3.3.2 Eye - Conjunctivitis/Infalammatory Periocular Probs Flashcards
Conjunctivitis presents?
Redness of eye
Watery eye
Discharge
How to classify conjunctivitis?
Infective Allergic Chemical Special: neonatal Associated with systemic disease
Hx of conjunctivitis?
One or both eyes?
Discharge?
Systemic illness?
If eye is itchy in conjunctivitis, most likely to be?
Allergic
Examination of conjunctivitis?
Test vision Look at conjunctiva Look at cornea - flurocine Skin rashes Lymphadenopathy
When do you need to investigate conjunctivitis?
Neonate
Chronic/recurrent
Suspected HSV 1/2
Atypical reaction
Neonatal conjunctivitis, what bacteria on day 1?
Gonococcal
Neonatal conjunctivitis wat bacteria on day 7-14?
Herpes simplex
Neonatal conjunctivitis what bacteria on day 8-12?
Chlamydia
Neonatal conjunctivitis what bacteria on day 4-6?
Strep/staph/haemopilus
Management of Neonatal conjunctivitis?
Investigate:
Swab: M/C/S
Chlamydia culture/PCR
HSV PCR
Neonatal conjunctivitis, how to treat chlamydia?
Erythromycin 5mg/kg/day
Neonatal conjunctivitis how to treat gonococcus?
Penicillin
Neonatal conjunctivitis don’t forget to treat?
The parents
Bacterial conjunctivitis treat with
Topical chloramphenicol/tobramycin
Drops every 2-4 hours
Infectious
Should you use steroid eye drops in children?
Nope, seldom used in kids
If cornea involved in conjunctivitis what is it called?
Keratitis
How to manage HSV conjunctivitis?
Examine cornea with fluroscein
HSV 1 and 2 PCR
How to treat HSV conjunctivitis?
- Acyclovir/famvir systemic: reduced rate of recurrence
- Topical acyclovir ointment
- If immunocompromised: IV
How to manage allergic conjunctivitis?
Avoid agent Cool compress Tears for 4-8 times per day - wash Antihistamine Corticosteroids if severe
What is vernal keratoconjuntivitis?
Males Spring/autumn Tarsal conjunctiva (upper lid) Get conjunctival papillae Scratches cornea Photophobia
How to manage vernal keratoconjunctivitis?
Cool compress
Topical eye drops: antihistamine/lubricants
-use STEROIDS (FML/Maxidex) short term.
Dexamethasone drops. 4 times a days for 4 days, 3 times a day for 4 days, 2 times a day for 4 days, then once a day for 4 days.
Complication of verbal keratoconjunctivitis?
Shield ulcer:
Needs to be scraped
Chloramphenicol
F/U in 1-3/7
Acids damage what in eye?
Surfaces
Alkali damage what in eye?
Penetrate and damage cornea
Management of chemical conjunctivitis?
Tap water rinse
- GP
- local anaesthetic drop
- Irrigate for 30 minutes with normal saline
- remove particles
- chloramphenicol
- REFER to ED
What is Stevens-Johnson syndrome?
Usually caused by medication or infection
Shedding of top layer of skin widespread, bulbous blisters around mouth, nose, eyes, genitals
What is presentable cellulitis?
Usually unilateral
Associated with systemic illness, insect bite, periocular infection
Hospital
IV Abx
Image if no better in 48 hours
How does a child with orbital cellulitis present?
Unwell, fevers miserable
Limited eye movement
Proptosis
Where does the eye drain into?
Cavernous sinuses: ethmoid
Orbital cellulitis management?
Emergency, refer Admit to hospital Needs IV Abx Imaging Drain abscess
How to treat chalazion or Meibomian cyst?
Heat compress
Abx
Incise and curette under GA
How to differentiate preseptal from orbital cellulitis?
Orbital:
- proptosis,
- movement restriction
- unwell child
