Blue 1-1 Flashcards
(31 cards)
What does fluoresceing stain
De-epithelialisation
What does Rose Bengal stain
Devitalised viral infected epithelial cells
What is treatment for Herpes epithelial keratitis
Topcial aciclovir 3% for 10-14d
Cotninued for 3d aftercomplete healing
If resistant consider trifluorothymidine 1% 9x/d
Cycloplegial (cyclo 1% BD) for comfort/AC inflammation
What is treatment of stromal keratitis?
Topical steroid - defer until epithelium in tact - aim ofr minimum effective dose
E.g prednisolon 0.1-1% OD - QDS titrating down
Antiviral: systemic aciclovir - 400mg 5x/d then BD
Consider PO aciclovir prophylaxis ( 400mgBD)
Cycloplegia
Monitor IOP
Surgery for perforation - tectonic grafe or PK for scarring
What can be used if patients intolerant to aciclovir
Valaciclovir
Famciclovir
What is is seen in HSK disciform
Endotheliitis
Central disc of corneal oedema
DM folds
Mild AC activity
Fine KPs
Wessely ring - stormal halo of precipitated viral antigen/host antibody)
What IX and treatment for disciform keratitis
AC paracentesis nad viral PCT
False negatives as long term aciclovir will reduce HSV DNA
Topical steroid - defer until epithelium intact
May require low dose for months
P.F if coexistant surface disease
Antiviral systemic aciclovir PO 400mg 5x/d
Continue prophylaxis until on low freq/low strength topical steroid
Cycloplegia
Monitor IOP
When to use aciclovir prophylaxis
Stromal or endothelial disease
No evidence of reducing recurrence in epithelial disease
What happens in cicatricial conjunctivitis?
Loss of goblet cells
Ocular surface failure - limbal epithelial stem cell failure - blinding keratopathy
Progressive conjunctival scarring
What is assocaition of MMP? Type of hypertenstivity?
RA pernicious anaemia
Type 2 hypersensitvity
What is seen on DIF in OCP
Identification of linear deposition of IgG and IgA C3 complement at the epithelial basement memvrane zone
Diagnositc
What is conjunctival biopsy transport in?
Michel medium for immunohistochemical analysis
Formalin for evidence of neoplastic changes
Where to take conjunctival biopsy from?
Less inflamed areas as inflamed conj can result in scarring which may reduce diagnostic yield
Clinical features of OCP
Chornic/acute papillary conjucntivitis
Subconj bulla and ulceration
Progressive cicatrization
Loss of plica semilunaris
Symblepharon (scar tisseu between bulbar and subtarsal conj)
Akyloblepharon (Upper/lower lids partially/completely fused)
Treatment for OCP
Topical corticosteroids
Doxycycline OD 3 months
Step up from dapsone - mycophenolate, methotreatxate, azathioprine, cyclophosphamide, IV MP
IV immunoglobulin
Anti CD20
AntiTNF
Stains for corneal dystrophy
Macualr
Granular
Lattice
Schnyder
Marilyn Monroe Always
Macular - Mucopolysaccharide Alcian Blue
Gets Her Men
Grandular Hylanie
MAssone Trichrome
in LA City
Lattice Amyloid
Congo Red
She Likes Obese
Schnyder
Lipid Oil Red O
What is Avelino corneal dystrophy
Lattice + granular
What are predictors of poor prognosis in chemical eye injury
Limbal involvement >9-12 clock hours
Conjunctival involvement 75-100%
Why does ocnjunctival invovlment affect prognosis in chemical injury
Ability to re-epithelialise the cornea if there is limbal stem cell deficiency.
conj stem cell loss can affect this
What is the most common malignant conj or corneal tumour? Associations
Ocular surface squamous neoplasia
50yo
UV B radiation and HPV risk factors, immunisuppression, smoking
HIV1/2 HPV
May be associated with HIV
Presentation and treatment of OSSN
ocular surface squamous neoplasia
Persistent unilateral keratoconjunctivitis - atypical dysplastic epithelium to limbal gelatinous mass
Excision with 2-3 mm clear margins
MMC
Double freeze thaw cryo to margins
Repeat conjunctival map biopsies to define spread
Subconj injection of interferon alpha
What organisms are able to penetrate intact corneal epithelium
CHANeLS
Corynebacterium
Haemophilus influenza
Acanthamoeba
Neisseria gonorrhoea/meningitidis
Listeria
Shigella
What is seen on corneal impression cytology in LSCD
Presence of goblet cells
Absence of corneal surface markers
Absence of CK3
Absence of CK12
Presence of conjunctival surface markers
Presence of CK13
Presence of CK19
What is treatment for partial LESC deficiency?
Sequential sector conjunctival epitheliectomy
If visual axis involved + AMG
