Ophth lectures

 

Chlymydiae

Follicular conjunctivitis (acute)

 

Adenovirus

Herpes viruses

Chlamydial inclusion conjunctivitis

Allergic reaction

Adenovirus

Measles, mumps

Flu

Poxviruses (smallpox and vaccinia)

 

Chronic

Chlamydial infections

Parinaud's oculoglandular syndrome

Molluscum contagiosum

Moraxella, lyme

Toxic

 

Infectious particle: elementary body

Enters the body, then becomes reticulate body, replicates, lyses cell

 

3 types of chlams

C. pneumoniae and psitti have only rarely been in eye infections

C. trachomatis

A-c (found in classic trachoma)

D-K (found in urogenital dz)

xxx

 

Lab dx:

Giemsa staining

cell culture

DFA (direct fluor antibody test)

ELISA

PCR

 

Leading cause of preventable blindness worldwide

severe inflam in childhood leads to tarsal scarring that leads to entropion, trichiasis, xxx

 

more prominent in upper tarsus

 

major pathway to blindness is severe tarsal scarring - entropion and trichiasis

destroys goblet cells -- dry eye

K changes - keratitis and anterior stromal, vascularization, superior

 

unique char is lymphoid follicles in the limbal conjunctiva, which on resolution leave depressions called Herbert's pits

Arlt's line: horizontal bands of scarring, assoc with very advanced forms of dz

in late trachoma, can get dense corneal scars

 

Management:

for control of active infectious trachoma, topical application of 1% tetracycline ointment bid for 5 days/month x 6 months

Can use oral tet or erythromycin in older kids

 

Azithromycin is particularly effective

Surgical correction of entropion and trichiasis is necessary

 

Adult inclusion conjunctivitis (D-K serobars)

relatively uncommon, ocurs in 1 in 300 cases of genital chlamydial infection

Infection of eye occurs through contact

 

Sx begin 1-2 weeks after exposure

Sx:

FBS, conj injection, mucopurulent dc, preauricular node, follicles (inferior conj)

If both papillary and follicular response is present, can use red-free to better see follicles

K involvement - PEK, marginal and central infiltrates, subepith opacities similar to EKC

K vascularization, more on inferior border

tx: tetracycline or erythro, azithro

 

Reiter's syndrome

assoc with C. trachomatis infection

thought to be immune related

classic triad

assoc with HLA-B27

10% develop iridocyclitis

 

Ophthalmia Neonatorum

inflammation of conj appearing within the first month of life

only a papillary rxn is seen, because unable to form follicles until 6-8 weeks

causes include: c. trachomatis, n. gonorrhoeae, chemical, other bacterial

 

gonorrhea:

ceftriaxone 125mg IM x 1 for gonorrhea

then admit for chlamydia treament (2 weeks of xxx)