Clinical Medicine: Ocular Manifestations Associated with Dermatological Conditions I

Isotretinoin (Accutane)

What is the medication (discussed in lecture) that is used to treat severe acne & rosacea, that works to alter lipid composition & sebaceous gland size, & decreases sebum production & anti-inflammatory properties?

Sun Exposure

What is the most highly associated environmental trigger for rosacea?

Acne

What is the multifactorial chronic inflammatory skin disease that primarily affects adolescents & young adults?

Demodex

What is the saprophytic mite that resides in the sebaceous follicles?

0.2-0.3 mm

How big are demodex folliculorum brevis mites?

0.3-0.4 mm

How big are demodex folliculorum longus mites?

Permanent

The compromise of dark adaptation in patients who use isotretinoin tends to be _____________(permanent/reversible).

Reversible

The decrease of color vision in patients who use isotretinoin tends to be _____________(permanent/reversible).

Reversible

The negative impact to the meibomian glands that occurs in patients who use isotretinoin tends to be _____________(permanent/reversible).

Demodex, Eyelid Margin Talengiectasia, Erythema, Interpalpebral Conjunctival Injection, Spade-Shaped Corneal Infiltrates, Scleritis, & Sclerokeratitis

What are the manifestations that are associated with Ocular Rosacia?

Retinol Dehydrogenase

Isotretinoin causes a compromise in the dark adaptation of patients through competitive inhibition of what enzyme?

True

True or False: The severity of ocular rosacea does not necessarily match the severity of facial rosacea.

False

True or False: The severity of ocular rosacea will typically match the severity of facial rosacea.

Erythematotelangiectatic, Papulopustular, Phymatous, & Ocular

What are the clinical subtypes of rosacea?

Rosacea, Acne, Basal Cell Carcinoma, & Squamous Cell Carcinoma

What are the dermatological conditions (listed in lecture) that are associated with ocular manifestations?

Cosmetics & Medications

What are the extrinsic factors that contribute to acne?

Evaporative Dry Eye, Meibomian Gland Dysfunction, Compromised Dark Adaptation, Decreased Color Vision & Idiopathic Intracranial Hypertension w/ Optic Nerve Disc Edema

What are the ocular manifestations of Isotretinoin use that were highlighted in lecture?

Ulcerative Disease & (or) Vascularized Pannus

What complications may develop from spade-shaped corneal infiltrates in a patient with rosacea?

Rosacea

What dermatological condition presents a higher incidence of demodex?

Rosacea

What is the chronic inflammatory syndrome that primarily affects the face in episodes of remission & exacerbation that can be triggered by environmental factors?

Spade-Shaped Corneal Infiltrates

What are the triangular infiltrates that are charactaristic of ocular rosacea & may be found at the base of the limbus?

Follicular Hyperkeratininization (forms a plug), Proliferation of Cutibacterium Acnes (which triggers inflammation), Increased Sebum Production (within a pilosebaceous skin follicle), & Inappropriate Innate & Acquired Immuno response (more inflammation)

What are the four major steps involved in the pathogenesis of acne?

Neuroendocrine stimuli & Genetic History

What are the intrinsic factors that contribute to acne?

Demodex Folliculorum Longus & Demodex Folliculorum Brevis

What are the two types of Demodex?

Hypertension or Intracranial Mass

If your patient presents with idiopathic intracranial hypertension with optic nerve disc edema, what other etiologies should be ruled out before determining the problem is isotretinoin?

12 weeks

If your patient's idiopathic intracranial hypertension with optic nerve disc edema is caused by isotretinoin, discontinuation may relieve the signs/symptoms but could take how long to do so?

Idiopathic Intracranial Hypertension with Optic Nerve Disc Edema

What ocular manifestation of isoretinoin causes an increased resistance to CSF outflow resulting in postural headaches, blurred vision, subjective visual obscurations, & tinnitus?

Nose

Where does phymatous thickening of the skin most commonly occur in a patient with rosacea?

Papulopustular

Which clinical subtype of rosacea involves appearance of acne-like breakouts, skin plaques & visible broken blood vessels with sensitive oily skin?

Ocular

Which clinical subtype of rosacea involves appearance of bilateral inflammation of the eyelids & cornea?

Erythematotelangiectatic

Which clinical subtype of rosacea involves appearance of central facial flushing, redness & visible broken blood vessels with dry, sensitive skin?

Phymatous

Which clinical subtype of rosacea involves appearance of large pores and oily thick skin with a bumpy texture?

Pilosebaceous

Which skin follicles are involved in the pathogenesis of acne?