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NBEO step 2 > Conj/cornea/refractive surgery > Flashcards

Conj/cornea/refractive surgery Flashcards

(93 cards)

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1
Q

what is this?

A

pterygium

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2
Q

What layers does a pterygium affect?

A

Bowmans layer

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3
Q

what causes a pterygium?

A

Uv exposure
ocular irritation - ex. dry eye

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4
Q

What is a complication of pterygium?

A

induced astigmatism

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5
Q

What is this?

A

stocker’s line
- iron line at the edge of a pterygium
- sign of stability

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6
Q

what is this?

A

cicatricial pemphigoid: autoimmune disease bo f the mucous membranes of the body
- entire body!

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7
Q

who gets cicatricial pemphigoid?

A

females >60 yo

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8
Q

signs of cicatricial pemphigoid?

A

inferior symblepharon
ankyloblpeharon
tighter/shorter inf fornix
entropion
discharge
keratitis /keratinization
trichiasis

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9
Q

what is a systemic symptoms a patient with cicatricial pemphigoid might have?

A

dyspnea

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10
Q

what is dyspnea

A

trouble breathing

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11
Q

what is the treatment of cicatricial pemphigoid?

A

systemic condition so: systemic steroids / immunosuppressive
agents

treating complications like dry eye

corneal defects with antibiotics

surgery for symblepharon/ankyblepharon

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12
Q

what are erythema multiforme (EM) and SJS reactions ?

A

type 4 herpersensitivity reactions

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13
Q

which is the milder form ie. self-limiting?
SJS and EM ?

A

erythema multiforme

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14
Q

what causes erythema multiforme (EM) and SJS reactions ?

A

infection
poor rxn to medication

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15
Q

signs of erythema multiforme (EM) and SJS reactions ?

A

skin lesions
+ cicatrices pemphigoid signs

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16
Q

treatment of erythema multiforme (EM) and SJS reactions ?

A

dry eye treatment
corneal defects - antibiotics
inflammation - steroids
surgery

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17
Q

how long does it take for a subconj heme to heal?

A

2-3 weeks

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18
Q

what do you need to rule out if a patient has recurrent subconj hemes?

A

bleeding disorder

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19
Q

What causes superior limbic keratoconjunctivitis?

A

friction of the UP on the superior bulbar conj caused by:

TED
dry eye
RA
Sjogrens
cls wear

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20
Q

what is the treatment for superior limbic keratoconjunctivitis?

A
  1. ATs, punctal plugs for dry eye
  2. steroids/mast cell stabilizers for conj inflammation
  3. topical cyclosporine - if also have KCS (Keratoconjunctivits sicca)
  4. silver nitrate - no longer used for this
  5. surgery for severe symptoms of conj/ tenons cause
  6. if you see filaments/ mucous strands - topical aceylcysteine
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21
Q

What causes seasonal allergic conjunctivitis?

A

air-borne pathogens - pollens and hay fever

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22
Q

what causes perennial allergic conjunctivitis and when does it occur?

A

year round

cause: dust and dander

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23
Q

who gets atopic conjunctivitis?

A

hereditary predilection for allergic disease like dermatitis, eczema, allergic rhinitis, asthma

13-50yo

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24
Q

signs of atopic conjunctivitis?

A

itchy eyes + papillae + chemosis + possible pain

dermatitis, ectropion, trichiaisis, madarosis, corneal staining/erosisions, symblepharon, neo, keratoconus, cataracts

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25
who gets vernal conjunctivitis ?
m < 10yo who live in hot climates
26
complaints of someone with vernal conjunctivitis ?
itchiness + pain
27
signs of vernal conjunctivitis ?
cobblestone papillae + chemosis thick ropy discharge tranta dots shield ulcer
28
what is this and what cells are located in this?
tranta dots eosinophils
29
what is this?
shield ulcer - superiorly located, sterile, well-delineated grey infiltrate
30
what are signs of bacterial conjunctivitis?
papillae + no lymphadenopathy - mostly seen in kids
31
how do you treat bacterial conjunctivitis ?
antibiotics
32
what causes non-gonococcal bacterial conjunctivitis?
normal climates adults - s. aureus adults in warmer climates - haemophilus influenza adults in cooler climates - strep pneumonia kids under 5 = H influenzae
33
what is the most common cause of conjunctivitis in kids under 3 ?
bacterial conjunctivitis non-gonococcal
34
what are symptoms of bacterial conjunctivitis non-gonococcal
starts in 1 eye and then may spread to the other eye will be able to tell you time of day it started, not exact moment hx of recent illness/cold FBS
35
signs of bacterial conjunctivitis non-gonococcal
mucopurulent discharge redeness chemosis (conj) papillae lid swelling eyelids stick together in morning , maybe SPK NO lymphadenopathy and NO corneal involvement
36
how is bacterial conjunctivitis non-gonococcal spread?
contact with secretions
37
treatment for bacterial conjunctivitis non-gonococcal
topical antibiotic - ocuflox (any fluroqoquinolone) qid for 5-7 days polytrim - for kids because ointment is easier to put in and won't remove it by crying remove large mucous strands before installation no cls wear
38
when do you follow up for bacterial conjunctivitis non-gonococcal
2 days post start of treatment then every 3-5 days until resolution
39
what is another conjunctival condition that can be associated with a pinguecula?
dellen
40
what are the gonococcal conjunctivitis signs
hyper acute - ie. explosive symptoms, will be able to tell you exact second it happened severe pus discharge severe chemosis papillae prominent pre auricular lymphadenopathy corneal ulcers - bacteria attacking the corneal epithelium = infectious keratitis
41
what is gonococcal conjunctivitis treatment ?
systemic therapy is mandatory!! ceftriaxone IM if cornea not involved - IV if cornea is involved hospitalized if cornea involved use fluroquinolones if allergic to pennicillins or cephalosporins
42
fluroquinlone ending
floxacin
43
what is ophthalmia neonatorum?
newborn gonococcal conjunctivitis - occurs within 4 days of birth
44
how do you treat ophthalmia neonatorum?
if active infection - IM/IV ceftriaxone not exceeding 125 mg prophylactically use erythromycin ointment / historically used silver nitrate
45
What types of conjunctivitis does chlamydia cause?
adult inclusion conjunctivitis trachoma both are chronic - ie. can last up to 12 months without treatment
46
what serotypes cause adult inclusion conjunctivitis ?
D-> K
47
what serotypes cause trachoma?
A -> C
48
what is the leading cause of preventable blindness in the world?
trachoma , but not really seen in developed countries
49
What are signs of a chlamydial conjunctivitis ?
follicles stringy mucous tender pre auricular nodes on side of the involved eye
50
where are the follicles located in adult inclusion conjunctivitis ?
inferior palpebral conj.
51
what are signs of trachoma?
look for follicles in the superior palpebral conj - they then can press along the globes and cause indentations along the superior limbus (Herbert's pits) after time the follicles can cause scarring along the superior palpebral conj = Arlt's line
52
what is this?
herbert's pits
53
what is this?
Arlt's line
54
how do you treat the 2 forms of chlamydial conjunctivitis?
1) single dose of oral azithromycin 2) daily dose of doxycycline , erythromycin, or tetracycline for 1-2 weeks 3) can use topical antibiotics if cornea involved f/u every 24 hours - few days
55
signs of viral conjunctivitis
follicles + lymphadenopathy
56
treatment of viral conjunctivitis
self- limiting only treat symptoms ATs for comfort steroids for inflammation
57
what is adenovirus conjunctivitis?
the most common cause of pink eye/ viral conjunctivits
58
how long is adenoconjunctivitis contagious for?
14 days - highly contagious
59
symptoms of adenoconjunctivits
hx of recent illness FBS , itching, burning
60
what are the 3 types of adenoconjunctivits?
nonspecific EKC pharyngoconjunctival fever
61
what is nonspecific Aadenoconjunctivits?
most common type of adenoconjunctivits
62
what is Epidemic keratoconjunctivits what are the signs/symptoms
EKC = sub epithelial infiltrates - see 2-3 weeks after infection - when you see these infiltrates mean no longer infectious - severe pain
63
what are signs of SLK?
bilateral, chronic, recurrent redundant, keratinized, thickened superior conj filaments micopannus spk on cornea
64
what is pharyjgoconjunctival fever?
swimming pool conjunctivitis also has fever _ sore throat/pharyngitits
65
what is the treatment of adenoviral conjunctivitis ?
followed for 2-3 weeks. avoid contact with people. clean bedsheets and towels
66
what is this?
molluscum contagiosum
67
what causes molluscum contagiosum?
dna pox virus
68
what should you suspect if you see multiple lesions of molluscum contagiosum?
HIV
69
what happens when one of the molluscum contagiosum nodules ruptures?
can lead to annus and chronic conjunctivitis !
70
what is a pannus?
fibrous vascular tissue growth over the cornea
71
how do you treat molluscum contagiosum?
remove nodules
72
what is HIV testing?
western blot ELISA
73
What is conjunctival intraepithelial neoplasia?
CIN leads to squamous cell carcinoma
74
what is this?
conjunctival intraepithelial neoplasia
75
what is the most common conjunctival malignancy in the US?
conjunctival intraepithelial neoplasia
76
what causes CIN and squamous cell carcinoma (SCC)?
smoking UV HPV
77
what is this?
squamous cell carcinoma
78
who gets conjunctival intraepithelial neoplasia and SCC?
old white males if you see it under the age of 50 - suspect HIV
79
how common is it for metastasis and orbital invasion for SCC?
rare!
80
conjunctival intraepithelial neoplasia and SCC + malignant melanoma treatment?
1. MRI and workup so see if orbital invasion - may need exenteration 2. biopsy 3. radiation if recurrent - topical interferon, mitomycin C or 5-fluorouracil
81
what is exenteration?
removal of globe and all the contents of the eye socket (muscles, fat, nerves, eyelids)
82
what is mitomycin C?
DNA synthesis inhibitor - stops growth of cancer cells
83
what does PAM lead to ?
primary acquired melanosis -> malignant melanoma
84
what is this?
malignant melanoma
85
what is malignant melanoma
slow growing, elevated, vascularized pigmented mass
86
where is the first area of metastasis for malignant melanoma secondary to pam?
parotid/submandibular lymph nodes
87
normal tear meniscus size?
0.20 mm or greater
88
normal tear osmolarity
316 mOsm/L or less
89
normal shirmers
> 15 mm without anesthesia (reflex + basal) after 5 mins >10 mm with anesthesia (basal only) limited repeatability - not super useful
90
individuals diagnosed with sjogrens have an increased risk of what?
lymphoma
91
phenol red test
cotton thread is placed in the temporal fornix for 30 sec > 10 mm = NORMAL
92
vitamin A deficiency
can lead to dry eye
93

NBEO step 2 (3 decks)

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