Tropical ophthalmology

Question 1

Name examples of HIV associated ocular conditions

Answer 1

HIV microangiopathy
OIs (HSV, VZV, CMV, TB)
Malignancies
- OSSN
- kaposi’s
- lymphoma
IRIS

Question 2

What is OSSN?

Answer 2

Ocular surface squamous neoplasia

Question 3

What are the characteristics of HIV microangiopathy and the treatment?

Answer 3

Retinal haemorrhages
Cotton wool spots
Microaneurysms

Treatment: ARVs

Question 4

Why are OIs common in HIV?

Answer 4

1. Increased susceptibility
2. Increased reactivation of latent organisms
3. Increased pathogenicity of organisms

Question 5

What ocular manifestations can HSV cause?

Answer 5

Keratitis
Uveitis
Retinitis

Question 6

What ocular manifestations can VZV cause?

Answer 6

HZ ophthalmicus
Keratitis
Uveitis
Retinitis

Question 7

What ocular manifestations can CMV cause?

Answer 7

Uveitis
Retinitis

Question 8

What is the clinical characteristic of HSV keratitis?

Answer 8

Dendritic appearance in cornea

Question 9

What is significant regarding HSV keratitis in the HIV population?

Answer 9

Increased incidence
Increased severity
Can be bilateral

Question 10

What is herpes zoster ophthalmicus?

Answer 10

Reactivation in the ophthalmic division of trigeminal nerve

Question 11

Name risk factors for herpes zoster ophthalmicus

Answer 11

Older age
HIV

Question 12

What is the clinical presentation of herpes zoster ophthalmicus?

Answer 12

Papules, vesicles, pustules, crusting
Hutchinson sign
Postherpetic neuralgia
Skin severity does not correspond with ocular severity

Question 13

What is the chance of eye involvement if Hutchinson sign is observed?

Answer 13

80%

Question 14

What is the management of herpes zoster ophthalmicus?

Answer 14

Oral acyclovir within 72h of rash
Oral steroids
Ophthalmologist referral for complications

Question 15

Name long term complications of herpes zoster ophthalmicus

Answer 15

Neurotrophic keratopathy
Lid changes

Question 16

At what CD4 is CMV retinitis most common?

Answer 16

Low Cd4

Question 17

What is the characteristic appearance of CMV retinitis?

Answer 17

Characteristic margherita pizza appearance (vasculotrophic virus)

Question 18

Discuss the management of CMV retinitis

Answer 18

ARVs
Ganciclovir (intravitreal or oral)

Question 19

What is the spectrum of OSSN?

Answer 19

Conjunctival intraepithelial neoplasia
CiS (carcinoma in situ)
SCC (squamous cell carcinoma)

Question 20

Name risk factors for OSSN and which has the highest pathogenecity?

Answer 20

UVB
HIV
HPV (highest pathogenicity)

Question 21

Discuss treatment of OSSN

Answer 21

Excision
Tropical chemotherapy

Question 22

Which virus is Kaposi’s associated with?

Answer 22

HH8

Question 23

What is the management of Kaposi’s sarcoma?

Answer 23

ARVs

Question 24

Which virus is lymphoma associated with?

Answer 24

EBV

Question 25

What is the management of lymphoma?

Answer 25

Excision Radiotherapy

Question 26

Which virus causes molluscum contagiosum?

Answer 26

Poxvirus

Question 27

What can be the complication of molluscum contagiosum?

Answer 27

Follicular conjunctivitis

Question 28

Discuss the management of molluscum contagiosum

Answer 28

Conservative Excision if non-resolving or conjunctivitis

Question 29

What is ophthalmia neonatorum?

Answer 29

Conjunctivitis within 1st month of life

Question 30

Name causes of ophthalmia neonatorum

Answer 30

C. trachomatis N. gonorrhoea HSV

Question 31

Discuss management of ophthalmia neonatorum

Answer 31

Topical chloramphenicol Saline irrigation of conjunctiva Systemic ABs - n. gonorrhoea IV CTX - c. trachomatis PO erythromycin - HSV IV acyclovir

Question 32

What is the leading cause of preventable blindness?

Answer 32

Trachoma

Question 33

Which pathogen causes trachoma and how is trachoma transmitted?

Answer 33

C. trachomatis A, B, C transmitted by direct contact or flies

Question 34

What is the WHO grading of trachoma?

Answer 34

FIST Follicular Inflammation Scarring Trichiasis Corneal opacity

Question 35

Discuss management of trachoma

Answer 35

WHO SAFE strategy - surgery - antibiotics - face cleanliness - environmental improvement

Question 36

Which antibiotics should be used for trachoma?

Answer 36

1g azithromycin stat to patient AND family Repeat annually if endemic

Question 37

What is ophthalmomyasis?

Answer 37

Infestation with fly larva, mostly in summer months when female fly releases larvae into eye

Question 38

Discuss management of ophthalmomyasis

Answer 38

Removal Ivermectin

Question 39

Name the causative organism of leprosy

Answer 39

M. leprae M. lepromatosis

Question 40

What are the systemic features of leprosy?

Answer 40

1. Tuberculoid 2. Borderline (most common) 3. Lepromatous

Question 41

Describe tuberculoid leprosy

Answer 41

Hypopigmented macules Anaesthetic skin patches

Question 42

Describe borderline leprosy

Answer 42

Similar to tuberculoid but more numerous and extensive

Question 43

Describe lepromatous leprosy

Answer 43

Widespread cutaneous thickening Leonine facies Peripheral plaques and nodules URTI Loss of digits due to peripheral neuropathy

Question 44

Discuss the ocular features of leprosy

Answer 44

Anterior uveitis Iris pearls Keratitis Pannus

Question 45

Which fly transmits onchocerciasis?

Answer 45

Simulium black fly

Question 46

What is onchocerciasis also called?

Answer 46

River blindness

Question 47

How is onchocerciasis caused?

Answer 47

Black fly bites human -> larvae in nodules migrate to eyes

Question 48

What is the maculopapular rash in onchocerciasis also called?

Answer 48

Leopard skin rash

Question 49

What are the ocular features of onchocerciasis

Answer 49

Microfilariae in cornea/anterior chamber Anterior uveitis Keratitis Chorioretinitis Optic neuritis

Question 50

Discuss management of onchocerciasis

Answer 50

Ivermectin

Question 51

What causes neurocysticercosis?

Answer 51

Taenia solium

Question 52

What are the ocular features of neurocysticercosis?

Answer 52

Cysts in conjunctiva, anterior chamber and vitreous

Question 53

Discuss management of neurocysticercosis

Answer 53

Cyst removal Anti-helminths Steroids

Question 54

What causes hydatid cysts?

Answer 54

Echinococcus species

Question 55

What is the management of hydatid cysts?

Answer 55

Excision Praziquantel

Question 56

What is the function of vitamin A?

Answer 56

Maintain epithelial surfaces Immune function Retinal function

Question 57

What is xerophthalmia?

Answer 57

Spectrum of ocular disease due to vitamin A deficiency

Question 58

Name causes of xerophthalmia

Answer 58

Malnutrition Malabsorption Alcoholism Diarrhoea Measles

Question 59

How is xerophthalmia classified?

Answer 59

XN - night blindness X1 - conjunctival xerosis with Bitot spots X2 - corneal xerosis X3 - corneal ulceration Xs - corneal scar XF - xerophthalmic fundus

Question 60

What is a bitot spot?

Answer 60

Keratinised triangular lesion seen with xerophthalmia

Question 61

Discuss management of xerophthalmia

Answer 61

Vitamin A supplementation - 200 000IU oral - diet Ocular - lubrication - structural support in case of perforation

Question 62

What is ocular perforation in xerophthalmia also called?

Answer 62

Corneal melt