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Flashcards in Conjunctiva/Cornea Deck (19):
1

Episcleritis
- diffuse
- nodular

- young adults, recurring
- benign, self-limiting, acute, unilateral, sectoral, mild pain
- blanches with 10% phenyl

Causes:
- idiopathic
- collagen vascular disease (CRAP)
- spirochetes (syphilis, Lyme)
- virus
- metabolic/gout
- vasculitis

2

Scleritis
a) non-necrotizing
b) necrotizing
c) granulomatous

- female 30-50 years old
- severe boring pain to side of head/face

a) Non-Necrotizing:
- diffuse (least severe systemic) vs nodular (immobile)

b) Necrotizing:
- with inflammation: deadly, 33% die within a few years due to SEVERE autoimmune disease
- without inflammation: scleromalacia perforans - due to chronic RA, minimal injection, large patches of blue-grey thinning, lack of symptoms

c) Granulomatous:
RA > Wegener's

3

Differentials for epiphora with mild to no pain.

- blepharitis
- ectropion
- dry eye disease
- nasolacrimal duct obstruction
- conjunctivitis

4

Differentials for epiphora with moderate to severe pain.

- corneal pathology
- anterior uveitis
- dacrycosystitis
- entropion with trichiasis

5

Dacryocystitis

- unilateral, painful, crusting, epiphora and occasional fever
- below medial canthal tendon (if above, suspicious for lacrimal sac tumour)

6

Canaliculitis

- unilateral, epiphora, mild tenderness, swollen puncta ("pouting puncta")
- mucopurulent discharge upon lacrimal sac expression
- smoldering red eye
- resistant to topical ophthalmic antibiotic

Caused by Actimoyces israelii

7

Most common cause of dacryocystitis

- Staphylococcus aureus
- Staphylococcus epidermis
- Pseudomonas
- Haemophilus influenzae in children

8

Jones I Test

- checks patency of the nasolacrimal system
- fluorescein on inferior fornix, drain in 5 minutes

Positive = patent nasolacrimal, fluorescein drains out
Negative = no draingage

9

Jones II Test

- nasolacrimal irrigation with saline following negative test

- reflex of saline from same canaliculus and punctum indicates blockage within canaliculus
- reflex of saline from opposite canaliculus and punctum indicate nasolacrimal blockage

10

What condition gets "Trantas dots"? What is it?

- collections of epithelial cells and eosinophils near the limbus
- VKC

11

Causes of GPC

Immune mediated response:
- protein deposits
- mechanical trauma

Other causes:
- blebs
- prosthetics
- scleral buckles
- sutures

12

What is a giant papillae?

> 1mm in diameter; forms when neighbouring papillae break down septae and coalesce together after prolonged inflammation

13

Risks of GPC

- EW hydrogel contact lenses
- high water-ionic lenses
- higher modulus of elasticity
- poor replacement compliance

14

Ophthalmia neonatorum

Acute conjunctivitis within the first month of life. Can be caused by:

1) Gonoccocal - occurs within first 5 days
2) Chlamydia - 5 days - 2 weeks after.

15

What is "Bitot's Spot"?

Keratin build-up in the epithelium due to Vitamin A deficiency and associated with dry eye.

16

Common associations for:
Acute, anterior, unilateral, non-granulomatous uveitis

- Psoriatic arthritis
- Ankylosing spondylitis
- Inflammatory bowel disease
- Reactive arthritis
^ also commonly HLA-B27 positive

- Behcet's disease
- Glaucomatocyclitic crisis (Posner-Schlossman syndrome)

17

Common associations for:
Chronic, anterior, non-granulomatous uveitis

- Fuch's heterochromic iridocylcitis (unilateral)
- Juvenile idiopathic iritis (JIA)

18

Common associations for:
Chronic, anterior, granulomatous uveitis

- Sarcoidosis
- Tuberculosis
- Lyme
- Zoster/Simplex
- Syphilis

19

Causes of Peripheral Ulcerative Keratitis (PUK)

- collagen vascular disease
- rheumatoid arthritis
- granulomatosis
- SLE
- GCA
- relapsing polychondritis