Podcast
Questions and Answers
Which symptom is considered a hallmark sign in the diagnosis of keratitis?
Which symptom is considered a hallmark sign in the diagnosis of keratitis?
What is a common symptom that accompanies keratitis and involves inflammation?
What is a common symptom that accompanies keratitis and involves inflammation?
Which diagnostic tool is primarily used to diagnose conditions like keratitis?
Which diagnostic tool is primarily used to diagnose conditions like keratitis?
What characteristic describes the vesicular rash associated with keratitis onset?
What characteristic describes the vesicular rash associated with keratitis onset?
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In severe cases of keratitis, which additional conditions can occur?
In severe cases of keratitis, which additional conditions can occur?
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What is one of the classic signs observed in patients with keratoconus?
What is one of the classic signs observed in patients with keratoconus?
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What is the primary underlying mechanism contributing to keratoconus?
What is the primary underlying mechanism contributing to keratoconus?
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How does keratoconus typically progress in terms of age?
How does keratoconus typically progress in terms of age?
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What is the most common cause of bacterial keratitis?
What is the most common cause of bacterial keratitis?
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Which of the following represents a symptom of keratoconus?
Which of the following represents a symptom of keratoconus?
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What symptom is commonly associated with keratitis?
What symptom is commonly associated with keratitis?
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What is the classification based on the shape of keratoconus cones?
What is the classification based on the shape of keratoconus cones?
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Which of the following signs is associated with herpes zoster ophthalmicus?
Which of the following signs is associated with herpes zoster ophthalmicus?
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Which treatment is recommended for small corneal ulcers without impending perforation?
Which treatment is recommended for small corneal ulcers without impending perforation?
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What type of corneal shape does keratoconus develop from?
What type of corneal shape does keratoconus develop from?
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What condition is characterized by a hypopyon?
What condition is characterized by a hypopyon?
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Which of the following factors does NOT predispose a person to keratitis?
Which of the following factors does NOT predispose a person to keratitis?
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Which of the following classifications indicates severe keratoconus?
Which of the following classifications indicates severe keratoconus?
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Which of the following is a potential contributing factor to the development of keratoconus?
Which of the following is a potential contributing factor to the development of keratoconus?
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What treatment is indicated for acute hydrops related to keratoconus?
What treatment is indicated for acute hydrops related to keratoconus?
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Which complication arises from bacterial keratitis?
Which complication arises from bacterial keratitis?
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What is a complication that can arise from nasociliary nerve involvement?
What is a complication that can arise from nasociliary nerve involvement?
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What is the purpose of scraping for gram staining and culture in cases of keratitis?
What is the purpose of scraping for gram staining and culture in cases of keratitis?
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What is the appropriate treatment for fungal keratitis?
What is the appropriate treatment for fungal keratitis?
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Which of the following conditions would contraindicate the use of topical steroids?
Which of the following conditions would contraindicate the use of topical steroids?
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What symptom is characteristic of herpes zoster ophthalmicus?
What symptom is characteristic of herpes zoster ophthalmicus?
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Which treatment is not typically recommended for nasociliary nerve involvement?
Which treatment is not typically recommended for nasociliary nerve involvement?
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What is a potential outcome of corneal scarring?
What is a potential outcome of corneal scarring?
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What is the primary cause of disciform keratitis?
What is the primary cause of disciform keratitis?
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What is characterized by a yellow to white ulcer with suppuration similar to bacterial keratitis?
What is characterized by a yellow to white ulcer with suppuration similar to bacterial keratitis?
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Which condition is associated with a characteristic ring abscess?
Which condition is associated with a characteristic ring abscess?
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Which treatment is commonly used for Candida infections?
Which treatment is commonly used for Candida infections?
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What is the primary cause of hyphema?
What is the primary cause of hyphema?
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What is a common risk factor for acquiring acanthamoeba keratitis?
What is a common risk factor for acquiring acanthamoeba keratitis?
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Which of the following symptoms is most severe in acanthamoeba keratitis?
Which of the following symptoms is most severe in acanthamoeba keratitis?
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What defines a hyphema?
What defines a hyphema?
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What is the recommended treatment for a corneal perforation resulting from trauma?
What is the recommended treatment for a corneal perforation resulting from trauma?
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Study Notes
Keratoconus and Keratitis
- Keratoconus: A non-inflammatory condition of the cornea with progressive central thinning. This thinning changes the cornea from dome-shaped to cone-shaped, causing blurred and distorted vision, even with glasses or contact lenses.
- Etiology: The cause is often sporadic (90%), linked to an imbalance of corneal enzymes. Heredity plays a role in 10% of cases.
- Risk factors: Eye rubbing, contact lens wear, hormonal changes, and collagen systemic disease.
- Progression: Keratoconus usually starts in puberty and progresses for 10-20 years.
- Symptoms: Frequent changes in glasses and contact lenses, blurred and distorted vision, nearsightedness, astigmatism.
- Signs: Fleischer's ring, Vogt's striae, apical scarring, corneal thinning, oil droplet sign, prominent corneal nerves, acute corneal hydrops, Munson's sign.
- Treatment: Hard contact lenses, corneal rings, cornea transplant, crosslinking of the stromal collagen for slow progression.
- Complications: Thinning of cornea, sloughing of infected stroma, irregular astigmatism, corneal ulcer and perforation, secondary endophthalmitis and loss of eyes, vision loss, corneal leukoma.
Keratitis
- Bacterial keratitis: Most common type caused by Staphylococcus, Streptococcus, and Pseudomonas aeruginosa. Commonly found in contact lens users.
- Risk factors: Contact lens wear, prolonged use of topical steroids, breach in corneal epithelium after surgery.
- Symptoms: Rapid onset of pain, light sensitivity (photophobia), decreased vision, purulent discharge, Hypopyon (pus in the anterior chamber).
- Signs: Dense stromal infiltrate, subepithelial infiltrates, white cornea opacity, conjunctival hyperemia.
- Treatment: Scraping for Gram staining and culture. Topical antibiotics (including vancomycin + levofloxacin). Monotherapy with ciprofloxacin for small, peripheral ulcers with no impending perforation.
Viral Keratitis
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Herpes Simplex Keratitis
- Cause: HSV 1 (most common), HSV 2 (rarely).
- Symptoms: Variable degree of pain, irritation, watery discharge, fever, unilateral red eye, vesicular skin rash, follicular conjunctivitis.
- Signs: Dendritic corneal ulcer (hallmark sign), inflammatory infiltration, and edema.
- Diagnosis: By slit-lamp examination.
- Treatment: Topical antiviral (trifluridine or acyclovir ointment). Oral and topical acyclovir. Avoid topical steroids. Cycloplegic agents to relax ciliary muscles.
- Complications: Corneal scarring, Chronic interstitial keratitis.
-
Herpes Zoster Ophthalmicus
- Cause: VZV affecting the ophthalmic division of the CN5.
- Symptoms: Unilateral severe burning pain starting 4 days after onset. Vesicular rash on forehead, upper eyelid, and nose, respecting vertical midline.
- Signs: Vesicular skin rash, conjunctivitis, uveitis, iritis, keratitis, scleritis, chorioretinitis, optic neuritis.
- Hutchinson's Sign: Vesicular rash on nasal alae preceding herpes zoster ophthalmicus.
- Treatment: Oral and topical acyclovir, cycloplegic agent.
Fungal Keratitis
- Rare but severe and devastating
- Cause: Filamentous fungi (Aspergillus or Fusarium), Candida.
- Progression: Slower and less painful than bacterial keratitis.
- Signs: Filamentous Keratitis: Grayish infiltrate with indistinct margins. Candida infection: Yellow to white ulcer with suppuration similar to bacterial keratitis.
- Treatment: Topical antifungals, Pimaricin 5%.
Acanthamoeba Keratitis
- Amoeba found in air, soil, and water.
- Related to contact lens wear (increased risk with soft/extended wear).
- May coexist with Herpetic keratitis.
- Symptoms: Severe persistent painful infection, pain, redness, tearing, discharge, photophobia, corneal nerves infiltrated.
- Signs: Ring abscess, dense corneal infiltrate with overlying epithelial defect, Hypopyon, corneal destruction, ocular perforation.
- Diagnosis: Scraping and culture.
- Treatment: Topical anti-amoebic agents, topical steroids (controversial).
Disciform Keratitis
- Immunogenic reaction to Herpes.
- Signs: Disc or ring-shaped stromal edema and clouding without ulceration.
- Often associated with Iritis.
- Treatment: Steroids.
Corneal Ulcers
- Presentation: Painful acute loss of vision.
- Risk factors: Contact lens wear, recent trauma, poor lid apposition, history of ocular surgery, chronic topical steroid use.
- Signs: Dense corneal infiltrate with overlying epithelial defect.
- Symptoms: Pain, redness, tearing, discharge, photophobia.
Iris Prolapse
- Result of full thickness corneal wound.
- Caused by penetrating trauma.
- Treatment: Immediate primary repair.
- Complications: Cataract, keratitis, blindness.
Hyphema
- Presence of red blood cells in the anterior chamber.
- Usually caused by blunt trauma to the eye.
- Results from disruption of blood vessels in the iris or ciliary body.
- Potential for internal ocular structural damage.
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Description
Explore the key aspects of keratoconus and keratitis including their etiology, risk factors, symptoms, and treatment options. Understand how these conditions affect vision and the progression they undergo over time. This quiz provides a comprehensive overview for students and medical professionals alike.
