AED - Conjunctival Infections I - Week 7 Flashcards by B H

Define conjunctivitis.

Non specific term that means inflammation of the conjuctiva.

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List 7 diverse aetiologies for conjunctivitis.

Viral
Bacterial
Allergic
Toxic
Contact lens related
Trauma
Lid/corneal pathology

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List 5 possible symptoms of conjunctivitis.

Discomfort
-gritty, itchy, burning, scratchy
Discharge
-watery/mucoid/purulent/mucopurulent
Increased redness
Variable vision from discharge
Mild photophobia from PEE/SPK

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List 4 possible signs of conjunctiva.

Little or no corneal involvement
Slight lid oedema
Lymphadenopathy
Pseudomembranes/membranes

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List 5 features of conjunctivitis that can be used for a differential diagnosis.

Types of discharge
Types of conjunctival reaction (papillary vs follicular)
Pattern of hyperaemia
Presence of membranes/pseudomembranes
Presence/absence of lymphadenopathy

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What 5 things can conjunctival discharge contain?

Exuldates from dilated conjunctival blood vessels
Mucus from goblet cells
Debris from dead/dying cells
Tear production
White blood cells (usually neutrophils)
Microorganisms

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For the following types of conjunctival discharge, what is a rule of thumb on their possible cause:
Watery (2)
Mucoid (1)
Purulent (1)
Mucopurulent (3)

Watery - viral/allergic
Mucoid - allergic
Purulent - acute bacterial
Mucopurulent - mild/chronic bacterial or chlamydial

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Is it normal to have follicles in the palpebral conjunctiva? What about in children?

Normal to have a few, especially in kids, but not apparent until >2 years old

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Which region of the eye are follicles most common?

Forniceal conjunctiva

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Follicles near what two structures of the eye indicate pathology?

Near the lid margin or the centre of the tarsus

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What do follicles generally have at their base that distinguishes them from papillae?

Blood vessels, often surrounding them

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How big are follicles generally? What does it depend on?

0.2 to 2mm
Depends on the severity and duration of inflammation

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List three main acute causes of a follicular reaction.

Viral infections
Chlamydial infections
Medication hypersensitivity

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What occurs for a follicle to appear?

Hyperplasia of lymphoid tissue in the conjunctival stroma

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Are papillae more or less diagnostic than follicles?

Less diagnostic

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Are papillae more or less variable in appearance compared to follicles?

More variable

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What kind of core do papillae have?

Subepithelial fibrovascular core

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Where on the eye can papillae generally be found (2)?

Palpebral conjunctiva and bulbar conjunctiva at the limbus

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What is characteristic of papillae in appearance?

Central blood vessel

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List 4 common causes of papillae.

Chronic blepharitis
Allergic disease
Bacterial infection
Contact lens related problems

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What occurs for papillae to form (2)?

The tarsal conjunctiva undergoes a form of hyperplasia of its epithelium and infliltration of inflammatory cells

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If there are follicles present and you see herpetic signs (dedrites, skin vesicles), what is a possible cause?

HSV

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If there are follicles present and you dont see herpetic signs (dedrites, skin vesicles), what is a possible cause (2)?

Adenovirus
Chlamydia

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What are three possible causes of non-follicular conjunctivitis?

Toxic conjunctivitis
Molluscum
Pediculosis

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If there are papillae present with severe purulent discharge, what is a possible cause?

GC (gonococcal)

If there are papillae present with scant purulent discharge, what is a possible cause?

Bacterial other than GC

If there are papillae present with watery or mucoid discharge, what is a possible cause (2)?

Allergic Atopic

What is a pseudomembrane? Is it adhered or loose? Can it be peeled off without bleeding? Does this leave the underlying conjunctival epithelium intact?

Coagulated fibrinous exudate lightly adhered to inflammed conjunctiva Can be peeled without bleeding and leaves the conjunctival epithelium intact

List three main causes of pseudomembranes.

Adenoviral infections Gonococcal conjunctivitis Alkali burns

What are true membranes? Is it adhered or loose? Can it be peeled easily without bleeding? Does this leave the conjunctival epithelium intact?

Coagu;ated fibrinous exulates anchored to the inflammed conjunctival epithelium Peeling is more difficult and rips the epithelium, causing bleeding

Are true membranes common or rare?

Rare

List 4 common causes of true membranes.

β-haemolytic streptococci Diphtheria Gonococcal infection Autoimmune conjunctivitis

What two structures can lymphadenopathy generally involve?

Preauricular nodes Submandibular nodes

List three common causes of lymphadenopathy.

Viral infection Chlamydial infection Severe gonococcal infections

Where is the preauricular node found?

Just anterior to the middle of the ear

Is bacterial conjunctivitis common or rare?

Very common

Is bacterial conjunctivitis generally acute or chronic?

Acute, usually self limiting within 10-14 days

Is bacterial conjunctivitis uni- or bilateral? Is it symmetrical with onset? Explain.

Bilateral, but asymmetric with onset over a couple of days (usually starting in one eye and transferring to the other)

List 4 common pathogens causing bacterial conjunctivitis. Note which is common in kids.

Staph. aureus Staph. epidermidis Strep. pneumoniae Haemophilus influenzae (kids)

List 5 symptoms of bacterial conjunctivitis.

Acute onset of: -redness -gritty/burning -sticky discharge Eyelids stuck together on waking May have mild photophobia due to SPK

Are most conjunctivitis bacterial or viral?

Viral

List 5 signs of bacterial conjunctivitis.

Conjunctival hyperaemia Mild SPK Mild papillary reaction Mucopurulent discharge Crusted lids

List three differential diagnoses for bacterial conjunctivitis.

Viral conjunctivitis Allergic conjunctivitis Gonococcal conjunctivitis

List 4 components of a bacterial conjunctivitis workup.

Slit lamp Fluorescein Evert lids Conjunctival swab if severe

What is generally the treatment for bacterial conjunctivitis?

It is self-limiting, so monitor to resolution Will resolve quicker if treated with antibiotic

What is the treatment option for bacterial conjunctivitis if there is no corneal involvement?

Bathing with NaCl solution

What are two antibiotic classes that can be used to treat bacterial conjunctivitis?

Chloramphenicol Aminoglycoside

What is the followup schedule like for bacterial conjunctivitis (2)? What about if there is no resolution?

3-5 days then 7-10 days If not resolved, review diagnosis

Why should one be cautious when prescribing antibiotic eyedrops for bacterial conjunctivitis?

Most are generally viral-caused, and can contribute to antibiotic resistance

According to the general consensus, are antibiotics necessary for the treatment of bacterial conjunctivitis?

No, not for most of them

When simply monitoring bacterial conjunctivitis to resolution, list 4 supportive care options to aid in resolution.

Frequent eye cleansing with sterile water and cotton balls Warm water compresses Proper hand and eyelid hygiene Temporary use of artificial tears for comfort

Are gonococcal bacterial conjunctivitis common or uncommon? How is it usually transmitted?

Uncommon, often sexually transmitted

Is gonococcal bacterial conjunctivits uni- or bilateral? Is onset symmetrical or asymmetrical?

Bilateral, but onset for each eye is asemmetrical, typically 12 hours

What population can gonococcal bacterial conjunctivitis be seen in? List two reasons why.

Also seen in kids and neonates Causes are generally due to sexual abuse and the birth canal

List two common pathogens causing gonococcal bacterial conjunctivitis. Which one is more common and what disease is associated with one of them?

N. gonorrhoea (usually) N. meningitidis (risk of associated meningitis)

List 4 symptoms of gonococcal bacterial conjunctivitis.

Hyperacute onset of: -redness -gritty/burning Copious discharge with sticking eyelids May have mild photophobia due to SPK

List 5 signs of gonococcal bacterial conjunctivitis.

Marked conjunctival hyperaemia Papillary reaction with lid swelling Often preauricular lymphadenopathy Purulent discharge Corneal involvement

What risk is associated with corneal involvement in gonococcal bacterial conjunctivitis?

Risk of perforation

What is generally the treatment for gonococcal bacterial conjunctivitis (2)?

Refer - it is often systemic so IM cephalosporin needed and/or fluoroquinolone

List the components of assessing a case of gonococcal bacterial conjunctivitis (2). What is essential (2)?

Slit lamp Evert lids Conjunctival swab and lab analysis is essential

What should be excluded in a case of gonococcal bacterial conjunctivitis?

Corneal involvement

What pathogen is the usual cause of viral conjunctivitis?

Adenovirus

What virus commonly causes pharyngoconjunctival fever and what two serotypes specifically?

Adenovirus serotypes 3 and 7

In what population is pharyngoconjunctivital fever more common in?

Children

Is pharyngoconjunctival fever a low or high grade fever? Is it highly contagious or not?

Low grade fever Highly contagious

List 5 symptoms of pharyngoconjunctival fever.

Warer Gritty FB sensation Pharyngitis (sore throat) Fever

Is pharyngoconjunctival fever often uni- or bilateral? Explain.

Often unilateral, then may become bilateral in 3-5 days

List 5 signs of pharyngoconjunctival fever.

Follicular conjunctivitis Often preauricular lymphadenopathy Eyelid oedema May have pseudomembranes May have keratitis (SPK/subepithelial infiltrates)

List 4 differential diagnoses for pharyngoconjunctival fever.

EKC Molluscum contagiosum conjunctivitis Allergic conjunctivitis Topical drug hypersensitivity

What is the treatment for pharyngoconjunctival fever?

Optometrist hygiene during the exam (clean equipment, gloves) Educate patient to prevent spread GP referral Povidone-iodine therapy

What supportive therapy can be given for pharyngoconjunctival fever (4)?

Cold compresses Artificial tears Relief of pharyngitis and fever Steroids if inflammation is severe

Is there an effective antiviral agent for pharyngoconjunctival fever?

What is the followup schedule like for pharyngoconjunctival fever?

Resolves in 7-14 days Monitor for corneal involvement