Seminar O - Opthamology Section 2 Flashcards Preview

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Flashcards in Seminar O - Opthamology Section 2 Deck (96):
1

Lids

common conditions

Blepharitis
Chalazion
Malposition

2

Conjunctiva common conditions

Conjunctivitis

3

common conditions Sclera

Episcleritis
Scleritis

4

common conditions Cornea

Keratitis

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common conditions Uveal Tract

Uveitis

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common conditions Trabecular Meshwork

Acute Glaucoma

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Periorbital Skin common conditions

Preseptal cellulitis
Orbital Cellulitis

8

Blepharitis: Definition:







A combination of:
• Infection of the lid margins by staphylococcal bacteria
• Overproduction of sebum by the glands at the lid margin

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Blepharitis: History Presentation

• Chronic ocular irritation
• Watery eye
• Red eye

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Blepharitis: Examination results

• Crusting and scaling of the lash line
• Careful examination can demonstrate plugs of sebum in the meibomian gland orifices.

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Chalazion – a meibomian cyst (lipogranuloma) Definition

Meibomian gland dysfunction

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Chalazion – a meibomian cyst (lipogranuloma) Occurs with

Increased frequency in patients with acne rosacea and seborrhoeic dermatitis

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Chalazion – a meibomian cyst (lipogranuloma) Treatment

Hot Spoon bathing and antibiotics but often chalazia require surgical incision and curettage.

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Malposition:
Definition:

Abnormal position of the lids is extremely common and can often be overlooked as a cause of red eye.

15

Entropion: Definition

Turning inwards of the lid margin
Can affect the upper or lower eyelid
Normal eyelashes cause corneal abrasions

16

Entropion: Causes of entropion include

• Ageing (involuntional)
• Conjunctival scarring (cicatricial)
o Trachoma
o Stevens-Johnson syndrome
o Ocular pemphigoid
• Acute spastic entropion - spasm of orbicularis muscle

17

Conjunctiva: Aetiology


• Bacterial
• Viral
• Chlamydial
• Allergic
• Neonatal
• Iatrogenic

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Conjunctiva: Memorable way to remember causes

Ocular Cicatricial Pemphigoid
Herpes

Gonococcal infection
Ligneous
Adenoviral infection
Diptheria infection

Stevens-johnson syndrome
Candida or chlamidya infection (newborn only)
Alkali burn
Beta-haemolytic streptococcal infection
Springtime (allergic conjunctivitis)

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Bacterial Conjunctivitis: Main symptoms


• Red eye
• Eyelids stuck together
• Minimal pain
• Purulent discharge

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Bacterial Conjunctivitis: On examination

• Red eye
• Purulent discharge
• Conjunctival papillae

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Bacterial Conjunctivitis: Cause

• Staphylococcal aureus
• staphylococcal epidermidis
• streptococcus pneumoniae.

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Bacterial Conjunctivitis: Management

via broad spectrum topical antibiotics such as chloramphenicol or fucithalmic acid.

23

Viral Conjunctivitis: Symptoms



• Red eye
• Watery discharge
• Usually bilateral
• Often preceding coryzal symptoms

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Viral Conjunctivitis: On examination

• Red eye
• Watery discharge
• Conjunctival follicles
• Preauricular lymph nodes
• Keratitis (see later)

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Viral Conjunctivitis: Usual Organisms

o Adenovirus (different serotypes)
o Herpes Simplex Virus (HSV-1)

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Viral Conjunctivitis:Treatment

Conservative – spontaneously resolves in approx. 2 weeks
• Lubricants - can be used for comfort
• Antibiotics (chloramphenicol) - to prevent secondary bacterial infection
• Topical Aciclovir (Zovirax) drops - if HSV-1 has been isolated
• Topical steroid drops - should only be used under ophthalmological supervision, and only if the inflammation is very severe.

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Viral Conjunctivitis: Contagious

Viral conjunctivitis is extremely contagious and patients should avoid touching their eyes, shaking hands with other people as well as sharing hand towels.

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Chlamydial Conjunctivitis → Chlamydia Trachomatis is

An obligate intracellular bacterium with multiple serotypes.

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Chlamydial Conjunctivitis →Serotypes:

Serotypes A-C cause Trachoma (a chronic conjunctivitis, endemic to Africa and Asia)
Serotypes D-K cause Adult inclusion conjunctivitis

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Chlamydial Conjunctivitis →Adult inclusion conjunctivitis

• Young adults
• Possible concomitant urethral or vaginal symptoms
• Transmission is via autoinoculation from genital secretions, although eye-eye spread may occur

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Chlamydial Conjunctivitis →Symptoms

• Unilateral mucopurulent discharge
• The conjunctivitis can become chronic and persist for months if left untreated

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Chlamydial Conjunctivitis →Signs

• Large conjunctival follicles
• Preauricular lymphadenopathy
• Subepithelial corneal deposits

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Chlamydial Conjunctivitis → Treatment:

• Topical erythromycin ointment - 2 weeks
• Referral to GUM clinic for one of the following systemic antibiotic treatment
• Azithromycin single dose
• Doxycycline
• Erythromycin
• Trace sexual contacts

34

Allergic Conjunctivitis: Definition


Seasonal allergic rhinoconjunctivitis (allergen most commonly pollen with onset of 'hayfever' in summer months)
Perennial allergic rhinoconjunctivitis (allergen such as house dust mite may cause symptoms throughout year)

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Allergic Conjunctivitis: Main presenting Symptoms

 Rapid onset
 Itching
 Red eye
 Often in children following exposure to an allergen usually pollen

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Allergic Conjunctivitis: On Examination

• Usually bilateral
• Conjunctival papillae (GIANT)
• Conjunctival Chemosis (Oedema)
• Preauricular lymphadenopathy

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Allergic Conjunctivitis: Treatment

• Topical Antihistamine - e.g: levocabastine
• Topical Mast Cell Stabiliser - e.g: Sodium cromoglycate
• Combination of both antihistamine & mast cell stabiliser - e.g. olopatadine
• Systemic antihistamines
• Topcial steroid use under ophthalmological supervision

38

Follicles

• Significant diagnostic importance
• Hyperplasia of lymphoid tissue
• Translucent avascular mounds of plasma cells and lymphocytes
• Each follicle is encircled by a small blood vessel
• Main causes include:
o Viral infections including HSV
o Chlamydial infections

39

Papillae

• Non-specific and of less diagnostic value
• Hyperplastic conjunctival epithelium thrown into numerous folds
• Central vascular tuft
• Can be large - cobblestone or giant
• Main causes include:
o Non-specific & can be seen in any conjunctival irritation or conjunctivitis

40


Chronic Conjunctivitis:

• Both 'vernal' and 'atopic' keratoconjunctivitis are within a spectrum of chronic allergic conjunctivitis.
• Both result from repeated exposure to an allergen. Symptoms include itching, burning as well as red eye.

41

Vernal Keratoconjunctivitis → description

o Occurs in children
o Seasonal (warm months)
o Associated with family history of atopy (asthma, rhinitis, dermatitis)
o Bilateral
o Ulceration and infiltration of upper cornea

42

Atopic Keratoconjunctivitis → Description

o occurs in adults
o associated with atopy
o bilateral
o can also cause corneal ulceration and scarring

43

Atopic Keratoconjunctivitis → Treatment

Chronic conjunctivitis treatment is similar to that of acute conjunctivitis, but the use of topical and oral steroids is required more often.

44

Neonatal Conjunctivitis (Ophthalmi Neonatorum)

o Occurs in newborns
o Usually infectious secondary to N. gonorrhoeae or Chlamydia. trachomatis

45

Episcleritis → Description

The condition of episcleritits is common, self-limiting, frequently recurrent and occasionally there is an underlying systemic disorder.

46

Episcleritis → Symptoms

• Mild discomfort
• Epiphora (watering)

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Episcleritis →Examination

• Unilateral redness

48

Episcleritis → Treatment

• Observation
• Simple lubricants - usually sufficient for most cases
• Oral NSAIDS
• Topical steroids - may be required in persistent cases

49

Scleritis → Definition

Scleritis is much less common than episcleritis but is far more serious. It is characterised by cellular infiltration of the entire thickness of the sclera. Scleritis is frequently part of a general inflammatory reaction associated with a system immune-mediated collagen vascular disease..

50

Scleritis → Defining difference to episcleritis

EXTREMELY PAINFUL and can wake patient at night

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Scleritis → Pathology

Inflammation of the sclera can progress to ischaemic and necrosis, eventually leading to scleral thinning and perforation of the globe.

52

Scleritis →Aetiology

1. Systemic associations
1. Wegeners Granulomatosis
2. Rheumatoid Arthritis
3. Polyarteritis Nodosa
2. Infections
1. Secondary to corneal ulcers - often pseudomonas aeruginosa
3. Post ocular surgery

53

Scleritis →Symptoms

Similar to episcleritis but pain much more severe often keeping patient awake at night
Localised or Generalised redness

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Scleritis →Clinical Signs

Scleral necrosis and thinning

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Scleritis → Treatment

1. Oral Prednisolone
2. Immunosuppressive agents, e.g. mycophenolate mofetil (cellcept) or azathioprine

56

Keratitis → Definition

Defined as inflammation of the cornea. Because of its potential to permanently impair vision or perforate the eye, a corneal ulcer is considered an ophthalmologic emergency.

57

Keratitis →Aetiology of keratitis

1. Bacterial
2. Viral
3. Fungal
4. Acanthamoeba

58

Keratitis →Risk factors in Bacterial Keratitis

• Contact lens wear
• Trauma
• Compromised ocular surface, e.g. dry eye or blepharitis
• Corneal exposure, e.g. facial nerve palsy
• Immunosuppresion, e.g. topical steroid use

59

Keratitis →Clinical Symptoms

o Purulent conjunctivitis
o Reduced vision

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Keratitis →Clinical Signs

o Corneal ulcer / opacity

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Keratitis →Common Causative Organisms

• Pseudomonas aeruginosa - causes aggressive infections
• Staphylococcus epidermidis
• Sterptococcos pneumoniae
• Haemophilus influenzae

62

Keratitis → Treatment

A bacterial corneal ulcer is a sight threatening condition. Patients are often admitted for intensive treatment.
• Corneal Scrape - should always be taken and sent for M,C & S
• Broad spectrum topical Antibiotics, e.g: Ofloxacin. - initially every hour day an night.
• Topical Steroid therapy - should only be undertaken under ophthalmological supervision. Can be given to help with scarring and necrosis

63

Viral Keratitis →
Herpes Simplex Virus
Description



Primary infection usually occurs in childhood. It is caused by direct transmission of virus through infected HSV secretions. Primary infection is usually subclinical.
Following initial infection, the HSV virus lies dormant within the trigeminal ganglion. A recurrent epithelial keratitis is then caused by reactivation of the latent virus and invasion of the corneal epithelium.

64

Viral Keratitis →
Herpes Simplex Virus
Symptoms and signs

• Painful red eye
• Dendritic ulcer - which may develop into a Geographic ulcer
• Decreased corneal sensation

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Herpes Zoster Opthalmicus: Description







Also known as Shingles, Herpes Zoster Ophthalmicus is caused by the varicella-zoster virus (VZV). Herpes Zoster Ophthalmicus (HZO) accounts for approximately 10% of shingles with infection of the T10 (umbilical) dermatome being more common.
Primary infection usually occurs in childhood in the form of chicken pox. The latter may cause conjunctivitis. Secondary infection (shingles) is caused by reactivation of latent VZV within the trigeminal ganglion. It usually affects the skin causing a cellulitis but may also result in infection of any ocular structure.

66

Herpes Zoster Opthalmicus: Ocular complications

• Conjunctivitis
• Keratitis
• Iritis
• Scleritis
• Secondary glaucoma
• Cranial nerve palsies
• Retinitis

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Herpes Zoster Opthalmicus:Sequelae

• Post herpetic neuralgia
• Recurrent Keratitis

68

Herpes Zoster Opthalmicus: Management

• Oral Aciclovir (zovirax) - reduces duration & severity of disease as well as post herpetic neuralgia
• Topical Steroids - often used for ocular inflammation

69

Adenovirus →

Patients will complain of blurring of vision as well as glare and the lesions may persist following resolution of the conjunctivitis.
The Adenospots often spontaneously resolve but occasionally topical steroids can be utilised to speed up resolution.

70

Fungal Keratitis → Description

In the UK, fungal infection of the cornea is not particularly common. However in developing countries such as India where there are far more agricultural injuries, fungal organisms have been quoted to be the major cause of corneal infections.

71

Fungal Keratitis → Common Pathogens

1. Filamentous fungi - e.g: Aspergillus, Fusarium
2. Candida Albicans

72

Fungal Keratitis → Symptoms

3. Red eye
4. Photophobia
5. Blurred vision
6. Discharge

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Fungal Keratitis →Signs

Filamentous fungi
1. Greyish stromal infiltrate
2. Surrounding satellite infiltrates
Candida
8. Yellow-white ulcer similar to a bacterial keratitis picture
1. Hypopyon

74

Fungal Keratitis →Management

• Topical antifungal agents e.g: Natamycin, Amphotericin
• Corneal graft - in unresponsive cases

75


Acanthamoeba Keratitis → Description




Acanthamoeba is a hardy protozoan organism, which is ubiquitous within the environment, particularly in water.
It is a difficult diagnosis to make and should always be considered in individuals who have been swimming in their contact lenses.

76


Acanthamoeba Keratitis →
Symptoms

Typically symptoms (particularly pain) are disproportionate to ocular signs

77


Acanthamoeba Keratitis →
Clinical signs

• Red eye
• Dendritiform epithelial lesions
• Non-suppurative ring with variable epithelial breakdown (established cases)

78

Uveitis → Definition

As inflammation of the uveal tract which includes the iris, ciliary body and the choroids.

79

Uveitis → Sub classified into

• Anterior Uveitis (Iritis) - inflammation of the iris and anterior chamber
• Intermediate Uveitis - inflammation localised to the vitreous and peripheral retina
• Posterior Uveitis - inflammation of the posterior part of the uveal tract and overlying retina

80

Uveitis → Aetiology

Idiopathic
Infectious
Sarcoidosis
Juvenile Idiopathic arthritis

81

Uveitis → Idiopathic

HLA-B27 associated arthropathies
Psoriatic arthritis
Ulerative collitis
Behcets
Crohns
Ank spond
Reiter syndrome

82

Uveitis →Infectious

• Syphilis
• Tuberculosis
• Syphilis
• Herpes Simplex / Zoster

83

Uveitis →Symptoms

Red eye
Pain
Blurred vision

84

Uveitis →Clinical signs

• Circumcorneal injection (redness)
• Cells within the anterior chamber
• Keratic precipitates (KPs) - clumps of cells on the corneal endothelium
• Posterior synechiae - adhesions between the lens and iris

85

Uveitis → Treatment

Topical steroid drops - e.g: Prednisolone
Dilating drop (mydriatic) - e.g: Cyclopentolate (to try and prevent posterior synechiae formation and ease pain by inhibiting accommodation)

86


Trabecular Meshwork →
Acute Angle Closure Glaucoma Risk Factors



• Elderly
• Female
• Hypermetropic
• Family History

87

Why does an individual get angle closure glaucoma? Symptoms

• Haloes
• Red eye
• Nausea
• Eye pain
And subsequently:
• Vomiting
• Photophobia
• Visual loss

88

Why does an individual get angle closure glaucoma? Signs

Red eye
Corneal oedema (hazy)
Fixed semi-dilated pupil
Shallow anterior chamber
Visual loss

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Why does an individual get angle closure glaucoma? Treatment - Lower intraocular pressure

1. Medical - lower intraocular pressure
1. IV acetazolamide (diamox)
2. Beta Blockers (topical)
3. Pilocarpine (topical) - to both eyes to try and prevent an attack in the fellow eye.
2. Surgical - reverse pathology
1. Laser iridotomy
2. Trabeculectomy

90

Orbital cellulitis Definition

Orbital cellulitis is an ophthalmological emergency. On presentation it is often difficult to distinguish between less severe preseptal cellulites. Orbital cellulitis is usually associated with infection of the paranasal sinuses.

91

Orbital cellulitisSymptoms

• Decreased Vision
• Unwell patient

92

Orbital cellulitisClinical Signs

• Unilateral swollen eyelids
• Decreased Eye Movements (Ophthalmoplegia)
• Proptosis

93

Orbital cellulitis Treatment

• CT scan
• Intravenous antibiotics

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Preseptal Cellulitis → Symptoms

• Swelling
• No Decreased Vision

95

Preseptal Cellulitis →The Clinical signs are that there is no

• Proptosis
• Decrease in eye movements

96

Preseptal Cellulitis →Treatment

• Broad spectrum oral antibiotics

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