Ch 42. Conjunctivitis

Question 1

What is the time frame to define conjunctivitis as acute vs chronic?

Answer 1

3 weeks.

Question 2

Papillary conjunctivitis, in a patient presenting for acute conjunctivitis, must mean:

Answer 2

Bacterial conjunctivitis.

If purulent: neisseria.

If catarrhal: staph, strep, Haemophilus, etc.

Question 3

What type of conjunctivitis is associated to clamidia?

Answer 3

Inclusion conjunctivitis: acute, purulent, and follicular.

Trachoma: chronic, and follicular… associated with the other typical tracoma changes.

Question 4

Does viral conjunctivitis present with papillary or follicular conjunctivitis?

Answer 4

Follicular.

Question 5

If acute conjunctivitis develops membranes, what are the possible etiologies?

Answer 5

Bacterial and viral.

• _{The main way to make the distinction is gram or culture.} *
• _{Main bacteria are Corynebacterium diphtheriae, B-H streptoccoci, adenovirus, herpes simplex.} *

Question 6

What is conjunctival folliculosis?

Answer 6

Normal presence of conjunctival follicles in young patients, which tend to regress after adolescence.

Question 7

Describe parinaud’s oculoglandular syndrome and its causes.

Answer 7

A triad of:

1. unilateral conjunctivitis
2. ipsilateral preauricular lymphadenopathy
3. Fever

_{The main causes are cat-scratch disease, tularemia, sporotrichosis, tuberculosis, syphilis, lymphogranuloma venereum, and rickettsiosis.}

Question 8

What is the epidemiologic difference between AKC and VKC

Answer 8

AKC presents throughout the year, while VKC presents in a seasonal pattern.

Question 9

Describe the inclusion conjunctivitis presentation.

Answer 9

Unilateral, acute but insidious (that may continue to chronic) follicular conjunctivitis, with mucous or mucopurulent discharge. Follicles develop after 2-3 weeks of involvement and become larger and more opalescent than those of viral conj.

Corneal superficial punctate epithelial keratitis may be noted.

Follicules predominate in the inferior fornix.

Question 10

Describe the natural history of corneal lesions in epidemic keratoconjunctivitis.

Answer 10

1. after few days difuse punctate epithelial erosions develop
2. 7-10 days: coalescence into larger epithelial infiltrates.
3. after 2 weeks: focal subepithelial infiltrates randomly distributed. these may last for months if untreated.

_{Caused by serotypes 8 and 19.}

Question 11

Does alcohol isopropil 70% kill adenovirus?

Answer 11

No.

_{Therefore, alcohol-based cleaning solutions may be replaced with 500 to 5000 parts per million (PPM) sodium hypochlorite}

Question 12

What adenovirus serotype produces pharingoconjunctival fever?

Why is this relevant?

Answer 12

serotypes 3 & 7

It is important because these viruses does not affect the cornea, no subepithelial infiltrates reproduced, and membranes develop very rarely.

Therefore, if the patient presents with acute, follicular conjunctivitis + lymph nodes + faringitis + fever… Recovery without corneal involvement is likely.

Question 13

Incubation of chlamydia in inclusion conjunctivitis

Answer 13

2-19 days

Question 14

Describe the corneal manifestartions of HSV first infection.

Answer 14

During the first infection, conjunctivitis is usually associated with vesicular skin lesions, which associate corneal fine superficial erosions that may coalesce to form micro-dendrites.

Coarse dendrites seen in recurrences are not typical of the first infection.

Question 15

To which other conjunctivitis is EBV most similar?

Answer 15

probably to adenovirus.

• they are both folicular,
• may be associated to upper respiratory symptoms and faringitis.
• both may associate fever and lymphadenopathy
• both may display subepithelial infiltrates.

Question 16

A chronic, unilateral, papillary conjunctivitis must arise the suspicion of which diagnosis

Answer 16

mascarade syndrome caused by an underlying malignancy.

Question 17

What is the name of the only chronic membranous conjunctivitis?

Answer 17

Ligneous Conjunctivitis