Podcast
Questions and Answers
Which antibiotic inhibits protein synthesis at the 50S ribosomal subunit?
Which antibiotic inhibits protein synthesis at the 50S ribosomal subunit?
- Trimethoprim
- Tobramycin
- Polymyxin B
- Azithromycin (correct)
What is the treatment duration recommended for Tobramycin or Gentamycin?
What is the treatment duration recommended for Tobramycin or Gentamycin?
- 1 week
- 3-5 days (correct)
- 1 month
- 2 weeks
What category is AzaSite classified under?
What category is AzaSite classified under?
- D category
- A category
- C category
- B category (correct)
Which of the following medications is specifically mentioned for suspected Heamophilus infection?
Which of the following medications is specifically mentioned for suspected Heamophilus infection?
What is the consequence of using Tobramycin/Gentamycin for a longer duration?
What is the consequence of using Tobramycin/Gentamycin for a longer duration?
If marked inflammation and a marginal infiltrate/ulcer are observed, which treatment is a second option?
If marked inflammation and a marginal infiltrate/ulcer are observed, which treatment is a second option?
How often should Zymar or Vigamox be administered for a suspected bacterial ulcer?
How often should Zymar or Vigamox be administered for a suspected bacterial ulcer?
What is the follow-up time recommended after treatment for moderate to severe suspected Staph infection?
What is the follow-up time recommended after treatment for moderate to severe suspected Staph infection?
What should be done if the condition worsens after initial treatment?
What should be done if the condition worsens after initial treatment?
What is the primary function of the epithelium layer in the conjunctiva?
What is the primary function of the epithelium layer in the conjunctiva?
Which part of the conjunctiva connects the eyelids to the eyeball?
Which part of the conjunctiva connects the eyelids to the eyeball?
Which arteries provide the blood supply to the conjunctiva?
Which arteries provide the blood supply to the conjunctiva?
The palpebral conjunctiva is associated with which area of the eyelid?
The palpebral conjunctiva is associated with which area of the eyelid?
What characterizes papillae found in conjunctivitis?
What characterizes papillae found in conjunctivitis?
Which type of conjunctivitis is associated with follicles?
Which type of conjunctivitis is associated with follicles?
What type of conjunctiva lies loose over the underlying structures?
What type of conjunctiva lies loose over the underlying structures?
What is the primary recommended treatment for mild conditions associated with severe itching and photophobia?
What is the primary recommended treatment for mild conditions associated with severe itching and photophobia?
Which of the following contributes to sensory innervation of the superior palpebral conjunctiva?
Which of the following contributes to sensory innervation of the superior palpebral conjunctiva?
Which medication is recommended for treating moderate to severe papillary hypertrophy?
Which medication is recommended for treating moderate to severe papillary hypertrophy?
When dealing with a severe or resistant case, which of the following treatments might be added?
When dealing with a severe or resistant case, which of the following treatments might be added?
What is the follow-up schedule recommended for moderate to severe cases after initial treatment?
What is the follow-up schedule recommended for moderate to severe cases after initial treatment?
In the case of a patient with a shield ulcer, which of the following treatments is NOT recommended?
In the case of a patient with a shield ulcer, which of the following treatments is NOT recommended?
What are the common oral antihistamines mentioned for treating allergic conjunctivitis?
What are the common oral antihistamines mentioned for treating allergic conjunctivitis?
Which condition is most likely associated with contact lens wearers?
Which condition is most likely associated with contact lens wearers?
What is a possible acute treatment option during exacerbations of allergic conjunctivitis?
What is a possible acute treatment option during exacerbations of allergic conjunctivitis?
What should patients be cautioned about after using antihistamines for eye treatment?
What should patients be cautioned about after using antihistamines for eye treatment?
In Giant Papillary Conjunctivitis, what indicates a late-stage symptom?
In Giant Papillary Conjunctivitis, what indicates a late-stage symptom?
What is the recommended follow-up duration when treating with steroid nasal sprays?
What is the recommended follow-up duration when treating with steroid nasal sprays?
Which of the following is NOT a common treatment for chronic allergic conjunctivitis?
Which of the following is NOT a common treatment for chronic allergic conjunctivitis?
What type of hypersensitivity reactions are involved in Giant Papillary Conjunctivitis?
What type of hypersensitivity reactions are involved in Giant Papillary Conjunctivitis?
What is a recommended intervention for mild to moderate Giant Papillary Conjunctivitis?
What is a recommended intervention for mild to moderate Giant Papillary Conjunctivitis?
Which symptom is commonly associated with early-stage Giant Papillary Conjunctivitis?
Which symptom is commonly associated with early-stage Giant Papillary Conjunctivitis?
What is the most common organism responsible for chronic bacterial conjunctivitis?
What is the most common organism responsible for chronic bacterial conjunctivitis?
Which symptom is specifically NOT associated with chronic bacterial conjunctivitis?
Which symptom is specifically NOT associated with chronic bacterial conjunctivitis?
What is an important treatment consideration for purulent eye conditions?
What is an important treatment consideration for purulent eye conditions?
What is one of the suggested treatments for eyelid margin disease associated with chronic bacterial conjunctivitis?
What is one of the suggested treatments for eyelid margin disease associated with chronic bacterial conjunctivitis?
What condition should be suspected in children with a history of sinusitis presenting swollen eyelids?
What condition should be suspected in children with a history of sinusitis presenting swollen eyelids?
How often should hot compresses and lid scrubs be performed when treating eyelid margin disease?
How often should hot compresses and lid scrubs be performed when treating eyelid margin disease?
Which topical treatment should be used to manage chronic bacterial conjunctivitis?
Which topical treatment should be used to manage chronic bacterial conjunctivitis?
What additional medication may be added for managing meibomian gland dysfunction (MGD)?
What additional medication may be added for managing meibomian gland dysfunction (MGD)?
What is the primary reason against using sulfa antibiotics in purulent infections?
What is the primary reason against using sulfa antibiotics in purulent infections?
What is a common sign of chronic bacterial conjunctivitis?
What is a common sign of chronic bacterial conjunctivitis?
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Study Notes
Conjunctiva Anatomy
-
Composed of transparent mucous-like connective tissue, connecting eyelids to the eyeball.
-
Palpebral conjunctiva:
- Marginal conjunctiva extends ~2 mm from the lid margin, leads to the sulcus subtarsalis.
- Tarsal conjunctiva attaches to the whole tarsal plate in the upper lid; adheres to half the tarsus in the lower lid.
- Orbital part lies loosely between tarsal plate and fornix.
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Forniceal conjunctiva:
- Joins bulbar conjunctiva with palpebral conjunctiva.
- Contains superior, inferior, medial, and lateral fornices.
- Caruncle: A small fleshy prominence (5x3 mm) at the nasal portion of the interpalpebral fissure, containing modified cutaneous tissue and accessory lacrimal glands.
-
Bulbar conjunctiva:
- Lies loosely over underlying structures, separated from the anterior sclera by Tenon’s capsule.
- Limbal conjunctiva forms a ridge around the cornea and is dense at the corneoscleral junction.
Histology
- Epithelium: Acts as a protective barrier.
- Adenoid Layer: Serves as a secretory portion.
- Fibrous Layer: Functions as adhesive fibrous attachment.
Blood and Nerve Supply
- Blood supply from the ophthalmic artery through anterior ciliary and palpebral arteries.
- Sensory innervation:
- Superior palpebral conjunctiva: Frontal and lacrimal branches of the ophthalmic nerve (V1).
- Inferior palpebral conjunctiva: Lacrimal nerve and infraorbital branch of the maxillary nerve (V2).
Papillae and Follicles
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Papillae:
- Inflammatory response with a vascular core; less than 1 mm size, common in allergic (upper) and bacterial (lower) conjunctivitis.
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Follicles:
- Avascular, gelatinous, rounded nodules (~1 mm) found in tarsal conjunctiva; indicate viral or toxic conjunctivitis.
- Associated with lymphoid collections and resemble lymphoid follicles.
Chronic Conditions
-
Chronic Bacterial Conjunctivitis:
- Commonly caused by S.aureus; symptoms include redness, mucous discharge, and eyelid margin disease.
- Treatment includes bacitracin ung, lid scrubs, and addressing meibomian gland dysfunction.
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Chronic Allergic Conjunctivitis:
- Variable acute signs; treatment focuses on maintaining therapy with artificial tears and antihistamines.
Giant Papillary Conjunctivitis
- Primarily affects contact lens wearers; arises from hypersensitivity reactions.
- Early symptoms include itching and hyperemia; late stage presents with intolerance to contact lenses and giant papillae.
- Treatment involves stopping contact lens wear, cold compresses, and potentially topical antihistamines.
Important Treatment Considerations
- Avoid sulfa antibiotics in cases of purulent conjunctivitis as pus deactivates their effectiveness.
- Refer patients with suspected bacterial ulcers immediately.
- Monitor patients with extensive symptoms or uncontrolled inflammation carefully and adjust treatment based on clinical response.
Other Treatment Options
- For moderate to severe allergic responses, consider steroids and cyclosporine A for resistant cases.
- Severe cases may require surgical interventions for papillary hypertrophy or shield ulcers.
Symptoms and Follow-up
- Regular follow-up is crucial, typically within 3-7 days, to assess treatment efficacy and monitor for complications.
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