Questions and Answers
Which of the following is the primary drug of choice for treating gram-positive infections in corneal ulcers?
What is a common risk factor for developing fungal keratitis?
What condition is most likely to necessitate surgical treatment for bacterial keratitis?
Fungal keratitis is less common than bacterial keratitis, making up what percentage of corneal infections?
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In what type of environment does filamentous fungal keratitis occur more frequently?
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Patients with fungal keratitis typically present with which symptom?
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Which of the following is NOT a recommended drug for monotherapy in the treatment of corneal ulcers?
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What is a leading risk factor for fungal keratitis?
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Corticosteroid therapy's role in treating bacterial keratitis is considered:
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Which of the following would likely NOT indicate the need for surgical intervention in bacterial keratitis?
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Study Notes
Treatment of Lid Conditions
- Lid hygiene involving diluted baby shampoo is essential for maintaining eyelid cleanliness.
- Topical corticosteroids may be briefly prescribed for inflammatory components around eyelid margins.
Demodectic Blepharitis
- Caused by the mite Demodex folliculorum, particularly prevalent in elderly patients.
- Characterized by minimal inflammation and asymptomatic presence.
- Distinctive waxy, cylindrical cuffs (hypertrophic follicular epithelium) observed at eyelash bases.
Meibomian Gland Dysfunction (MGD)
- Meibomian blepharitis (posterior) results from blocked oil glands, leading to poor tear quality and eyelid redness.
- Involves lipase-producing bacteria that alter gland secretion, causing focal or diffuse lid inflammation.
- Posterior eyelid margins exhibit irregularity with visible telangiectatic blood vessels.
- Management includes daily lid hygiene, warm compresses, and gland expression to relieve symptoms.
Pharmacological Management
- Oral tetracycline (250 mg QID) or doxycycline (100 mg BID) for 4-6 weeks can decrease bacterial lipase production and stabilize ocular surface.
- Alternative antibiotics such as azithromycin (500 mg for 3 days, repeated at weekly intervals).
- Temporary treatments include lubricants and taping off the lid.
- Surgical intervention may be required for definitive treatment.
Trichiasis
- Characterized by misdirected eyelashes that rub against the globe, causing irritation and tearing.
- Causes may include chronic anterior blepharitis, herpes zoster ophthalmicus, or trauma.
- Treatment methods include:
- Epilation for a few misdirected lashes.
- More severe cases may require electrolysis, cryotherapy, or surgery.
- Superficial punctate keratitis (SPK) treated with antibiotic ointment.
Ptosis
- Defined as the abnormally low positioning of the upper eyelid.
- Classification includes congenital, mechanical, neurological, myogenic, and aponeurotic forms.
- Aponeurotic ptosis is the most common, linked to disinsertion of the levator muscle, primarily in the elderly.
Pseudoptosis
- May falsely appear as true ptosis due to several factors:
- Lack of globe support from orbital volume deficits.
- Contralateral eyelid retraction or ipsilateral hypotropia.
- Brow ptosis or dermatochalasis, which may mimic ptosis but often requires separate assessment.
Evaluation of Ptosis
- History and physical examination assess for congenital versus acquired causes.
- Critical measurements include vertical interpalpebral fissure height and margin-reflex distance.
Trachoma Diagnosis
- Clinical diagnosis requires at least two features: follicles on the tarsal conjunctiva, Herbert pits, typical scarring, and vascular pannus.
- WHO classification breaks down stages from follicular inflammation to corneal opacity.
SAFE Strategy for Trachoma Treatment
- S: Surgery for trichiasis
- A: Antibiotics for active infection
- F: Facial cleanliness
- E: Environmental hygiene improvements
Bacterial Keratitis Treatment
- Topical fluoroquinolone is effective for corneal ulcers.
- Recommended drugs vary by bacterial type: Gram-positive and Gram-negative coverage with specific antibiotics.
- Corticosteroid therapy in bacterial keratitis is debated; surgical intervention needed for progressive cases or complications.
Fungal Keratitis
- Accounts for less than 10% of corneal infections, frequently occurs in warm, humid environments.
- Major risk factors include corneal trauma with organic material, contact lens use, and systemic immunosuppression.
- Patients may present with less conjunctival injection yet report significant pain despite limited inflammatory signs.
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Description
This quiz covers the treatment options for demodectic blepharitis, including lid hygiene and corticoid use. It highlights the role of the mite Demodex folliculorum in elderly patients and its clinical characteristics. Test your knowledge on managing this condition effectively.
