conjunctiva disorders Flashcards
What are pinguecula and pterygium
benign growths of the conjunctiva that can result for chronic actinic irritation
What is a pinguecula
raised yellowish-white mass within the bulbar conjunctiva, adjacent to the cornea
*does NOT grow onto the cornea
What is a pterygium
Fleshy triangular growth of bulbar conjunctiva that may spread across and distort cornea, induced astigmatism, change refractive power of the eye
What are the symptoms of pterygium
Decreased vision and foreign body sensation
Where do pterygium occur more commonly in the US
sunny, hot, dry climates
How do you treat pterygium
artificial tears or short period of steroid drops or ointments
When is a removal of a pterygium indicated
documented growth
cosmetic concerns
reduce irritation
improve/preserve vision
What is the most common cause of eye redness
conjunctivitis
How is conjunctivitis characterized
Acute (1-2 weeks)
Chronic (>4weeks)
Infectious
Non- infectious
What is the conjunctiva
transparent, lubricating mucous membrane covering the outer surface of the eye
What are the 2 parts of the conjunctiva
bulbar conjunctiva (covers globe)
Tarsal (Lines inner eyelid)
What are the three most common types of conjunctivitis
Viral
Allergic
Bacterial
What is the most common cause of Viral conjunctivitis
adenovirus
What is the most common form of conjunctivitis
non-infectious
Who is at higher risk of bacterial conjunctivitis
Adults
What are the causes of bacterial conjunctivitis in adults
S. pneumoniae
H. influenza
What are the causes of pediatric conjunctivitis
H. influenza
S. Pneumoniae
What is the most common cause of conjunctivitis in neonates
N. gonorrhea
What is the epidemiology with conjunctivitis
Varies by age, sex, and time of year
How much of the conjunctiva is involved with conjunctivitis
Entire conjunctiva, often with discharge
How long is viral conjunctivitis contagious
10-14 days
What is Picornavirus
acute hemorrhagic conjunctivitis
*highly infectious
What is HIV conjunctivitis
Protracted course marked by irritation, redness, and tearing
Which patient population is most susceptible to viral conjunctivitis
Peds
How will patients present with viral conjunctivitis
Foreign body sensation
red, itchy eyes
light sensitivity
burning
watery discharge
*Usually with a recent URI or sick contact
What occurs with HSV conjunctivitis
vesicles may appear on face/eyelids and vision changes and corneal involvement possible
What occurs if someone gets conjunctivitis with Zoster
vesicular dermatomal pattern with a red conjunctiva with mucopurulent discharge
What is the clinical presentation of viral conjunctivitis
Injected conjunctiva
small, dome shaped nodules without prominent central vessels on palpebral conjunctiva
Preauricular lymph nodes may be reactive and tender
What helps differentiate between bacterial and viral conjunctivitis
Preauricular lymph nodes being reactive and tender
When is lab testing indicated with viral conjunctivitis
not resolving
sus. chlamydial inf. (newborns)
Excesses amount of discharge
Sus. gonorrhea co-infection
immunocompromised
How long can it take for viral conjunctivitis to clear
up to 3 weeks
*generally within 14 days
What are some ophthalmologic interventions for viral conjunctivitis
Membrane / pseudo-membrane may be peeled off with cotton swab
Topical steroid (can cause prolonged viral shedding)
What are the common complaints with bacterial conjunctivitis
redness
tearing
discharge from 1 or both eyes
glued eyes
When a child has conjunctivitis, what other symptoms should be checked
otic
may have a concurrent OM
When are cultures drawn with bacterial conjunctivitis
Copious discharge (gonorrhea)
Ophthalmia neonatorium
inclusion bodies on immunofluorescents (Chlamydia)
How do you treat bacterial conjunctivitis
Dont need treatment, will resolve in 1 week
*if complicated, can give topical antibiotics
What are topical antibiotic choices for bacterial conjunctivitis
Polymyxin B/ Trimethoprim
Fluoroquinolones
Which types of bacterial conjunctivitis require systemic treatment
gonococcal or chlamydial
How do you treat ophthalmia neonatorium
Gonorrhea: admit, single dose IV/IM ceftriaxone and eye irrigation
Chlamydia: PO/IV erythromycin + topical erythromycin x14days
What is Keratoconjunctivits
Inflammatory process involving both conjunctiva and superficial cornea
What are the most common causes of keratoconjunctivitis
Viral and bacterial
Viral»Bacterial
What is the cause of epidemic keratoconjunctivitis (EKC)
Adenovirus
What causes vernal keratoconjunctivitis (VKC)
Severe allergic conjunctivitis
What is superior limbic keratoconjunctivitis (SLK)
Chronic inflammatory condition
Keratoconjunctivitis sicca (Dry eye syndrome - DES)
Various etiologies including primary autoimmune and systemic conditions
What is SLK associated with
Thyroid disfunction and keratoconjunctivitis sicca
What are the symptoms of keratoconjunctivitis
Eye discomfort/irritation
pruritis
light sensitivity
minor blurring
epiphora
What are common signs of keratoconjunctivitis
Conjunctival injection
conjunctival chemises
eye discharge
If someone presents with keratoconjunctivitis, what questions must be asked
Contact lenses?
Systemic conditions?
What is viral conjunctivitis
Initially unilateral with spread to contralateral side
How does viral conjunctivitis present
ocular discomfort/itching
light sensitivity
conjunctival injection
chemoses
watery discharge
What occurs with the palpebral conjunctiva with viral keratoconjunctivitis
Follicular reaction
petechial hemorrhage
pseudomembrane
How long to s/sx last with keratoconjunctivitis
7-21 days and may remain infectious for 10-14 days
What occurs with keratoconjunctivits sicca
Chronic intermittent, bilateral burning, stinging, foreign body sensation, photophobia
What is the symptoms with keratoconjunctivitis sicca
eye fatigue
sense of eyelid heaviness
pruritus
epiphoria
watery discharge
blurred vision
What will be seen on exam with keratoconjunctivitis sicca
Conjunctival injection
eyelid margin telangiectasia
erythema
decrease tear lake and production
What is SLK
Bilateral burning, irritation, foreign body sensation
asymmetric involvement
What are characteristic findings of SLK
Watery discharge
epiphora
superior palpebral and bulbar conjunctival injection
chemosis
What tests can be done for keratoconjunctivitis
Fluoroscein staining with woods lamp / slit lamp
How do you workup keratoconjunctivitis
Acuity
motion
pupillary reaction
visual fields
IOP
Eyelid exam + eversion
How do you treat keratoconjunctivitis sicca
artificial tear, gels, ointments
warm compress
lid scrub
What are medications for keratoconjunctivitis sicca
topical cyclosporin / tacrolimus
Topical steroid (monitor IOP)
PO doxy
What is a procedural treatment for keratoconjunctivits sicca
punctual plugs to prevent lacrimal drainage of tear film
What is the first line treatment for SLK
Preservative free artificial tears, cells, ointments
What is second line treatment for SLK
Mast cell stabilizers
antihistamines, Vit A, NSAIDS
What are the 3 subtypes of allergic conjunctivitis
Acute
seasonal
perennial
What is atopic keratoconjunctivits
Combination of allergen exposure and atopic dermatitis
What is giant papillary conjunctivitis
Allergen exposure and response to ocular foreign body
What population is simple allergic conjunctivitis most common in
<20y/o
What population is vernal keratoconjunctivitis most common in
males in warm, dry climates
<10yo w/ hx atopy or asthma
What population is atopic keratoconjunctivitis common in
30-50y/o males
What patient population is giant papillary conjunctivitis most common in
teens / young adults
*generally seen 1-2 years after starting soft contact lenses
What type of immune reaction is simple allergic conjunctivitis
IgE mediated hypersensitivity
What type of immune reaction is atopic keratoconjunctivitis
combination of delayed type iV and immediate type I
What is the most common symptoms of allergic conjunctivitis with all subtypes
Itchiness and diffuse conjunctival injection
What is seen on physical exam with simple allergic conjunctivitis
clear, water discharge
bilateral
minimal crusting
chemosis and eyelid edema
What is seen on physical exam with renal keratoconjunctivitis
thick mucus discharge
pain
photophobia
blurred vision
corneal ulcers
What is seen on physical exam with renal keratoconjunctivitis
thick mucus discharge
pain
photophobia
blurred vision
corneal ulcers
What is seen on physical exam with atopic keratoconjunctivitis
Perennial
pain
blurry vision
photophobia
What is seen on physical exam with giant papillary conjunctivitis
Itch (worse than simple allergic)
Thick mucus discharge
worsening pain/ blurry vision
What is the initial treatment for vernal and atopic keratoconjunctivitis
Topical combo of AH/mast cell stabilizer
