Conjunctiva Flashcards
Acute Bacterial Conjunctivitis
Redness, white-yellow discharge/chemosis causing discomfort, tearing, blurry vision.
TX: Observation, severe cases or infection may warrant ABs
Polytrim 1 get QID x 1 week in affected eye
Vigamox 1 get QID x 1 week in affected eye
FU: every few days during treatment
Gonococcal Conjunctivitis
Hyperacute onset purulent discharge w/ pain/discomfort. Lymphadenopathy
TX:
1g Ceftriaxone IM or IV
1g Azitrhomycin po single dose is usually given to cover for chlamydial infection
IM gentamicin or oral gemifloxacin may be used in lieu of ceftriaxone in the case of cephalosporin allergy
FU: daily until consistent improvement, then every few days.
Chlamydial Conjunctivitis (AIC)
Tarsal follicles, mucopurulent discharge, Lymphadenopathy, corneal opacification and vascularization with discomfort and blur.
TX:
1g Azithromycin po (single dose)
Doxycycline 100mg po bid x 1 week
FU:
weekly
Allergic Conjunctivitis
Conjunctival papillae | Chemosis | Conjunctival injection | Watery discharge - itching
TX: Cool compresses
Avoidance of allergens
Pataday 1 gtt OU dam
Zatidor 1 gtt OU bid
Alrex 1 gtt OU qid
FU: two weeks
Vernal Keratoconjunctivitis
Ropy discharge, limbal papillae, large conj. papillae in upper lid, shield ulcer, trantas dots - significant itch/disharge
TX: Cool compresses
Pred Forte 1gtt OU x 2 weeks
Lotemax: 1gtt OU qid x 2 weeks
Along with:
Pataday 1 get OU dam
Zatidor 1 get OU bid
Restasis 1 get OU bid
Folllow up: every 2 weeks or every 2-3 days if shield ulcer present
Toxic Keratoconjunctivitis (Medicamentosa)
Corneal SPK, conj papillae or follicles, injection with mild pain, photophobia, blur, tearing
TX: PF Artificial tears q1h
Pred forte 1% got qid in affected eye
Oral ibuprofen or acetaminophen to control pain
Bandage CL or amniotic membranes may be used if appropriate
FU: Every few days during treatment
Giant Papillary Conjunctivitis
Mucous discharge | Itching | Contact lens discomfort
SIGNS Mucous discharge | Giant papillae (superior tarsal plate)
WORK-UP Thorough history and slit lamp examination with upper lid eversion
TREATMENT Discontinue contact lens wear, topical steroid (Pred Forte 1% or Lotemax 1 gtt qid) | Topical allergy eye drops are minimally effective, especially if significant GPC is present) | If contact lens wear is to be resumed, switch to a daily disposable modality
FOLLOW-UP 2-4 weeks during treatment
Viral Conjunctivitis (Non-EKC)
Tearing | Itch | Discomfort | Blurry vision
SIGNS Conjunctival injection | Follicles | Chemosis | Tearing | Preauricular lymphadenopathy
WORK-UP Thorough history. Slit lamp examination
TREATMENT Observation, preservative-free artificial tears, cool compresses | While steroids may prolong the infectious period, they are often used clinically to alleviate symptoms - Pred Forte 1% or Lotemax 1 gtt OU qid x 1 wk
FOLLOW-UP 1 week during treatment
Epidemic Keratoconjunctivitis (EKC)
Tearing | Itch | Discomfort | Blurry vision
SIGNS Pseudomembrane | Subepithelial infiltrates (SEIs) | Conjunctival injection | Follicles | Chemosis |Tearing | Preauricular lymphadenopathy
WORK-UP Thorough history. Slit lamp examination
TREATMENT
Observation | Preservative-free artificial tears | Cool compresses
Topical steroids: Pred Forte 1% 1 gtt OU qid x 1 wk |
Lotemax 1 gtt OU qid x 1 wk
If a pseudomembrane is present peel with a cotton-tip applicator or smooth forceps |
Consider the use of a betadine (povidone-iodine) wash in early EKC
FOLLOW-UP 1 week during treatment
Parinaud Oculoglandular Conjunctivitis
Discomfort | Mucopurulent discharge | Possible fever
SIGNS
Conjunctival injection | Mucopurulent discharge | Preauricular (and/or submandibular) lymphadenopathy | Conjunctival nodules
WORK-UP
Thorough history. Slit lamp examination
TREATMENT
Oral ibuprofen or tylenol (antipyretics)
Tx is dependent on the etiology:
Cat-scratch:
Oral Bactrim or Azithromycin |
Tularemia: IV or IM Gentamicin or oral Doxycycline
FOLLOW-UP
Weekly during treatment
Superior Limbic Keratoconjunctivitis (SLK)
Pain | Burning | Photophobia
SIGNS
Superior bulbar conjunctival injection and thickening | Tearing | Superior corneal/limbal/conjunctival staining with NaFl
WORK-UP Thorough history and slit lamp exam with NaFl. Lift the upper eyelid and ask the patient to look down.
TREATMENT
TOPICAL: Preservative-free artificial tears | steroids (Pred Forte 1% or Lotemax 1 gtt qid).
Steroids should be tapered slowly to avoid rebound inflammation |
Consider long-term cyclosporine 0.05%
Botox injections into the muscle of Riolan may help reduce friction
In severe cases, surgery may be considered:
Conjunctival resection | Cautery | Cryotherapy
FOLLOW-UP
Every 2-4 weeks during treatment. Every 6 months for monitoring
Phlyctenular Keratoconjunctivitis
Discomfort | Photophobia
SIGNS
White nodule on cornea and/or conjunctiva with associated engorged vessels | Conjunctival injection | Possible corneal scarring
WORK-UP Thorough history. Slit lamp examination
TREATMENT Combination antibiotic/steroid drop: Tobradex 1 gtt qid | Zylet 1 gtt qid
FOLLOW-UP
Every few days during treatment
Conjunctivial Intraepithelial Neoplasia (CIN)
Discomfort | Irritation
SIGNS
Gray-white gelatinous lesion(s) | Dilated vessels
WORK-UP Thorough history. Slit lamp examination
TREATMENT Interferon (IV or topical) |
Topical mitomycin C
Topical 5-fluorouracil | Excision with biopsy
FOLLOW-UP
Every few days during treatment
Oculodermal Melanocytosis (Nevus of Ota)
No symtoms
SIGNS
Episcleral blue-gray pigmentation (not conjunctival) | Ipsilateral skin may also be pigmented.
WORK-UP Thorough history. Slit lamp examination
TREATMENT Observation | Annual eye exams to assess glaucoma and melanoma risk.
FOLLOW-UP Frequent follow-ups are not required with no other ocular concerns.
Conjunctival Concretions
Foreign body sensation | Tearing | Often asymptomatic
SIGNS
Yellow-white palpebral conjunctival nodules
WORK-UP Thorough history. Slit lamp examination
TREATMENT Observation | If irritating, can remove with a cotton-tip applicator, small gauge needle, or forceps.
FOLLOW-UP Frequent follow-ups are not required
Pterygium
Irritation | May affect vision if advanced | Often asymptomatic
SIGNS
Injection | Wing-like fibrovascular tissue extending from the conjunctiva to the cornea - usually at the 3-9 o’clock position | Iron line (Stocker line)
WORK-UP Thorough history. Slit lamp examination
TREATMENT
Observation | UV-blocking sunglasses | Preservative-free artificial tears for comfort |
Surgical excision may be indicated if vision is affected or excessive astigmatism is induced.
Topical steroids may be indicated if inflamed or symptomatic:
Pred Forte 1% 1 gtt OU qid
Lotemax 1 gtt OU qid
FOLLOW-UP Annual eye exams, every 1-2 weeks during topical steroid treatment
Pinguecula
Mild irritation | Usually asymptomatic
SIGNS
Yellow-white elevated conjunctival lesion
WORK-UP Thorough history. Slit lamp examination
TREATMENT
Observation | UV-blocking sunglasses | Preservative-free artificial tears for comfort
Topical steroids are rarely indicated but if inflamed (pingueculitis) or symptomatic can use:
Pred Forte 1% 1 gtt OU qid x 1 week |
Lotemax 1 gtt OU qid x 1 week
FOLLOW-UP Frequent follow-ups are not required unless undergoing steroid treatment
Conjunctival Inclusion Cyst
Irritation/discomfort | Dryness
SIGNS Raised conjunctival cavity filled with clear serous fluid
WORK-UP Thorough history. Slit lamp examination
TREATMENT Observation | Drainage | Surgical excision of the entire cyst.
FOLLOW-UP Frequent follow-ups are not required unless surgery is performed
Conjunctival Nevus
No symptoms
SIGNS
Pigmented lesion on the bulbar conjunctiva (rarely on the palpebral conjunctiva) |
Usually flat and brown (but can be amelanotic or pink-ish)
WORK-UP Thorough history and slit lamp examination. Consider baseline anterior segment photos.
TREATMENT Observation with photodocumentation | Suspicious lesions may warrant biopsy
FOLLOW-UP Annually to assess for malignancy risk
Senile Scleral Plaque
No symptoms
SIGNS
Gray area of increased scleral translucency (underlying uvea becomes visible)
WORK-UP Thorough history. Slit lamp examination
TREATMENT
No treatment is required
FOLLOW-UP Frequent follow-ups are rarely necessary.
Conjunctivochalasis ( CCH)
Tearing | Discomfort/irritation | Dryness | Often asymptomatic.
SIGNS
Redundant bulbar conjunctiva (wrinkle appearance) | Disruption of tear meniscus
WORK-UP Thorough history. Slit lamp examination
TREATMENT Observation | Preservative-free artificial tears |
Surgical excision and resection may be indicated in advanced cases | Off-label brimonidine 0.025% (Lumify) has been used with some anecdotal success
FOLLOW-UP Frequent follow-ups are not required
