Term
| Turnover for entire epithelium |
|
Definition
|
|
Term
| Healing of: squamous cells, cuboidal-wing and basal cells |
|
Definition
| Squamous – hours; Cuboidal-wing, and basal cells – (hours to days) |
|
|
Term
| Basal Cells secrete BM q? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Difference between a superficial and deep abrasion |
|
Definition
| Superficial – loss of superficial/squamous cells; Deep – loss of cells to basal cells layer to BM |
|
|
Term
| Symptoms: Pain, Photophobia, FB sensation, Tearing, HX of scratching the eye |
|
Definition
|
|
Term
| Signs: +NAFL, FB track, no pooling or deep staining, conjunctival injection, mild eyelid edema, mild corneal edema, mild A/C reaction, |
|
Definition
|
|
Term
| Work-up superficial abrasion |
|
Definition
| History, Anesthetic, Evertion of lids, irrigate and swab with q-tip all sufaces, R/O traumatic uveitis; NO FLUROSCEIN UNTIL YOU CHECK FOR CELLS AND FLARE; you can cause false glare if you put the fluorescein |
|
|
Term
|
Definition
|
|
Term
| On deeper abrasion epithelial healing process begins when? |
|
Definition
| basal epithelial cell undergo mitosis |
|
|
Term
|
Definition
|
|
Term
| Healing time for basal cells |
|
Definition
|
|
Term
| Symptoms: Pain, Photophobia, FB sensation, Tearing, HX of scratching the eye Signs: +NAFL, FB track, no pooling or deep staining, conjunctival injection, mild eyelid edema, mild corneal edema, mild A/C reaction, |
|
Definition
| Antibiotic: 1. flouroquinolone qid or aminoglycoside qid (TOBRAMYCIN) 2. Polytrim qid or polysporin q2-4 h if superifcian and NON-CL WEARER; If A/C rxn (mild) – cyclopentaolate 1% bid |
|
|
Term
| Pain for superficial abrasion |
|
Definition
| 1. keterolac, diclofenac both qid; Nevanac tid; Xibrom bid |
|
|
Term
| Follow-up for superficial abrasion |
|
Definition
|
|
Term
| If superficial abrasion due to contact Lens wear treatment |
|
Definition
| 1. tobramycin, or fluoroquinolone 2. polysporin or ciprlfloxacin ung hs; NO PATCH |
|
|
Term
| Follow up schedule for superficial abrasion contact lens related |
|
Definition
|
|
Term
| You should not patch when? |
|
Definition
| Cl wearers, vegetable organic material, false fingernails or if you see infiltrate |
|
|
Term
| Lose of cells of basal cells layer to BM |
|
Definition
|
|
Term
| Symptoms: Pain, photophobia, blepharospasm, tearing, |
|
Definition
|
|
Term
| Work up for a deep abrasion |
|
Definition
| Irrigate any debris, measure it, determine cells layer involved: basal cells have a more irregular, “grainy” NAFL pattern BM appears smoother brighter, Look for epithelial tags at edge of abrasion. |
|
|
Term
|
Definition
| R/O penetration/perforation; 1. Stromal entry: stromal channel. 2. Endothelial disruption behind abrasion 3. Seidel test 4. Foreign material in aqueous/lens |
|
|
Term
|
Definition
| TX: don’t patch, refer to cornea specialist |
|
|
Term
| Management for Deep epithelial abrasion |
|
Definition
| 1. fluoroquinolone qid 2. aminoglycoside QID; 2. Polytrim 3. ALTERNATE May use tobrex or ciloxan in ung Q2-4h; A/C RXN: MODERATE: HOMATROPINE 5% TID; SCOPOLAMINE 0.25% TID |
|
|
Term
| For Pain in Deep Epithelial Abrasion |
|
Definition
| Ketorolac, diclofenac (qid,tid, bid); If the patient is allergic to aspirin do not use topical; NSAIDS may cause corneal melting; Use for first 2-3 days or until sx’s resolve |
|
|
Term
| Burns Pain Management: mild to moderate (oral non-narcotic analgesics) |
|
Definition
| 1) acetaminophen 500 – 1000mg qid 2) NSAIDS (e.g.,Ibuprofen 200-800 q6h; naproxen 250, 375 and 500 bid) * ask for aspirin allergy / peptic ulcers * Cox-2; if the patient is allergic to NSAIDS give them acetaminophen |
|
|
Term
| Pain Management for Moderate Pain |
|
Definition
| Acetaminophen w/ NSAIDS (e.g. acetaminophen 1000 mg w/ iburpofren 400-600 qid) Option 2) Tramadol (ultram) (opiod but not a schedule drug) Dosage is 50 mg tablets; 50-100 mg po q4-6 h; Ultracet: tramadol 37.5 mg and acetaminophen 325 mg. 2 tabs q 406 h |
|
|
Term
| Pain management (moderate to severe) |
|
Definition
| Schedule III: 1. Lortabe 5 mg hydorocone w/ 500 mg acetaminophen; Vicodoine Same; Vicoprofen (with ibuprofen ) 7.5/ 200 mg 2). Tyelenol III -30 mg codeine w/ 300 mg acetaminophen; Schedule II 1. Perecocet (5 mg oxycodone, 325 mg acetaminophen) 2. Tylox (5 mg oxycodone, 500 mg acetaminophen):DOSAGE IS 1-2 TABS P.O Q 4-6 H, AS NEEDED; F/U 3-5 D |
|
|
Term
| If you have significant edema in a deep epithelial abrasion you should rx |
|
Definition
| 5% NaCl q2-4 hours and ung hs |
|
|
Term
| When can you use a bandage in Cl in a deep epithelial abrasion |
|
Definition
| If abrasion is 10mm and no vegetative matter or infiltrates |
|
|
Term
| Follow up schedule for deep epithelial abrasion |
|
Definition
|
|
Term
| Deep abrasion related to CL wear |
|
Definition
| DC cl wear, Fluoroquinolone or tobramycin QID; 2. Polysporin ung hs; Pain management; If edema add 5% Nacl q-2-4 h; RTC NEX DAY UNTIL RESOLVED; NO CL WEAR OR PATCH |
|
|
Term
| Recurrent corneal erosion occurs because of?? |
|
Definition
| Defective basement membrane; Hemidesmosomes of the basal layer fail to adhere to the basement membrane; Hemidesmosomes attach BM to rest of epithelium and anchoring fibrils to stroma |
|
|
Term
|
Definition
| 1. Past injury 2. Chronic, persisten cause as dystrophies (EBMD, lattice, Meesmann, Reis-Buckler, bullow) |
|
|
Term
| What percent of EBMD experience severe RCE during their lifetime? |
|
Definition
|
|
Term
| What percent of RCE have Rosacea? |
|
Definition
|
|
Term
| Symptoms: recurrent pain attacks and photophobia upon awaekening or during sleep when the eyelids are rubbed or opened. May have hx of trauma or family hx of corneal dystrophy, cataracts surgery, refractive surgery hx, DM, rosacea |
|
Definition
|
|
Term
| Almost what percent of RCE cases occur in the inferior third of the corne? |
|
Definition
|
|
Term
| If a dystrophy is present in RCE you may have |
|
Definition
| map dot fingerprint patterns, bilaterally |
|
|
Term
|
Definition
| treat as abrasion protocol, May use a bandage contact lens |
|
|
Term
|
Definition
|
|
Term
| In RCE after epithelial defect is healed: TX |
|
Definition
| Artificial tears 4-8 times a day; or FRESHKOTE 1 gtt up to qid; Hypertonic ung (5% NaCl) HS MURO-128; Treatment will be for at least 3 months. |
|
|
Term
| F/U in RCE after epithelial defect is healed |
|
Definition
|
|
Term
| RCE treatment form the Bascom Palmer study |
|
Definition
| doxycycline 50 mg bid for 2 months and topical penisolone tid for 2-3 weeks showed no recurrence in 21.9 months; (appears to be thru anti-inflammatory activity and metalloproteinase inhibition |
|
|
Term
| Patient with RCE and conventional treatment has not resolved the problem the pt. should be given |
|
Definition
| 1. Steroids (Lotemax) qid x 2-4 weeks then BID x 4-6wks 2. Oral tetracycline (doxyycline 50 or 20 mg (Alodox) bid x 2 months; FOLLOW UP 1 MONTH |
|
|
Term
| Other Permenant RCE treatments: |
|
Definition
| Stromal puncture with Nd. Yag lase, Excimer Laser phototherapy; This method removes enough of the superficial bowman layer to permit formation of a new basement membrane with adhesion structures; Corneal dealmination w/ 20% alcohol |
|
|
Term
|
Definition
| R/O intraocular FB Seidel Test; DILATE; Treat as abrasion protocol ACCESS A/C; |
|
|
Term
| Follow up schedule for FB; |
|
Definition
| q 24 hours at the beginning and when startng to heal q3-4 h; patient eduation about wearing protection glasses, deep stromal FB; refer to corneal specialist |
|
|
Term
|
Definition
| Pseudodendrite, edema, coat ring, if bowman’s/stroma is disrupted you will start to see a white scar |
|
|
Term
| Stromal penetration to any depth is called a |
|
Definition
|
|
Term
| Work up for Corneal Laceration |
|
Definition
| Seidel, DILATE, if small treat like an abrasion, If the laceration is larger with or without perofration: refer to specialist with shield, NEVER PATCH |
|
|
Term
| Signs Mild or Severe of Burn? Conjunctival hyperemia, chemosis, eyelid edema, AC reaction, skin with first degree burn cornea may present SPK to focal epithelia erosin with mild stromal haze; |
|
Definition
|
|
Term
|
Definition
| Mild – Perilimbal ischemia: faint; MODERATE: Perilimbal ischemia: little or none Stromal haze: moderate; MODERATE TO SEVERE: Perilimbal ischemia <1/3 stromal haze: blurs iris detail; SEVERE: Perilimbal ischemia 1/3 to 2/3 Stromal Haze: blur pupil; Cornea often marbleized; VERY SEVERE: Perilibal ischemia: >2/3 Stromal Haze: pupil not visible, Cornea often marbleized |
|
|
Term
| Management for Mild alkali or acidic immediate care |
|
Definition
| Irrigation with flushing water x 30 min, before coming to office or clinic;; If presents without flushing, prolonged irrigation with saline solution or a balanced buffered solution, RINGER’S LACTATE SOLUTION; Test eye with litmus paper; wait 5-10 min; if 6-8 pH discontinue lavage; DEbride necrotic corneal or conjunctival tissue; CYCLOPLEGIC: Like scopolamine or homatropine; BID-TID; Broad spectrum AB; fluoroquinolone q2-h-qid; Aminoglycoside as alternative; Cipro or tobrex ung; |
|
|
Term
| In mild alkali or acidic burn if you have excessive inflammation you should rx |
|
Definition
| Prednisolone 1%; q4h, qid; Dosage lesser than the antibiotics and during first 5-7 DAYS |
|
|
Term
|
Definition
| Daily and continue medication until resolved; Monitor IOP spikes; Secondary glaucoma may occur due to blockage of the TM by inflammatory debreis; Longterm tx include PF lubricants (dry eye) |
|
|
Term
|
Definition
| Immediate irrigation; Day one will look better than 2-3 days; Most acid/alkali burns are manageable if mild Refer if >mild to cornea specialist |
|
|
Term
| Options in management for >Mild alkali burns |
|
Definition
| Sodium Ascorbate 10% topical and Sodium Citrate 10% topical q2h; Oral Vitamin C 500 mg po QID; Doxycycline 100 mg BID; Surgical options: 1. amnioticic membrane transplantation, Limbal cell tranplanatation, Lamellar Keratoplasty |
|
|
Term
| Signs and symptoms Pain, photophobia, tearing, coagulation of epithelium, stromal involvement: haze |
|
Definition
|
|
Term
| Treatment for thermal burn |
|
Definition
| Mild or small – treat as abrasion protocol; Larger epithelia necrosis: debride w/ qtip or spud; Tx as deep abrasion protocol; analgesics as before; F/U – Daily; If stromal involvement REFER |
|
|
Term
| Signs and symptoms pain, photophobia, tearing; superficial keratitis, sun burns on skin, conjunctiva injection |
|
Definition
|
|
Term
| Treatment for UV or Radiation burn |
|
Definition
| Lubricants, Fluroquinolones qid, Cipro or tobrex ung hs or steroids: in combo Tobradex, Zylet q2h-quid; Cycloplegia, Analgesic; F/U 24 h Degenerative changes could be due to inflammation, aging, or systemic disease and can result in thinning, VASCULARIZATION, or depositon of material into corneal tissue; They are usually unilateral but if bilateral they can be asymmetric; May be due to INVOLUTIONAL changes or related to other disease (NO FAMILY HISTORY) |
|
|
Term
|
Definition
| primary, inherited corneal diseases that occur without past ocular diseases or associated systemic disease, so rule out any scarring or inflammation from trauma before making your diagnosis; MANY of the dystrophies are inherited through an AUTOSOMAL DOMINANT MODE; usually bilateral and symmetric; More central location; NO VASCULARIZATION; Primarily will involve single layer thus the classificiaton is accordingly; Most are progressive and have an early onset |
|
|
Term
| White ring in peripheral cornea; Started inferior then progressed superior and then 360 degree; Clear interval form limbus to arcus; Located in the Bowman’s Layer; Accumulation of cholesterol, triglycerides and phospholipids 60% 40-60; 100%>80; Usually not hyperlipedemia factor after age 40 |
|
Definition
|
|
Term
| 39 y.o. with white ring; started inferior then has progressied superiorly; Clear interval from limbus to arucs, Located in the Bowman’s Layer: Management |
|
Definition
| Refer for Lipid Profile Lab and cardiovascular risk factors |
|
|
Term
| Cardiovascular risk factors associated with Arcus Seniles |
|
Definition
| Family History, HBP, Obesity, Smoking, No exercise, Diet, Stress |
|
|
Term
| 50 y.o.; white ring in peripheral cornea; Management |
|
Definition
| Go by systemic HX, advise annual exams and F/U; Patient counseling about medical exams; monitor ocular signs |
|
|
Term
| Peripheral degeneration, White opacity in the medial and temporal limbal areas; with a clear zone separating it from the limbus; It is a subepithelial degeneration, calcium deposit (may or may not be present); considered an aging change |
|
Definition
| White Limbal Girdle of Vogt |
|
|
Term
| White limbal Girdle of Vogt Health and Visual Consequences |
|
Definition
|
|
Term
| Management for White Limbal Girdle of Vogt |
|
Definition
| None; Re-assurance F/U: PRN |
|
|
Term
| Bilateral, slow, painless, progressive thinning of the peripheral stroma that usually begins in the superior nasal quadrant and spreads circumferentially. It leaves the epithelium intact but may result in some vascularization of the gutter. A yellow border of lipid is characteristically present at the lesion's advancing edge Opacification and stromal thinning can lead to eventual corneal perforation Leads to high astimatism |
|
Definition
| Terrien’s Marginal Degeneration |
|
|
Term
| Bilateral, slow, painless, yellow border, Increased Astigmatisim Mangement: |
|
Definition
| Terrien’s Marginal Degeneration: Supportive; If inflammation: topical steroids Correct astigmatism: CL’s; Advance disease: surgical repair such as lamellar or full thickness keratoplasty F/U as needed |
|
|
Term
| Non-involutional; Ca Deposits on subepithelial space Bowmans and anterior stroma in interpalpebral fissure; Swiss cheese pattern; Starts at nasal or temporal cornea and then spreads to the center |
|
Definition
|
|
Term
| Ocuarl Causes of Band Keratopathy |
|
Definition
| Ocular: chronic inflammation (iridocyclitis) JIA, corneal edema, old interstitial keratitis, trauma, longstanding glaucoma, ocular surgery |
|
|
Term
| Drugs Causes of Band Keratopathy |
|
Definition
| : mercury exposure, silicone, preservatives |
|
|
Term
| Metabolic systemic disease Causes of Band Keratopathy |
|
Definition
| : hypercalcemia (Hyperparathyroid), sarcoidosis, Pagets, excess Vit D, Gout I |
|
|
Term
| Idiopathic Causes of Band Keratopathy |
|
Definition
| : age related( the least cases) |
|
|
Term
| Symptoms: Often asymptomatic If central, VA is affected Ocular irritation if thick calcium plaque flake off and causes epithelial defect Signs: Interpalpebral band of calcium separated from limbus by a thin clear cornea Plaque begins at temporal or nasal and extends centrally Small holes: swiss cheese” |
|
Definition
|
|
Term
| Treatment/Work-up for Band Keratopathy |
|
Definition
| *History of systemic disease, signs of ocular disease or longstanding glaucoma, trauma or drugs* |
|
|
Term
| If no ocular disease/history: in Band Keratopathy; R/O systemic disease such as |
|
Definition
| : R/O hyperparathyroidism/hypercalcemic: Order: calcium, Mg, albumin, phosphate levels |
|
|
Term
| R/O Sarcoisosis in Band Keratopathy by ordering |
|
Definition
|
|
Term
| In Children with Band Keratopathy you must R/O |
|
Definition
| R/O JIA in children: Order ANA, RF, HLA-B27 |
|
|
Term
| Treatment forBand Keratopathy and F/U |
|
Definition
| Mild: observe and lubricants sol q2-4h and ung hs F/U q2-3months |
|
|
Term
| If VA down In Band Keratopathy treatment |
|
Definition
| : Refer for debridement of epithelium with scalpel/spatula and application of chelating agents: EDTA (disodium ethylenediamine tetraacetic acid 3%) to remove calcium; PTK (phototherapeutic keratectomy) Superficial lamellar keratectomy, amniotic membrane; *alcohol debridement like in lasek |
|
|
Term
| Poor corneal dehydration, fluid not removed by pump: endothelial decompensation. Fluid accumulates in epithelium and stroma and separates epith. from Bowman's forming an epithelial bullae (“blister”) With time bullae ruptures causing an epithelial defect |
|
Definition
|
|
Term
| Causes Of Bullous Keratopathy |
|
Definition
| Post op cataract sx.; Intraocular Inflammation; Fuchs’ endothelial Dystrophy; Chronic high IOP Trauma |
|
|
Term
| Signs: Corneal Stroma and epithelial edema, Bullae or vesicles, Descement Folds, Guttata, CME |
|
Definition
|
|
Term
| Symptoms: Pain, blurry vision* “AM loss of vision”, Photophobia, Redness, Tearing, FB sensation, |
|
Definition
|
|
Term
| Bullous Keratopathy Treatment: |
|
Definition
| Check IOP, SLE (look at fellow eye), DFE; Hyperosmotics q2h-3 until noon, then q4-6h; oint hs: 5% NACL (muro-128) Hair dryer (low!!!) 10 min in AM; F/U weekly to monthly; IN HIGH IOP avoid CAI; prostaglandins*, epinehrine (if post-opt) |
|
|
Term
| Bullous Keratopathy Treatemtn in bullae rupture cases cases |
|
Definition
| If bullae rupture: ab oint (erythromycin, polyosporin), cyclopege (homatropine 5% or scopolamine 0.25%) and bandage CL for 24 hours; F/U daily |
|
|
Term
| Bullous Keratopathy Treatment in recurrent ruptured bullae |
|
Definition
| Bandage CL for recurrent ruptured bullae |
|
|
Term
| If severe Bullous Keratopathy |
|
Definition
| DSEK (descement stripping endothelial keratoplasty),penetrating keratoplasty, PTK, anterior stromal puncture |
|
|
Term
| Corneal thinning, usually at limbus; Localized “excavation” due to dryness; Ellipsoid shape; Adjacent conjunctival or corneal elevation; Epithelium is intact; Eye is not inflamed; mostly at 3-9 o’clock; Usually asymptomatic; Can cause irritation and foreign body sensation; Any age |
|
Definition
|
|
Term
| What is Dellen usually associated with: |
|
Definition
| Conjunctiva: Pinguecula, chemosis, thick SCH; Eyelids: internal chalazion, irregular tarsus, lagophthalmos; Thick edge of firm CL |
|
|
Term
| Decreaseed corneal sensitivity is the hallmark of |
|
Definition
|
|
Term
| A degenerative disease of the corneal epithelium characterized by impaired healing. Epithelial breakdown can lead to ulceration, infection, melting, and perforation secondary to poor healing. |
|
Definition
|
|
Term
| Most common Type of Neutrophic Keratopathy |
|
Definition
| Infection: DUE TO Herpes simplex Herpes zoster |
|
|
Term
| Second Most common type of Neutrophic Keratopathy |
|
Definition
| Fifth nerve palsy: Surgery for trigeminal neuralgia Neoplasia (acoustic neuroma) Aneurysms Facial trauma Congenital |
|
|
Term
| Topical medications Medications that Cause Neutrophic Keratopathy |
|
Definition
| Anesthetics Timolol NSAIDS |
|
|
Term
| Corneal dystrophies that may cause Neutrophic Keratopathy |
|
Definition
|
|
Term
| Systemic disease that may be responsible for Neutrophic Keratopathy |
|
Definition
| Diabetes mellitus Vitamin A deficiency Multiple sclerosis Stroke Drug abuse: crack keratopathy |
|
|
Term
| Post refractive surgery: LASIK can lead to |
|
Definition
|
|
Term
| Stages: The Mackie classification for neurotrophic keratopathy |
|
Definition
| I- Rose bengal staining of palpebral conjunctiva, low TBUT, tear mucus, SPK II- localized loss of epithelial, ovoid shape, rolled borders, stromal edema, could have cells and flare III- Stromal lysis, perforation |
|
|
Term
| Work-up for Neutrophic Ulcer |
|
Definition
| : History: surgery, neuro, medical, ocular, meds`, drugs: Cranial Nerves evaluation: III, IV, VI, V and VII, pupils: If suspect neuro: MRI or CT of brain External examination: Ectropion, lagophthalmos, scars from surgery, chemical burns, or thermal burns. |
|
|
Term
| Management of Neutrophic Ulcer Stage I |
|
Definition
| D/C topical drugs> Do not use Acular, Voltaren, etc Lubricants PF q1h-q4h and ung hs Consider punctal plugs Asses eyelid position and treat accordingly F/U 3-7 days |
|
|
Term
| Stage II Management of Neutrophic Ulcer |
|
Definition
| If large ulcer: AB ung (tetracylcine, erythromycin), cycloplege and PP/CL and see in 24 h Alternate tx for large ulcer: no patch, ab ung q2h and cycloplege w/ homatropine bid F/U daily NOTE: Doxycycline 100 mg PO daily has been used to promote healing; Tasorrhapy |
|
|
Term
| Sage II Management of Neutrophic Ulcer |
|
Definition
| Thinning and lysis of stroma: cyanoacrylate glue w/ BCL, conjunctival flaps, amniotic membranes, scleral lenses Larger defects may need penetrating keratoplasty |
|
|
Term
| Hereditary, bilateral, symmetric, usually in central Cornea Avascular, unrelated to other local or systemic disease Appears 1 to 2 decade-autosomal dominant, the majority Slowly progressive Epithelial/BM, Stromal, DM and Endothelium |
|
Definition
|
|
Term
| Most common anterior corneal dystrophy |
|
Definition
| Map-dot-fingerprint or Cogan’s Dystrophy |
|
|
Term
| Abnormal epithelial turnover, maturation and production of basement membrane thickened basement membrane abnormal epithelial cells with microcysts ( absent or abnormal hemidesmosomes) fibrillar material between BM and Bowman’s layer |
|
Definition
| Epithelial Basement Membrane (EBMD) |
|
|
Term
| Bilateral; More common in women; Some cases show hereditary pattern: autosomal dominant. Then, onset is between 4-8 years of age Others, no hereditary pattern. Then onset is adulthood, 40-70 year |
|
Definition
|
|
Term
|
Definition
| intraepithelial microcysts that contain nuclear, cytoplasmic, and lipid debris. |
|
|
Term
|
Definition
| curvilinear clusters of reduplicated and thickened basement membrane and fibrillogranular material. Corneal fingerprints are clusters of contoured concentric lines They are seen best with retroillumination or indirect illumination |
|
|
Term
|
Definition
| , a less common manifestation of map-dot-fingerprint dystrophy, are localized areas of fibrillogranular material or thickened basement membrane. Corneal blebs are clear, round, bubblelike defects. They are seen best with retroillumination. |
|
|
Term
| Symptoms: Asymptomatic, if mild Photophobia glare Reduced VA Pain AM from RCE Signs: map, dot, lines Negative NAFL Bilaterality RCE (sx’s of it) |
|
Definition
|
|
Term
|
Definition
| Patient education, family members; If sx’s in the morning, hypertonic oint hs. Drops during day: follow long term protocol w/ hypertonics (MURO-128) for RCE; Lubricants PF, Fresh Kote, q2-4h during the day Bandage CL may be used |
|
|
Term
| In EDMD and epithelium is heaped and loose |
|
Definition
| Debridement as specified in RCE protocol; Treat RCE as before* F/U according to severity |
|
|
Term
|
Definition
| Stromal puncture or PTK; PTK more preferred for centrally located erosions |
|
|
Term
| Name other epithelial dystrophies |
|
Definition
| Messman’s, Reis-Buckler-Bowman layer, Anterior Mosaic-Bowmans |
|
|
Term
| Autosomal dominant in inheritance Characterized by recurrent painful corneal erosions (1st to 2nd decade) Minimal corneal changes are seen at first Then ring and map-like opacities appear at the level of bowman's membrane which become denser and more irregular over time Increasing fibrosis results in visual difficulty; corneal surface is rough |
|
Definition
|
|
Term
| Autosomal dominant in inheritance Characterized by recurrent painful corneal erosions (1st to 2nd decade) Minimal corneal changes are seen at first Then ring and map-like opacities appear at the level of bowman's membrane which become denser and more irregular over time Increasing fibrosis results in visual difficulty; corneal surface is rough. TREATMENT |
|
Definition
|
|
Term
| Rare; epithelial dystrophy Seen in the first years of life, but asymptomatic until middle age Autosomal dominant Tiny, discrete epithelial vesicles diffused across the palpebral fissure Condition/Treatment |
|
Definition
| Meesmann’s Dystrophy; Treatment - usually not required - bandage contact lenses - Superficial keratectomy if visual acuity is impaired |
|
|
Term
| Breaks in Bowman’s layer that resemble the skin of a crocodile with gray-white opacities in a polygonal pattern with clear intervening spaces. Its late onset suggests that it is a degeneration rather than a dystrophy. Most patients with anterior mosaic dystrophy/degeneration are asymptomatic. |
|
Definition
| Anterior Mosaic corneal dystrophy (crocodile skin) |
|
|
Term
|
Definition
| Stromal: Granular, Lattice and macular – dystrophies stain their home; (Very Rare) |
|
|
Term
| Stromal Dystrophies Treatement |
|
Definition
| No tx, unless VA is way down; If VA down, penetrating keratoplasty If RCE, treat accordingly |
|
|
Term
| POSTERIOR CORNEAL DYSTROPHIES |
|
Definition
| Deep stromal and endothelial: Central cloudiness, Post polymorphous, Fuch’s |
|
|
Term
| Symptoms Glare and blurred vision, especially in the morning May progress to severe pain Autosomal dominant Bilateral, more in women; 5th-6th decade Pain if develops from bullous keratopathy |
|
Definition
| Fuch’s endothelial dystrophy |
|
|
Term
| Signs Corneal guttata Corneal stromal edema Bilateral, asymmetric May present fine pigment in endothelium, bullae, descemet’s folds, subepithelial scar Ruptured bullae |
|
Definition
|
|
Term
| Fuch’s Dystrophy Treatment |
|
Definition
| Topical hypertonic sol q2h-qid and ointment hs Blow dry 5-10 min in the morning to dehydrate cornea If IOP > 22mmhg, glaucoma medication, keep IOP low!!!!! Avoid CAI Take pachymetry |
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|
Term
| If rupture bullae in Fuch’s Dystrophy |
|
Definition
| Treat ruptured bullae as corneal abrasion/RCE protocol - Can use: antibiotic ung, BCL - cycloplegic (homatropine, scopolamine) - f/u 24h |
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Term
| If VA reduced , or is painful and advanced in Fuch’s (treatment) |
|
Definition
| , corneal penetrating keratoplasty, DSEK (descement stripping endothelial keratoplasty transplant is indicated F/U 4 weeks when no bullae rupture |
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|
Term
| 17 year old patient with blurry vision and high astigmatism |
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Definition
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|
Term
| Evidence as an hereditary condition Diagnosed between 10-30 years age Progresses for 7-8 years, the stabilizes Bilateral and asymmetric Histopath: fragmentations/interruption on Bowman’s Defective collagen?? Rubbing eyes Hard CL?? |
|
Definition
|
|
Term
| Symptoms slow ,progressive refractive changes with reduced VA over months to years Frequent hx of BA, allergies, atopias, chronic eye rubbing, also Down’s syndrome, Turner syndrome, Marfans, RP Glare, mild photophobia, painless, diplopia or polyopia may be reported May have family hx |
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Definition
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|
Term
| Signs Usually bilateral, but asymmetric Progressive irregular astigmatism secondary to paracentral thinning Maximal thinning near the apex of the protrusion Vogt’s striae ( vertical lines of tension in the posterior cornea) Irregular retinoscopy reflex Egg-shaped K’s |
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Definition
|
|
Term
| Specific Signs of Keratoconus |
|
Definition
| Fleischer’s ring ( epithelial iron deposits at the base of the cone) Munson’s sign Superficial corneal scarring If Descement ruptures: Corneal hydrops (stromal edema in cone area) |
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Term
| Keratoconus Management and Treatmetn |
|
Definition
| Correct refractive error with glasses or RGP; If patient cannot tolerate CL or vision is not satisfactory: corneal transplant Corneal Hydrops protocol: Cycloplegia hypertonic ointment bid prophylactic ab (erythromycin ung) qid Wear protection |
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|
Term
| Keratoconus Hydrops Follow- UP |
|
Definition
| After corneal hydrops episode : every 5-7 days until resolved Then, Depending on symptoms: 3-12 mo. |
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|
Term
| Specific corneal conditions that are non-infectious but are inflammatory: |
|
Definition
| Filamentary keratitis, Thygeson’s keratopathy, Exposure keratopathy, Ocular Rosacea |
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|
Term
| Disrupted epithelial Integrity; Dead epithelial cells combine with mucin to form threads (filaments) one end is attached to a dry spot in cornea; the other end moves freely |
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Definition
|
|
Term
| Causes of Filamentary Keratitis |
|
Definition
| KCS (keratoconjunctivitis sicca)- Most common, SLK (superior limbic keratoconjunctivitis), AKC (atopic keratoconjunctivitis), VKC (vernal keratoconjunctivitis), Neurotrophic keratitis, post-surgery, long term patching, Medications: Benadryl, Chronic, mechanical (FB, abrasions, CL) Burns RCE (recurrent corneal erosions) HSK (herpes simplex keratitis) HZK (herpes zoster keratitis) EBMD (epithelial basement membrane disorder)Systemic: Diabetes Mellitus, Sarcoid, Psoriasis |
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|
Term
| Signs: filaments accumulate on corneal region most involved from primary cause Filaments stain with rose bengal/NAFL Symptoms: FB sensation burning Lacrimation photophobia FK |
|
Definition
|
|
Term
| Work-up For Filamentary Keratitis |
|
Definition
| History: R/O the underlyinig causes (conditions previously described) SLE, staining |
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|
Term
| Treatment for Filamentary Keratitis |
|
Definition
| Treat underlying condition 1. Debridement*: remove the filaments w/ a jewelers forceps or Q-tip 2. PF Lubricants: q2-4h and ung (Refrersh PM) hs. Consider punctal occlusion |
|
|
Term
| If moderate-severe or recurrent Filamentary Keratitis |
|
Definition
| : 10% N-Acetylcysteine (Mucomyst) may be used qid for 3-4 weeks 4. If severe and not responding to debridement, lubrications or Mucomyst: consider Bandage Cl, 5. 5% NACL qid and ung hs. Regimen appears to work at the corneal epithelium reducing edema and promoting adhesion or by drawing interstitial fluid osmotically to corneal surface reversing the dry eye state. (Hamilton) 6. But then, Grinbaum et al, studied patients w/ FK and treated them w/ diclofenac sodium 0.1%, and found it to more effective than 5%NACL. So it is given as a sole modality or in conjunction w/previous options in the following schedule: A Diclofenac sodium .1%(Voltaren) QID for 3-4 weeks F/U q1-2 weeks depending on case |
|
|
Term
| Bilateral, chronic, central, focal epithelial keratitis without conjunctival or stromal inflammation; “keeps no company” |
|
Definition
|
|
Term
| Etiology: unknown, immunological autoimmune response. sub-clinical viral etiology suspected in the past has but 2007 report disproves the viral theory: |
|
Definition
|
|
Term
| Duration: 6 months to 4 years. Active disease last 1-2 months, then go into remission for 4-6 months, and then recur. After 2-4 years the disease resolves. Cases lasting 20 years. Dramatic symptomatic relief when used topical steroids |
|
Definition
|
|
Term
| Symptoms: Photophobia FB sensation Lacrimation Tearing Mild decrease in vision Signs: Corneal lesion in active disease is a group of coarse, , ovaloid, slightly raised, white or gray dot that stains with NAFL. Central: 1-50 dots with normal epith. in between. Inactive lesions appear intraepith. and flat and do not stain Conjunctiva not injected No corneal edema Anterior chamber clear |
|
Definition
|
|
Term
| Treatment:of Thygeson’s Keratitis |
|
Definition
| Mild:Artificial tears: q1-4 hr; ung hs Mod-sev.: Mild steroid: such as .1% FML, Lotemax, Alrex (loteprednol .25%: tid-qid for 1-4 weeks and taper VERY SLOWLY Bandage CL if no improvement or as an alternate tx during recurrence if NI or there is contraindication for steroids Cyclosporin A qd-qid, *Another “off label” use* See article Can be used as adjunctive or alternate tx F/U weekly and then q 3-12 months |
|
|
Term
| Causes: Bell Palsy with secondary lagophthalmos Nocturnal lagopthalmos or incomplete closure Proptosis Ectropion or eyelid deformity (scarring from trauma etc) Floppy eye lid |
|
Definition
|
|
Term
| Symptoms: FB sensation “dryness” more in am after cornea has been exposed all night Signs: Signs of underlying etiology SPK in interpalpebral fissure |
|
Definition
|
|
Term
| Work Up for Exposure Keratitis |
|
Definition
| Work-up History Evaluate Bell’s reflex, eyelid closure corneal sensation tear layer; NAFL, Rose bengal or Lissamine Look for secondary infection: cells, flare, red “angry” eye’, infiltrates, discharge Exophthalmometry- Proptosos:Thyroid? Tumor? Exposure Keratopathy |
|
|
Term
| Treatment for Exposure Keratitis |
|
Definition
| Treat underlying disease PF Lubricants q1-4 h; ung hs with lid taping Punctal plugs might be considered F/U q 2-4 weeks when no corneal erosions/ulcerations |
|
|
Term
| Exposure Keratopathy risk for infection or infected signs and treatment |
|
Definition
| epithelial erosion, infiltrates, A/C reaction, severe conjunctival injection, then add: topical antibiotics accordingly to infectious keratitis protocol |
|
|
Term
| Cornea: inferior vascularization Inferior SPK 3-9 o’ clock hyperemia and/or SPK Marginal infiltrates Peripheral thinning |
|
Definition
|
|
Term
| Management of active corneal disease: |
|
Definition
| See systemic treatment guides in Rosacea readings assigned before: Dermatoocular Disease Co manage with dermatologist: CONSULT Treat eyelid disease as before (see lectures) Tetracycline drugs as before: Topical steroids in combo w/ antibiotics for inflammation, vascularization, marginal SEI (R/O infectious!): Zylet or Tobradex q4-6h. Erythromycin ung tid while active disease Do not use steroids if risk of perforation or high risk factors for infectious! F/U carefully and accordingly |
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|
Term
| Treatment for Ocular Rosacea |
|
Definition
| Doxycycline 100mg bid 1-2 weeks (up to 6 weeks*), then taper slowly: example: taper to 50mg qd for 1 mo, then 50mg qd every other day for 1 month, then stop acording to sx’s. Tetracycline (TTC) 250 mg PO qid and taper; Minocin (minocycline)100mg bid and taper *Erythromycin 250mg qid PO if allergic, pregnant, nursing or < 8 yr child Could have the patient in a maintenance dose of EX: TTC 250 mg qd or Doxycycline or Minocin 50 mg qd as long as you see active disease |
|
|
Term
|
Definition
| Atopic, Vernal, Infiltrative, Immunological keratitis, Marginal Keratitis (marginal ulcer is a misnomer), Staph Toxic SPK, Medicamentosa, Non-syphilitic interstitial keratitis (Cogan syndrome), Contac lenses related |
|
|
Term
|
Definition
| Bacterial, Fungal, Adenoviral, Chlamydial, Acanthamoeba, Herpetic Keratitis: epithelial and stroma, Interstititial or syphilitic keratitis, |
|
|
Term
|
Definition
| Diffusion or accumulation of substances not normal to, or in amounts that exceed the normal, in a tissue or cell |
|
|
Term
|
Definition
| Is an inflammatory condition associated to a microorganism on or in the cornea |
|
|
Term
|
Definition
| Excavation of an organ or tissue produced by material shed by the inflammatory necrotic tissue |
|
|
Term
| Damage to epithelial layer in a pinpoint pattern |
|
Definition
|
|
Term
| Etiology: of Superficial Keratitis |
|
Definition
| Mechanical: trauma: abrasions, RCE, etc; Non-inflammatory (such as dystrophies); Inflammatory: Non-infectious or true infectious etiology) |
|
|
Term
|
Definition
| : ADV, toxic staph rx, medicamantosa, HSV, HZV, Thygeson's, verrucae, Molluscum contagiosum, CL, microsporidia |
|
|
Term
|
Definition
| : toxic staph rx, trichiasis, medicamentosa, entropion, rosacea, lid disease, CL, atopic KC |
|
|
Term
|
Definition
| : dry eye, KCS, exposure keratitis, CL |
|
|
Term
|
Definition
| VKC, SLK, Inclusion KC, Trachoma, CL, atopic KC |
|
|
Term
| If related to toxicity to staph, lid margin disease, rosacea or there is risk of infection treatment |
|
Definition
| add ab’s: erythro or bacitr. ung bid to qid Alternate: solutions:aminoglycosides sol, fluoroquinolones or polytrim qid F/U: more frequently ( q 2-5 days) |
|
|
Term
| Sterile keratitis treatment |
|
Definition
| steroids are contraindicated in infectious (ulcerative) keratitis or suspicious origins If there is any suspicion of infection or ulcer or risk factors do not introduce steroid x 24-48 h or until clinical picture is better and/or cultures are (-)*: COMPLICATIONS: 2ry infection, anterior stromal damage F/U: variable according to condition |
|
|
Term
| RISK FACTORS TO INFECTION in keratitis: IMPORTANT!!!!!!! |
|
Definition
| EWSCL wearer contaminated ophth. solutions, poor personal hygiene, DM, AIDS, recent or concurrent use of topical steroid, recent ocular surgery, dry eyes or epithelial damage, Neurotrophic keratopathy, CN VII palsy |
|
|
Term
| Marginal Infiltrative Keratitis Etiology : |
|
Definition
| suggested to be an Ag-Ab rx or hypoxia ( not infection); Infiltrative immune response to staphylococcal exotoxins, usually from LL margin glands; 4-8 o’clock more vulnerable; Island lesions with clear area between limbus and lesion Usually as a result from Staphylococcal blepharoconjunctivitis, but also associated to acute conjunctivitis by ?-hemolytic Streptococcus, Haemophilus aegyptus,Moraxella lacunata and from chronic dacryocystitis; Secondary to hypoxia to cornea from SCL wear; Scrapings show neutrophils: patients' antibody response results |
|
|
Term
| Is a sterile response to bacterial toxins or to hypoxia in SCL wear; Does not have live bacteria (cultures are negative) |
|
Definition
| Marginal Infiltrative Keratitis |
|
|
Term
|
Definition
| Redness (vasodilation release PMN’s), Edema, Infiltration, Ulceration, Scarring |
|
|
Term
| Symptoms: Acute or subacute, most of the time unilateral Usually sterile infiltrate gives mild pain; infectious ulcer is very painful; previous hx ,corneal symptoms; Hx staph lid condition; watery eye, some pain w or w/o photophobia *Consider infectious keratitis risk factors** |
|
Definition
| Marginal Infiltrative Keratitis |
|
|
Term
| Signs: Single or multiple island intraepithelial infiltrates lesions separated from the limbus by a clear area.; Could have edema (clouding the clear area); Infiltrates size : from 0.5 mm to 2.0 mm (rarely>1mm); Infiltrates location: 2, 4, 8 and 10 O’clock; (Most common at 4 and 8 o’clock); May coalesce; Usually no overlying epithelial defect, but if present it is smaller than infiltrate IMPORTANT!!!!! |
|
Definition
| Marginal Infiltrative Keratitis |
|
|
Term
| Conjunctival signs of Marginal Infiltrative Keratitis: |
|
Definition
| Hyperemia: mild-moderate (not too severe) if very severe: Red Flag Hyperemia is more segmental: greater inferior leashes of vessels toward infiltrate; Conj vessels may cross the corneolimbal juncture causing prominent arcades and pannus; If chronic, then NV into stroma |
|
|
Term
| To consider Marginal Infiltrative Keratitis an Ulcer DX the signs to look for would be |
|
Definition
| If the infiltrates has Stromal haze NaFl staining showing a bright Island: overlying epithelial defect Equal or larger than infiltrate: **Red Flag!!!! Island is larger and depressed |
|
|
Term
| Chronic , subacute, undertreated lesions, may cause anterior stromal infiltrates resulting in corneal scars. Don’t confuse them w/ active ones! May progress ( rare, but possible) and cause anterior stromal necrosis consider this as sterile ulcer, but treat as |
|
Definition
|
|
Term
| Marginal Infiltrative Keratitis Work-up/Management |
|
Definition
| True infection or sterile?: THIS IS ALWAYS IN YOUR MIND!!!!!1- look at accompany sx’s and signs of infection:Signs of Infection: sterile versus bacterial keratitis (true infection) SEE table in Bartlett page 519 Required!! |
|
|
Term
| Signs of Infection in marginal infiltrative keratitis |
|
Definition
| discharge; evere conjuncival hyperemia, generalized; epithelial defect over it usually larger; NAFL staining!!!; iritis, hypopyon; Pain 6. infiltrate is larger, no clear interval w/ limbus *Sterile infiltrates will not have the above mentioned signs:* |
|
|
Term
| RISK FACTORS: for Marginal Infiltrative Keratitis |
|
Definition
| EWSCL wearer, specially “over users” contaminated ophthalmic solutions poor personal hygiene trauma DM, other systemic disease AIDS or immunocompromised recent or concurrent use of topical steroid recent ocular surgery dry eyes, chronic lid disease or epithelial damage Bell’s palsy, neurotrophic |
|
|
Term
| Marginal infiltrate + blepharitis signs Management |
|
Definition
| (marginal infiltrate has no overlying epithelial defect)Resolve blepharitis: warm compresses and lid scrubs Combo drug: Tobradex or Zylet QID F/U in 2-3 days |
|
|
Term
| Marginal infiltrate due to CL wear (marginal infiltrate has no overlying epithelial defect): |
|
Definition
| Look at the differential dx between “true infection vs sterile” If you truly think it is sterile from hypoxia: 1. D/C CL wear 2. Tobradex or Zylet q2h for 2 days and then qid for 4-7 days or until improvement 3. F/U daily, looking for true infection signs |
|
|
Term
| For all marginal infiltrates: If corneal epithelial overlying defect OR ulcer suspect and/or a definite dx between sterile or infectious keratitis cannot be made:Management/Treatment |
|
Definition
| Obtain corneal culture first, then: If multiple risk factors are present: treat as infectious keratitis protocol (treatment of corneal ulcers) |
|
|
Term
| If, again, (same as above) a definite dx between sterile or infectious keratitis cannot be made BUT: no risk factors are present: Treatment |
|
Definition
| Cycloplegic agent (5% homatropine) 1 drops of 0.3% aminoglycoside or fluoroquinolone q1h until following day F/U within 24 h to see clinical picture |
|
|
Term
| Infiltrative keratitis due to Immune related disease: |
|
Definition
| (ex: RA, SLE, Wegener granulomatosis, Relapsing polychondritis, polyarteritis nodosa) |
|
|
Term
| If patient does not have a hx of systemic disease: refer for work-up; should include: |
|
Definition
| ANA, ESR, RF, CBC, ANCA (P-ANCA and C-ANCA) |
|
|
Term
| Management of Infiltrative Keratitis associated with KCS: |
|
Definition
| lubricants, punctal plugs, topical steroids and Restasis |
|
|
Term
| Management of Infiltrative Keratitis associated with Corneal thinning: |
|
Definition
| co-manage w/ rheumatologist, corneal specialist Lubricants q1h, erythromycin ung hs w/ PP; Cycloplege if A/C rxn or pain 3. Oral Prednisone 60-100mg PO qd and taper according to healing response 4. Oral immunosuppressive agents by rheumatologist: cyclophosphamide, methotrexate, etc 5. Restasis bid 6. No topical steroids 7. If high risk of perforation: cyanoacrylate, ammionic membrane* and conjunctival flaps are used. F/U daily until improvement |
|
|
Term
| Infiltrative Keratitis 3.PUK and keratolysis Treatment |
|
Definition
| Systemic treatment and cyanoacrylate adhesive and bandage contact lens |
|
|
Term
| Infiltrative Keratitis Sclerosing keratitis and stromal infiltration: Treatment |
|
Definition
| lubricants q1h, ung hs, punctal plugs, bandage CL and topical cylcosporine are options together w/ systemic treatment and scleritis treatment. |
|
|
Term
| Rare and painful peripheral corneal ulceration which occurs in the absence of any associated scleritis, and any detectable systemic disease. Antibodies to corneal antigens Secondary to surgery or ocular disease In 1994, Wilson et al 2 pt’s w/ the bilateral type were + for Hepatitis C |
|
Definition
|
|
Term
|
Definition
| 1- Unilateral in older pt’s (75%), mild inflammation 2- Progressive and bilateral in younger pt’s (more so black males); aggressive, more redness and inflammation 3- Bilateral indolent Mooren’s ulceration (BIM), which usually occurs in middle-aged patients presenting with progressive peripheral corneal guttering in both eyes, with little inflammatory response, no vascularization |
|
|
Term
| Symptoms redness, tearing, photophobia, but pain is the most outstanding feature. Signs: serpiginous ulcer of the cornea begins peripherally, spreads circumferentially and progresses to central cornea Has overhanging epithelial edge involvement of the limbus No discharge |
|
Definition
|
|
Term
| Work-up /management: of Mooren’s Ulcer |
|
Definition
| Work-up to R/O systemic disease( this is diagnosis of exclusion): CBC, ANCA, ANA, Hepatitis panel, ESR, RF, PPD, VDRL, FTA-ABS |
|
|
Term
| Initial approach of Mooren’s Ulcer |
|
Definition
| Pred Forte 1% q1h and taper slowly over next months; Fluoroquinolone or polytrim qid; Atropine bid or homatropine tid |
|
|
Term
| If unresponsive to topical steroids, after 7 to 10 days, or in cases where topical steroids may be contraindicated because of suspicious deep ulcer or infiltrate or severe bilateral in Mooren’s Ulcer |
|
Definition
| Prednisone 60-100 mg PO; Cyanoacrylate flaps, Conjunctival resection, amniotic membrane; Oral immunosuppressants if bilateral and not responsive to above therapy: Cyclophosphamide, Methotrexate, Azathioprine, oral cyclosporine; Anti-HCV, HCV RIBA, HCV-RNA; Interferon if Hepatitis; F/U daily |
|
|
Term
| Corneal signs: Whitish or pinkish nodule Adjacent to limbus, long axis ia perpendicular to limbus Leash oc perilimbal vessels Scarring leaves a triangular scar w/ base at limbus |
|
Definition
|
|
Term
| Work-Up/Approach for Phlyctenulosis |
|
Definition
| Determine the cause: inspect lids, (staph hypersensitivity), (blepharitis), ask about recent infection; ocular rosacea TB: PPD is indicated if patient is a TB suspect or no other cause can be found; if + order chest x-ray R/O Behcets, HIV, Rosacea Phlyctenules can resolve spontaneously, but usually ulcerate and leave a scar |
|
|
Term
| Treatment of corneal Phlyctenule To prevent scarring: |
|
Definition
| indefinitely eye lid scrubs for chronic staph blepharitis; Rosacea treatment if applies; 1% prednisolone acetate or loteprednol .5% 1 gtt q 2-4 h x 3-4 days; Prophylactic AB ointment (polyosporin) or drops (polytrim) qid and continue while the steroid is used |
|
|
Term
| Alternate Treatment for Phlyctenule |
|
Definition
| : Combo: Tobradex or Zylet qid Once improved, taper the steroid; AB and steroid tx should lasts for 10-14 days; |
|
|
Term
| F/U schedule on Phlctenulosis |
|
Definition
| : q 2 days initially; when improved q5-7 days |
|
|
Term
| Corneal changes- has various levels of severity SPK: can be severe, ? VA and photophobia; pannus, neovascularization; Keratitis; Shield ulcers; Scarring; |
|
Definition
|
|
Term
| VKC Shield Ulcer Treatment |
|
Definition
| Topical Steroid q4h-q6h; Topical antibiotic (erythromycin ung q4h); Cycloplegic (homatropine tid-qid) |
|
|
Term
| RTC for Shield Ulcer in VKC |
|
Definition
|
|
Term
| Most common type of bilateral interstitial keratitis |
|
Definition
| Congentital Syphilis; Cogan’s syndrome is another type of bilateral interstitial keratitis |
|
|
Term
| Most common type of uniltateral stromal keratitis |
|
Definition
|
|
Term
| Young-Middle adult patients with acute vertigo, tinnitus and hearing loss; Might have systemic vasculitis (aortitis, inflammatory bowel disease, pericarditis); may have polyarteritis nodosa |
|
Definition
|
|
Term
| Autoimmune etiology; believed to be a common autoantigen in ear and cornea; Laboratory study may reveal leukocytosis and elevated ESR/CRP Other inflammation of the eye (episcleritis, scleritis, retinal vasculitis) |
|
Definition
|
|
Term
| Inactive IK characteristics |
|
Definition
| Corneal scarring, ghost vessels or blood containing in a white and quiet eye |
|
|
Term
|
Definition
| corneal stromal blood vessels, edema, stromal infiltration, limbal injection; other signs also include A/C cells and flare, fine KP, conjunctival hyperemia |
|
|
Term
|
Definition
| 1. Active: History: Vernereal, External Signs of Syphilis, DFE, chorioretinitis, AC, Hx of Herpes Infections, Cough Chest Pain: R/O COGAN’S, Tinnitus, Vertigo, Systemic Diseases; MUST PERFORM FTA-ABS (Fluorescent treponemal antibody absorption or MHA-TP (MIcrohemagglutination assay) for antibiodies; VDRL (Veneral Disease Research Laboratory and RPR (Rapid plasma Reagin) for active disease |
|
|
Term
| All test to consider for follow on on IK |
|
Definition
| CBC, ESR,CRP, ANA, RF, HLA-typing, Lyme titers, Epstein Barr virus panel |
|
|
Term
| Treatment of acute ocular condition of Infectious Keratitis |
|
Definition
| Cyclopegic –homatropine TID or Atropine 1%;Topical Steroid (Prednisolone Acetate 1% q 1-6 h) according to inflammation TAPER OF VERY SLOWLY; MONITOR IOP F/U DAILY; F/U Q 2-4WEEKS AFTER INFLAMMATION SUBSIDES |
|
|
Term
| If Prednisolone Acetate increases IOP in IF what is the management after this |
|
Definition
| Switch to lotemax, if this continues to increase IOP give them glaucoma medication all except prostaglandins |
|
|
Term
| Treatment for inactive presentation |
|
Definition
| refer to corneal specialist for keratoplasty; or sectorial or VA not compromises: F/U daily |
|
|
Term
| Gonoccocal Management (ulcer) |
|
Definition
| Culture; Ceftriaxone 1 g IV q12-24 h in hospital; TOPICAL FLUOROQUINOLONE q1h until IMPROVEMENT |
|
|
Term
| Gonococcal Ulcer Management if allergic to Penicillin |
|
Definition
| Oral Fluoroquinolones (Cipro 500 mg po single dose or ofloxacin 400 mg po single dose , OR Moxifloxacin 400 mg or Levofloxacin 500 mg (LEVAQUIN) ; |
|
|
Term
| Besides the antibiotic treatment in gonoccocal ulcer what other treatment |
|
Definition
| Ocular lavage: frequently, cyclopleia, Scopolamine TID, Atropine BID; Treat sexual partners, Treat for Chlamydia if can be ruled out. |
|
|
Term
| Oral Treatment Options Trachoma/Inclusion |
|
Definition
| 1. Tetracycline 250mg QID for 2 wks 2. Doxycycline 100 mg bid for 2 wks 3. EES 500 mg qid for 2 weeks 4. Azitrhomycin (Zithromax 10000mg single dose 20 mg/kg/weight child |
|
|
Term
| Chlamydia Corneal involvement |
|
Definition
| Superficial epithelial keratitis, Superficial superior pannus, Corneal Infiltrates (superior, diffuse, limbal), Marginal Ulceration |
|
|
Term
| Infiltrates will be see in Epidemic Keratoconjunctivitis in how many days |
|
Definition
|
|
Term
|
Definition
| Lotemax, FML, Prenisolone uid and then taper; lotemax qid for 3-4weeks then tid for 3-4weeks then bid for 3-4 weeks then qd for 3-4 weeks |
|
|
Term
| EKC first 3-6 days management plan |
|
Definition
| 1 gtt proparacaine, then 2 gtt Betadien 0.5%; for a after 60-90 min. lavage ocular tissues; prescribe lotemax qid 5-7 days, aritificial tears qid, cold compresses |
|
|
Term
| Recurrent HSV keratitis is a unilateral or bilateral |
|
Definition
|
|
Term
| What percentage of HSV keratitis have a history of atopy |
|
Definition
|
|
Term
| Borders of HSV ulcers stain with |
|
Definition
| Rose Bengal or Lissamine green but not with NaFL |
|
|
Term
| Epithelial Infection in HSV Keratitis |
|
Definition
| Consider gentle debridement of ulcer con cover w/ topical fluoroquinolones qid (Zymar, Vigamox, Besivance) 2. Trifluridine 1 % (Viroptic) 1 gtt q 2 h ( no more than 9 X( after 5-6 d; taper to 5x/day; Alternate to Viroptic (Acyclovir 400 mg 5x/day or Valcyclovir 500 mg tid, Famcyclovir 250 mg tid; If pt is on steroids discontinue or taper; PF Lubricants, TREATMENT IS USUALLY FOR 10-14 D/ BY 2ND WEEK 97% RECOVERED; Cycloplegic: |
|
|
Term
| F/U schedule in epithelial infection in HSV keratitis |
|
Definition
| q 2 days then once you see improvement q 3-5 d |
|
|
Term
| Causes of neutrophic ulcer |
|
Definition
| stroke, complications of CNV surgery, tumor, acoustic neuroma |
|
|
Term
| Treatment of Neutrophic ulcer is small epithelial defect |
|
Definition
| D/C antiviral ADD PF artificial tears q2-4 h and ung hs. Add AB ung (EEM) q-3-6h |
|
|
Term
| Treatment of Neutrophic ulcer is large ulcer |
|
Definition
| AB ung, cycloplege and BCL/PPX 24. |
|
|
Term
| Alternate treatment for large ulcer (neutrophic) |
|
Definition
| no patch, a bung q 2h and cycloplege |
|
|
Term
| Follow up schedule in neutrophic ulcer |
|
Definition
|
|
Term
| In there is no response w/ tx in neutrophic ulcer |
|
Definition
| amniotic membrane, tarsorrhaphy or conjunctival flap |
|
|
Term
| Signs: Limbitis, iritis w/ KPs in diffuse pattern; sectorial iris atrophy, pupillary dilation, stromal edema, IOP may be potentially high, decreased corneal sensation, Hx of HSV |
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Definition
|
|
Term
| Management of HSV stromal or disciform keratitis |
|
Definition
| Test for CN V; cycloplegia (scopolamine 0.25% tid); topical steroid (prednisolone acetate 1% q 1h-qid; Trifluridine 1 qid or oral acyclovir for prophylaxis 400 mg bid; F/U daily |
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|
Term
| HEDS showed that ACV was beneficial in |
|
Definition
| HSV keratouveitis but not in tx o f stromal disease |
|
|
Term
| Corneal Involvement in HZV |
|
Definition
| Punctate epithelial Keratitis (50%); Pseudodendrites, Anterior Stromal Infiltrates, Immune Stromal Keratitis, Neurotrophic Keratitis |
|
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Term
|
Definition
| Scleritis (can lead to melting stage); Uveitis; Iris Atrophy, Secondary glaucoma, Optic Neuritis, Post herpetic Nuralgia, corneal hypoesthesia, ONH edema, CN palsies III; |
|
|
Term
| Epithelial Keratitis HZV Characteristics |
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Definition
| diffuse SPK early, resolve or followed by small epithelial dendrites, then larger pseudodendrites (2-4 dates after rash) |
|
|
Term
| Pseudodendrite is characherized by |
|
Definition
| infiltrative; selflimiting, usually peripheral, tapered endings, appears stuck in epith, poor staining w/ NaFl; subepithelial haze or anterior stromal keratitis may follow |
|
|
Term
| In HZV how many days after onset will you have stromal involvement (nummular keratitis) |
|
Definition
| 10 days; this is similar to EKC |
|
|
Term
| In HZV when will you have disciform keratitis |
|
Definition
| 1-2 months after rash, central or peripheral disc shaped stromal edema and infiltrates, delateyed hypersensitivity cell mediated response to viral antigens, Iritis KP’s, immune rings, vascularization and opacificiation as sequel |
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|
Term
|
Definition
| ACV 800 mg 5 x day x 7days; VAlcyclovir 100 mg tid for 7 days; 3 famciclovir 500 mg tid for 7 days |
|
|
Term
| HZV with corneal SPK or pseudodendrites treatment |
|
Definition
| PF lubricants 1 gtt q h and ung bid |
|
|
Term
| Follow up schedule HZV with corneal SPK or pseudodendrites |
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Definition
|
|
Term
| HZV Neurotrophic Keratitis mild epithelia defects treatment |
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Definition
|
|
Term
| HZV Neutrophich Keratitis (corneal larger ulceration) |
|
Definition
| If small epithelial defect only: D/C antiviral ADD PF artificial tears q2-4h and ung hs. Add AB oint (EEM) q3-6h for for several days or until resolved.If large ulcer: AB ung, cycloplege and BCL/PPX 24. Repeat procedure daily until healed. Can use a bandage CL. Consider Doxycycline as before Alternate tx for large ulcer: no patch, ab ung q2h and cycloplege; F/U daily If NI or infectious ulcer suspect: culture If no response w/ tx, consider amniotic membrane, tarsorrhaphy or conjunctival flap |
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|
Term
|
Definition
| topical steroids, cycloplegia based on uveitic rx, anti-glaucom meds if high IOP; FU daily |
|
|
Term
| If you have dendriform keratitis and distinction is not clear |
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Definition
|
|
Term
|
Definition
| Bacitracin or EEm oin bid for skin lesions or |
|
|
Term
| If HZV lesions are painful |
|
Definition
| Capsaicin cream 0.025% tid quid (zostrix) |
|
|
Term
| What percentage of HZV patients will develop PHN in HZV |
|
Definition
| 60 and >60% chance of developing PHN and 70 and >75% chance of developing PHN |
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|
Term
| What can reduce Acute Neuralgia |
|
Definition
|
|
Term
|
Definition
| (oral non-narcotic analgesics) 1) acetaminophen 500 – 1000mg qid 2) NSAIDS (e.g.,Ibuprofen 200-800 q6h; naproxen 250, 375 and 500 bid) * ask for aspirin allergy / peptic ulcers * Cox-2; if the patient is allergic to NSAIDS give them acetaminophen |
|
|
Term
| Pain Management for Moderate Pain |
|
Definition
| Acetaminophen w/ NSAIDS (e.g. acetaminophen 1000 mg w/ iburpofren 400-600 qid) Option 2) Tramadol (ultram) (opiod but not a schedule drug) Dosage is 50 mg tablets; 50-100 mg po q4-6 h; Ultracet: tramadol 37.5 mg and acetaminophen 325 mg. 2 tabs q 4-6 h |
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|
Term
| Pain management (moderate to severe) |
|
Definition
| Schedule III: 1. Lortabe 5 mg hydorocone w/ 500 mg acetaminophen; Vicodoine Same; Vicoprofen (with ibuprofen ) 7.5/ 200 mg 2). Tyelenol III -30 mg codeine w/ 300 mg acetaminophen; Schedule II 1. Perecocet (5 mg oxycodone, 325 mg acetaminophen) 2. Tylox (5 mg oxycodone, 500 mg acetaminophen):DOSAGE IS 1-2 TABS P.O Q 4-6 H, AS NEEDED; F/U 3-5 D |
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Term
|
Definition
| Aerobic Microorganisms (staph) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Neisseria Gonnor and Haemophilus |
|
|
Term
| Sbouraud Agar w/out Cyclhexamide (added chloramphenicol or gentamicin) |
|
Definition
|
|
Term
|
Definition
| Fungi that do not gorw in Sabouraud |
|
|
Term
| Loweinstein-Jensen Medium |
|
Definition
| mycobacteria, nocardia: atypical ulcers; pt’s w/ LASIK sx |
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|
Term
| Agar w/out nutrients (previously inoculated with E. Coli |
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Definition
|
|
Term
|
Definition
| Slide culture w/ fluorescent microscope for Acanthamoeba and fungi |
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|
Term
| Indications for Corneal Biopsy |
|
Definition
| Keratitis with negative growths in cultures or non-demonstrative; very deep infiltrate that cannot be reached with scraping; Rare dystrophies or systemic metabolic disorder with corneal manifestation |
|
|
Term
| Acanthamoeba Lab Procedures |
|
Definition
| Non-nutrient agar w/ E.Coli and stain a slide w/ Calcofluor White; PCR; Confocal Microscopy |
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|
Term
| Staph. Aureus in Agar is characterized |
|
Definition
| Gram + (cocci) in clusters- grape like |
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|
Term
| Strep Pneuomaniae is characterized in agar |
|
Definition
| Gram + diplococcic (chains) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Sabourad Agar; Colcofluor |
|
|
Term
| How many Cl wearers develop infectious keratitis in US |
|
Definition
|
|
Term
| Most common bacterial Keratitis in CL wearers |
|
Definition
| Pseudomonas 62-64%; Staphylococcus 14-33% |
|
|
Term
| Symptoms: Pain, Redness, Pt describes a white dot in cornea, Photophobia, Discharge, Decreased Vision |
|
Definition
| Bacterial Infectious Keratitis |
|
|
Term
| What sign is characteristic of S. Penumonai Infectious Keratitis |
|
Definition
| Severe Uveitis and Hypopyon |
|
|
Term
| Describe a Staph. Gram + (Bacterial) infectious keratitis |
|
Definition
| Well defined white-grey or creamy stromal infiltrate that may enlarge to form a dense stromal abscess; may have satellite lesions, Uveitis and Hypopion (less than strep) |
|
|
Term
| Most common cause of bacterial corneal ulcer in CL wearers; plants; common in the environment, contaminated make up and CL solutions, artificial nails, Common cause in corneal injury and extensive body burns, colonizes humidifiers, therefore pts on respiratory assistance are prone |
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Definition
|
|
Term
| Yellow green mucopurulent discharge; difficult to treat due to toxins that continue destroying the stroma and eptiehlium |
|
Definition
|
|
Term
| Ulcer that is central with a gay infiltrate and overlying epithelial defect; it progress is very rapid, large corneal area; Ring ulcer can develop; Will have satellite infiltrates, granular like |
|
Definition
| ; can cause perforation within 24-84 hours; areaPseudomona |
|
|
Term
|
Definition
| History; CC: Pain and Rednes; CL Wear?; Trauma, with what: nails, plants; Ocular surface disease hx, surgery: cataracts, refractive, Systemic disease: review systems; Meds: antibiotics, steroids, Social HX |
|
|
Term
| When should you culture an ulcer |
|
Definition
| Infiltrates >1-2mm; infiltrates on visual axis, poor acuity, older or unusual characteristics, steroid use or long antibiotic use, monocular patients, Ulcers not responding to treatment |
|
|
Term
| Small <1mm nonstaining peripheral ulcer w/ minimal symptoms and minimal discharge and A/C reaction or sterile infiltrate suspect w/o risk factors TREATMENT |
|
Definition
| Topical Fluoroquinolones (cipro, moxifloxacin, gatifloxacin, besifloxacin) q1 h; 2. If CL pt add cipro or tobrex ung hs; NO CL wear; Cycloplegia if A/C rx; F/U DAILY |
|
|
Term
| Borderline Risk medium peripheral mid peripheral (1-1.5mm), A/C reaction and discharge or small <1 mm with epithelial defect: Treatement |
|
Definition
| Loading Dose of Fluoroquinolone: gatifloxacin (ZYMAR); Moxifloxacin (VIGAMOX); Ciprofloxacin (CILOXAN) (BETTER FOR PSEUDOMONAS AND SERRATIA BUT NOT FOR GRAM +); Besifloxacin (BESIVANCE); LOADING DOSE: Day1-2 initial loading dose of 1 gt every 5 min for 5 doses then 1 gt q 15 min for 3 doses then q 303 min until midnight then q 1 h or 2 gtt q 15 min for 6 h, then 2 gtt q 30 min for 18 h followed by 2 gtt q h for 24 h and then taper as day 2-3; day 4-14 2 gtt q 2-4h; after day 14 according to severity |
|
|
Term
| Larger Ulcers >1-2 mm involving Visual axis and vision threatening: signicant A/C rxn and hypopyon an discharge: HIGH RISK TREATMENT |
|
Definition
| Fortified Gentamicin or Tobramyinc (15mg/mL) every 60 min alternated w/ fortified cefazolin (50mg/mL) or Vancomycin (24mg/mL) q 60 min |
|
|
Term
| Bacterial Ulcer for G(+) cocci and bacilli |
|
Definition
|
|
Term
| For Cephalosporin Allergic, MRSA infection |
|
Definition
|
|
Term
| Moderate and Severe Risk Ulcers |
|
Definition
| Oral Fluoroquinolones are given when ulcer involves the sclera or extremely deep ulceration (500 mg or Levofloxacin 500 mg); No CL; Cycloplegia Homatropione 5% bid-qid; Scopolamine 0.25% tid; Atropine 1% bid if severe presentation; Topical Steroids GIVEN to reduce any further stromal damage and reduce scarring in severe inflammation is given ONLY AFTER 48-72 HOURS (PREDNISOLONE ACETATE 1% OR LOTEMAX Q4-8 H can be added to reduce corneal scarring and severe inflammation) |
|
|
Term
| When are steroids given in a Bacterial Ulcer |
|
Definition
| when ulcer bed is still open (48-72h) after initiating treatment; make sure there is no fungi or acanthaomeba (so culture are necessary) |
|
|
Term
| If ulcer is due to N. Gonrrhea: |
|
Definition
| Culture; Ceftriaxone 1 g IV q12-24 h in hospital; TOPICAL FLUOROQUINOLONE q1h until IMPROVEMENT; Oral Fluoroquinolones (Cipro 500 mg po single dose or ofloxacin 400 mg po single dose , OR Moxifloxacin 400 mg or Levofloxacin 500 mg (LEVAQUIN) ; Ocular lavage: frequently, cyclopleia, Scopolamine TID, Atropine BID; Treat sexual partners, Treat for Chlamydia if can be ruled out. |
|
|
Term
| If com;iance is questionable or fortified ab can not be prescribed N. Gonorrhea |
|
Definition
| Subconj. inj. w/ AB (cefazolin, gentamicin, penicillin G) |
|
|
Term
| Prevalent in warm climates in US are SW and Southern regions(fusarium). Also farming communities, Northern Areas (candida and aspergillus) |
|
Definition
|
|
Term
| Who are compromised host for fungal keratitis |
|
Definition
| steroid users, cancer tx, AIDS patients |
|
|
Term
| Etiology of Fungal Keratitis |
|
Definition
| Candida, Asp[ergillus, Cephalosporium, Fusarium |
|
|
Term
| What is a risk factor for filamentary |
|
Definition
|
|
Term
| Who are more prone for Fungal Keratitis |
|
Definition
|
|
Term
| Most common organisim agent that causes Fungal Keratitis |
|
Definition
| Septate filamentous organisms, usually after trauma w/ vegetative: Fusarium,Aspergillus, Cephalosporium Curvularia, Penicillum sp., Dematiaceous Fungi; Non-filamentous: Candida yeast mostly in pre-existing cornea diseas (dry eye, steroid use, exposure keratitis, herpes) |
|
|
Term
| Geographical Location Influences: what is more common in southern regions |
|
Definition
| septate filamentous (Fusarium) (hot/humid) |
|
|
Term
| Geographical Location influences Norhtern States |
|
Definition
|
|
Term
| Non-filamentous In the Northern Regions |
|
Definition
|
|
Term
| Worldwide Fungal ulcer (organism) most common |
|
Definition
| Aspergillus and then Fusarium |
|
|
Term
| Symptoms: history: Previous corneal trauma with vegetation (sticks, wood, branches, trimming the lawn); Pain, Photophobia, Steroid Use HX, Decreaed Vision, White dot in eye |
|
Definition
|
|
Term
| Risk factor for fungal ulcer |
|
Definition
| EWSCL; due to contaminated case |
|
|
Term
| Systemic conditions associated with fungal keratitis (especially Candida) |
|
Definition
| DM, AIDS, Cancer TX pts, Chronic use of topical steroids and AB |
|
|
Term
| An early ulcer that resembles a dendritic one w/ minimal signs of inflammation |
|
Definition
|
|
Term
| Gray or white dirty infiltrate w/ feather borders surrounded by finger-linke infiltratate satellite stromal lesions. Corneal surface is dry w/ rough texture; frequently on peripheral cornea, Speringinous ulcerative process, along the periphery (may move centrally) |
|
Definition
|
|
Term
| Inflammation in Fungal Ulcer will be |
|
Definition
|
|
Term
| Conjunctival Injection, A/C reaction, Hypoyon, Endothelial Plaque, Wessely Ring, Featehr Borders, are signs of |
|
Definition
|
|
Term
| What lab test should be ordered if you suspect Fungal Ulcer |
|
Definition
| Sabouraud, Slide stains (giemsa, Colcoflour), PCR; add A/C paracentesis if deep stromal involvement |
|
|
Term
| How can differentiate Candida from Filamentous |
|
Definition
| Candida is more suppurative or wet and Filamentous is more dry |
|
|
Term
| Characteristics that aids DX |
|
Definition
| reports symptoms no sooner than 5 days after injury (slow progression); Includes descement folds, endothelial plaque, ciliary flush, conjunctival injection, A/C reaction, Hypopyo |
|
|
Term
| What lab test should be performed if fungal keratitis is suspected |
|
Definition
| Giemsa stains, Calcofluor white stain, Potassium hydroxid smear; Sabouraud’s agar, Thioglycollat broth (requires 48 hrs to grow); Confocal microscopy PCR |
|
|
Term
|
Definition
| if stains show fungal keratitis: Polyenes: Natamycin (ophthalmic) , Amphotericin B; 2. Imidiazoles: Miconazole, Ketoconazole, Clotrimazole, 3: Pyrimidine: flucytosine; Triazole Fluconazole, Itraconazole, Voriconazole (recently new triazole) |
|
|
Term
| After staining you see hyphae fragment in smear/culture suggesting |
|
Definition
|
|
Term
| Filamentous Fungi Treatment |
|
Definition
| Natamycin 5%: Administration 1 gt 1 h including at night x several days and taper 4-6 weeks; 2. Cyclopegia: Scopolamine 0.25% tid, if hypopyon use atropine bid-tid; |
|
|
Term
| Natamycin is more effective against |
|
Definition
| Fussarium and Aspergillus; Less effective against Candida; |
|
|
Term
|
Definition
| Amphotericin B (1.5mg/mL) 1 gt q 30-1h (better for candida) |
|
|
Term
| If infection involves deeper stroma or is worsening or simply as ADJUNCT therapy one or more of the following can be added |
|
Definition
| Amphotericin B 1.5mg/mL; Oral fluconazole 400 mg loading dose and then 200 mg qd or Voriconazole 200 mg pog bid; Minconazole or clotrimazole topical (prepared) (1-10 mg/mL) q1h; Vorconazole topical 1% |
|
|
Term
| In smear Candida will look like |
|
Definition
| oval buds or pseudohyphae |
|
|
Term
| Topical steroids are contraindicated in |
|
Definition
| fungal ulcer; it will allow more replication; only after weeks of therapy if high # of inflammation |
|
|
Term
| Follow up schedule for fungal keratitis |
|
Definition
| daily and then 3-5 days after improvement in seen |
|
|
Term
| Protozoan Acanthamoeba: associated risk |
|
Definition
| tap water or homemade saline for cl; swimming in hot tubs w/ cl’s ; Over80% of cases are related to contact lens use. All lens types have been implicated, including soft, hard, gas permeable, disposable extended wear |
|
|
Term
| Acanthamoeba: associated risk |
|
Definition
| stagnant, contaminated water, water sources, contaminated cl solutions, warm climate, hot tubs, swimming pools |
|
|
Term
|
Definition
| Pain is acute and dramatic compared to the early physical signs |
|
|
Term
| Pain extreme compared to findings, Lacrimation, photphobia, blepharospasm, reduced VA, had foreighn body sensation, usually little or no discharge |
|
Definition
|
|
Term
| Epithelial/subepithelial infiltrate appearing as a pseudodendrite early on; a non suppurative ring infiltrate w/ epithelial defect develops over weeks; epithelial and stromal edema; elevated epithelial lesions; keratoneuritis (most common misdiagnosis is HSV: (corneal hypoesthesia, (+) PA , conj. follicular |
|
Definition
|
|
Term
| Treatment for Acantamoeba |
|
Definition
| consider corneal specialist: TX: weeks-months; medical therapies usually ineffective: culture if suspected (diagnosis); colcofluor white stain, non-nutrient agar w/ e.coli. PCR; Confocal microscopy |
|
|
Term
| Medical Treatement for Acanthamoeba |
|
Definition
| 1. Polyhexamethylene Biguanide (PHMB) (Baquacil 0.02%) q h antiseptic inhibits membrane function; Chlorhexidine 0.2% qh is alterate to Baquacil. (2). Propamadine 0.1% (Brolene) against trophozoites (available OTC in Europe not US) q 1h2; Neosporin (polymyxin b/neomycin*/gramicidin) aminoglycoside destroys the plasmalemaa of org and facilitates entry of drug (combination 1 and 2); Cyclopegia: atropine 1% tid |
|
|
Term
| F/U schedule for acanthamoeba |
|
Definition
|
|
Term
| Other options for acanthamoeba |
|
Definition
| Itraconazole 400mg PO loading dose, then 100-200mg PO qd; or Ketonazole 200mg po qd for weeks-months and taper; clotrimazole 1% drops; Topical steroids use is controversial; Oral medications for pain as bebore; If diagnosed early ( epit, not stroma) : epithelial debridement may eliminate the organism; Corneal grafting is usually the long term prognosis |
|
|
Term
| If a patient does not have a dx of systemic disease a blood panes should be ordered |
|
Definition
| CBC, RF, ANA, ANCA, Hepatitis C Panes, Chest X ray or Chest CT |
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|
