2 102 ExtDisReview2 (3) 11m 38s - 17m 48s

When is this most contagious?

Typically it is most contagious

in the first 8 to 14 days.

After two weeks, it's usually not contagious,

but the patient may still have symptoms,

particularly from the cornea infiltrates.

What is the difference

between adult STD chlamydia conjunctivitis

and newborn infant chlamydia conjunctivitis?

The newborn, it is the most common STD

in infants,

it's passed down from the mother who has this.

It is a diffusely very red,

hyperemic-appearing conjunctivitis,

easily treated.

And in the adult, it is...

the most common STD in the US,

and in this case, the adult,

it's a low-grade follicular.

It's often very chronic,

and it's misdiagnosed for other problems,

so know the difference between these two.

A pterygium destroys

what layer of the cornea?

It destroys the Bowman's membrane,

so it's going to leave a little scar there

when it's removed.

Most cases of episcleritis,

what is the cause?

Episcleritis.

It is... idiopathic.

We usually don't find the cause

of most cases of episcleritis

and it's usually not associated

with a serious problem,

although it can be with an immunological,

but usually not, and so

how do we treat an episcleritis?

With mild topical steroids.

This just requires a mild topical steroid.

Most cases of scleritis

differ from the above,

so how would you know the difference

between these two?

Although sometimes,

if you have a really bad episcleritis,

it's hard to tell the difference,

and we can use an OCT,

which will reveal some changes, so.

It is these-- scleritis

are usually more injected,

more tender, there can be some swelling,

and with an OCT, we will find that the sclera

is thickened with a scleritis

and not with an episcleritis,

because this just involves the episcleral tissue.

This involves the sclera itself.

Now, episcleritis, usually not serious.

What are the possible causes of scleritis?

They are:

some autoimmune disorders,

such as the rheumatoid arthritis.

And how do we treat these?

Remember, we treated the episcleritis

with mild topical steroids.

We treat this with stronger topical steroids,

and these also may require systemic steroids

or other drugs

to treat the underlying autoimmune disease.

What is the medical term

for a corneal opacity, a corneal scar?

It's called a leucoma.

Name some common causes

of superficial punctate keratitis,

and see if you could write down eight causes,

there are a lot more.

But here are some more common eight:

overuse or chronic use of any topical drop,

which can be due to the preservative,

more commonly preservative, or sometimes the active ingredient

in the drop itself;

benzoconium chloride;

topical anesthetics;

topical NSAIDs,

there is an FDA paper

that says if you have to use a topical NSAID

more than 21 days,

it must be observed frequently

because of this, is one problem,

and you can also have corneal melt;

ultraviolet light, such as beaches,

snow, tanning lights;

EKC; dry eye.

So there's quite a few, and there's even more than this.

What are the two main types

of herpes simplex keratopathy?

And so, let's talk about the least serious type first.

It is...

the epithelial form, the dendritic ulcer.

This only involves the epithelium,

and in most cases, it'll heal itself

within a couple weeks,

although we use topical drops

and systemic antivirals

to reduce the chance of recurrence

and shorten the case by several days.

Now, this one usually is not... not serious,

but the more serious form

involves the stromal,

or interstitial.

These two words are the same area.

We're talking about the stroma or the interstitial area,

it's interchangeable, and so, inflamma--

so the involvement of the keratopathy

in the stroma with the herpes simplex.

Now you have a bad, bad problem.

This becomes chronic and recurrent.