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