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Repeating KHIO 1 > 6 Red eye/Conjunctivitis > Flashcards

6 Red eye/Conjunctivitis Flashcards

1
Q

Allergic conjunctivitis presentation:

A

Bilateral inflammation (lids/conj.)
Itching
Redness
Mucinous discharge
Photophobia
Pain/blur has cornea involvement
May associate with rhinitis/asthma

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2
Q

Classifications of allergic conjunctivitis

A

Seasonal allergic (SAC)
Vernal kerato- (VKC)
Atopic kerato-(AKC)
Perennial allergic (PAC)
Contact blepharo-
Giant papillary (GPC)

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3
Q

Initial treatment of allergic conjunctivitis

A

Topical antihistamines
Mast cell stabilizers
Nonsteroidal anti-inflammatory drugs (NSAIDs) / short term steroids (ophthal)

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4
Q

Seasonal Allergic conjunctivitis epidemiology/risk:

A

Hay fever (25-50% ocular allergy cases) most common.
Type 1 Hypersensitivity to allergens (tree/weed pollen, mold/grass)
Most severe in spring/summer when pollen high

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5
Q

SAC pathophysiology

A

Airborne allergen binding to IgE receptors in mast cells > degranulation of mast cells of MCt subtype > proinflammatory mediator release > eosinophil / basophil attraction

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6
Q

SAC clinical presentation:

A

Bilateral, sudden onset, associated with airborn antigen variation.
Itching, tearing, photophobia, burning
Conj. Swelling (chemosis) greater than Conj. Hyperemia (injection)
Corneal punctate epithelial keratitis (spots) rare

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7
Q

Perennial allergic conjunctivitis epidemiology:

A

Hypersensitivity to indoor antigens (mites, animal dander, mold)
No seasonal distribution, associated with DED

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8
Q

PAC pathophysiology

A

Airborne allergen binding to IgE receptors in mast cells > degranulation of mast cells of MCt subtype > proinflammatory mediator release > eosinophil / basophil attraction

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9
Q

PAC clinical presentation:

A

Mild
Itching
Conj. Swelling (chemosis) greater than Conj. Hyperemia (injection)
Fine papilliary reaction (bumps on tarsal conj.)
DED increases symptoms
Corneal punctate only with DED

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10
Q

Vernal keratoconjunctivitis epidemiology / risk:

A

Serious allergic reaction
0.5% allergic ocular disease
Mainly 11-13 years
50% px have atopy (asthma/rhinitis/exzema)
More common in hot/dry climates

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11
Q

VKC pathophysiology:

A

Type I/IV hypersensitivity reaction
Antigenic stimulation > lymphocyte activation (T-helper 2) with eosinophil infiltrate
Goblet cell increase > MUC5AC increase > abundant mucous

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12
Q

VKC clinical presentation:

A

Bilateral itching, Sticky discharge, photophobia
Lid edema with conj. Injection (hyperemia)
5% corneal involvement, blur > scarring
Type 1 (palpebral): giant tarsal papillae (7mm), cobblestone look on eversion
Type 2 (limbal/bulbar): gelatinous eosinophilic mounds (Trantas dots) at limbus

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13
Q

VKC Giant papillae corneal examination:

A

Corneal abrasion leads to:
Superficial punctate keratopathy, small fluorescein points upper cornea
Corneal macroerosions / shield ulcer: epithelial loss > large staining upper half
Superficial pannus: corneal opacification near limbus

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14
Q

Atopic keratoconjunctivitis epidemiology and pathophysiology:

A

Inflammatory disorder 20-50 years and male mainly
With atopic diseases 95% (dermatitis).
Type I/IV hypersensitivity, Reduction in MUC5AC

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15
Q

AKC clinical presentation:

A

Itching, burning, tearing, eryhematous/swollen lids, eczema on lids, madarosis (lash loss) from scratching.
Lid edema > dennie-morgan fold in lower lid / Allergic shiner
Inferior tarsal small pappillae (<1mm)
Inflammtion > lower fornix adhesions
Inf. Corneal abrasions (punctate epithelial keratitis, pannus, ulceration
Increases suceptibility to herpetic keratitis (vision threatening)

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16
Q

Contact blepharoconjunctivitis epidemiology/risk:

A

Secondary to chemical/plant re-exposure
Cosmetics: nail varnish, eyeliner, mascara, soap
Preservatives: benzalkonium chloride, thimerosal (CL solution)
Antimicrobials: aminoglycosides, polymyxin
Ocular medications: atropine, tropicamide, scopolamine

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17
Q

Contact blepharoconjunctivitis pathophysiology:

A

Type IV hypersensitivity
Partial antigen (hapten) binds proteins forming antigen > langerhans cells (type 2 MHC) present antigen to T helper 1 in lymph > T cells sensitize (week-months) > T cell present to ocular surface > cytokine/inflammatory cell accumulation
Unlike SAC/PAC, reaction to agent takes 2-3 days instead of 2-3 hours

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18
Q

Contact blepharoconjunctivitis clinical presentation:

A

Can be unilateral
Itching, burning of conj.
Lid exzema / erythematous (red) / lichenificated (leather) look
Conj. May form follicles
Inf. Cornea may form superficial puncatace keratitis from substance pooling

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19
Q

Giant papillary conjunctivitis epidemiology/risk:

A

CL wear
Risk with atopy, ocular prostheses / sutures / foreign bodies

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20
Q

GPC pathophysiology:

A

Mechanical damage to conj. Epithelium > Th2 lymphocyte resonse
Allergic component from CL/prosthetic deposits
Protein deposits serving as haptens (partial allergens) > type IV hypersentitivity

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21
Q

GPC clinical presentation:

A

Can be unilateral
CL/prosthetic may be present for years before symptoms
Iching, mucous discharge, photophobia
Giant papillae (>1mm) on tarsal

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22
Q

Management of allergic conjunctivitis:

A

Avoidance of antigen
Artificial tears dilute agents
Topical drops;
Antihistamines
Mast cell stabilizers
NSAIDs (require ophthal)

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23
Q

Topical medications for allergic conjunctivitis:

A

Antihistamines: 2nd generation (levocabastine / emedastine) > 1st generation (Antazoline / pheniramine)
Mast cell stabilizers: Lodoxamide > Cromoglycate
Multimodal agents: control H1 and mast cells
Avoid topical decongestants (phenylephrine), results in rebound hyperemia and CBC

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24
Q

Antihistamine treatment of allergic conjunctivitis:

A

1st generation: sedative and anticholinergic activity
2nd generation: cause ADDE and may exacerbate symptoms, Used for rhinoconjunctivitis

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25
Adenoviral keratoconjunctivitis:
Many manifestations, commonly epidemic keratoconjunctivitis (EKC) > Pharyngoconjunctivitis (PCF) > isolated follicular conjunctivitis Commonly causes epidemics
26
Adenoviral keratoconjunctivitis transmission:
Most common infectious conjunctivitis Transmitted via eye contact, ocular secretion, respiratory droplets, ophthalmic tools. Biphasic, infective phase > inflammatory phase 7-10 days after infection, infectious 2-3 weeks.
27
Adenovirus keratoconjunctivitis epidemiology:
Most common viral conj. Infection (75%), more common in adults Epidemic KC mainly 20-40 years, involves whole ocular surface Pharyngo-CF in children, involves pharyngitis/fever Commonly unilateral, 70% bilateral 1-3 days
28
Epidemic keratoconjunctivitis clinical presentation
Watery discharge, Hyperemia (pink eye), foreign body, photophobia pain, chemosis, ipsilateral lymph adenopathy (swelling) Pseudo/vascular membrane, symblephara (bulbar fuses lids), subepithelial infiltrates Tarsal follicles, petechiae (blood spots), subconj. Hemorrhage
29
Adenovirus contributing symptoms (other illnesses):
Can lead to; conjunctivitis, gastroenteritis, hepatitis, myocarditis, pneumonia. Often preceded by Fever, nausea, diarrhea, myalgia (muscle pain)
30
Pharyngoconjunctival fever clinical presentation
Abrupt fever/rhinitis, pharyngitis (upper res. Infection), Preauricular (ear) lymph andenopathy (swelling), follicular/papilliary conjunctivitis (conj. Follicules) Crusting, lid swelling, epiphora (watering), injection, chemosis, sub conj. Hemorrhage Common in children
31
Isolated follicular conjunctivitis:
Adenoviral conjunctivitis, without sore throat or lymph hyperplasia (adenopathy) No corneal / systemic involvment
32
Adenovirus structure:
Icosahedral, non-enveloped, ds DNA From genus Mastadenovirus of Adenoviridae family Classification from A-G, 65-80nm made of 252 capsomeres, with nucleoprotien core
33
Adenovirus serotypes
EKC associated with serotypes 8, 19, 37 (species D) Newly 53/54 found in japan PCF associated with serotypes 3> (2, 4, 5, 7, 11, 14) (species B/C) Serotypes 1-11 (B/C/E) cause isolated follicular conjunctivitis
34
Complications of adenoviral infection (EKC):
Pseudo / vascular membrane formation in tarsal conj. Of fibrin exudate Epithelial keratitis (infiltrates), immune reaction with viral antigens in corneal stroma, decreases corneal sensitivity, lasts weeks-years. Bacterial superinfection of strep
35
Adenoviral infection pathway
Lytic infection of epithelia > 10^4/6 virus release (5% are infective) Latent infection of lymph > small viral release 95% replication rate (10 days) > 5% (16 days)
36
Adenoviral immune response:
Inhibition of cellular apoptosis Inhibition of interferon > tumour necrosis Prevention of MHC-1 expression
37
Adenovirus diagnosis:
Rapid antigen detection strip PCR Immunofluroescence assay
38
Viral conjunctivitis DDX
Adenovirus > follicules/upper res. infection HSV/HZV > unilateral / very painful, with dendritic keratitis Varicella/zoster virus > fever Picornavirus > hemorrhagic conjunctivitis in young Px Molluscum contagiosum > follicular conjunctivitis / nodules at lid margin
39
Adenovirus / allergic conjunctivitis DDX
Both are bilateral with itching Adenoviral > forign body sensation, follicular tarsal reaction Allergic > papillary conjunctival reaction
40
Adenovirus treatment:
Self limiting resolution < 3 weeks, no effective treatment Symptomatic relief via lubricants / cool packs Topical antibiotics prevent bact. Infection Topical antihistamine/vasoconstrictors reduce discomfort (risk toxicity) Steroids restricted to pseudomembrane/infiltrates (severe) Scarring > Keratectomy with mitomycin C.
41
Adenovirus drug treatments:
Adenovirus drug treatments: Rarely used for side effects Virustatics: ganciclovir > mild efficicacy Antiviral: cidofovir > decreased infiltrates Cyclosporine > decreased pain Never use antibiotics
42
Adenovirus prevention:
Hygiene (hand/instrument disinfection) Ethanol/bleach cleaning Ensure cleaning for 2 weeks
43
Herpes simplex virus conjuntivitis clinical presentation:
Unilateral Watery, preauricular lymph adenopathy, pain, burning, foreign body sensation. Decreased vision, dendritic corneal lesions
44
HSV treatment:
Topical antiviral (trifluridine 1%) or (vidarabine 3%) 5/day Dosage x2 and oral if corneal/skin involvement Cool compress
45
Herpes zoster ophthalmicus conjunctivitis clinical presentation:
unilateral Nose ulcer, injection, conj. Edema, petechiae (blood spot) Branching corneal lesions with bulbs
46
HZO treatment:
Resolves in 1 week Antibiotic for bacterial protection Cool compress / lubricants
47
Bacterial conjunctivitis causes
Gram-positive: streptococcus pneumoniae / Staphylococcus aureus (children) Gram-negative: Haemophilus influenzae Neisseria gonorrhoeae: hyperacute
48
Bacterial conjunctivitis clinical presentation:
Unilateral > bilateral 2 days ^abrupt than viral Tearing, irritation, crusting, injection (most at fornix) Mucopurulent Yellow sticky discharge (mattes lids/lishes) Corneal ulceration, chemosis
49
Bacterial conjunctivitis treatment:
Self-limiting, Broard-spectrum antibiotics reduces course / spread / ulceration Erythromycin and bacitracin/polymyxin B Aminoglycosides have poor staph/strep coverage CLs to be removed Fluroquinolone for corneal ulcers
50
Hyperacute bacterial conjunctivitis causes:
Gram negative Neisseria gonorrhoeae (STD) or uncommonly N meningitidis Hand/genital/eye contact, neonates from birth canal. Neonates present bilateral discharge in 5 days
51
Hyperacute conjunctivitis clinical presentation:
Abrupt bilateral onset Copius purulent (pus) discharge Injection, chemosis, lid swelling, globe tenderness, preauricular lymph adenopathy ulceration
52
Hyperacute conjunctivitis treatment
Saline irrigation Topical antibiotics N gonorrhoea requires systemic antibiotics for concurrent diseases
53
Chlamydial conjunctivitis:
STD Serotypes A-C cause Trachoma > keratoconjunctivitis (common preventable blindness) Serotypes D-K cause inclusion conjunctivitis
54
Chlamydial conjunctivitis clinical presentation:
Common STD for newborns > adults Uni/bilateral Hyperemia, foreign body sensation, mucopurulent (mucus/pus) discharge, preauricular lymph adenopathy
55
Chlamydial conjuntivitis treatment:
Oral azithromycin 1g/day or erythromycin 500mg 4/day Topical erythromycin ointment reduces ocular infection
56
Subconjunctival hemorrhage:
Conj. / episclera bleeding into sub conj. Space Caused by trauma, systemic illness (diabetes/hypertension), anticoagulants, valsalva (cough/vomiting) Dry eye > spontaneous
57
Subconjuntival hemorrhage treatment:
Self resolving 10-14 days Reassurance Warm compress / lubrication may increase recovery
58
Episcleritis:
Self resolving (2-3 weeks) inflammation of membrane between sclera and conj. Idiopathic or from systemic disease NSAIDs can help
59
Episcleritis clinical presentation:
Abrupt redness, gritty feel, headache Swelling, vessel displacement outward
60
Scleritis:
Inflammation of sclera either Ant. / Pos. Ant. Is either diffuse/nodular/necrotizing Associated with RA, infection (viral/bac./fungal), women
61
General scleritis presentation:
Uni/bilateral Severe orbit pain, headache Irregular vasculation, blue colour
62
Scleritis treatment:
Testing / Treating underlying cause NSAIDs, Corticosteroids, immunosupression
63
Uveitis:
Ant. Iris/ciliary/choroid inflammation Post. (iridocyclitis): retina/choroid/vitrious Associated with MHC antigen HLA B-27 May relate to infection, parasitic (toxo), viral (herpes), bacterial (tuberc.)
64
Uveitis clinical presentation:
Often unilateral Limbal hyperemia, pain, photophobia, blur, tearing, Constricted pupil Pos. No redness, floaters, photopsia. Accumulation of inflammatory material in pos. Chamber (white spots)
65
Uveitis treatment
Corticosteroids (topical prednisolone 1%) Mydriatics (phenelephrine) protect iris from synechiae
66
Acute angle glaucoma (AAGC):
Blockage of outflow ant. Chamber Mydriasis / accomodative obstruction
67
Acute angle glaucoma risk:
Elderly / hyperopic (large lenses)
68
Acute angle glaucoma (AAGC) clinical presentation:
Global injection, Mid-dilation without light reaction, high IOP (>21), pain, blur Headache, nausea (from light halo blur) Corneal edema, ant. Chamber precipitates
69
Acute angle glaucoma (AAGC) treatment:
Attacks can self resolve Mydriatics (phenelephrine/pilocarpine 1%) Beta blockers (timolol .5%) Topical steroids (Prednisolone1%) Apraclondine 1%, brimonidine .2% Oral acetazolamide .5g (reduce fluid production)
70
Conjunctivitis DDX:
Pain, Photophobia, blur > refferal Hyperpurulent dis. > gonococca Mucopurulent dis. > bacterial Serous dis. > Allergic (itching) / Viral (no itch)
71
Bacterial conjunctivitis ophthalmic treatment
Aminoglycoside (gentamicin) Fluroquinolone (ciprofloxacin) Macrolides (azithromycin)
72
viral conjuntivitis ophthalmic treatments
Cold compress Drops Antihistamines
73
Allergic conjunctivitis ophthalmic treatment
Antihistamine (Azelastine) Mast cell inhibitor (Lodoxamide) NSAIDs (Ketorolac)

Repeating KHIO 1 (15 decks)

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