Case 4: Keratitis Flashcards Preview

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Flashcards in Case 4: Keratitis Deck (33)
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1
Q

Classic description of staph marginal keratitis

A

Mulitple, bilateral, peripheral corneal stromal infiltrates (w/o overlying epi defects) secondary to chronic blepharitis

2
Q

Corneal ulcer

A

Corneal epi defect w/ an underlying stromal infiltrate

3
Q

Recurrent corneal erosions

A

Poor hemidesmosome attachments between corneal epi & underlying basement membrane

4
Q

RCEs are most common in eyes w/ a Hx of ______or ______ ______

A

Trauma; corneal dystrophies

5
Q

What would a pt w/ an RCE report?

A

Pain in the morning upon awakening, photophobia, FB sensation

6
Q

50% of pts w/ RCEs have ______, only 10% of pts w/ _____ will develop RCEs

A

EBMD, EBMD

7
Q

Corneal abrasion

A

Occur secondary to trauma that results in corneal epi defect WITHOUT an underlying infiltrate

8
Q

Infectious corneal ulcers

A

The size of the epi defect will match the size of the infiltrate

9
Q

Sterile corneal ulcers

A

Epi defect will be smaller than size of the infiltrate

10
Q

Staphylococcus marginal keratitis is a type ______ hypersensitivity reaction

A

3

11
Q

What is staph marginal keratitis most commonly assoc w/?

A

Staph bleph, acne rosacea, & phylctenule

12
Q

Which inflammatory bowel disease most commonly is assoc w/ uveitis?

A

Ulcerative colitis

13
Q

IBD is most commonly assoc with what type of uveitis?

A

Acute, bilateral, anterior or posterior, non-granulomatous uveitis

14
Q

MC systemic sx of IBD

A

chronic diarrhea w/ alternating episodes of constipation, cramping & feeling bloated after meals

15
Q

What is most appropriate to treat staph marginal keratitis?

A

Topical ophthalmic antibiotic/steroid combo (Tobradex)

16
Q

Anterior Blepharitis Tx

A
  1. eyelid scrubs BID or TID until the condition stabilizes, & then QD thereafter 2. Bacitracin or erthromycin ointment at bedtime for approx 2-4 weeks 3. Azasite (topical ophthalmic azithromycin) drops BID x 2 days then QD x 12 days 4. Topical ophthalmic antibiotic/steroid combination ointment at bedtime if sig redness or inflammation is present
17
Q

Posterior blepharitis Tx

A
  1. warm compress 5-10 min QID 2. eyelid scrubs BID or TID until condition stabilizes, then QD after 3. topical opthal antibiotic/steroid combo (Tobradex) 4. Azasite BID 2 days then QD x 12 days 5. Oral doxy 100 mg BID for 4 wks, then 100 mg QD for 3-6 mo. or 40-50 mg QD for 6-12 mo. 6. Fish oil + omega 3 fatty acids
18
Q

Seborrheic blepharitis

A

Less eyelid inflammation, more oily, greasy scales, & flaking compared to staph bleph

19
Q

What are 3 objectives for RCEs?

A
  1. Prevent infection & heal the corneal defect 2. reduce pain 3. prevent occurences
20
Q

3 ways to prevent infection & heal corneal defect in RCE

A
  1. broad-spectrum topical opthal antibiotic BID to QID 2. preservative-free AT up to Q1H 3. debridement
21
Q

3 ways to reduce pain of RCE

A
  1. cycloplegic 1 gt in office 2. topical opthal NSAID BID x 2-3 days or until corneal epi heals 3. bandage CL
22
Q

2 ways to prevent occurrence of RCE

A
  1. oral doxy 50 mg BID & topical opthal steroid TID x 3-4 wks 2. muro 128 ointment qhs x 3mo.
23
Q

Anterior stromal micropuncture

A

making numerous micropunctures into & thru the corneal epi BM/Bowman’s layer complex -> SL w/ blunt stromal micropuncture needle

24
Q

What is the MC type of infectious keratitis?

A

Bacterial keratitis

25
Q

Canadian National Hockey League- bacteria that can invade an intact corneal epi

A

Corynebacterium diphtheria, Nisseria gonorrhea & meningitidis, Haemophilus, Listeria

26
Q

Tx of small corneal ulcers

A

Topical ophthal antibiotic Q1-2H after initial loading dose followed by slow taper

27
Q

Tx of large sight-threatening ulcers

A

Fortified topical opthal antibiotics (cephazolin 50 mg/mL & tobramycin 14 mg/mL every 15-30 min after a loading dose of 1 drop every min for 5 min

28
Q

Fungal keratitis presentation

A

Gray-white corneal infiltrate w/ feathery edges & satellite infiltrates

29
Q

Fungal keratitis Tx

A

Topical opthal antifungals Q1H while awake (Amphotericin B & Natacin). Systemic antifungals advised in severe cases (Ketaconazole, Itraconazole)

30
Q

Acanthamoeba keratitis presentation

A

Severe pain that is out of proportion to corneal signs in early stages of keratitis. Corneal signs include mild SPK & pseudodendritic defects.

31
Q

What culture does acanthamoeba keratitis grow on?

A

Culture requires a non-nutrient agar w/ Eschericha coli; acanthamoeba can also grow on blood or chocolate agar but not as well

32
Q

Acanthamoeba keratitis Tx

A
  1. Topical opthal anti-parasitic agents: Propamidine isethionate Q1H (Brolene and/ or polyheamethyl biguanide PHNB) Q1H, followed by slow taper (often over the course of months. 2. oral anti-fungal agents: ketaconazole 200 mg or itraconazole 100 mg BID 3. cycloplegic agent TID 4. topical opthal antibacterial agent: Neosporin Q1H 5. topical opthal anti-inflammatory agents: topical opthal steroids (controversial)
33
Q

When is the FU for corneal ulcer?

A

1 day