Ocul Disease-Cornea1

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Ocul Disease-Cornea1
2012-10-02 07:49:05

Cornea 1
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  1. Punctate Epithelial Keratitis
    -superificial lesion, hallmark of viral disease, granular opalescent swollen epithelial cells, visible without stain
  2. Epithelial edema
    • -superficial lesion
    • -endothelial decompensation, acute IOP elevation, loss of corneal lustre, vescicles and bullae (maybe)
  3. Filaments
    • -superficial lesions, mucus strangs lined with epithelium
    • -stains with rose bengal
    • -assocatied with keratoconjunctivitis sicca, superior limbic keratoconjunctivitis, recurrent erosion
  4. Pannus
    -superficial lesions, inflammatory or degenerative sub-epithelial ingrowth of fibrovascular tissure from the limbus
  5. Superficial lesions
    • -punctate keratitis
    • -epithelial edema
    • -filaments
    • -pannus
  6. Infiltrates
    • -sign of stromal lesion in cornea
    • -focal area of active stromal inflammation (accumulation of leucocytes and cell debris), caused by non-infectious or infectious keratitis
  7. signs of stromal lesions in cornea?
    • -infiltrates (non-infectious, infectious)
    • -edema (keratoconus, Fuch's dystrophy, surgery)
    • -vascularization
  8. Signs of Descemets membrane affected in corneal disease
    • -breaks (corneal enlargement, birth trauma, keratoconus) -> AH influx into cornea
    • -folds (surgical trauma, ocular hyptony (low P-> cornea collapse), stromal inflammation, edema)
  9. Pachymetry
    • measure thickness of cornea with ultrasound
    • >0.6 corneal thickness centrally suggests endothelial disease
  10. Topical steriods main function?
    • -suppress inflammation
    • -limit scarring
    • -may suppress corneal repair
    • -contraindicated with HSV epithelial disease
  11. Promotion of re-epithelialization
    • 1. lubrication
    • 2. bandage soft CLs
    • 3. eyelid closure
  12. Mx of infection/inflammation
    • 1. antimicrobial agent
    • 2. topical steroid
    • 3. systemic immunosupressives
  13. Antibiotic procedures for corneal disease that is low risk of VA loss
    • -small, non-staining peripheral infiltrate with minimal anterior chamber reaction
    • -fluoroquinoline q 2-4h (and tobramycin for CL wearer)
  14. Antibiotic procedure for corneal disease that is borderline risk of VA loss
    • -med size peripheral infiltrae with epithelial defect adn lid AC reaction or moderate discharge
    • -fluoroquinolone q1h around the clock
  15. Antiobiotic procedure for corneal disease that is vision threatening
    • -fortified antibiotics
    • -intensive fluoroquinolone therapy
  16. Microbial Keratitis
    • -infection of cornea (due to hypoxia and/or epithelial break)  by replicating microbes -> excavation of epithelium, bowman's, stroma, infiltration and necrosis
    • -often Pseudomonas aeruginosa (bacterial keratitis and white spot on cornea and red eye)
  17. Bacterial keratitis signs
    • -photophobia, pain, blurred vision, eyelid edema, dicharge
    • -injection
    • -infiltrate
    • -stromal edema
    • -hypopyon
    • -corneal perforamtion, endophthalmitis
  18. Mx of microbial keratitis
    • -stop wearing CL
    • -NO patching
    • -oral painkillers
    • -cycloplegic agent (to prevent posterior synechiae, increase Pt comfort)
    • -if Pseudomonas, then use fluoroquinolones (vigamox) and fortified antibiotics
    • -culture if unresponsive
  19. Fungal Keratitis
    • -stromal necrosis and AC affected
    • -Aspergillus, Fusariu, Candida due to trauma with organic material
    • -filamentous keratitis: greyish, satellite lesions, fuzzy, plaque, hypopyon
    • -candida keratitis: yellow-white ulcer, dense
  20. Acanthamoeba MK
    -most affected?
    • -in air, soil, water, pools, hot tubs, poor hygiene, tap water
    • -CL wearers
    • -radial perineurititis, anterior stromal infiltrates, scattered dendritic-like appearance, PAIN
    • -cycloplege, Brolene, PHMB, polymyxin (neosporin), systemic antifungal (ketoconazole)
  21. Adenoviral keratitis
    • -adenoviral infrection (type 8 and 19) leading to acute, self-resolving follicular conjunctivitis that can spread to cornea (SPK, infiltrates) and cause an acute stromal response
    • -pallative (artificial tears, cool compresses, vasoconstrictor/antihistamine, steroids (for stromal involvement)
  22. HSV
    • -HSV, a DNA virus,  that spreads through direct contact (cold sores) is dormant in trigeminal
    • -minor fever, corneal lesion (50%), unilateral red eye, pain, photophobia
    • -stain with rose bengal- see dendritic ulcer, scattered punctate epitheliopathy
  23. Herpes simplex keratitis
    • -antiotiobic oinment for skin lesions (bid, erythromycin, bacitracin), cool soaks (tid)
    • -corneal epithelial disaes: trifluridine antiviral (viroptic), cycloplegic (if AC rxn present), oral antiviral (acyclovir)
  24. Herpes zoster ophthalmicus
    • -infection caused by human herpes virus 3, dormant in dorsal root ganglia
    • -skin rash, Hutchinson's sign (tip of nose = nasociliary nerve and high change of ocular involvement)
    • -unilateral headache, blurred vision, red eye, corenal sensation reduced, pseudodendritic epithelial infiltrates
  25. Herpes zoster ophthalmicus
    • -antibacterials: bacitracin or erythromycin oinment (skin lesions)
    • -oral antivirals: acyclovir (w/i 72 hrs of rash onset)
    • -antificial tears for corneal pseudodendrites
    • -monitor raised IOP and uveitis (cells and flare)