28/29/30. Definition and classification of conjunctivitis. Differential diagnosis of red eye. Flashcards
what is conjunctivitis ?
Inflammation of the bulbar and or palpebral conjunctiva -the transparent lubricating mucous membrane that covers both the surface of the eye and lining of the undersurface of the eyelid)
classification of conjunctivitis?
Acute conjunctivitis: duration < 4 weeks
Chronic conjunctivitis: > 4 weeks.
signs and symptoms of conjunctivitis ?
pain,
scratchiness
ephoria -stuck shut in morning
eyelids edematous and tender
eye appear pink or reddish
Etiology of conjunctivitis
infectious: bacteria, viruses, fungi, parasites
- irritation: physical or chemical stimuli, UV light, trauma
- allergic diseases
spreaded inflammation (sinusitis)
dd for red eye
keratitis - pain , impaired eye sight , photophobia
glaucoma - open angle glaucoma asymtptomatic
close angle gloucoma - sudden occular pain ,seeing halo around light , red eye
uveitis - burning of eye , photophobia, blurred vision , irregular pupil
corneal barasion
pinguecula
blepharitis
dacrocystitis
causes of bacterial conjunctivitis ?
S. aureus and epidermidis
Strep pneuomniae
gram negative - h influenza , moroxella lacunata
extremely pathogenic bacteria, such as Chl. trachomatis or N. gonorrhoeae - corneal irritation - vision loss
in bacterial conjunctivitis are both eyes involved ?
yes
what is the treatment of bacterial conjunctivitis ?
bathe all discharge away
broad spectrum antibiotic drops - chloramphenicol , ciprofloxacin
what are the distinctive ocular features about gonococcal keratoconjunctivitis
prominent preauricular lymphadenopathy and, in severe cases, there may be
suppuration of the pre auricular nodes
keratitis may occur in severe
cases
frequent pseudomembrane
marginal ulceration in the pus filled sulcus between swollen conjuctiva and cornea - marginal ulceration can form ring ulcer
central corneal ulceration - perforation endopthalmus
treatment of gonococcal keratoconjunctivitis?
systemic antibiotic therapy - cefoxitin
topial gentamicin , bacitran
bacterial conjuctivitis and viral conjunctivitis is usually elf limiting ?
yes
aetiology for viral conjuctivitis ?
adenovirus
hsv
vzv
poxvirus
how contagious is viral conjunctivitis ?
Viral conjunctivitis is highly contagious
in viral conjunctivitis is usually acute or chronic ?
acute
what are the significant diagnostic symptoms to viral conjunctivitis ?
photophobia.
follicles
adenovirus - diffuse epithelilal keratitis
what are the signs and symptoms which are diagnostic to herpes simplex conuuctivitis ?
eyelids and periorbital skin show unilateral herpetic vesicles
lymphadenopathy is tender
KERATITIS IS UNCOMMON
which serotypes causes adult chlamydial conjunctivitis ?
intracellular bacterium chlamydia trachomatis serotypes D to K
what is a characteristic time period for adult chalymidial conjuctivitis ?
conjunctivitis may persis for 3-12 months if untreated
what are the the specific diagnostic signs and symptoms of chlamydial conjunctivitis ?
palpebral conjunctiva at first shows papilaoment hypertrophy,
then large follicles which are most prominent in the inferior forniceal conjunctiva
lymphadenopathy non tender
long standing - less prominent follicles , mild conjunctival scarring and superior micropannus
what is the treatment of chlamidyal conjunctivitis of serotype d and k ?
tetracycline oitnment - four times daily
systemic doxycyclin / tetracyclin
what is trachoma
infection caused by serotypes A, B, Ba and C of Chlamydia trachomats
who is at risk for trachoma?
poor conditions of hygiene. The common fly is the major vector in the infection
what is the diagnostic features of trachoma ?
keratitis, pannus formation
presentation is during childhood with the development of follicular conjunctivitis associated with diffuse papillary infiltration
limbal follicles are a unique feature. On resolution they leave characteristic depressions (herbert pits)
chronic conjunctival inflammation results in scarring with linear or small stellate scars in milder cases, or broad confluent scars, in severe cases produce trichiasis and entropion
end stage trachoms is characterized by severe visual impairment or blindness from corneal ulceration and opacification
what is the treatment for trachoma ?
single dose of azithromycin
personal hygiene
what is another name for allergic conjunctivitis ?
Vernal keratoconjunctivitis
what are the three main types of venal keratoconjuctivitis ?
palpebral, limbal & mixed
what are the diagnostic features for palpebral vernal keratoconjuctivitis
diffuse papillary hypertrophy, most marked on the superior tarsus
the papillae enlarge and have a flat toped polygonal appearance reminiscent of cobblestones
what are the complication in severe cases of palpebral vernal keratoconjuctivitis
severe cases the connective tissue septa rupture, giving rise to giant papillae which
may be coated by copious mucus
how do we know the difference between active inflammation of vernal palpebral inflammation and resoluting ?
tightly packed papillae. As
inflammation settles papillae become more seperated
how can you differentiate between viral , bacterial , chlamydial , allergic conjunctivitis ?
all of them have hyperaemia, lacrimtion
itching - only allergic
bleeding - only bacterial and viral
discharge
bacterial - purulent and crusts
chlamydial - mucopurulent
viral - watery - ropy white viscous
chemosis - bacterial , allergic
viral - mild
pseudomembranes - occasional bacterial and allergic - in severe cases
swollen lymph nodes - mainly in viral ,
bacterial and
chlamydial too
PANNUS FORMATION - only in chlamydial trachoma
concurrent keratitis - moderately chlamydial
occasional in bacteria
and viral
cytological smear
bacteria - granulocytes
chlamydial - intracytoplamic inclusion in epithelial cells , leukocytes , plasma cells
viral - lympho and monocytes
allergic - eosinophils
