Eye Infections - 5Qs

Question 1

Def. bacterial conjunctivitis

Answer 1

Inflammation of conjunctiva due to bacterial inf

Question 2

List possible etiology of bacterial conjunctivitis (BC)

Answer 2

Mechanical / irritative/ toxic
Allergic
Infectious (bacterial and virus)
Immune mediated
Neoplastic

MAIIN

Question 3

What are the most common bacterial pathogens resp 4 BC in neonates?

Answer 3

C. Trachomatis
H. Influenzae
Staphylococcus aureus
Streptococcus Pnuemoniae
N. gonorrhoeae

C HSSN

Question 4

What are the most common bacterial pathogens resp 4 BC in children?

Answer 4

H. Influenzae
S. aureus
S. pneumoniae

Question 5

What are the most common bacterial pathogens resp 4 BC in adults?

Answer 5

H. Influenzae
S. aureus
S. pneumoniae
Coagulase-negative staph org

Question 6

Name risk factors for BC wrt

• eye
• inf
• sex

Answer 6

Disorders of the tear ducts, eyelids, or tear film

Adjacent inf e.g. Dacryocystitis

Sexual abuse and sex with multiple persons - gonococcal and chlamydia inf

Question 7

What’s the clinical presentation of C. trachomatis in neonates?

Answer 7

Conjunctival inj (dilation of conjunctival vessels) and eyelid edema

Purulent unilateral or bilateral ocular discharge one week after delivery from a chlamydia-infected mother

50% of neonates have chlamydia pnuemoniae

Question 8

What’s the clinical presentation of N. gonorrhea in neonates?

Answer 8

Hyperacute inf

Rapid onset of conjunctival inf and eyelid edema

Eyes glued shut

Corneal involvement and perforation

Question 9

What’s the clinical presentation of H. influenzae in children?

Answer 9

Xtics by concurrent upper respiratory tract inf and conjunctivitis otitis syndrome

75% of children

Question 10

What’s the clinical presentation of S. pneumoniae in children?

Answer 10

Xtics by conjunctivitis-otitis syndrome

Question 11

What’s the clinical presentation of staphylococci aureus in adults?

Answer 11

Associated with chronic blepharo-conjunctivitis

Question 12

List complications BC.

Answer 12

Corneal scarring and perforation

Loss of vision

Question 13

List diagnosis for BC

Answer 13

Comprehensive medical eye exam (Main)

Conjunctival cultures

Smears for cytology and stains (gram, giemsa)

Question 14

When is Conjunctival cultures indicated?

Answer 14

Suspected infectious neonatal conjunctivitis

Recurrent or severe purulent conjunctivitis

Non-responding conjunctivitis

Question 15

When is Smears for cytology and stains (gram, giemsa) indicated?

Answer 15

Suspected infectious neonatal conjunctivitis

Chronic or recurrent conjunctivitis

Suspected gonococcal conjunctivitis

Question 16

What pathogens cuz BC that need to be treated systematically?

Answer 16

N. gonorrhoeae

C. trachomatis

Question 17

When is topical tx preferred in BC?

Answer 17

Non-chlamydial and non- gonorrhoeae causes of BC

Question 18

What medication should be avoided in BC?

Answer 18

Corticosteroids - may worsen herpetic keratitis

Question 19

What’s the 1st line for BC caused by N. gonorrhoeae in neonates, children and adults?

Answer 19

Ceftriaxone

Question 20

What’s the 1st line for BC caused by C. trachomatis in neonates and children < 45kg?

Answer 20

Erythromycin/ ethylsuccinate (EES, Ery-Tab, Erythrocin)

Question 21

What’s the 1st line for BC caused by C. trachomatis in children > 45kg but < 8yr, children >= 8yr and adults?

Answer 21

Azithromycin (Zithromax)

Question 22

List topical tx options for BC.

Answer 22

Bacitracin ung

Ciprofloxacin ung

Question 23

What pt education is applicable to BC?

Answer 23

No contact lenses

Avoid rubbing and touching eyes to spread inf

Question 24

What is the etiology of Viral Conjunctivitis (VC)

Answer 24

Adenoviral

Herpes Simplex Virus (HSV)

Varicella Zoster Virus (VZV)

Molluscum contagiosum

Question 25

Name risk factors for VC?

Answer 25

Blepharitis (eyelid inflammation) Poor hand hygiene Other causes of ocular surface inflammation Dry eye B- POD

Question 26

What are the clinical presentations of Adenoviral?

Answer 26

ABRUPT onset Lymphadenopathy, petechial, and subconjuntival hemorrhages

Question 27

What are the clinical presentations of HSV?

Answer 27

Unilateral conjunctival inj, watery discharge Vesicular rash or ulceration of eyelids

Question 28

What are the clinical presentations of VZV?

Answer 28

Unilateral or bilateral conjunctival inj, watery discharge Vesicular rash or ulceration of eyelids

Question 29

What are the clinical presentation of Molluscum contagiosum?

Answer 29

Unilateral or bilateral Shiny dome-shaped lesion of eyelid

Question 30

What are the complications of VC?

Answer 30

Scarring, infiltrates and necrosis Perforation Uveitis Keratitis Loss of vision

Question 31

How do you diagnose VC?

Answer 31

Comprehensive medical eye evaluation Culture NOT routinely done in VC

Question 32

What should be avoided in the treatment of VC?

Answer 32

Topical AB and topical corticosteroids

Question 33

How do you treat VC caused by Adenoviral?

Answer 33

No effective tx

Question 34

What may be considered in Adenoviral?

Answer 34

Sx control e.g. Artificial tears Topical antihistamine Cold compresses

Question 35

How do you treat VC caused by Molluscum contagiosum?

Answer 35

Req Surgical removal of lesions

Question 36

How do you treat VC caused by HSV?

Answer 36

Trifluridine 1% solution (Viroptic) Acyclovir (Zovirax)

Question 37

How do you treat VC caused by VZV?

Answer 37

Acyclovir (Zovirax)

Question 38

What's the pt education for VC?

Answer 38

Same as BC

Question 39

Define Blepharitis.

Answer 39

Sty in the eye (inflammation of eyelid)

Question 40

What's the etiology of Blepharitis?

Answer 40

Staphylococcus epidermidis S. aureus Seborrheic Meibomian gland dysfunction (MGD).

Question 41

Name risk factors for Blepharitis.

Answer 41

Rosacea (main RF) Aqueous tear deficiency Isotretinion (Accutane) Contact lens associated conjunctivitis

Question 42

What's the clinical presentation of Blepahritis caused by staphylococcus?

Answer 42

Scaling crusting of the eyelid Loss and misdirection of eyelashes, eyelid scarring Conjunctival injection, tear deficiency, corneal involvement

Question 43

What's the main complication of Blepharitis?

Answer 43

Keratitis

Question 44

How do you diagnose Blepharitis?

Answer 44

Same as VC.

Question 45

When is culture indicated in Blepharitis?

Answer 45

Recurrent B with severe inflammation Hx of non-response to AB

Question 46

What's the preferred tx for B?

Answer 46

Topical AB e.g. Bacitracin or Erythromycin X 1 week

Question 47

What's the recommended tx for chronic MGD Blepharitis?

Answer 47

Doxycycline Monocycline

Question 48

When is the recommend tx for chronic MGD Blepharitis contra-indicated?

Answer 48

Pregnancy Lactation Children < 10yr

Question 49

Name the 4 main pathogens responsible for Bacterial Keratitis.

Answer 49

Gram tve cocci Gram tve bacilli Gram - ve bacilli Gram -ve coccobacilli

Question 50

What's the clinical presentation of Bacterial keratitis?

Answer 50

Eye redness, pain and swelling Ocular tearing or discharge Increased light sensitivity Blurry vision

Question 51

What the complication of BK?

Answer 51

Corneal scarring, irregularities, perforation Endophthalmitis Loss of vision

Question 52

How's BK diagnosed?

Answer 52

Comprehensive medical eye exam

Question 53

When's culture and smears needed for BK?

Answer 53

Large extensive corneal infiltrate Chronic or non-responsiveness keratitis Atypical clinical presentation Unusual hx Sight-threatening or severe keratitis

Question 54

When's corneal biopsy indicated?

Answer 54

Non-responsive and has negative cultures

Question 55

What is the preferred route of tx for BK?

Answer 55

Topical AB eyedrops or ointment

Question 56

What's the preferred tx for BK caused by no m.o. Identified or multiple m.o. identified? And Gram tve cocci

Answer 56

Cefazolin

Question 57

What's the preferred tx for BK caused by gram tve bacilli - Mycobacterium species?

Answer 57

Amikacin

Question 58

What's the preferred tx for BK caused by gram - ve rods?

Answer 58

Tobramycin or Gentamicin

Question 59

What's the preferred tx for BK caused by gram -ve cocci?

Answer 59

Ceftriaxone

Question 60

What AB is reserved for if all else fails in BK tx?

Answer 60

Topical corticosteroids