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Final Review

Final Review. Kelli Shaon, O.D. Identify. Follicles. 4 main causes: Chlamydia Viral (HSV, Adenovirus) Topical med toxicity Parinaud oculoglandular syndrome (rare) Are a collection of lymphocytes Appear as flesh colored raised lesion Size varies

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Final Review

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  1. Final Review Kelli Shaon, O.D.

  2. Identify

  3. Follicles • 4 main causes: • Chlamydia • Viral (HSV, Adenovirus) • Topical med toxicity • Parinaud oculoglandular syndrome (rare) • Are a collection of lymphocytes • Appear as flesh colored raised lesion • Size varies • Has vessels surrounding or encapsulating the follicles

  4. Further testing for Differentials • Location of follicles • Upper > Lower – think Chlamydia • Lower>>> Upper – other etiologies • Look for type of discharge • Watery – viral • Mucopurulent - Chlamydia • Check preauricular nodes for adenopathy • Yes – think viral or Chlamydia • Ask about recent colds/flu symptoms

  5. Adenovirus Conjunctivitis • EKC is most severe form • Start unilateral but bilateral w/in 1 wk • Very contagious for 7-10 days after symptoms begin – stress hygeine and minimal personal interaction • Palliative care: Cool compresses & artificial tears • Rule of 8’s: conjunctivitis, SPK, SEI • Watch for psuedomembrane - REMOVE

  6. Identify

  7. Herpetic blepharokeratitis • Blepharitis if skin lesion only • Keratitis if corneal involvement • Dendritic, disciform, or stromal (may get uveitis if stromal) • Unilateral red eye • Often recurrent • Decreased corneal sensitivity common (**Perform cotton wisp test)

  8. Treatment for HSV • Topical Viroptic 5x/day • Some recommend bacitracin ung to spread over skin lesion to prevent bacterial infection of compromised skin • NO STEROIDS IF EPITEHIAL DISEASE • Oral Anti-virals –debatable • HEDS 1: Topical steroids useful in stromal disease, No benefit in PO in stromal Dz • HEDS 2: PO reduced rate of outbreaks and reduces rate of stromal herpes by 50%

  9. Identify

  10. Papillae • Numerous causes: • Allergies • Bacterial • Contact lenses • Chronic lid disease • Floppy eyelid syndrome • Is hyperplastic conjunctival tissue infiltrated with inflammatory cells • Contains a CENTER, feeder vessel

  11. Further testing for Differentials • Ask if h/o allergies, rhinitis, etc.. • Ask about itch • Allergies will ITCH *** • Chronic blepharitis may cause some itch • Ask about type of discharge • Watery &/or ropy, stringy mucous – Allergy • Mucopurlent – bacterial • Ask about contact lens wear

  12. Allergic conjunctivitis • Remove allergen • Don’t rub or itch – increases cascade of inflammation which worsen symptoms • Cool compresses • Artificial tears • Topical antihistamine/mast-cell stabilizer

  13. Bacterial conjunctivitis • Lid hygiene • Antbiotic ung will cover lids, cornea, and conjunctiva (ie. Polysporin) but will blur vision OR a topical antibiotic drop can be used (no use for expensive med if just conjunctivitis)

  14. Blepharitis vs. Meibomianitis • Blepharitis • Seborrhea: greasy, matted lashes with flakes • Staphylococcal: collarettes, ulceration, redness, thickening of lid margins • Tx: lid scrubs & antibiotic ung • Meibomianitis • Clogged/compacted oil glands – toothpaste like discharge • Frothy tears • Tx: Warm compresses, masssage, artifical tears(b/c dry eye), Doxycycline PO – if severe (b/c effect on fat inoil gland)

  15. Chalazion vs. Hordeloum • A chalazion is a residual aggregation of inflammatory cells following an eyelid infection such as hordeolam • Hordeloum will be tender to touch..Chalazion will not • Tx: Warm compresses QID and Orals if severd, Kenalog or I&R may be needed • If recurrent chalazion in same location…. Need to have biopsy to r/o sebaceous gland carcinoma

  16. Identify

  17. Optic nerve drusen • No small vessel obscuration by NFL at the ONH margins • May look lumpy/bumpy • Drusen may autofluoresce with red-free • Helpful to get HVF and/or B scan

  18. Identify

  19. Optic nerve edema • (+) small vessel obscuration by NFL at the ONH margins • Due to increase ICP from intracranial mass (papilledema) or Psuedotumor Cerbri • Need MRI to look for mass followed by LP to measure ICP

  20. Identify

  21. Normal variations • Picture 1: Tilted disc may have PPA associated • Picture: Myelinated Nerve fibers

  22. Identify

  23. Disc variations • Picture 1: Optic nerve hypoplasia • Picture 2: Megalopapillae (larger ONH) – often has large cup • Can use direct o-scope test to determine (small spot aperture)

  24. Glaucoma

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