infections

Question 1

Most common organism in preseptal cellulitis

Answer 1

Staph Aureus

Question 2

most common cause of proptosis in children

Answer 2

orbital cellulitis

Question 3

orbital cellulitis

Answer 3

often secondary to sinusitis
can have associated subperiosteal abscess
Fevers, decreased VA, RAPD, proptosis, pain with eye movements, restricted EOM, optic disc swelling

Question 4

organisms most commonly causing orbital cellulitis

Answer 4

Staph aureus (most common in children)
Strep pneumo
fungi (phycomycetes - most aggressive)

Question 5

Ophthalmia Neonatorum

Types and time spans

Answer 5

Within first month
papillary conj (cant have follicular reaction 2/2 immature immune system)
Chemical - 0-24 hrs - silver nitrate or povodine iodine
Nessaria Gonorrhea - 1-2 days - Hyperacute conjunctivits
Other bacterial 4-5 days - strep, staph, h. flu, enterococci
HSV - 5-14 days (70% type 2)
Chlamydia 5-14 days - most common neonatal infection

Question 6

Ophthalmia neonatorum

Diagnosis and treatment by type

Answer 6

chemical - no tx
gonococcal - Gram neg intracellular diplococci,
IV ceftriaxone for 7 days, bacitracin oint
bacterial - GS/culture erythromycin/bacitracin oint
HSV - scraping with multinucleated giant cells
IV acyclovir, for 10 days + Zirgan/Viroptic
Chlamydia - gram pos intracytoplasmic inclusions on Giemsa stain
Azithromycin PO, topical erythromycin

Question 7

Prophylaxis against ophthalmia neonatorum at birth

Answer 7

topical tetracycline or erythromycin ointment at birth

Question 8

Pediatric bacterial conjunctivitis - organisms

Answer 8

H Flu (50-65%)
Strep Pneumo (20-30%)
Moraxella (10%)
Staph - rare

Question 9

Vernal Keratoconjunctivitis

Answer 9

seasonal allergic conjunctivitis (warm months)
M > F
RF: Atopic dermatitis and atopy
Findings: Horner trantas dots (eosinophils at limbus) cobblestone papilla on tarsus, limbal follicles, pseudomembranes
Shield ulcer

Question 10

Ligneous conjuncitvitis

Answer 10

rare bilateral psudomembranous conjunctivitis in young girls
Exaggerated response after injury surgery or trauma
white thinckened avascular ligneous mass with highly vascularized raised, friable lesion on peripheral conj
affects all mucous membranes

Question 11

Kawasaki’s Disease

age, race, findings,treatment, associations

Answer 11

children under 5
japanese, but epidemics also with high risk in siblings
fever
bilateral conj, bilateral mild iritis (with perilimbal sparing - hallmark)
cervical lymphadenopathy
oral lesions (strawberry tongue)
rash/desquamation of hands and feet
polyarthritis
TX: aspirin
assoc: coronary arteritis - coronary artery aneurysm (incr risk with steroid tx)

Question 12

Interstitial keratitis

Answer 12

congenital syphilis
starts age 5-20, triggered by minor trauma
3 stages:
progressive - pain, photophobia, KP, ciliary flush, ground-glass corneal opacity
florid - cute inflammatory respons - salmon patch of hutchinson (deep vascularization makes cornea look pink)
Retrogression - vessels meet at center of K
ghost vessels (stromal, just ant to Descemet’s) - late finding
can get secondary glaucoma from iris/angle damage
Tx - steroids, penecillin

Question 13

congenital syphylis

Answer 13

maternal transmission after 4th month
Interstitial keratitis
ectopia lentis
argyll robertson pupils
optic atrophy
panuveitis with salt and pepper retinopathy (usually)
Systemic: hutchinson’s teeth, frontal bossing, saddle nose, deafness, tabes dorsalis, saber shins

Question 14

Hutchinson’s triad

Answer 14

interstitial keratitis
hutchinson’s teeth (peg-shaped)
deafness

Question 15

HSV

Answer 15

asymptomatic primary infection

ocular involvement in 10% of disseminated disease

Question 16

Perinaud’s oculoglandular syndrome

Answer 16

unilateral
Conjunctival granuloma
lymphadenopathy

Etiology: Cat Scratch fever
Tularemia
Pasteurella
LGV
Mycobacteria
Sperochetes

Question 17

Congenital Rubella

Answer 17

cataracts (bilateral - pearly white nuclear with retention of lens nuclei)
Live virus within lens (extreme inflammation with extraction)
Salt-and-pepper fundus
glaucoma (with not get both cataract and glaucoma)
microphthalmos (15%)

Also: cardiac defects (PDA), deafness, MR