AED - Conjunctival Infections I - Week 7 Flashcards
Define conjunctivitis.
Non specific term that means inflammation of the conjuctiva.
List 7 diverse aetiologies for conjunctivitis.
Viral Bacterial Allergic Toxic Contact lens related Trauma Lid/corneal pathology
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
List 4 possible signs of conjunctiva.
Little or no corneal involvement
Slight lid oedema
Lymphadenopathy
Pseudomembranes/membranes
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
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
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
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
Which region of the eye are follicles most common?
Forniceal conjunctiva
Follicles near what two structures of the eye indicate pathology?
Near the lid margin or the centre of the tarsus
What do follicles generally have at their base that distinguishes them from papillae?
Blood vessels, often surrounding them
How big are follicles generally? What does it depend on?
0.2 to 2mm
Depends on the severity and duration of inflammation
List three main acute causes of a follicular reaction.
Viral infections
Chlamydial infections
Medication hypersensitivity
What occurs for a follicle to appear?
Hyperplasia of lymphoid tissue in the conjunctival stroma
Are papillae more or less diagnostic than follicles?
Less diagnostic
Are papillae more or less variable in appearance compared to follicles?
More variable
What kind of core do papillae have?
Subepithelial fibrovascular core
Where on the eye can papillae generally be found (2)?
Palpebral conjunctiva and bulbar conjunctiva at the limbus
What is characteristic of papillae in appearance?
Central blood vessel
List 4 common causes of papillae.
Chronic blepharitis
Allergic disease
Bacterial infection
Contact lens related problems
What occurs for papillae to form (2)?
The tarsal conjunctiva undergoes a form of hyperplasia of its epithelium and infliltration of inflammatory cells
If there are follicles present and you see herpetic signs (dedrites, skin vesicles), what is a possible cause?
HSV
If there are follicles present and you dont see herpetic signs (dedrites, skin vesicles), what is a possible cause (2)?
Adenovirus
Chlamydia
What are three possible causes of non-follicular conjunctivitis?
Toxic conjunctivitis
Molluscum
Pediculosis
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?
No
What is the followup schedule like for pharyngoconjunctival fever?
Resolves in 7-14 days
Monitor for corneal involvement
