Term
| Are ulcers or infiltrates more common? |
|
Definition
| infiltrates are far more common (and thankfully less serious) |
|
|
Term
| Can an infiltrate turn into an ulcer? |
|
Definition
|
|
Term
| What is a marginal infiltrate? |
|
Definition
| An infiltrate next to the limbus on the cornea |
|
|
Term
| What are the types of infiltrates? |
|
Definition
Intraepithelial vs subepithelial
marginal vs central
stromal involvement vs no stromal involvement |
|
|
Term
| What is the pathology of an infiltrate? |
|
Definition
|
|
Term
| What is the most common attribute of pt's presenting infiltrates? |
|
Definition
| adult and teenage CL wearers |
|
|
Term
|
Definition
| Contact Lens Related Acute Redeye |
|
|
Term
|
Definition
| Contact Lens Peripheral Ulcer |
|
|
Term
| What are infiltrates usually surrounded by? |
|
Definition
|
|
Term
| If an epithelium defect is present, will it be bigger or smaller than the infiltrate? |
|
Definition
|
|
Term
| What are common SE of corneal infiltrates? |
|
Definition
pain "irritating" (mild-moderate)
tearing
photophobia
FB sensation |
|
|
Term
| What are tx for corneal infiltrates? |
|
Definition
treat cause of chronic conj/bleph
discontinue CL wear or change solutions
If non infectious, steroids or steroid/AB combo |
|
|
Term
| What is the tx regimen for corneal infiltrates with steroids? |
|
Definition
| 4x/day; Taper as condition improves over 7-14 days |
|
|
Term
| If corneal infiltrates are suspected to be due to CL wear, what should be done? |
|
Definition
discontinue CL use
check the fit
hydrogen peroxide cleaning system
switch to a daily CL |
|
|
Term
|
Definition
| infectious compromise of the epithelium with stromal invasion |
|
|
Term
| What surrounds a corneal ulcer? |
|
Definition
|
|
Term
| What is VERY IMPORTANT in treating corneal ulcers? |
|
Definition
| Treat quickly and aggressively to prevent permanent scarring and associated vision loss! |
|
|
Term
| What are risk factors for ulcerative keratitis? |
|
Definition
extended CL wear
male
poor tear film
staph
smoking
swimming with CL in
Under 22 yo |
|
|
Term
|
Definition
Corneal ulcer mnemonic:
Pain
Epithelial Defect
Discharge
Anterior chamber rxn
Location (usually centrally located) |
|
|
Term
| Where are corneal ulcers usually found? |
|
Definition
|
|
Term
| What are 4 pathogens that can attack a HEALTHY cornea? |
|
Definition
neisseria gonorrhea
Listeria
corynebacterium diptheriae
haemophilus |
|
|
Term
| What 7 pathogens need a compromised cornea to initiate an infection? |
|
Definition
staph
strep
pseudomonas
enterobacteriaceae
moraxella
klebsiella
proteus |
|
|
Term
| What are s/sx of bacterial corneal ulcers? |
|
Definition
Decreased VA
photophobia
pain
redness
lid swelling
purulent discharge
"white spot on my eye" |
|
|
Term
| What is a serious sign of bacterial corneal ulcer? |
|
Definition
| destruction of corneal tissue |
|
|
Term
| What are signs of an advanced corneal ulcer? |
|
Definition
hypopyon
synechiae
elevated IOP
Severe anterior chamber rxn |
|
|
Term
| What are traits of Staph related corneal ulcer? |
|
Definition
gram +
round or oval, distinct border ulcer
Low AC rxn
yellow-white infiltrated central ulcer |
|
|
Term
| What are traits of Strep related corneal ulcer? |
|
Definition
gram+
round or oval
leading edge may be shaggy or indistinct
hypopyon is common
often has resistant strains
low AC rxn |
|
|
Term
| What are traits of pseudomona related corneal ulcer? |
|
Definition
Gram -
commonly associated with corneal abrasion trauma
Gray infiltrate
profuse borders
yellow-green discharge
hypopyon and severe anterior chamber rxn possible |
|
|
Term
| What corneal ulcer etiology displays resistance to AB commonly? |
|
Definition
|
|
Term
| If a pseudomonas related corneal ulcer is left untreated, what is the window before it will perforate? |
|
Definition
|
|
Term
| How are bacterial corneal ulcers treated? |
|
Definition
discontinue CL use
broad spectrum AB until pathogen is ID'd
Take a swab to culture pathogen
3 different paths:
1. monotherapy with fluoroquinolones
2. combination therapy (cefazolin and fortified tobramycin)
3. combination therapy AND fluoroquinolones |
|
|
Term
| How often are bacterial corneal ulcer tx's instilled? |
|
Definition
| 1 per min for 5 minutes, then 2 ggts q15mins x 6 hrs. If pt cannot comply, may need to be hospitalized |
|
|
Term
| What are fluoroquinolones that are used for corneal ulcers? |
|
Definition
moxifloxacin
gatifloxacin
besifloxacin |
|
|
Term
| What are fortified topical antibiotics? |
|
Definition
| Non commerically available concentration where pharmacist will create a strong variant |
|
|
Term
| When should a corneal specialist be referred to when a bacterial corneal ulcer is seen? |
|
Definition
| >3mm in diameter and near the visual axis |
|
|
Term
| What should be added if fluoroquinolone tx is not working for a bacterial corneal ulcer? |
|
Definition
| polytrim hourly, used to treat MRSA |
|
|
Term
| When should steroids be used on corneal ulcer? |
|
Definition
Only after pathogen is identified and proper AB's have been selected
Should not be used if perforation is a threat
If the ulcer is on the visual axis |
|
|
Term
| If pt's cannot comply with corneal ulcer tx regimen and you don't want to hospitalize, what is an option? |
|
Definition
|
|
Term
| What corneal ulcer etiologies can be a systemic infection? |
|
Definition
|
|
Term
| When should tx be tapered for corneal ulcers? |
|
Definition
once improvement is seen:
decreased edema
decreased infiltrates
decreased AC rxn |
|
|
