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OD2 - Applied Clinical Training & Research Studies in Vision and Optometry > AED - Conjunctival Infections I - Week 7 > Flashcards

AED - Conjunctival Infections I - Week 7 Flashcards

1
Q

Define conjunctivitis.

A

Non specific term that means inflammation of the conjuctiva.

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2
Q

List 7 diverse aetiologies for conjunctivitis.

A 
Viral
Bacterial
Allergic
Toxic
Contact lens related
Trauma
Lid/corneal pathology
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3
Q

List 5 possible symptoms of conjunctivitis.

A 
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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4
Q

List 4 possible signs of conjunctiva.

A

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

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5
Q

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

A 
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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6
Q

What 5 things can conjunctival discharge contain?

A 
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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7
Q 
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)
A

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

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8
Q

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

A

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

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9
Q

Which region of the eye are follicles most common?

A

Forniceal conjunctiva

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10
Q

Follicles near what two structures of the eye indicate pathology?

A

Near the lid margin or the centre of the tarsus

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11
Q

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

A

Blood vessels, often surrounding them

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12
Q

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

A

0.2 to 2mm

Depends on the severity and duration of inflammation

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13
Q

List three main acute causes of a follicular reaction.

A

Viral infections
Chlamydial infections
Medication hypersensitivity

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14
Q

What occurs for a follicle to appear?

A

Hyperplasia of lymphoid tissue in the conjunctival stroma

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15
Q

Are papillae more or less diagnostic than follicles?

A

Less diagnostic

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16
Q

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

A

More variable

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17
Q

What kind of core do papillae have?

A

Subepithelial fibrovascular core

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18
Q

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

A

Palpebral conjunctiva and bulbar conjunctiva at the limbus

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19
Q

What is characteristic of papillae in appearance?

A

Central blood vessel

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20
Q

List 4 common causes of papillae.

A

Chronic blepharitis
Allergic disease
Bacterial infection
Contact lens related problems

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21
Q

What occurs for papillae to form (2)?

A

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

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22
Q

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

A

HSV

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23
Q

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

A

Adenovirus

Chlamydia

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24
Q

What are three possible causes of non-follicular conjunctivitis?

A

Toxic conjunctivitis
Molluscum
Pediculosis

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25
Q

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

A

GC (gonococcal)

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26
Q

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

A

Bacterial other than GC

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27
Q

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

A

Allergic

Atopic

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28
Q

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

A

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

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29
Q

List three main causes of pseudomembranes.

A

Adenoviral infections
Gonococcal conjunctivitis
Alkali burns

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30
Q

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

A

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

31
Q

Are true membranes common or rare?

A

Rare

32
Q

List 4 common causes of true membranes.

A

β-haemolytic streptococci
Diphtheria
Gonococcal infection
Autoimmune conjunctivitis

33
Q

What two structures can lymphadenopathy generally involve?

A

Preauricular nodes

Submandibular nodes

34
Q

List three common causes of lymphadenopathy.

A

Viral infection
Chlamydial infection
Severe gonococcal infections

35
Q

Where is the preauricular node found?

A

Just anterior to the middle of the ear

36
Q

Is bacterial conjunctivitis common or rare?

A

Very common

37
Q

Is bacterial conjunctivitis generally acute or chronic?

A

Acute, usually self limiting within 10-14 days

38
Q

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

A

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

39
Q

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

A 
Staph. aureus
Staph. epidermidis
Strep. pneumoniae
Haemophilus influenzae 
(kids)
40
Q

List 5 symptoms of bacterial conjunctivitis.

A 
Acute onset of:
-redness
-gritty/burning
-sticky discharge
Eyelids stuck together on waking
May have mild photophobia due to SPK
41
Q

Are most conjunctivitis bacterial or viral?

A

Viral

42
Q

List 5 signs of bacterial conjunctivitis.

A 
Conjunctival hyperaemia
Mild SPK
Mild papillary reaction
Mucopurulent discharge
Crusted lids
43
Q

List three differential diagnoses for bacterial conjunctivitis.

A

Viral conjunctivitis
Allergic conjunctivitis
Gonococcal conjunctivitis

44
Q

List 4 components of a bacterial conjunctivitis workup.

A

Slit lamp
Fluorescein
Evert lids
Conjunctival swab if severe

45
Q

What is generally the treatment for bacterial conjunctivitis?

A

It is self-limiting, so monitor to resolution

Will resolve quicker if treated with antibiotic

46
Q

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

A

Bathing with NaCl solution

47
Q

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

A

Chloramphenicol

Aminoglycoside

48
Q

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

A

3-5 days then 7-10 days

If not resolved, review diagnosis

49
Q

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

A

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

50
Q

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

A

No, not for most of them

51
Q

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

A

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

52
Q

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

A

Uncommon, often sexually transmitted

53
Q

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

A

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

54
Q

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

A

Also seen in kids and neonates

Causes are generally due to sexual abuse and the birth canal

55
Q

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

A

N. gonorrhoea (usually)

N. meningitidis (risk of associated meningitis)

56
Q

List 4 symptoms of gonococcal bacterial conjunctivitis.

A 
Hyperacute onset of:
-redness
-gritty/burning
Copious discharge with sticking eyelids
May have mild photophobia due to SPK
57
Q

List 5 signs of gonococcal bacterial conjunctivitis.

A 
Marked conjunctival hyperaemia
Papillary reaction with lid swelling
Often preauricular lymphadenopathy
Purulent discharge
Corneal involvement
58
Q

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

A

Risk of perforation

59
Q

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

A

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

60
Q

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

A

Slit lamp
Evert lids
Conjunctival swab and lab analysis is essential

61
Q

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

A

Corneal involvement

62
Q

What pathogen is the usual cause of viral conjunctivitis?

A

Adenovirus

63
Q

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

A

Adenovirus serotypes 3 and 7

64
Q

In what population is pharyngoconjunctivital fever more common in?

A

Children

65
Q

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

A

Low grade fever

Highly contagious

66
Q

List 5 symptoms of pharyngoconjunctival fever.

A 
Warer
Gritty
FB sensation
Pharyngitis (sore throat)
Fever
67
Q

Is pharyngoconjunctival fever often uni- or bilateral? Explain.

A

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

68
Q

List 5 signs of pharyngoconjunctival fever.

A 
Follicular conjunctivitis
Often preauricular lymphadenopathy
Eyelid oedema
May have pseudomembranes
May have keratitis (SPK/subepithelial infiltrates)
69
Q

List 4 differential diagnoses for pharyngoconjunctival fever.

A

EKC
Molluscum contagiosum conjunctivitis
Allergic conjunctivitis
Topical drug hypersensitivity

70
Q

What is the treatment for pharyngoconjunctival fever?

A

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

71
Q

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

A

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

72
Q

Is there an effective antiviral agent for pharyngoconjunctival fever?

A

No

73
Q

What is the followup schedule like for pharyngoconjunctival fever?

A

Resolves in 7-14 days

Monitor for corneal involvement

OD2 - Applied Clinical Training & Research Studies in Vision and Optometry (174 decks)

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