Ophthalmology Phlyctenular Conjunctivitis

Questions and Answers

What initial recommendation is made for patients with bleeding disorders?

Administer NSAIDs for pain relief

Perform emergency surgery immediately

Start anticoagulant therapy

Order CBC, PT, PTT for bleeding disorders (correct)

Which of the following is NOT suggested in the management of bleeding disorders?

Lubricants

Use of NSAIDs (correct)

Patient reassurance

Referral to an internist if a blood disorder is suspected

Ocular Cicatricial Pemphygoid primarily affects which part of the body?

The brain

The digestive tract

The mucous membranes (correct)

The skin

At what age is Ocular Cicatricial Pemphygoid most commonly diagnosed?

After the age of 55 Signup and view all the answers

Which systemic treatment options are recommended for Ocular Cicatricial Pemphygoid?

Oral steroids and Dapsone Signup and view all the answers

What is the primary cause of blister formation in Ocular Cicatricial Pemphygoid?

Autoimmune reaction Signup and view all the answers

Which sign is commonly associated with Ocular Cicatricial Pemphygoid?

Mucous membrane vesicles Signup and view all the answers

What stage of Ocular Cicatricial Pemphygoid involves conjunctival shrinkage and its associated complications?

Stage II Signup and view all the answers

Which of the following drugs is NOT associated with drug-induced Ocular Cicatricial Pemphygoid?

Dapsone Signup and view all the answers

What is a potential complication of blisters in conjunctiva due to Ocular Cicatricial Pemphygoid?

Vision loss Signup and view all the answers

Which of the following antibiotics is NOT recommended for severe staphylococcal infections?

Ciprofloxacin 500 mg BID x 2-4 weeks Signup and view all the answers

What is the age demographic most commonly affected by Superior Limbic Keratoconjunctivitis (SLK)?

Middle-aged women aged 20-55 Signup and view all the answers

Which condition is associated with over 50% of patients suffering from Superior Limbic Keratoconjunctivitis?

Keratoconjunctivitis sicca (KCS) Signup and view all the answers

What is the primary characteristic of Superior Limbic Keratoconjunctivitis?

Chronic, progressive inflammation Signup and view all the answers

What is the suggested cause of the etiology of Superior Limbic Keratoconjunctivitis?

Mechanical trauma and friction from eyelids Signup and view all the answers

Which oral antibiotic class is noted as best for reducing collagenases in inflammation?

Tetracyclines Signup and view all the answers

What is a common associated condition in patients with Superior Limbic Keratoconjunctivitis?

Thyroid disease Signup and view all the answers

What treatment is NOT part of the regimen for severe staph infections?

Topical antihistamines Signup and view all the answers

What is a treatment regimen for severe staphylococcal infections involving topical medication?

Líd scrubs and Erythromycin/Bacitracin ung hs Signup and view all the answers

What is a typical follow-up interval for patients treated for severe staphylococcal infections?

Every 5-7 days Signup and view all the answers

What is the primary treatment for inflamed conditions related to pingueculitis?

FML QID for 5-7 days Signup and view all the answers

Which of the following symptoms is most commonly associated with corneal phlyctenules?

FB sensation Signup and view all the answers

Which statement about the lesions associated with conjunctival phlyctenules is accurate?

They tend to be small white nodules surrounded by a hyperemic response. Signup and view all the answers

Which testing method is primarily used to check for tuberculosis in the context of phlyctenular conjunctivitis?

PPD skin test Signup and view all the answers

What is a potential complication of untreated corneal phlyctenules?

Progression to a gray-white corneal mass Signup and view all the answers

Which demographic is most frequently affected by conjunctival phlyctenules?

Women in the 1st and 2nd decades living in impoverished environments Signup and view all the answers

What underlying condition is commonly associated with the occurrence of phlyctenular conjunctivitis?

HIV Signup and view all the answers

When can lubricants be used for treating non-inflamed conditions?

Every 3 hours - QID Signup and view all the answers

What does the systemic treatment typically involve for managing oral lesions?

Oral mouthwash and topical steroids Signup and view all the answers

Which of the following ocular conditions is characterized by the presence of a membrane on the conjunctiva?

Pseudomembrane conjunctivitis Signup and view all the answers

How should abrasions typically be treated?

Using antibiotic ointment and frequent follow-up Signup and view all the answers

What is an appropriate initial management step for ocular dry eye conditions?

Non-preserved lubricants Signup and view all the answers

Which treatment is indicated for lacerations that are greater than 1-1.5 cm?

Referral for suturing Signup and view all the answers

What is the primary treatment approach for hemolytic anemia?

Immunosuppressants with oral steroids Signup and view all the answers

Which of the following factors can precipitate Steven’s-Johnson Syndrome?

Mycoplasma pneumoniae Signup and view all the answers

Which feature is characteristic of the primary lesions in Steven’s-Johnson Syndrome?

Target lesions with red centers Signup and view all the answers

What is the recommended follow-up interval for ocular treatments in patients with hemolytic anemia?

Every few days to weeks Signup and view all the answers

Which treatment is suggested for patients experiencing lid margin disease?

Punctal occlusion Signup and view all the answers

In which demographic is Steven’s-Johnson Syndrome most commonly observed?

Young, healthy individuals aged 3-4 decades Signup and view all the answers

What type of ocular treatment is used for trichiasis or entropion/ectropion?

Bandage contact lenses Signup and view all the answers

What are the common early symptoms of Steven’s-Johnson Syndrome?

Malaise, fever, and headaches Signup and view all the answers

What type of lubricant is recommended for ocular care in patients with specific conditions?

Preservative-free lubricants Signup and view all the answers

What skin condition is characterized by erosive mucocutaneous lesions?

Steven’s-Johnson Syndrome Signup and view all the answers

Study Notes

Treatment Overview

Non-inflamed conditions treated with lubricants every 3 hours (QID) with follow-ups as needed.
Inflamed conditions require lubricants every 3 hours (QID) and FML (fluorometholone) drops QID for 5-7 days with follow-ups every 3-7 days.

Pingueculitis

Degeneration of the conjunctiva often presenting as redness and irritation.
Associated with phlyctenular conjunctivitis, an immune reaction linked to staphylococcal proteins and tuberculosis, common in autoimmune diseases like Behcet’s and HIV.
Distinguishes between conjunctival and corneal phlyctenules.
Symptoms include foreign body sensation and burning, more prominent with limbal/corneal phlyctenules.

Diagnostic Tests for Phlyctenular Conjunctivitis

Tuberculosis assessed via PPD and Chest X-ray.
HLA-B51 testing for Behcet’s.
HIV screening as needed.

Treatment for Phlyctenular Conjunctivitis

Topical steroids to be tapered after initial treatment.
If staphylococcal involvement is found, combination treatments including antibiotics may be necessary.
Severe cases may require oral doxycycline, tetracycline, or erythromycin.

Superior Limbic Keratoconjunctivitis (SLK)

Chronic inflammatory condition affecting the superior bulbar conjunctiva.
Primarily affects middle-aged women (aged 20-55), often associated with thyroid disease.
Common signs include irritation and inflammation; symptoms can resolve with time.

Management of SLK

Treatment focuses on reassurance and lubricants.
Avoid NSAIDs and aspirin; regular follow-ups are recommended.
Advanced cases may require referrals for underlying conditions.

Mucous Membrane Disorders

Includes diseases like ocular cicatricial pemphigoid (OCP) and erythema multiforme.
Immune-mediated reactions affecting the mucosal basement membrane.

Ocular Cicatrical Pemphygoid (OCP)

Rare disease (incidence of 1 in 15,000-40,000).
Typically presents in older adults (after age 55).
Blister formation and scarring in the eye can lead to vision loss, with stages of progression noted.

Systemic and Ocular Treatment for OCP

Requires a multidisciplinary approach involving internists and dermatologists.
Treatment typically includes systemic steroids and immunosuppressants.
Ocular management includes lubricants, punctal occlusion, and potential surgery for eyelid deformities.

Stevens-Johnson Syndrome

Severe inflammatory condition causing erosive lesions in skin and mucous membranes, typically triggered by medications or infections.
Symptoms include fever, malaise, and distinctive target lesions.
Requires hospitalization and elimination of potential causes with extensive ocular treatment for complications.

Abrasions and Lacerations

Abrasions show localized staining with NaFl; treatment includes topical antibiotics without the need for patching.
Lacerations can reveal a loose conjunctival flap; management involves evaluation and possible suturing for larger lacerations.
Follow-up for both conditions occurs in a range of 3-7 days depending on severity.

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Description

This quiz covers the treatment and diagnosis of phlyctenular conjunctivitis and pingueculitis. It details management strategies including the use of lubricants and steroids, along with necessary diagnostic tests such as PPD and HLA-B51 testing. Perfect for ophthalmology students or healthcare professionals wanting to test their knowledge.