26. Conjunctivitis II & Eyelid Disorders Flashcards
What are the 7 viruses that can cause viral conjunctivitis?
- Adenovirus
- Herpes simplex virus
- Variola
- Molluscum
- Rubella
- Epstein-Barr
- COVID-19
What are the prevalence of viral conjunctivitis?
80% of all acute conjunctivitis are viral
65-90% of viral conjunctivitis are adenovirus
What are the 2 viral conjunctivitis that adenovirus commonly cause?
- Pharyngoconjunctival fever (PCF)
- Epidemic keratoconjunctivitis (EKC)
PCF stands for ...
. It is caused by ...
serotypes ... and ...
. This is more common in ...
. It causes a characteristic trifactor of conditions: ...
, ...
and ...
. PCF is ...
but ...
. Symptoms include: watery, ...
eyes and ...
. Often arise ... and then become ... in ... days
. Can be associated with ...
and ...
.
PCF stands for pharyngoconjunctivtial fever
. It is caused by adenovirus
serotypes 3 and 7
. This is more common in children
. It causes a characteristic trifactor of conditions: pink eye
, low grade fever
and upper respiratory tract infection
. PCF is self-limiting
but highly contagious
. Symptoms include: watery, gritty
eyes and FB sensation
. Often arise unilateral and then become bilateral in 3-7 days
. Can be associated with pharyngitis
and fever
.
Signs of PCF:
*...
conjunctivitis
* Eyelid ...
* Often ...
in presentation
* Positive ... = ...
usually ... days
after onset
* May have ...
→ should be removed
* May have ...
in up to ...%
of cases, involve `` or rarely ...
.
Signs of PCF:
*Follicular
conjunctivitis
* Eyelid oedema
* Often bilateral
in presentation
* Positive PAN → preauricular adenopathy
usually 3-4 days
after onset
* May have psuedomemebrane
→ should be removed
* May have keratitis
in up to 30%
of cases, involve diffuse SPK
or rarely subepithelial infiltrates
.
Treatment of PCF is relatively simple due to PCF being ...
. Px should be ...
in order to prevent spread of ...
, infected individuals tend to be infectious for ... (...)
. Symptoms may persist ...
. There are no ... proven effective
against adenovirus. Some practitioners may use ... (... ...%)
off label or combine ... with ...
QID for 5 days. General treatment is mostly for .../ ...
, which includes ...
, ...
, ` relief of … and … and use of
… for severe inflammation e.g.
… (dosing regimen) with …. PCF should resolve within
… to … days and Optoms should
… and … for any …`.
Treatment of PCF is relatively simple due to PCF being self limiting
. Px should be educated
in order to prevent spread of adenovirus
, infected individuals tend to be infectious for 2 weeks (2/52)
. Symptoms may persist after px is not contagious anymore
. There are no antiviral agent proven effective
against adenovirus. Some practitioners may use Betadine (povidone-iodine 2%)
off label or combine betadine with dexamethosome
QID for 5 days. General treatment is mostly for symptom relieve/ supportive therapy
, which includes cold compresses
, artificial tears
, relief of pharyngitis and fever
and use of steroids
for severe inflammation e.g. Flarex BID or QID with slow taper
. PCF should resolve within 7-14 days
and Optoms should review and monitor for any corneal involvement
.
What are the 4 differential diagnosis for pharyngoconjunctival fever?
• Epidemic keratoconjunctivitis
• Molluscum contagiosum conjunctivitis
• Allergic conjunctivitis
• Topical drug hypersensitivity
EKC stands for ...
. It is caused by ...
serotypes ..., ..., ...
. It has a characteristic ...
onset of ...
, ...
with ...
. This may become ...
later on. It can be associated with ...
, ...
, or ...
conjunctivitis. Unlike, PCF, there is no ...
. Px may present with ..., ...
eyes. Conjunctivitis will persist for ... weeks
and may also involve ...
. Px tend to be highly contagious for ...-... days
.
EKC stands for Epidemic Keratoconjunctivitis
. It is caused by adenovirus
serotypes 8, 19, 37
. It has a characteristic acute
onset of unilateral
, follicular conjunctivitis
with ipsilateral node
. This may become bilateral
later on. It can be associated with haemorrhagic
, pseudomembranous
, or membranous
conjunctivitis. Unlike, PCF, there is no respiratory involvement
. Px may present with watery, uncomfortable
eyes. Conjunctivitis will persist for 1-2 weeks
and may also have corneal involvement
. Px tend to be highly contagious for 21-28 days
.
What are the corneal involvement overtime with EKC? (At infection → 1 week → 2 weeks → 1 month)
• At infection → fine SPK
• Week 1 → focal epithelial opacities
• Week 2 → subepithelial infiltrates develop under opacities (49-80% incidence in EKC; No virus isolation after 14 days)
• 1 month → epithelium healed but subepithelial infiltrate persist for months up to 1 year
Treatment of EKC:
* There are no ...
. Px should be prescribed ...
, which involves ...
and ` ….
* Some practitioners may use
…-… 2% ` (…) off label
* Topical ...
may be required to control inflammation, such as ... ... to ... with slow ...
. This may be continued ... period
, which is useful in reducing ...
, therefore can ...
.
Treatment of EKC:
There are no antivirals proven to be effective against Adenovirus
. Px should be prescribed supportive treatments
, which involves vasoconstrictors
and cold compress
.
* Some practitioners may use Povidone-Iodine 2%
(Betadine) off label
* Topical steroids
may be required to control inflammation, such as Flarex BID to QID with slow taper
. This may be continued post-infectious period
, which is useful in reducing subepithelial infiltrates
, therefore can improve visual acuity
.
What are the main prevention methods of EKC?
• Px education → frequent hand washing, avoid eye rubbing; stay home during infectious period
• Office outbreaks are common
∴ should disinfect equipment; beware of contaminated eye drops bottle tops; use hydrogen peroxide; use glove; frequent hand washing
Herpes conjunctivitis can be caused by two different viruses: ...
or ...
.
* ...
presents as a ...
. It makes up of ...%
of acute conjunctivitis. Common characteristics involve ... discharge
, ` … lesions on eyelid skin, and postive
….
Antivirals are commonly used to treat this, which includes
…,
…,
… and trifluridine.
*
… involves conjunctivitis,
…,
…,
… and
…`.
Herpes conjunctivitis can be caused by two different viruses: Herpes Simplex virus
or Herpes Zoster Virus
.
* Herpes Simplex virus
presents as a unilateral follicular conjunctivitis
. It makes up of 1.3-4.8%
of acute conjunctivitis. Common characteristics involve water discharge
, vesicular lesions on eyelid skin
, and postive preauricular lymphadenopathy
.
Antivirals are commonly used to treat this, which includes ganciclovir
, idoxurdine
, vidarabine
and trifluridine.
* Herpes Zoster virus
involves conjunctivitis, eyelid lesions
, uveitis
, subepithelial infiltrates
and pseudodendrites
.
Link the viral infections to the conditions that they cause:
Herpes virus
* Varicella zoster - chickenpox
* Herpes zoster ophthalmicus - recurrent chickenpox
Paramyxoviruses
* Mumps virus
- follicular conjunctivitis, SPK, disciform keratitis
* Measles virus
- follicular conjunctivitis, SPK, interstitial keratitis, corneal ulcers
* Newcastle disease - follicular conjunctivitis
, SPK
, SEI
Papovaviruses
* Human papilloma virus - warts
, papillae
, SPK
Link the viral infections to the conditions that they cause:
Herpes virus
* Varicella zoster - chickenpox
* Herpes zoster ophthalmicus - recurrent chickenpox
Paramyxoviruses
* Mumps virus
- follicular conjunctivitis, SPK, disciform keratitis
* Measles virus
- follicular conjunctivitis, SPK, interstitial keratitis, corneal ulcers
* Newcastle disease - follicular conjunctivitis
, SPK
, SEI
Papovaviruses
* Human papilloma virus - warts
, papillae
, SPK
Link the viral infections to the conditions that they cause:
Picornavirus
* Entero (coxsackie) virus - ...
, ...
, ...
, ...
.
Poxvirus
* Variola (smallpox) - ...
, ...
* ...
- follicular conjunctivitis, SPK, pannus lesion
Togavirus
* ...
- follicular conjunctivitis, SPK
Link the viral infections to the conditions that they cause:
Picornavirus
* Entero (coxsackie) virus - acute haemorrhagic conjunctivitis
, follicular conjunctivitis
, subconjunctivital haemorrhages
, watery discharge
.
Poxvirus
* Variola (smallpox) - follicular conjunctivitis
, corneal pocks/ interstitial/ disciform keratitis
* Molluscum contagiosum
- follicular conjunctivitis, SPK, pannus lesion
Togavirus
* Rubella
- follicular conjunctivitis, SPK
Link the viral infections to the conditions that they cause:
Epstein-Barr virus
* Infectious mononucleosis - ...
, ...
, ...
Ebola viruses
* ...
, ...
Cornoaviruses
* Possible ...
Link the viral infections to the conditions that they cause:
Epstein-Barr virus
* Infectious mononucleosis - follicular conjunctivitis
, focal epithelial keratitis
, lamellar corneal infiltrates
Ebola viruses
* Acute haemorrhagic conjunctivitis
, subconjunctivital haemorrhages
Cornoaviruses
* Possible conjunctivitis