Podcast
Questions and Answers
Which gland is responsible for producing the lipid layer of the tear film?
Which gland is responsible for producing the lipid layer of the tear film?
The aqueous layer of the tear film is produced by which of the following?
The aqueous layer of the tear film is produced by which of the following?
What is the primary source of the hydrophillic mucin layer of the tear film?
What is the primary source of the hydrophillic mucin layer of the tear film?
What is the consequence of an abnormality in any of the tear film layers?
What is the consequence of an abnormality in any of the tear film layers?
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Which of the following is listed as a type of dry eye disease?
Which of the following is listed as a type of dry eye disease?
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Which factor is least likely to contribute to the development of bacterial keratitis?
Which factor is least likely to contribute to the development of bacterial keratitis?
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A patient presents with a stromal corneal ulcer, profuse tearing, and marked photophobia. What is the most likely stage of disease progression based on these signs and symptoms?
A patient presents with a stromal corneal ulcer, profuse tearing, and marked photophobia. What is the most likely stage of disease progression based on these signs and symptoms?
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Which of the following is typically classified as a sign of bacterial keratitis, rather than a symptom?
Which of the following is typically classified as a sign of bacterial keratitis, rather than a symptom?
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A patient presents with a corneal ulcer and anterior chamber activity and hypopyon. What does this suggest?
A patient presents with a corneal ulcer and anterior chamber activity and hypopyon. What does this suggest?
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Which of the following is the most appropriate first step in managing a patient suspected of bacterial keratitis?
Which of the following is the most appropriate first step in managing a patient suspected of bacterial keratitis?
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What is the importance of sending a contact lens and lens case to the referral appointment, in the case of contact lens associated bacterial keratitis?
What is the importance of sending a contact lens and lens case to the referral appointment, in the case of contact lens associated bacterial keratitis?
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Which of the following findings is most likely to be associated with a corneal infiltrate rather than bacterial keratitis?
Which of the following findings is most likely to be associated with a corneal infiltrate rather than bacterial keratitis?
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Besides bacterial keratitis, which other condition should be considered as a differential diagnosis in a patient presenting with a corneal ulcer?
Besides bacterial keratitis, which other condition should be considered as a differential diagnosis in a patient presenting with a corneal ulcer?
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A patient presents with a corneal epithelial defect that appears dendritic and is a contact lens wearer; what is the most appropriate first action?
A patient presents with a corneal epithelial defect that appears dendritic and is a contact lens wearer; what is the most appropriate first action?
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Which condition requires an emergency, same-day referral?
Which condition requires an emergency, same-day referral?
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What is the recommended frequency of Zovirax ophthalmic preparation for acute herpes simplex keratitis?
What is the recommended frequency of Zovirax ophthalmic preparation for acute herpes simplex keratitis?
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If a patient with herpes simplex keratitis is using Zovirax, when should you consider an urgent referral if the epithelium has not healed?
If a patient with herpes simplex keratitis is using Zovirax, when should you consider an urgent referral if the epithelium has not healed?
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Which of the following is the primary infection caused by the varicella-zoster virus (VZV)?
Which of the following is the primary infection caused by the varicella-zoster virus (VZV)?
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In herpes zoster ophthalmicus, which cranial nerve is primarily affected, leading to a characteristic vesicular rash?
In herpes zoster ophthalmicus, which cranial nerve is primarily affected, leading to a characteristic vesicular rash?
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Which of the following is NOT a common sign or symptom of herpes zoster ophthalmicus?
Which of the following is NOT a common sign or symptom of herpes zoster ophthalmicus?
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A patient with herpes zoster ophthalmicus has vesicles on their nose; what is the approximate chance of ocular involvement?
A patient with herpes zoster ophthalmicus has vesicles on their nose; what is the approximate chance of ocular involvement?
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Which of the following ocular conditions is associated with herpes zoster ophthalmicus?
Which of the following ocular conditions is associated with herpes zoster ophthalmicus?
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What is the underlying cause of herpes zoster reactivation?
What is the underlying cause of herpes zoster reactivation?
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Which of the following is NOT a typical cause of recurrent corneal erosion (RCE)?
Which of the following is NOT a typical cause of recurrent corneal erosion (RCE)?
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Why is daily review recommended for a patient with RCE?
Why is daily review recommended for a patient with RCE?
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What is the recommended dosage for Diclofenac Sodium 0.1% for RCE?
What is the recommended dosage for Diclofenac Sodium 0.1% for RCE?
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Cyclopentolate 1.0% is used to treat what issue associated with RCE?
Cyclopentolate 1.0% is used to treat what issue associated with RCE?
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If a topical form of Diclofenac Sodium is not available, what is an alternative?
If a topical form of Diclofenac Sodium is not available, what is an alternative?
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What is the main reason for RCE happening with regards to the corneal cells?
What is the main reason for RCE happening with regards to the corneal cells?
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Who is usually administered Cyclopentolate 1.0% for the treatment of RCE?
Who is usually administered Cyclopentolate 1.0% for the treatment of RCE?
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How often is Cyclopentolate 1.0% typically administered for RCE?
How often is Cyclopentolate 1.0% typically administered for RCE?
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What is the typical duration of time that Diclofenac Sodium 0.1% is used for RCE treatment?
What is the typical duration of time that Diclofenac Sodium 0.1% is used for RCE treatment?
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What is the definition of Recurrent Corneal Erosion (RCE)?
What is the definition of Recurrent Corneal Erosion (RCE)?
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What symptom is NOT commonly associated with corneal epithelial dystrophy?
What symptom is NOT commonly associated with corneal epithelial dystrophy?
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Which management strategy is recommended for preventing symptoms upon waking at night?
Which management strategy is recommended for preventing symptoms upon waking at night?
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What duration is advised for using lubricants after the last symptom date?
What duration is advised for using lubricants after the last symptom date?
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What can indicate a more severe case of corneal epithelial dystrophy?
What can indicate a more severe case of corneal epithelial dystrophy?
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Which sign is NOT typically observed in healed corneal epithelial dystrophy?
Which sign is NOT typically observed in healed corneal epithelial dystrophy?
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What is not a common reason for diagnosing corneal epithelial dystrophy?
What is not a common reason for diagnosing corneal epithelial dystrophy?
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Which of these symptoms could indicate corneal epithelial dystrophy upon waking?
Which of these symptoms could indicate corneal epithelial dystrophy upon waking?
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Which treatment option is aimed at enhancing lubrication in severe cases?
Which treatment option is aimed at enhancing lubrication in severe cases?
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What symptom is commonly described by patients recurring after eye rubbing?
What symptom is commonly described by patients recurring after eye rubbing?
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What could be a potential sign observed during an examination of someone with corneal epithelial dystrophy?
What could be a potential sign observed during an examination of someone with corneal epithelial dystrophy?
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What is an unlikely evaluation method for diagnosing corneal epithelial dystrophy?
What is an unlikely evaluation method for diagnosing corneal epithelial dystrophy?
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What is the recommended follow-up frequency for patients with corneal epithelial dystrophy?
What is the recommended follow-up frequency for patients with corneal epithelial dystrophy?
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What is a typical symptom described by patients when remaining symptoms persist?
What is a typical symptom described by patients when remaining symptoms persist?
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Which condition is NOT an inflammatory disorder associated with evaporative dry eye?
Which condition is NOT an inflammatory disorder associated with evaporative dry eye?
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What is a common symptom of evaporative dry eye?
What is a common symptom of evaporative dry eye?
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What management option is a non-pharmacological approach for treating evaporative dry eye?
What management option is a non-pharmacological approach for treating evaporative dry eye?
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In cases of severe dry eye associated with Sjorjen's Syndrome, which referral is required?
In cases of severe dry eye associated with Sjorjen's Syndrome, which referral is required?
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What is the characteristic sign of chronic dacryocystitis?
What is the characteristic sign of chronic dacryocystitis?
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Which of the following is a common cause of epiphora?
Which of the following is a common cause of epiphora?
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Which treatment option is indicated for acute dacryocystitis?
Which treatment option is indicated for acute dacryocystitis?
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What would indicate a severe case of keratoconjunctival syndrome (KCS)?
What would indicate a severe case of keratoconjunctival syndrome (KCS)?
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What symptom might lead to diagnosing exposure keratopathy instead of evaporative dry eye?
What symptom might lead to diagnosing exposure keratopathy instead of evaporative dry eye?
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Which of the following could exacerbate symptoms of evaporative dry eye?
Which of the following could exacerbate symptoms of evaporative dry eye?
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Which of the following would NOT be a sign of evaporative dry eye?
Which of the following would NOT be a sign of evaporative dry eye?
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What surgical intervention might be considered for very severe keratoconjunctival syndrome?
What surgical intervention might be considered for very severe keratoconjunctival syndrome?
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Which clinical sign might suggest a secondary infection in a case of dacryocystitis?
Which clinical sign might suggest a secondary infection in a case of dacryocystitis?
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Study Notes
Microbial Keratitis
- Arises from various pathogens and triggers a range of host responses.
- Bacterial, fungal, acanthamoeba, viral, and marginal keratitis are subtypes.
- Bacterial keratitis subtypes include Staphylococcus Aureus, coagulase-negative staphylococci, Streptococcus species.
- Fungal keratitis subtypes include Candida spp. and Fusarium spp., which can progress rapidly and invasively.
- Viral keratitis involves Herpes Simplex Virus, Herpes Zoster Virus, Epstein Barr, Cytomegalovirus or Adenovirus..
- Marginal keratitis is a specific type of inflammation.
Bacterial Microbial Keratitis
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Rare in healthy eyes due to strong corneal defenses.
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Common in immunocompromised individuals, poor contact lens hygiene, and after corneal surgery.
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Disease progression can lead to endophthalmitis.
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Symptoms include acute onset, severe pain, rapid progression, profuse tearing, photophobia, redness, discharge, and reduced vision.
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Signs include: corneal ulcer, stromal deep with overlying epithelial loss, stromal abscess formation, corneal edema, activity with or without hypopyon, redness, upper eyelid edema, Descemet's membrane folds, corneal degradation, necrosis, and thinning, and scar formation.
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Management involves immediate referral to HES, contact lens removal for culture, scraping the corneal base and margin of ulcer (to collect material for culture and remove necrotic tissue), in-hospital admission if compliance is poor, and antibiotic treatment.
Fungal Keratitis
- Rare
- Corneal trauma involving organic material, contact lens related, or contaminated contact lens solutions are potential causes.
- Signs and symptoms are similar to bacterial conjunctivitis but progress more slowly.
- Management involves referral, corneal scraping and PCR testing, anti-fungal drops, and systemic therapy.
Acanthamoeba Keratitis
- Linked to contact lens wear, inadequate lens disinfection, and use of tap water in lens storage.
- Management involves stopping lens wear, appropriate disinfection, and referral.
- Treatment involves a combination therapy and referral if cases are severe.
Viral Keratitis
- Caused by herpes simplex virus, herpes zoster virus, cytomegalovirus, adenovirus, and Epstein Barr.
- Herpes simplex virus can occur in an intact epithelium.
- Symptoms may include unilateral red eye, pain, photophobia, epiphora, reduced vision, and possibly secondary uveitis.
- Management may involve ceasing lens wear, and antibiotic or antiviral medications, and referring a patient to a healthcare professional immediately.
Corneal Trauma
- Significant eye injury that may involve an object and/or inflammation.
- Symptoms include pain, foreign body sensation, photophobia, tearing, and decreased vision.
- Treatment options include removal of foreign objects, antibiotic prophylaxis, and monitoring for healing.
Recurrent Corneal Erosion
- Repetitive disruption of the corneal epithelium.
- Causes include mechanical trauma or corneal abrasion by a fingernail.
- Management includes treating the underlying cause, relieving symptoms (e.g., by using lubricating drops), and monitoring for healing.
Lacrimal Disorders
- Keratoconjunctivitis Sicca (dry eyes disease), dacryocystitis, and epiphora are included in this category,
- Tear film abnormalities and or diseases of the tear glands cause symptoms.
- Causes include various factors that disrupt tear production, drainage or viscosity.
Acute Dacryocystitis
- Bacterial infection in the lacrimal sac (often secondary to nasolacrimal duct blockage).
- Symptoms include sudden pain, erythema, edema around the lacrimal sac, and purulent discharge.
- Management involves antibiotics and may include referral.
Chronic Dacryocystitis
- Formation of a mucocele in the lacrimal sac.
- Symptoms include swelling, tenderness, redness, and epiphora (excessive tearing).
- Management depends on the progression of the condition and may include warm compresses and referral.
Epiphora
- Tears overflow, frequently seen in elderly patients.
- Causes include tear production exceeding drainage capacity.
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Description
This quiz covers the various types of microbial keratitis, including bacterial, fungal, viral, and marginal keratitis. It focuses on the pathogens involved, symptoms, and the risk factors associated with each subtype. Test your knowledge on this important topic in ophthalmology.
