4. HSV has two subtypes, HSV-1 and HSV-2, and these reside in
almost all neuronal ganglia. HSV-1 causes infection above the waist
(principally the face, lips and eyes), whereas HSV-2 causes
venereally-acquired infection (genital herpes). Rarely HSV-2 may be
transmitted to the eye through infected secretions, either venereally
or at birth (neonatal conjunctivitis)
Remember : Corneal Sensation in herpetic keratitis
ARN is a biphasic disease which tends to be caused by herpes
simplex virus (HSV) in younger patients and VZV in older individuals
6. Syphilis is often known as the “Great Imitator”. The differential diagnosis of
posterior uveitis is broad with ocular syphilis being particularly challenging to
diagnose as it presents similarly to any form of uveitis.
The disease must be suspected in any case of intraocular inflammation
resistant to conventional therapy.
Because syphilis may pursue a more aggressive course in HIV patients and
respond less well to conventional therapy it seems reasonable to test all
patients with ocular syphilis for HIV and vive-versa
Remember : Interstitial keratitiis , Argyll Robertson pupil
8. Gonorrhea is a venreal
genitourinary tract
infection caused by
Neisseria gonorrhoea,
which capable of invading
the intact corneal
epithelium
N.B. The patient must
be hospitalized if there
is corneal ulceration
N.B. Patients must be
referred to a
genitourinary department
to be screened for
associated chlamydial
infection and contact
tracing.
10. Conjunctival papillomata are strongly associated with human
papillomavirus infection
Venereal warts (condylomata acuminata) are a viral
infection that’s passed on by direct contact with wart
tissue. The warts can show up on the eyelids, mouth, or
genitals
12. Retinal microangiopathy is the most frequent retinopathy
in patients with AIDS. Postulated causes include
immune complex deposition
Cytomegalovirus (CMV) retinitis is the most common
opportunistic ocular infection among patients with AIDS
Remember : Kaposi sarcoma
14. The crab louse (Phthirus pubis) is adapted to living in pubic hair, but
is also commonly found in other hair-covered body areas such as the
chest, axillae and eyelids (phthiriasis palpebrarum).
N.B. One third of patients with pubic lice have a sexually transmitted
disease.
16. Adult chlamydial (inclusion) conjunctivitis is an oculogenital infection
usually caused by serovars (serological variants) D-K of C.
trachomatis, and affects 5–20% of sexually active young adults in
western countries. Transmission is by autoinoculation from genital
secretions although eye-to-eye spread probably accounts for about
10% of cases. The incubation period is about 1 week.
N.B. In males , C. trachomatis can act as a trigger for Reiter's
disease.
18. Neonatal conjunctivitis (ophthalmia neonatorum) is
defined as conjunctival inflammation developing within
the first month of life
Causes include: C. trachomatis, N. gonorrhoeae (now
rare in developed countries) and occasionally herpes
simplex virus (typically HSV-2), which may be
associated with severe ocular or systemic complications
20. Molluscum contagiosum virus can cause pearly white papules with
central umbilication on the skin of the eyelids or in the
periorbital area.
If they are on the eyelid margin there may be a secondary
keratitis and chronic follicular conjunctivitis unless the lid margin
is examined carefully the causative lesion may be overlooked.
Patients with concurrent HIV infection may suffer a more
aggressive disease with a common distribution in the chinstrap
region
23. Retinal vein occlusion, occasionally found in young
adults, has been described in patients taking the oral
contraceptives. Pseudotumour cerebri, optic neuritis and
changes in colour vision have also been reported
25. Ocular side effects of drugs with common
use by sexual health physicians
Medication Side effects
Bactrim StevensJohnsonsyndrome
Chloramphenicol Opticneuritis
Cidofovir Uveitis
Ethambutol Opticneuritis
Isoniazid Opticneuritis
Quinolones Pseudotumourcerebri
Rifampicin Blepharoconjunctivitis
Rifabutin Uveitis
Tetracycline Pseudotumourcerebri
27. Diabetic retinopathy is significantly associated with erectile
dysfunction, supporting the concept that it is a microvascular problem,
but it does not appear to be a useful marker for the disease
Impotence is an uncommon though well described side effect of
topical beta blockers, such as timolol, which are first line management
for glaucoma , Acetazolamide also has been reported for decreased
libido and impotence
29. There are some less serious visual side effects that are common
among users. These can include:
blurry vision, light sensitivity and decreased color vision
These side effects are temporary and have not been shown to have a
harmful effect
For patients already at risk for NAION, taking ED medication can
raise the risk by lowering blood pressure.
Using ED drugs can harm the vision of RP Patients