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Flashcards in random dobies info Deck (32):
1

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

2

what does phlyctenular keratoconjunctivities result from

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

3

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

OTC vasoconstrictors

4

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

5

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)

6

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

don't use steroid more frequently than the antibiotic

7

symptoms to look for in bacterial keratitis

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

8

abnormal signs in bacterial keratitis

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

9

what would you use to treat secondary iritis

cycloplegia, DO NOT USE steroids!

10

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

11

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

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

12

what do steroids do?

speed the healing and reduce corneal scarring by decreasing inflammatory response

13

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

ulcer bed is open

14

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

15

primary herpes simplex

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

16

for primary herpes simplex, take NO action with antivirals when

pt has conjunctivitis only without keratitis

17

herpes simplex keratitis primary symptoms and abnormal signs

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

18

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

19

treatment for HSK

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

20

treatment for mild keratitis SPK only

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

21

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

22

when using Zirgan for therapy...

pt should not wear contact lenses

23

HSV interstitial keratitis

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

24

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

25

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

26

for HSK stroma scarring when are steroids ok?

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

27

HSK interstitial keratitis ok to use steroids if

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

28

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

29

Chickenpox/Herpes zoster virus symptoms

fever, malaise, severely itchy skin rash

30

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

31

Reye's syndrome and aspirin

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

32

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