infection

Question 19

So for all types of conjunctivitis, how are cultures taken? (if there is any discharge)

Answer 19

Swabs are taken for cultures to identify the organism

Question 20

What is keratitis and who is it associated with?

Answer 20

Inflammation of the cornea

Associated with contact lens wearers

Question 21

What is the inflammatory exudate seen in the anterior chamber of the eye known as? it is seen in keratitis Why does it settle at the bottom of the eye?

Answer 21

It is known as a hypopyn

Settles at the bottom of the eye due to gravity

Question 22

How is the causative organism in keratitis diagnosed?

Answer 22

By taking a corneal scraping

Question 23

What two types of organisms are found in contact lens wearers?

Answer 23

Pseudomonas aerguinosa and acanthomoeba

Question 24

What is the first line treatment for keratitis?

Answer 24

A 4-quinolone (the second generation which are mostly prescribed are fluoroquinolones) - oflaxacin drops (covers most organisms)

Treats most gram negative coliforms including H.influenza and pseudomonas

Question 25

What bacteria is oflaxacin not active against?

Answer 25

Not active against strep pneumoniae

Question 26

What combination of antibiotics covers most gram positive and negative organisms and can be used in keratitis management?

Answer 26

Use gentamicin and cefuroxime

Question 27

What is the usual cause of a dendritic ulcer of the cornea?

Answer 27

Herpetic keratitis caused by HSV

Question 28

Why are steroids not given to treat herpetic keratitis?

Answer 28

Topical steroids can cause a corneal melt

Question 29

How does herpetic keratitis present?

Answer 29

Dendritic ulcer, very painful and can lead t blindness

Question 30

What do you stain with to see the dendritic ulcer? What is the treatment of herpetic keratitis?

Answer 30

Stain with fluoroscein dye

Treat with oral acyclovir