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Flashcards in random dobies info Deck (32):

when do you not use steroids alone

epithelial herpes simplex keratitis (no exceptions), active bacterial or fungal infection, large corneal epithelial defects, when you are unsure of diagnosis


what does phlyctenular keratoconjunctivities result from

TB, GI parasites or Type IV reaction to staphylococcal antigens. thus, must treat agressively!


if the condition is mild, how do you treat phlyctenular keratoconjunctivities?

OTC vasoconstrictors


signs of marginal corneal infiltrates

lid disease, collarettes, madarosis, trichiasis, plugged meibomian gland, clear zone between infiltrate and limbus, 4 to 8 arc where lids cross limbus


what would you give pt to decrease risk of corneal breakdown due to poor tear film

artificial tears (do this for pt with marginal corneal infiltrates)


when treating marginal corneal infiltrates what should you remember for treatment?

don't use steroid more frequently than the antibiotic


symptoms to look for in bacterial keratitis

R red eye
S sensitive to light
V vision change
P pain


abnormal signs in bacterial keratitis

AC cells and flare (hypopyon)
focal stromal infiltration surrounding excavation


what would you use to treat secondary iritis

cycloplegia, DO NOT USE steroids!


name an antibiotic-steroid drug and what it is used for

TobraDex or TobraDex ST; used for cases when you shouldn't use steroids alone


exceptions to steroid guidelines- using antibiotic + steroid (combo or separate)

epithelial Herpes Simplex Keratitis (NO EXCEPTIONS)
bacterial infections if significant concurrent secondary inflammation peresent


what do steroids do?

speed the healing and reduce corneal scarring by decreasing inflammatory response


for steroids to be useful they must be used while....

ulcer bed is open


signs of ulcer getting better

infiltrate shrinks, epithelium fills in, pt feels better (decrease RSVP), any AC reaction cell and flare is reduced); this is when you taper off drops


primary herpes simplex

aquired from enviornment. treat with warm saline soaks, drying agents (Burow's solution), and no steroids


for primary herpes simplex, take NO action with antivirals when

pt has conjunctivitis only without keratitis


herpes simplex keratitis primary symptoms and abnormal signs

RSVP, decreased corneal sensation, dendritiform/dendritic, conjunctivitis, chemosis, +RB stain at edges, central +NaFl pooling


ghost dendrites

seen in HSK. Term given to SEIs which have similar shape to that of epithelial lesions. SEIs develop beneath epithelial dendrites. Pt may have decreased sensitization where the ghost dendrites are located


treatment for HSK

acyclovir and other PO antivirals, topical ophthalmic trifluridine or ganciclovir, or observation alone `


treatment for mild keratitis SPK only

without dendrites use Viroptic QID, Zirgan TID as prophylactic agent. can use vasoconstrictors, lubricants, cool compresses. NO STEROIDS


treatment for HSK dendritic keratitis

Zirgan: 1gtt 5x/day until decrease in RB staining and re-epithelialization occurs, then 1gtt 3x/day for 7 days longer consider the dose change!
Viroptic: 9gtt/day for 3-4 days; start taper slowly with decreased RB staining and start of re-epithelialization in 5-6 days. continue taper QID 3 days, TID 3 days, BID 3 days


when using Zirgan for therapy...

pt should not wear contact lenses


HSV interstitial keratitis

syndrome of three corneal findings: stromal infiltration, thinning, neovascularization associated with recurring HSK (sign is most often associated with systemic syphilis)


recurrent Herpes Simplex Keratitis

can damage the epithelial BM and anterior stroma. pt may develop a post infectious keratopathy known as a trophic, indolent or metaherpetic ulcer


treatment plans for recurrent HSK

gangciclovir (Zirgan gel)
trifluridine (Viroptic sol)
vidarabine (Vira-A ung): continued 5-7 days after complete resolution
idoxuridine (Herplex sol, Stoxil ung): continued 5-7 days after complete resolution --> most toxic, least effective
oral acyclovir 400mg BIDx12 months


for HSK stroma scarring when are steroids ok?

stromal scarring, edema (make sure to pre-sterilize before)
if iritis presents with keratic percipitates


HSK interstitial keratitis ok to use steroids if

iritis is progressing in severity or visual axis is threatened AND steroids have been previously used


HSK trophic ulcers treatment

occurs from damaged BM and poor healing. protect cornea from lid abrasion with bandage soft lens. broad spectrum antibiotic drops BID while lens is in place, artificial tears QID


Chickenpox/Herpes zoster virus symptoms

fever, malaise, severely itchy skin rash


related symptoms/signs for herpes zoster virus

generalized nondermatomal distribution, infection by human herpesvirus 3, highly contagious and generally a childhood disease, distinguish primary varicella


Reye's syndrome and aspirin

rare and severe complication of flu and other viral diseases. 30% fatality rate. thus not recommended for chicken pox


distinction between varicella zoster (shingles) and herpes simplex disease

varicella zoster virus infection is the prime target disease of antivirals. simplex requires less antiviral to achieve virucidal levels