disease
Terms
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- staph aureus
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bleph
ulcer
blurred margins
perforation in 7 days - strep pneumo
-
acute bact conj
marginal infiltrates to ulcers
central snakelike ulcer that has hypopyon - moraxella lacunata
-
angular blepharoconj
with or without hypopyon - neisseria gonorrhea
-
lusterless cornea
34 hour progression to ulceration, perforation, or panophthalmitis - haemophilus influ
-
in fall
petechial hemorrhages
progression to preseptal cellulitis or metastatic meningitis - atopic keratitis
- anterior subcap cataract
- marginal infiltrates/ulcers
-
differentiate from herpes
hypersensitivity rxn
oval and linear infiltrates separated from limbus by interval of clear cornea
pain
photophobia - dellen
- corneal thinning d/t dehydration
- epithelial defect and ulcers
-
pathogens can access stroma
inflammatory response to stromal infiltration
promotion of ulceration - bacterial corneal ulcer pathogens
- staph aureus, strp pneumo, moraxella, pseudomas
- s/s bacterial corn ulcer
-
overlying epithelial defect
infiltrate extends beyond border of defect
hypopyon - staph ulcer
- mucopurulent discharge
- strep ulcer
- serpiginous nature with undermined borders
- moraxella ulcer
- alcoholics and institutionalized pts
- psudomonas ulcers
-
EW SCL pts
greenish mucopurulent discharge--GREEN GOO!
endothelial plaque
progress rapidly (perforate w/in 24 hours) - tx of bacterial ulcer
-
fortified tobra q1h alternated with fortified cefazolin q1h OR
ciprofloxacin 2gtt q15min x 6 hours, 2gtt q 30 min rest of day, 2gtt q1h on 2nd day, 2gtt q4h on days 3-14. continue past day 14 if reepithelialization hasn't occurred. - 4 main forms of hsv keratitis
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1. epithelial
2. disciform
3. necrotizing interstitial keratitis
4. indolent - punctate epithelial keratitis from HSV
- precursor to dendritic or ameboid. may not progress
- dendritic epithelial HSV
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arborized ulcer
true terminal end bulbs
raised edges - ameboid epithelial HSV
- large amoeba0-shaped ulcer with dendritic edge of elevated mounds
- disciform (stromal) HSV
- stromal edema with intact overlying epithelium
- necrotizing interstitial keratitis (stromal)
-
multiple/diffuse stromal infiltrates often with neo
bacterial superinfection must be r/o - indolent (neurotrophic) ulceration HSV
- sterile ulcer with smooth margins over area of stromal dixease persisting depspite antiviral therapy
- hallmark sign of HSV keratitis
- cornal hypoesthesia
- mngmt of HSF ocular dz
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debridement, topical antiviral
cycloyplegic, etc - mngmt of HSV epithelial keratitis
- mechanical debridement, topical antiviral (viroptic q2h while awake for no longer than 21 days)
- varicella zoster keratitis types
- spk, pseudodendrites, immune stromal keratitis, neurotrophic keratitis
- pseudodendrite zoster keratitis
-
periph cornea elevated
medusa-like lesions that stain vividly with rose bengal
chornic epi keratitis: corneal mucous plaque keratitis: accompanied by ciliary & tarsal conj injetion, mild anterior uveitis, fine keratic precipitattes, and corneal hypoesthesia - mngmt of herp zoster ophthal
- oral acyclovir within 72 hrs
- fungal corneal ulcer causative agents
- FACC: Fusarium, Aspergillus, Candida, Cephalosporium
- filamentous fungal infection fungal ulcer
- fusarium, aspergillus
- yeast infection fungal ulcer
- candida
- fungal ulcers
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satellite lesions
immune ring - protozoan corneal ulcers agents
- acanthamoeba
- s/s acanthamoeba keratitis
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severe ocular pain disproportionate to clinical signs
upper lid edema
stromal infiltrate in shape of ring - mngmt acanthamoeba keratitis
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hosp admission?
cornal transplant often required eventually - interstitial keratitis
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most commonly associated with syphilis
binocular: congenital
monocular: acquired - s/s old and acute
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old: deep corneal haze, stromal thinning, ghost vessels
new: pain, conj injection, ant uveitis - stromal edema 2nd to:
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endothelial dysfunction
apithelial dysfunction (less common)
signs: folds in descemet's membrane - epithelial edema
-
more effect on comfort and vision than stromal edema
may be 2nd to endothelial dysfunction or increased IOP
reducted by hyperosmotics
signs: microcystic edema, bullous keratopathy - verticillata
- Fabry's disease, differentiate from drugs like miodarone, plaquenil, indomethacin, etc
- fabry's dz lens findings
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granular ant capsular cat with radial pattern
unusual post subcap cat with spoke-like deposits of granular material radiating from central part of post cortex - marginal corneal melting/ulceration
- collagen vascular dx like RA SLE, sjogren's
- mgmt of marg corneal ulceration/melting
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bandage SCL-best
ocular lubrication
caution with steroids
r/o underlying dz - alkaptonuria
-
missign enzyme: homogentisic acid oxidase
ochronosis: pigmentation of cartilage and other connective tissues
ocular ochronosis: patches or particles of pigment in sclera conj andlimbic cornea
sclerosis of cardiac valves
degen. arthritis - Wilson's dz
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copper
liver, kidney, brain
descemet's membrane of periph. cornea leading to kayser-fleischer ring - mngmt of wilson's dz
- d-penicillamine (cuprimine): mobilizes copper from tissues
- leprosy cornea
- thick, prominent corneal nerves with beading
- when does epithelial regen begin and do peripheral or central defects heal faster?
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w/in one hour
peripheral heal faster b/c closer to limbal vascular supply - scar with Bowman's
- no scar if Bowman's is intact
- when to resume CL wear after corneal abrasion?
- no sooner than 2 days after resolution
- corneal laceration
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r/o foreign body
r/o thickness laceration: ant chamber flattening, prolapse of IO contents, seidel's sign - burns: better prognosis with white or red conj?
- red: the whiter the worse the prognosis
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radiation burns: UV radiation
wavelength? -
rarely results in ant segment damage b/c of imediagte discomfort caused by heat
lag of 6 hrs b/w exposure and s/s
shorter the wavelength, greater the tendency for keratoconj.
severe keratoconj may result in mucin deficiency - thermal burns
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debride, remove FB, cycloplege, abx, patch, reexamine in 24 hrs
can result in: ant uveitis, corneal scars, corneal pannus, 2ndary infection, cictricial conj changes, cictricial dermal changes, ocular penetration - chemical burns
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copius irrigation
may result in: ant uveitis, ischemic necrosis of conj, corneal scrring and pannus, etc etc