Congiundivite

Question 1

General findings: sono soprattuto VIRALI, e la causa più frequente sono glo ADENOVIRUS

🧨Conjunctivitis is the most common cause of ocular hyperemia.

La congiundivite non è dolorosa ma è fastidiosa. Le situazioni estremamente dolorose ricordiamoessere uveite (test fluorescina negativo) , cheratite e glaucoma acuto.

Answer 1

Conjunctivitis (pinkeye) is a very common inflammation of the conjunctiva (the mucus membrane that lines the inside of the eyelids and the sclera). It is most commonly caused by viruses or bacteria but can also have noninfectious (e.g., allergic) causes. It is also commonly associated with corneal inflammation (then referred to as keratoconjunctivitis). Conjunctivitis is the most common cause of ocular hyperemia. Other classic features are burning, foreign body sensation, excessive tearing, and photophobia. Additionally, in infectious conjunctivitis, general signs of viral or bacterial infection (e.g., fever) may be seen, while itching is particularly common in allergic conjunctivitis. Dry eye is a hallmark feature of keratoconjunctivitis sicca. In most cases, local pharmacologic therapy with anti-infective, anti-inflammatory and/or antiallergic agents is sufficient. However, bacterial conjunctivitis can lead to blindness in newborns; therefore, strict and rapid treatment and prevention is vital. Surgical intervention is only rarely useful or necessary (e.g., correction of eyelids).

Question 2

Clinica

Answer 2

• Conjunctival injection: conjunctival hyperemia with dilatation of blood vessels → ocular hyperemia and reddening
• Discharge and crust formation
• Chemosis: edema of eyelids and/or conjunctiva.
• Burning or foreign-body sensation
• Photophobia
• Itching (most intense in seasonal allergic conjunctivitis)

Question 3

Batterica (Neisseria, Chlamydia) Neisserial and chlamydial infections require systemic treatment.

UNILATERALE

Answer 3

• Usually unilateral👓
• Thick purulent discharge (yellow, white or green)
• Reduced vision and risk of blindness (if cornea is involved)!!!
• Extraocular signs of bacterial infection (esempio un’ingezione da clamidia con possibile coesistenza di uretrite sierovar D-K o secrezioni vaginali)

✔Clinical diagnosis
Conjunctival scrapings and culture (or PCR) required if persistent or severe disease (i.e., multiple or large corneal lesions), if the diagnosis is uncertain, and in newborn conjunctivitis

✔Treatment: Topical broad-spectrum antibiotics (e.g., erythromycin or trimethoprim-polymyxin B)
Special recommendations in newborn conjunctivitis
Neisserial and chlamydial infections require systemic treatment (ceftriaxzone/azitromicina, o doxicilina per chmamydia)

🧨N.gonorrhoeae infection is an ocular emergency that can lead to keratitis, perforation, and blindess without prompt treatment!

Question 4

Virale (HSV1 negli adulti, HSV2 nei neonati)

Key words

• BILATERALE (la cheratite invece è tipicamente monolaterale)
• FOLLICOLI
• epifora
• linfoadenopatia preauricolare

Answer 4

-Bilateral (usually begins with one eye and spreads to the other within a few days)

• Clear, watery discharge (with mucoid component) .
• Increased lacrimation (epiphora)
• Usually normal vision👓

🧨Conjunctival follicles
1.Small raised, yellowish-white hyperplasia of
lymphatic tissue, usually with peripheral (rather than
central) vascularization
2.Particularly on the palpebral and bulbar conjunctiva

-Extraocular/general signs of viral infection : e.g., fever, lymphadenopathy (e.g., preauricular node), pharyngitis

Question 5

Tracoma (sierovar A,B,AB,C)

La diagnosi è CLINICA

Answer 5

!Most common cause of blindness due to chronic scarring worldwide, predominantly affects young children and women

1. Active phase : conjunctival follicles (with eventual involution forming Herbert pits), inflamed upper tarsal conjunctiva
2. Cicatricial phase : chronic/recurring inflammation in both eyes → conjunctival scarring → progressive conjunctival shrinkage → corneal ulcers and opacities, superficial neovascularization with cellular infiltration (corneal pannus), entropion, trichiasis

Trattamento
Azitromicina, doxiciclina

Question 6

Congiundivite a corpi inclusi (sierovar D-K)

Answer 6

Route of infection: sexually , perinatally, or via swimming pools

Clinical features

• Conjunctival follicles
• Papillary hypertrophy
• Corneal pannus
• Preauricular lymphadenopathy!🧨

Treatment/prevention: oral azithromycin, erythromycin, or doxycycline