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corneal infiltrative events Flashcards

1
Q

what is an infiltrate?

A

white blood cells in conreal tissue due to inflammatory response to bacterial toxins

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2
Q

what is a corneal ulcer?

A

epithelial defect with underlying inflammation

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3
Q

are corneal ulcers infective?

A

can be non-infective or infective

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4
Q

what are the 3 different ways to classify CIEs?

A

ulcerative vs non-ulcerative
suppurative vs non-suppurative
central vs peripheral keratitis

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5
Q

how does a corneal ulcer form?

A

too much colonising bacteria on the CL, causes build up of endotoxins, which are trapped between CL and epithelium, then go into the epithelium, which triggers WBC response

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6
Q

what is a disadvantage of describing a CIE as ulcerative vs non-ulcerative?

A

lack of agreement over definition of ‘ulcer’

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7
Q

what does suppurative mean?

A

produces discharge (pus)

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8
Q

what is a disadvantage of describing a CIE as suppurative vs non-suppurative?

A

not all MK cases have discharge

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9
Q

what is a disadvantage of describing a CIE as central vs peripheral?

A

not always reliable indicator of whether infiltrate is sterile or not

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10
Q

what are asymptomatic infiltrates?

A

infiltrates in patients without symptoms

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11
Q

are asymptomatic infiltrates only in CL wearers?

A

no - can be in non-CL wearers too

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12
Q

what are asymptomatic infiltrates usually caused by?

A

environmental factors e.g air pollution

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13
Q

signs of asymptomatic infiltrates?

A

1 or more small discrete grey-white patches usually in periphery

intraepithelial

formed from inflammatory cells

no other signs of inflammation

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14
Q

symptoms of asymptomatic infiltrates?

A

none you donut

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15
Q

management of asymptomatic infiltrates?

A

px lens care review
review is concern over compliance or a larger number of infiltrates

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16
Q

what does this image show?

A

asymptomatic infiltrates

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17
Q

signs of asymptomatic infiltrative keratitis (AIK)?

A

small focal infiltrates up to 0.4mm
sub-epithelial
may be small punctate staining
mild limbal and/or bulbar redness

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18
Q

how to differentiate between AIK and AI?

A

sub epithelial in AIK, intraepithelial in AI
-also size on infiltrates in AI (<0.2mm) and AIK (<0.4mm)

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19
Q

management of AIK?

A

review lens care
review fitting and advise against sleeping in lenses

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20
Q

symptoms of AIK?

A

NONE YOU FRESHY

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21
Q

what does this image show?

A

AIK

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22
Q

who is AIK more common in?

A

those wearing lenses for 12-14 hours +
or sleeping in lenses

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23
Q

what do you say to a px with AIK?

A

you have signs of an inflammatory reaction, this is common if you get build up of toxins on the lenses which usually occurs when we aren;t cleaning the lenses as much as needed …. then go on to talk about your management or whatever

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24
Q

what is infiltrative keratitis?

A

inflammatory reaction of the conrea charaacterised by anterior stromal infiltration, with or without epithelial involvement, in the midperiphery to periphery of the cornea

25
what does this image show?
infiltrative keratitis
26
signs of infiltrative keratitis
single (or multiple) small round infiltrates in epithelium or anterior stroma may be unilateral or bilateral sectoral bulbar and/or limbal hyperaemia epithelium generally doesn't stain
27
symptoms of infiltrative keratitis
minor infiltrates = asymptomatic discomfort FB sensation irritation mild photophobia lacrimation symptoms reduce on lens removal
28
management of infiltrative keratitis
remove the cause cease lens wear use of lubricants for symptomatic relief and to flush out any toxins in the eye treat marginal disease monitor progress
29
what is CLARE?
cl induced acute red eye inflammatory reaction of the cornea and conjunctiva immediately following a period of eye closure with CL wear due to endotoxins from gram negative bacteria
30
signs of CLARE
acute, unilateral circumferential bulbar conjunctival hyperaemia small mid-peripheral infiltrates SEVERE = mild anterior chamber involvement
31
symptoms of CLARE
wake up in middle of the night with painful red eye lacrimation photophobia FB sensation
32
management of CLARE
self-limiting remove lens monitor 12-24 hours to ensure correct diagnosis ocular lubricants address lens compliance and lid hygiene as appropriate daily wear - possible refit prognosis good
33
cause of CLARE
usually sleeping in lenses
34
what is CLPU
inflammatory reaction with focal excavation of the epithelium, infiltration and necrosis of the anterior stroma
35
in CLPU which layer of the cornea remains intact>
bowmans layer
36
signs of CLPU
unilateral single (usually) small sterile infiltrate in the peripheral cornea (<1.5mm) clear cornea between ulcer and limbus epithelium may stain defined margins mild sectoral hyperaemia no lid oedema SEVERE = mild AC reaction
37
symptoms of CLPU
50% = asymptomatic possible FB sensation mild photophobia lacrimation general lens intolerance
38
management of CLPU
cease lens wear until resolves (~2weeks) self-limiting byt careful monitoring over first 24-48 hours due to MK risk ocular lubricants possible prophylactic antibiotics??? treat any lid margin disease address compliance regime - consider modality good prognosis - corneal scar likely
39
which modality of lens are you more likely to get a CLPU
extended wear lenses
40
associations of CLPU
bacterial contamination hypoxia tight lens poor hygiene
41
why is extended wear associated with CLPU?
the longer you are wearing the lenses, the more the cornea is exposed to endotoxins on the lens = inflammatory reaction
42
what is MK?
microbial keratitis INFECTION of the cornea characterised by excavation of the corneal epithelium, BOWMANS LAYER and stroma with infiltration and necrosis of tissue
43
which 2 bacterias are associated with microbial keratitis?
pseudomonas (gram -ve) staphylococcus (gram +ve)
44
other types of keratitis?
acanthameoba viral fungal
45
does MK or CLPU have a larger infiltrate?
MK (>1.5mm)
46
signs of MK
large infiltrate central or paracentral irregular appearance ill-defined margins unilateral severe hyperaemia lid oedema mucopurulent discharge AC flare often present
47
symptoms of MK
pain, acute onset, rapid progression very red reduced vision lacrimation photophobia mucopurulent discharge
48
how do you differentiate between CLPU and MK???
49
management of MK
cease lens wear refer to A&E - corneal scrapes TAKE CL CASE TO A&E px will require dialy follow up (possibly kept overnight) until condition resolves topical antibiotics dual therapy - combination of 2 antibiotics for gram +ve and -ve no lens wear until resolved consider dailies
50
signs of acanthamoeba keratitis
begins as a nonspecific keratitis with infiltrates along the conreal nerves in a radial pattern ring infiltrate typicaly appears later in the disease process
51
symptoms on acanthamoeba keratits
SAME AS MK pain, acute onset, rapid progression very red reduced vision lacrimation photophobia mucopurulent discharge
52
management of acanthamoeba keratits
immediate referral to HES mistaken for HSK culture maybe taken treated with broad spectrum antibiotics
53
what are the most common pathogens for fungal keratits
candida or fusarium
54
who is most likley to get fingal keratits
immune disorder
55
which has a slower onset: bacterial or fungal keratitis
FUNGAL
56
which keratitis is associated with trauma with vegatative material?
FUNGALs
57
signs of fungal keratitis
unilateral hyperaemia lacrimation hypopyon lid oedema
58
symptoms of fungal keratitis
pain photophobia vision reduction FB sensation
59
management of fungal keraittis
cease lens wear emergency referral topical anti-fungals may require corneal graft take lens case with you to A&E

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