Term
| Bacterial Keratitis (etiologies symptoms) |
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Definition
| More common etiologies: Staphylococcus 14-33% cases in CL, Streptococcus, Pseudomonas (gram negative rod)62-64% of ulcers in CL; Symptoms – Pain, Redness, Pt describes a “white dot” in cornea; Photophobia, Discharge, Decreased Vision |
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Term
| Infectious Ulcers vs. Sterile Ulcers |
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Definition
| Infectious Ulcers are usually found in the center. Pheripheral ulcers tend to be sterile. Sterile ulcer is smaller. In a infectious ulcer the effected epithelium is about the same size of the ulcer. An infectious ulcer will be red (intense hyperemia in infectious ulcer not as red in a sterile ulcer); Cells, Flare, Hypopyon are also found in Infectious ulcers. |
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Term
| Strep. Aureus, Strep. Pneumoniae vs. Pseudomonas Aeruginosa Bacterial Keratitis |
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Definition
| Staph. Aureus will appear yellow, gray, disc shaped ulcer, severe uveitis and hypopyon is charcacteristic; Strep. Pneumoniae will appear more yellowish/grayish more purulent than the Staph. pus is more yellowish; Staph. Pneumoniae – well defined white grey or creamy stromal infiltrate that may be enlarge to form a dense stromal absess; uveitis and hypopyon less common in the strep. Pseduomoas Aeruginosa – central with gray infiltrate and overlying epithelial defect which progresses very rapidly and a ring ulcer can develop; can cause corneal perforation within 24-48 hours. |
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Term
| Treatment for Bacterial Keratitis (moderate risk 1-1.5mm, peripheral or mid peripheral, A/C reaction and discharge) |
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Definition
| Fluoroquinolones – Ciprflozacin (ciloxan 0.3%); Ofloxaxin (Ocuflox 0.3%); Levofloxacin (Quixin 0.5%, Iquix 1.5%(the only one FDA approved only one approved for this), Gatifloxacinn (Zymar 0.3% better for gram (+)), Moxifloxacin (Vigamox 0.5% better for gram (+)) For gram negative you can use all of these. |
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Term
| Treatment for Bacterial Keratitis (High risk 1-1.5 mm, more central) |
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Definition
| These will appear with strong A/C reaction and discharge: Treatment require addition of fortified antibiotics – fortified GENTAMYCIN or TOBRAMYCIN alternated w/ fortified CEFAZOLIN or VANCOMYCIN every 60 min.; ORAL FLUROQUINOLONES are (AVELOX 400mg, CIPRO 500 mg, or LEVOQUIN 500 mg) are given when ulcer involves extremely deep ulcerations; In occasion pt’s are hospitalized for IV administration |
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Term
| Superficial vs. Deep Corneal Abrasions and common symptoms |
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Definition
| Superficial: Loss of superficial/squamous cells, Take hours to a day to heal; DEEP: Loss of cells to basal cells layer or to Basal Membrane; May take 3-4 days to a week to heal, BM damage may take -8-12 weeks to heel; Common Symptoms: Pain, Tear, Photophobia, Tearing, FB sensation, Blepharospams (deep) |
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Term
| What causes Cells and Flare in the A/C |
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Definition
| Phospholipase Cyclooxygenase from the prostaglandins |
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Term
| Superficial Corneal Abrasions |
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Definition
| +NaFL due to squamous cells loss; staining is diffuse and light; Tracking (FB); Mild corneal edema; Mild A/C reaction; Conjunctival Hyperemia |
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Term
| Deep Corneal Abrasion characteristics |
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Definition
| +NaFL of a “pooling or deep staining”; Lid edema; Corneal Edema; Conjunctival Hyperemia; Epithelial Tags; Moderate to severe Uveitis |
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Term
| Treatment for Corneal Abrasions |
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Definition
| Anti-infective agents (prophylaxis; not yet dealing with an infection) Fluoroquinolones, Aminoglycoside, Polytrim, Aza site quid, if related to Pseudomonas (Tobramycini or fluoroquinolone oph sol during day; Polyosporin ung hs |
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Term
| Recurrent corneal erosion |
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Definition
| any damage to the epithelium basement membrane or bowmans; Hemidesmosomes of the basal layer fail to adhere to the basement membrane; Loose epithelial layers are susceptible to separation and erosion; Causes – past injury, dystrophy; Symptoms – recurrent pain attacks and photophobia upon awakening or during sleep when the eyelids are rubbed or opened. Signs – Positive/negative NaFL staining, Localized roughening of the epithelium |
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Term
| Recurrent Corneal Erosion Treament |
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Definition
| Doxycline; Upon injury lucocytes secrete metalloproteinases which degrade dmaged BM andn anchoring system; Doxycycline inhibits metalloproteinases; In RCE abnormal high levels of metalloproteinases persists |
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Term
| Acquired Dacryocystitis(Lacrimal gland disorder) |
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Definition
| Most common cause is Staph, others: Streptococcus, Pseudomonal, and Haemophilus in children; Symptoms include epiphoria, pain, fever; Sign: swelling over sac, mucoid or purulent discharge, when pressure over sac |
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Term
| Treatment of Acquired Dacryocystitis in Children |
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Definition
| Augmentin (alternate treatment: Cefixime (Suprax or Cefaclor) if no fever and mild; Cefuroxime if patient presents with fever is moderate and severe. Erythromycin, Axythromycin, Clindamycin if the cause is Allergy |
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Term
| Treatment of Acquired Dacryocystitis in Adults |
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Definition
| Cephalexin (alternate treatment Augmentin) if patient presents with no FEVER and mild; Cefazolin IV – fever and ill; Zythromax, Fluoroquinolones for allergy; Adjunctive topical with polytrim qid |
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Term
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Definition
| inflammatory enlargement of Lacrimal gland, Bacterial etiology (staph A., N. Gonorrhea, Streptococci) Symptoms: unilateral, severe pain, redness, and pressure in the supratemporal region of the orbit, Signs: unilateral redness and swelling over 1/3 of upper lid, “S-shaped lid” |
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Term
| Treatment for Acute Dacryoadenitis (mild/mod and mod/sev) |
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Definition
| For mild/moderate :Augmentin or cephalexin if allergies: Erythromycin, Clindamycin, Azythromycin; For moderate/severe: in hospital, cefazolin (Ancef) or Timentin (Ticarcillin/Clvulanate) IV; If Allgeries: IV moxifloxacin; If G. Nisseria on culture – ceftriaxone as before |
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