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Alicat38
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Punctate Epithelial Keratitis
-def'n
-superificial lesion, hallmark of viral disease, granular opalescent swollen epithelial cells, visible without stain
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Epithelial edema
- -superficial lesion
- -endothelial decompensation, acute IOP elevation, loss of corneal lustre, vescicles and bullae (maybe)
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Filaments
- -superficial lesions, mucus strangs lined with epithelium
- -stains with rose bengal
- -assocatied with keratoconjunctivitis sicca, superior limbic keratoconjunctivitis, recurrent erosion
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Pannus
-superficial lesions, inflammatory or degenerative sub-epithelial ingrowth of fibrovascular tissure from the limbus
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Superficial lesions
- -punctate keratitis
- -epithelial edema
- -filaments
- -pannus
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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
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signs of stromal lesions in cornea?
- -infiltrates (non-infectious, infectious)
- -edema (keratoconus, Fuch's dystrophy, surgery)
- -vascularization
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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)
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Pachymetry
- measure thickness of cornea with ultrasound
- >0.6 corneal thickness centrally suggests endothelial disease
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Topical steriods main function?
- -suppress inflammation
- -limit scarring
- -may suppress corneal repair
- -contraindicated with HSV epithelial disease
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Promotion of re-epithelialization
- 1. lubrication
- 2. bandage soft CLs
- 3. eyelid closure
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Mx of infection/inflammation
- 1. antimicrobial agent
- 2. topical steroid
- 3. systemic immunosupressives
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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)
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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
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Antiobiotic procedure for corneal disease that is vision threatening
- -fortified antibiotics
- -intensive fluoroquinolone therapy
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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)
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Bacterial keratitis signs
- -photophobia, pain, blurred vision, eyelid edema, dicharge
- -injection
- -infiltrate
- -stromal edema
- -hypopyon
- -corneal perforamtion, endophthalmitis
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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
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Fungal Keratitis
-def'n
-source
-tyeps
- -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
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Acanthamoeba MK
-source
-most affected?
-Sxs
-Mx
- -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)
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Adenoviral keratitis
-Sxs
-Mx
- -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)
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HSV
-def'n
-Sxs
- -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
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Herpes simplex keratitis
-Mx
- -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)
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Herpes zoster ophthalmicus
-def'n
-Sxs
- -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
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Herpes zoster ophthalmicus
-Mx
- -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)
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