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Abnormal Ocular Conditions > Cornea > Flashcards

Cornea Flashcards

(36 cards)

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1
Q

Name the 3 types of microbial keratitis?

A
  1. Bacterial
  2. Viral
  3. Acanthamoeba
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2
Q

Define Keratitis

A

Inflammation of the cornea

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3
Q

Which bacteria is commonly related to CL infections?

A

Pseudomonas Sp (Gram -ve)

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4
Q

What are the predisposing factors for Microbial Keratitis?

A
  • CL wear (esp soft/extended wear lenses)
  • Ocular trauma/surgery
  • Lid margin infection
  • Ocular surface disease
  • Poor hand/case hygeine
  • Immune response
  • Topical steroids
  • Neurotrophic keratopathy (2ndry to HSV/Diab)
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5
Q

State the symptoms seen in Microbial Keratitis

A
  • Pain
  • Redness
  • Photophobia
  • Discharge (mucopurulent/purulent)
  • Blurred vision
  • White spot on cornea (ulcer)
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6
Q

What are the signs of Microbial Keratitis

A
  • Lid oedema
  • Epiphora
  • Corneal ulcer - usually single/ central-mid peripheral
  • excavation of epithelium
  • stromal infiltration
  • stromal oedema (folds in DM)
  • Anterior chamber activity - cells/flare/hypopyon
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7
Q

Optometric Management of Microbial Keratitis

A
  • same day referral to HES (sight threatening)
  • px advice/education
  • stop CL Wear
  • take CLs/Case to lab for cultures
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8
Q

Secondary management of Microbial Keratitis

A 
* corneal scrape/culture
BACTERIAL KERATITIS: 
* Antibiotics
* hospital admission - severe cases/compliance issues
* cycloplegia
* topical steroids - once infection controlled 
FUNGAL KERATITIS:
*combined topical/oral therapy
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9
Q

Name the 3 viruses responsible for viral Keratitis

A
  1. Herpes Simplex Virus (HSV)
  2. Herpes Zoster Virus (HZV)
  3. Adenovirus
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10
Q

What are the general predisposing factors of viral keratitis?

A
  • poor general health - immunodeficiency

* steroids/immunosuppressants

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11
Q

Name the typical predisposing factor for HSV

A

Previous Ocular HSV

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12
Q

State the peak incidence for HZV

A

50-70 Yr olds

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13
Q

State the typical predisposing factors for Adenovirus

A
  • Exposure to infection (Highly infectious)

* Upper respiratory tract infection

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14
Q

What are the symptoms for Viral keratitis

A
  • Redness
  • Epiphora
  • +/- blurred vision
  • Mild-moderate burning
  • Photophobia
  • Variable levels of pain
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15
Q

What are the SIGNS for viral keratitis

A
  • Conjunctival Hyperaemia
  • Corneal Ulcer
  • Epiphora/watery discharge
  • Keratitis
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16
Q

How would you manage Viral keratitis?

Study These Flashcards
A

If corneal involvement –> sight threatening

Same day EMERGENCY Referral

17
Q

What are the symptoms for HSK?

Study These Flashcards
A
  • specific symptoms (variable severity)
  • usually unilateral
  • irritation - pain
  • decreased corneal sensation
18
Q

Which part of the cornea does the HSK commonly affect?

19
Q

What are the ‘early’ signs of HSK

Study These Flashcards
A
  • Coarse punctate

* stellate pattern

20
Q

What are the ‘late’ signs of HSK

Study These Flashcards
A
  • Dendritic branching pattern (stromal infiltrates)
  • Geographical ulcer can follow
  • Reduced corneal sensitivity
  • Recurring
  • Heals 1-2 wks with scarring
21
Q

How would you manage a HSK px in clinic

Study These Flashcards
A
  • stromal involvement - same day referral
  • no stromal involvement - urgent referral (within 1 wk)
  • dilate - exclude viral retinitis (same day referral)
22
Q

what would the 2ndry management involve for HSK

Study These Flashcards
A
  • Swab/Biopsy
  • Antivirals - topical/systemic
    (Aciclovir 5x daily - 1wk)
  • Topical steroid AFTER initial treatment
23
Q

What are the general symptoms for HZO

Study These Flashcards
A
  • Pain/altered sensation of one side of forehead
  • vesicular rash - affecting forehead/upper eyelid
  • general malaise/HAs/fever
24
Q

What are the ocular symptoms for HZO

Study These Flashcards
A
  • discomfort/pain
  • watery/sticky discharge
  • photophobia
  • Redness
  • +/- blurring
25
What are the cutaneous signs of HZO
* Vesicular rash - unilateral/painful - forehead/upper eyelid * crusts in 2-3 wks * Hutchinson's sign
26
What are the ocular signs of HZO
* Mucopurulent conjunctivitis ( with vesicles on lid margin) * keratitis - PEE -- Disciform pseudodendrites * reduced corneal sensation * endothelial changes / keratic percipitates OTHER: * Uveitis * 2ndry glaucoma * Episcleritis/Scleritis * Posterior segment involvement
27
Optometric management of HZO
* Urgent referral - systemic anti-viral treatment (<72hrs) - corneal involvement / high IOP/ Anterior uveitis - risk of infecting others with chickenpox * Rest/general support * Topical lubricants * Systemic pain relief (paracetamol/ibuprofen)
28
State the signs of Adenovirus keratitis
* punctate epithelial keratitis (sub-epithelial opacities over time) * follicular conjunctivitis (upper/lower eyelids)
29
Management of viral keratitis caused by Adenovirus
* significant keratitis (pain/vision loss) - EMERGENCY referral * typically self-limiting * advise hygiene (no sharing towels etc) * antibiotic INEFFECTIVE * Topical steroids controversial (but may be given in some cases to reduce keratitis)
30
Where can Acanthamoeba be found
* well water * Swimming pools * Tap water * drains * soil * dust
31
What are the predisposing factors of Acanthamoeba induced viral keratitis
* Soft CL - extended wear * poor CL hygiene * water contact - esp whilst wearing CLs /with corneal abrasion - e.g. during swimming /showers
32
What are the typical symptoms seen with acanthamoeba viral keratitis
* pain (disproportionate to signs) * redness * watering * photophobia * vision loss * may be bilateral/ long history (misdiagnosis)
33
Early signs of Acanthamoeba keratitis
* Epithelial/sub-epithelial infiltrates * pseudodendrites * radial keratoneuritis * recurrent breakdown of corneal epithelium
34
Late signs of Acanthamoeba
* deep corneal inflammation * central/paracentral ring shaped infiltrate , disciform infiltrate/abscess * stromal thinning * scleritis - 10% - poor prognosis * anterior chamber activity (cells/flare/hypopyon/2ndry glaucoma/hyphema) * unresponsive to antibiotics/ steroids
35
Optometric management of Acanthamoeba keratitis
* stop all CL wear | * EMERGENCY referral
36
2ndry Management of Acanthamoeba keratitis
* anti-oemebic drug | * antibiotics - 2ndry infection

Abnormal Ocular Conditions (1 decks)

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