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ophthalmology > 28/29/30. Definition and classification of conjunctivitis. Differential diagnosis of red eye. > Flashcards

28/29/30. Definition and classification of conjunctivitis. Differential diagnosis of red eye. Flashcards

1
Q

what is conjunctivitis ?

A

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)

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2
Q

classification of conjunctivitis?

A

Acute conjunctivitis: duration < 4 weeks

Chronic conjunctivitis: > 4 weeks.

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3
Q

signs and symptoms of conjunctivitis ?

A

pain,

scratchiness

ephoria -stuck shut in morning

eyelids edematous and tender

eye appear pink or reddish

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4
Q

Etiology of conjunctivitis

A

infectious: bacteria, viruses, fungi, parasites
- irritation: physical or chemical stimuli, UV light, trauma
- allergic diseases
spreaded inflammation (sinusitis)

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5
Q

dd for red eye

A

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

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6
Q

causes of bacterial conjunctivitis ?

A

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

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7
Q

in bacterial conjunctivitis are both eyes involved ?

A

yes

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8
Q

what is the treatment of bacterial conjunctivitis ?

A

bathe all discharge away

broad spectrum antibiotic drops - chloramphenicol , ciprofloxacin

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9
Q

what are the distinctive ocular features about gonococcal keratoconjunctivitis

A

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

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10
Q

treatment of gonococcal keratoconjunctivitis?

A

systemic antibiotic therapy - cefoxitin

topial gentamicin , bacitran

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11
Q

bacterial conjuctivitis and viral conjunctivitis is usually elf limiting ?

A

yes

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12
Q

aetiology for viral conjuctivitis ?

A

adenovirus
hsv
vzv
poxvirus

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13
Q

how contagious is viral conjunctivitis ?

A

Viral conjunctivitis is highly contagious

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14
Q

in viral conjunctivitis is usually acute or chronic ?

A

acute

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15
Q

what are the significant diagnostic symptoms to viral conjunctivitis ?

A

photophobia.

follicles

adenovirus - diffuse epithelilal keratitis

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16
Q

what are the signs and symptoms which are diagnostic to herpes simplex conuuctivitis ?

A

eyelids and periorbital skin show unilateral herpetic vesicles

lymphadenopathy is tender

KERATITIS IS UNCOMMON

17
Q

which serotypes causes adult chlamydial conjunctivitis ?

A

intracellular bacterium chlamydia trachomatis serotypes D to K

18
Q

what is a characteristic time period for adult chalymidial conjuctivitis ?

A

conjunctivitis may persis for 3-12 months if untreated

19
Q

what are the the specific diagnostic signs and symptoms of chlamydial conjunctivitis ?

A

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

20
Q

what is the treatment of chlamidyal conjunctivitis of serotype d and k ?

A

tetracycline oitnment - four times daily

systemic doxycyclin / tetracyclin

21
Q

what is trachoma

A

infection caused by serotypes A, B, Ba and C of Chlamydia trachomats

22
Q

who is at risk for trachoma?

A

poor conditions of hygiene. The common fly is the major vector in the infection

23
Q

what is the diagnostic features of trachoma ?

A

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

24
Q

what is the treatment for trachoma ?

A

single dose of azithromycin

personal hygiene

25
Q

what is another name for allergic conjunctivitis ?

A

Vernal keratoconjunctivitis

26
Q

what are the three main types of venal keratoconjuctivitis ?

A

palpebral, limbal & mixed

27
Q

what are the diagnostic features for palpebral vernal keratoconjuctivitis

A

diffuse papillary hypertrophy, most marked on the superior tarsus

the papillae enlarge and have a flat toped polygonal appearance reminiscent of cobblestones

28
Q

what are the complication in severe cases of palpebral vernal keratoconjuctivitis

A

severe cases the connective tissue septa rupture, giving rise to giant papillae which
may be coated by copious mucus

29
Q

how do we know the difference between active inflammation of vernal palpebral inflammation and resoluting ?

A

tightly packed papillae. As

inflammation settles papillae become more seperated

30
Q

how can you differentiate between viral , bacterial , chlamydial , allergic conjunctivitis ?

A

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

ophthalmology (36 decks)

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