Term
| What is Blepharitis and what usually causes it? |
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Definition
inflammation of eyelash follicles along the edge of the eyelid
STAPH AUREUS |
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Term
| What are the symptoms of blepharitis? |
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Definition
Redness and swelling with NO BUMP
(if there is a bump, it is a stye) |
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Term
| What is a stye, and what causes it? |
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Definition
Inflammation of eyelid glands or follicles- usually benign
STAPH AUREUS |
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Term
| If a patient presents with tender small red painful bumps on the inside or outside edge of the eyelid, what are you most likely to see on gram stain and C&S? |
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Definition
Gram + Cocci, Coag +, Catalase + Beta Hemolytic- STAPH AUREUS
THIS IS MOST LIKELY A STYE |
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Term
| A 6 year old presents to you with swollen itchy red eyes and a sore throat- this problem began in one eye and spread to the other, after a pool party with other kids. What is your differential? |
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Definition
Viral or Bacterial Conjunctivitis
-Most likely Pharyngeal Conjunctival Fever caused by Adenovirus 3,4,7 |
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Term
| If a patient presents with redness, watery eyes, irritation, and occasional photophobia in the late fall or early spring, you should immediately think of what cause? |
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Definition
VIRAL CONJUNCTIVITIS
Classically Adenovirus |
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Term
| Your patient presents with a stringy discharge from the eye, swelling, redness, tearing, gritty feeling, and it started in one eye but spread to the other. What do you think it is, and what is the most important sign? |
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Definition
BACTERIAL conjunctivitis
Most important is the discharge, which is mostly PMNs- mucoid and yellowish |
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Term
| Your patient presents with watery discharge from the eye, irritation, and redness. It started in one eye and spread to the other. What do you think it is? |
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Definition
| VIRAL conjunctivitis (no purulent discharge) |
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Term
| Your patient presents with itching, tearing, swollen eyelids, and both eyes are affected at the same time. What cells are involved in this process, what are they secreting, and what is the process? |
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Definition
| Plasma cells secreting IgE- this is a TYPE I Hypersensitivity- allergic conjunctivitis |
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Term
| Name 5 bacteria that cause conjunctivitis: |
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Definition
| Staph, Strep, Haemophilus, Chlamydia, Neisseria |
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Term
| What is the most common virus to cause conjunctivitis? |
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Definition
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Term
| What is the most SERIOUS viral conjunctivitis caused by? |
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Definition
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Term
| What virus commonly causes conjunctivitis in AIDS patients? |
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Definition
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Term
What is the hemolysis pattern of Strep Pneumo?
What is the hemolysis pattern of Strep Pyogenes? |
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Definition
Strep Pneumo- Alpha Hemolytic
Strep Pyogenes- Beta Hemolytic |
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Term
| What bug is a Gram- rod, grows on chocolate but not blood agar? |
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Definition
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Term
| What is the #1 cause of bacterial conjunctivitis in any age group? |
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Definition
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Term
| What are the main bugs involved in bacterial conjunctivitis in children and adults? |
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Definition
| S. Aureus, S. Pneumoniae, H. Influenzae |
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Term
| What are the main bugs involved in bacterial conjunctivitis in neonates? |
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Definition
| S. Aureus, Pseudomonas, Chlamydia, Gonorrhea |
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Term
| What serotypes of what bacteria cause blindness in 6 million worldwide? |
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Definition
Chlamydia Trachomatis- TRACHOMA
Serotypes A-C |
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Term
| How is TRACHOMA serotypes A-C spread? |
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Definition
Repeated infection by direct contact
NOT SEXUALLY
Fomites, flies, fingers |
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Term
| What describes the histology of chlamydia? |
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Definition
Obligate Intracellular- 2 forms/stages
RETICULATE BODY- inside cell
ELEMENTARY BODY- outside the cell |
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Term
What chlamydia serotypes infect the eye AND urogenital tract?
(this is the sexy one)
Describe the presentation |
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Definition
Serotypes D-K (DICK)
Neonatal Conjunctivitis-
Fast, lots of discharge, BLINDNESS |
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Term
| How do we test for Chlamydia? |
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Definition
GIEMSA STAIN- for inclusion bodies- low yield except neonates
You will see lots of PMNs and no bugs |
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Term
| You see a newborn baby with tons of discharge from the eyes. On examination, the samples reveal only PMNs and no bugs. What do you think is the cause? |
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Definition
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Term
How do we treat neonatal conjunctivitis?
How do we treat chlamydia generally? |
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Definition
Oral Erythromycin
Oral Azithromycin |
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Term
| What is the SAFE strategy? |
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Definition
| Surgery, Antibiotics, Facial Cleanliness, Environmental Improvement |
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Term
| What causes opthalmia neonatorum, and how is it diagnosed? |
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Definition
Neisseria Gonorrhoeae
Gram- diplococci, cultured on THAYER MARTIN AGAR |
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Term
| A newborn presents with purulent discharge, eye pain, and redness. On testing, you find lots of neutrophils AND bacteria. Without even knowing what type of gram stain you see, what is your best guess for the bug? |
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Definition
Neisseria Gonorrhoeae
To make the point that with Chlamydia you see PMNs but no bug, with the Gon, you see Neutrophils AND bug |
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Term
| How is gonorrhea treated? |
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Definition
| IV penicillin G, ceftriaxone for resistant strains |
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Term
| How is gonorrhea prevented? |
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Definition
| Topical silver nitrate, erythromycin, or tetracycline |
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Term
| A young child presents to you with purulent conjunctivitis, fever, purpura, and vascular collapse- what is the offending organism? |
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Definition
| H. Influenzae Aegyptius- Brazilian Purpuric Fever |
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Term
| An 8 year old presents with fever, sore throat, coryza, red eyes, pharyngitis, tearing, itchy eyes. What is going on here? |
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Definition
Pharyngoconjunctival Fever
Adenovirus serotypes 3,4,7
Swimming pool conjunctivitis |
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Term
| If you see a swimming pool, and NOT a hot tub, in the thread of a micro question, the organism that you guess is very stable for what reason? |
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Definition
Adenovirus is a naked virus
NO ENVELOPE
Very stable |
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Term
| How is adenovirus spread? |
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Definition
Respiratory
Ocular Secretions |
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Term
| How do we differentiate classic pink-eye from swimming pool conjunctivitis? |
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Definition
NO PHARYNGITIS
Keratoconjunctivitis- Adenovirus
SUPER INFECTIOUS |
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Term
| How is Keratoconjunctivitis spread? |
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Definition
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Term
| An 11 year old presents to your office with eye redness, photophobia, tearing, pain, fever, lymphadenopathy, and headache- What do you think it is? (limit to micro ppt) |
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Definition
Keratoconjunctivitis
NO PHARYNGITIS
8 day incubation |
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Term
| What are the long-term dangers of Keratoconjunctivitis? |
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Definition
| Residual scarring, visual impairment |
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Term
| How do we check to see if the suspected Keratoconjunctivitis isn't really EBV? |
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Definition
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Term
| What herpes virus is responsible for neonatal eye disease? |
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Definition
| HSV-2 spread via vaginal delivery |
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Term
| What herpes virus causes keratoconjunctivitis in adutls? |
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Definition
HSV-1 reactivations
STEROIDS MAKE IT WORSE!!!!!!! |
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Term
| Your patient was on steroids for inflammation and developed eye pain, red eye, watery discharge, itching, blurred vision, and lid swelling. What happened? |
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Definition
| HSV-1 reactivation by the steroids |
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Term
| What is the characteristic diagnostic finding of HSV-1 and HSV-2 (as well as VZV)? |
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Definition
| MULTINUCLEATED GIANT CELLS on TZANK SMEAR |
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Term
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Definition
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Term
| What is the #1 cause of retinitis (chorioretinitis) in AIDS patients? |
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Definition
Cytomegalovirus- CMV retinitis
25% develop |
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Term
| An HIV positive patient presents with decreased VA, floaters, loss of visual fields. What are you likely to find on histology? |
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Definition
| Owl's eye inclusions characteristic of CMV |
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Term
| What is the danger to the neuroretina from CMV? |
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Definition
Retinal necrosis resulting in detachment
Intraretinal Hemorrhages |
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Term
| What causes the "cottage cheese and ketchup" appearance of the retina? |
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Definition
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Term
| What do we give for CMV retinitis in AIDS patients? |
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Definition
| IV Ganciclovir or foscarnet |
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Term
| Your patient presents with unilateral painful red eye, decreased vision, skin and eyelid rash, fever, and tearing. What do you suspect? |
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Definition
| Herpes Zoster Ophthalmicus |
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Term
| What nerve is involved in herpes zoster opthalmicus? |
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Definition
| First division of CNV nasociliary nerve |
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Term
| What are the 3 typical locations of Zoster lesions around the eye? |
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Definition
| Tip, side, or root of nose |
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Term
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Definition
| TZANK SMEAR and WRIGHT STAIN |
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Term
| How is herpes zoster opthalmicus treated? |
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Definition
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Term
| On a mission trip to Guatemala, you find an outbreak of hemorrhagic conjunctivitis that is painful and highly contagious. On PCR, you most likely find what viruses? |
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Definition
Coxsackie A24
Enterovirus E70 |
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Term
| An Amish child presents with high fever, cough, coryza, conjunctivitis, photophobia, and KOPLIK spots. What is the likely cause of the infection? |
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Definition
| Measles- patient was unvaccinated |
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Term
| Somehow you manage to diagnose a fetus with cataract, glaucoma, micropthalmia, and salt and pepper change in the retina. What virus caused this? |
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Definition
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Term
| Your patient has been wearing their contacts for too long and now has an infection of the cornea. What is this called, and what bugs are likely responsible? |
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Definition
Strep, Staph, PSEUDOMONAS (especially in contact wearers), Entero's
The enteros, if you remember, are Klebsiella, Enterobacter, Serratia, Proteus |
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Term
| What is the big problem with bacterial keratitis? |
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Definition
It is SIGHT THREATENING and moves fast
24-48 hours |
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Term
| What is the most common cause of fungal keratitis in the southern states? |
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Definition
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Term
| What is the most common cause of fungal keratitis in the northern states? |
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Definition
| Candida Albicans and Aspergillus |
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Term
| What type of fungi are fusarium and aspergillus? |
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Definition
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Term
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Definition
| Budding yeast with PSEUDOHYPHAE |
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Term
What type of fungus LOVES contact lenses?
What type of contact lens solution should you NEVER use? |
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Definition
Fusarium
ReNu with MoistureLoc |
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Term
| Your patient presents with a sensation of foreign body in their eye, pain, decreased vision, and light sensitivity. They never change their contact solution. What does the likely culprit grow on? |
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Definition
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Term
| How is fusarium keratitis treated? |
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Definition
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Term
What causes satellite lesions on the eye?
(This was ill-described- just go with what it says in lecture) |
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Definition
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Term
| What causes endopthalmitis and how is it acquired? |
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Definition
Candida Albicans- accidental or postop inoculation
Hematogenous seeding from BLOOD
(Candidemia) |
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Term
| Your febrile patient has oral thrush, ocular pain, photophobia, and floaters. What is the likely causative agent and what is the diagnosis? |
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Definition
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Term
| How is Candida endopthalmitis treated? |
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Definition
| Amphotericin B, then fluconazole |
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Term
| Your patient makes their own contact solution. They also swim in fresh water. They present to you with photophobia, blepharospasm, blurred vision, and severe pain. What is your diagnosis? |
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Definition
| Amebic Keratitis- acanthamoeba spp |
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Term
| What is the long term sequelae of amebic keratitis? |
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Definition
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Term
| How is amebic keratitis diagnosed? What is the bug? |
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Definition
GIEMSA-STAINED CORNEAL SCRAPINGS
Ancanthamoeba Spp.
Culture contaminated contact solution |
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Term
| Who the hell would make their own contact lens solution? |
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Definition
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Term
| How is amebic keratitis treated? |
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Definition
| Topical Propamidine, micronazole, neomycin |
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Term
| What and what is the MAIN etiology of ocular toxoplasmosis? |
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Definition
| Toxoplasma gondii- CONGENITAL |
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Term
| What are the consequences of ocular toxoplasmosis? |
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Definition
SEVERE SCARRING-irreversible vision loss
Atypical Severe Necrotizing Retinochoroiditis |
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Term
| How does toxoplasmosis (ocular toxoplasmosis) get spread, and how is it treated? |
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Definition
It crosses the placenta (TORCH)
Pyrimethamine, sulfonamides (controversial) |
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Term
| How is ocular cysticercosis diagnosed, what does it cause, and what is the organism? |
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Definition
| Cysts in the eye (EW!), loss of visual acuity and field defects, Taenia Solium |
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Term
| How is ocular cysticercosis treated? |
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Definition
| Praziquantel or albendazole |
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Term
| What does trichiniella spiralis cause, and how is it treated? |
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Definition
Cysts in the eye- periorbital edema
Corticosteroids and mebendazole |
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Term
| What causes African River Blindness? |
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Definition
Onchocerca Volvulus- transmitted by black fly
1-2 year incubation |
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Term
| What is transmitted by the Chrysops fly? |
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Definition
Loa Loa- AFRICAN EYEWORM
DOES NOT CAUSE BLINDNESS |
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Term
|
Definition
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Term
| What are the two stages of African River Blindness |
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Definition
Onchocerca Volvulus- 1-2 year incubation
Early Disease: itching, redness, photophobia, blurred vision
Late disease: Vision loss, BLINDNESS |
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Term
| How is African River Blindness treated? |
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Definition
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