Disorders of the Conjunctiva and Cornea

"Describe the etiology of dry eye syndrome."

"Evaporative: excessive tear evaporation, Aqueous: reduced tear production, inadequate production"

"Explain the epidemiology of dry eye syndrome."

"Females, over 40 years old"

"Define the clinical presentation of dry eye syndrome."

"Foreign body sensation, stinging, burning, epiphora, pain, erythema, blurry vision, intermittent excessive blinking, glare, severe inability to cry"

"Do a clinical evaluation for dry eye syndrome."

"Clinical through Schirmer test, referral to ophthalmologist"

"Describe the management of dry eye syndrome."

"Chronic for most, artificial tears, humidifier, short-term steroids, meds: cyclosporine, lifitegrast, ophthalmologist referral, no Visine, antibiotics, fatty omega acid"

"Explain the significance of the PEARL section."

"Additional insights or tips related to dry eye syndrome"

"Describe the most common infection causing corneal ulcers"

"Staph aureus"

"Explain the role of contact lens use in corneal ulcers"

"Pseudomonas infection risk"

"Define the initial condition that leads to a corneal ulcer"

"Keratitis"

"Describe the epidemiology of corneal ulcers"

"Developing countries, anyone"

"Explain the clinical presentation of corneal ulcers"

"Rapid pain onset, photophobia, foreign body sensation, conjunctival injection, blurry vision"

"Describe the diagnostic evaluation for corneal ulcers"

"Slit lamp exam, fluorescein staining, pain and physical exam findings"

"List the first-line treatments for corneal ulcers"

"Moxifloxacin, gatifloxacin"

"Explain the management for large or vision-threatening corneal ulcers"

"Fortified tobramycin, gentamicin"

"Describe the importance of patient education in corneal ulcer management"

"Contact lens use"

"List the topical antiviral treatment for HSV-related corneal ulcers"

"Trifuridine"

"Identify the antifungal treatment for corneal ulcers"

"Natamycin"

"Explain the treatment for Acanthamoeba-related corneal ulcers"

"Epithelial debridement, chlorhexidine, polyhexamethylene biguanide"

"Describe the management for autoimmune-related corneal ulcers"

"Systemic immunosuppressants"

"Identify the specialties involved in corneal ulcer management"

"Rheumatology, ophthalmology"

"Describe the etiology of bacterial keratitis"

"Staph. aureus, Staph. epidermidis, Strep, contacts: Pseudomonas, alteration in cornea's defense mechanism"

"Explain the epidemiology of bacterial keratitis"

"Rare, young people"

"Define the clinical presentation of bacterial keratitis"

"Rapid onset, redness, watering, photophobia, decreased vision, discharge, lid edema, matting, conjunctival chemosis, hyperemia, epithelial defect, stromal edema"

"How does Pseudomonas affect discharge in bacterial keratitis?"

"Green/yellow discharge"

"What is involved in the diagnostic evaluation of bacterial keratitis?"

"Refer to ophthalmology, corneal scraping under topical anesthesia"

"Describe the management steps for bacterial keratitis"

"Stop wearing contacts, small ulcers: fluoroquinolone, large ulcers: fortified tobramycin/gentamycin"

"What is the frequency of treatment for large ulcers in bacterial keratitis?"

"Every hour with fortified vancomycin"

"What is a key pearl regarding bacterial keratitis?"

"Other"

"Describe the most common causes of viral keratitis"

"HSV, VZV"

"Explain the pathophysiology of HSV in viral keratitis"

"Direct contact with secretions, trigeminal nerve involvement"

"Define the reactivation process of VZV in viral keratitis"

"Reactivation of trigeminal CN, replication in nerve cells"

"Identify the leading cause of blindness in the world related to viral keratitis"

"HSV"

"Who is most affected by VZV in viral keratitis?"

"Older adults"

"Describe the clinical presentation of HSV keratitis"

"Stromal keratitis, reactivated, can have cutaneous vesicles, recurrent bouts of corneal inflammation, scarring, progressive loss of vision"

"What are the prodromal symptoms of VZV keratitis?"

"Flu-like symptoms, malaise, headache"

"Explain the significance of Hutchinson sign in VZV keratitis"

"Indicates involvement of V1 (CN)"

"List the components of diagnostic evaluation for viral keratitis"

"Hx, ask about shingles, autoimmune, fluorescein stain, dendrites, referral to ophthalmology, pseudodendrites"

"What antiviral medications are used for HSV keratitis?"

"Acyclovir, famciclovir, valacyclovir, ganciclovir-topical"

"What is the management approach for VZV keratitis?"

"Urgent referral to ophthalmology, oral antivirals, vaccine prevention"

"What is the purpose of referral to ophthalmology in viral keratitis?"

"Specialized evaluation and management"

"Describe the role of vaccine prevention in VZV keratitis management"

"Prevents future outbreaks of shingles"

"Describe the etiology of ultraviolet keratitis"

"UV exposure from sunlight, welding arcs, sunlamps, reflected snow"

"Identify the population at risk for ultraviolet keratitis"

"Anyone"

"Explain the clinical presentation of ultraviolet keratitis"

"30 min - 12 hr after exposure: agonizing pain, severe photophobia, decreased vision, tearing in both eyes"

"Define the diagnostic evaluation for ultraviolet keratitis"

"Slit-lamp + fluorescein, diffuse punctate staining of both corneas"

"Outline the management for ultraviolet keratitis"

"Supportive: ointment + artificial tears, resolves in 24 - 72 hours"

"Describe the etiology of fungal keratitis"

"Fusiform, Aspergillus, Candida"

"Explain the pathophysiology of fungal keratitis"

"Follows compromised epithelial integrity, trauma, ocular surface disease, exposure to plant material, agriculture"

"Identify the epidemiology of fungal keratitis"

"Anyone, occurs worldwide, increasing"

"Describe the clinical presentation of fungal keratitis"

"Red, painful eyes, blurred vision, photophobia, FBs, tearing"

"What are the characteristics of corneal lesions in fungal keratitis?"

"White/gray infiltrate, feathery borders"

"Define hypopyon in the context of fungal keratitis"

"Presence of pus in the anterior chamber"

"Outline the diagnostic evaluation for fungal keratitis"

"Clinical history, ophthalmic referral, fluorescein stain"

"What is the management for fungal keratitis?"

"Topical Nyastatin, amphotericin B, antifungal"

"How long does healing take for fungal keratitis?"

"Months to years"

"What is a key pearl regarding fungal keratitis?"

"Not specified in the document"

"Identify the other considerations in fungal keratitis management"

"Not specified in the document"

"Describe the etiology of amoebic keratitis"

"Acanthamoeba, contact lens wear, fresh water, hot tub exposure, corneal trauma, exposure to parasite"

"Explain the epidemiology of amoebic keratitis"

"Contact lens wearers = 80%"

"What are the clinical presentations of amoebic keratitis"

"Pain out of proportion to exam, decreased vision, redness, fever, photophobia, tearing, discharge, wax & wane, ring infiltrate & pseudodendrites"

"Define the diagnostic evaluation for amoebic keratitis"

"Fluorescein stain, referral to ophthalmologist"

"Describe the management of amoebic keratitis"

"Ophthalmologist referral, biguanides (PHMB/chlorhexidine), alone or combined with diamidine"

"Describe the etiology/pathophysiology of uveitis"

"Localized viral infection, rarely medication reaction, associated with HLA-B27, genetic predisposition, molecular mimicry, iritis"

"What is the epidemiology of uveitis?"

"Anyone can be affected"

"Explain the clinical presentation of uveitis"

"Unilateral painful red eye, photophobia, decreased vision, tearing, lid puffiness, drooping, ciliary injection, irregular pupil, cell and flare in anterior chamber, hypopyon"

"Do a diagnostic evaluation for uveitis"

"Slit lamp exam optional, DFE, fluorescein stain, recurrent HLA-B27 and syphilis testing, bilateral granulomatous disease may need CXR"

"Define the management of uveitis"

"Ophthalmic referral, topical corticosteroids (prednisolone), cycloplegic/mydriatic (cyclopentolate)"

"What is a pearl related to uveitis?"

"Information not provided"

"Describe the role of fluorescein stain in uveitis diagnosis"

"Used to assess corneal integrity and detect lesions"

"Explain the significance of HLA-B27 testing in uveitis"

"Identifies genetic predisposition to certain types of uveitis"

"How does molecular mimicry relate to uveitis?"

"It can trigger an immune response leading to iritis"

"What are common symptoms of uveitis?"

"Painful red eye, photophobia, decreased vision, tearing"

"Describe the etiology of iritis"

"Inflammatory condition of the iris, idiopathic, infectious, autoimmune, due to injury"

"Define pathophysiology in relation to iritis"

"Same as anterior uveitis in slides"

"What is the typical age range for iritis epidemiology?"

"20-60 years old"

"Explain the clinical presentation of iritis"

"Red, painful eye, blurred vision, discomfort in bright light or reading, chronic cases can be painless with only red eye"

"Identify the diagnostic evaluation for iritis"

"Anyone"

"Describe the management of iritis"

"Ophthalmology referral & rheumatology, prednisolone & cyclopentolate, treat underlying cause"

"What is a key aspect of the clinical presentation of iritis?"

"Aching or discomfort, especially in bright light or reading"

"Explain the significance of chronic cases of iritis"

"Can be painless with only red eye"

"What is the role of ophthalmology in managing iritis?"

"Referral for evaluation and treatment"

"Define the term 'PEARL' in the context of medical topics"

"A useful tip or insight related to the topic"

"Describe the etiology of scleritis"

"Autoimmune with RA, infectious or trauma/surgery-induced, scleral necrosis, granulomatous inflammation, vasculitis"

"Explain the epidemiology of scleritis"

"More common in women, ages 40-60, men have infectious scleritis"

"Define the clinical presentation of scleritis"

"Severe/dull boring eye pain, worst with eye movement, radiates to orbit, injection, decreased vision, photophobia, tearing, scleral swelling, violet-bluish hue"

"Do a diagnostic evaluation for scleritis"

"Slit-light exam, clinical diagnosis, associated testing for diseases like ANCA, ANA, CBC, CRP, ESR, KFT, RFT, Lyme"

"Describe the management goals for scleritis"

"Reduce inflammation, referral to ophthalmology or rheumatology"

"Explain treatment options for scleritis"

"Oral prednisolone, oral NSAIDs like indomethacin, prolonged disease can lead to vision loss"

"What is a key pearl regarding scleritis?"

"Prolonged disease can result in vision loss"

"Describe the common pathogens in bacterial conjunctivitis for children and adults"

"Haemophilus influenzae, Staph. aureus"

"Define the pathogens associated with critically ill patients and neonates in bacterial conjunctivitis"

"Pseudomonas, Neisseria gonorrhoeae, Chlamydia"

"Explain the typical epidemiological pattern for bacterial conjunctivitis"

"December to April"

"Describe the clinical presentation of bacterial conjunctivitis"

"Benign, self-limited, lasts 14 days, purulent discharge, starts in one eye"

"Do bacterial conjunctivitis symptoms include itching and blurred vision?"

"No itching, no blurred vision"

"Define the diagnostic evaluation for bacterial conjunctivitis"

"Culture, check visual acuity, corneal involvement"

"Explain the management strategies for bacterial conjunctivitis"

"Antibiotics, patient education, refer to ophthalmology"

"Describe the types of antibiotics used in bacterial conjunctivitis management"

"Polymyxin B-trimethoprim, fluoroquinolone, ciprofloxacin, bacterial ointment"

"What supportive treatments are recommended for bacterial conjunctivitis?"

"Cool compress, lid scrubs"

"Explain the importance of patient education in managing bacterial conjunctivitis"

"No sharing of personal items"

"Describe the etiology of viral conjunctivitis"

"Adenovirus, direct contact with pathogen"