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?
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
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
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