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HEENT Clin Med > conjunctiva disorders > Flashcards

conjunctiva disorders Flashcards

1
Q

What are pinguecula and pterygium

A

benign growths of the conjunctiva that can result for chronic actinic irritation

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2
Q

What is a pinguecula

A

raised yellowish-white mass within the bulbar conjunctiva, adjacent to the cornea

*does NOT grow onto the cornea

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3
Q

What is a pterygium

A

Fleshy triangular growth of bulbar conjunctiva that may spread across and distort cornea, induced astigmatism, change refractive power of the eye

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4
Q

What are the symptoms of pterygium

A

Decreased vision and foreign body sensation

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5
Q

Where do pterygium occur more commonly in the US

A

sunny, hot, dry climates

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6
Q

How do you treat pterygium

A

artificial tears or short period of steroid drops or ointments

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7
Q

When is a removal of a pterygium indicated

A

documented growth
cosmetic concerns
reduce irritation
improve/preserve vision

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8
Q

What is the most common cause of eye redness

A

conjunctivitis

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9
Q

How is conjunctivitis characterized

A

Acute (1-2 weeks)
Chronic (>4weeks)
Infectious
Non- infectious

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10
Q

What is the conjunctiva

A

transparent, lubricating mucous membrane covering the outer surface of the eye

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11
Q

What are the 2 parts of the conjunctiva

A

bulbar conjunctiva (covers globe)
Tarsal (Lines inner eyelid)

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12
Q

What are the three most common types of conjunctivitis

A

Viral
Allergic
Bacterial

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13
Q

What is the most common cause of Viral conjunctivitis

A

adenovirus

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14
Q

What is the most common form of conjunctivitis

A

non-infectious

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15
Q

Who is at higher risk of bacterial conjunctivitis

A

Adults

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16
Q

What are the causes of bacterial conjunctivitis in adults

A

S. pneumoniae
H. influenza

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17
Q

What are the causes of pediatric conjunctivitis

A

H. influenza
S. Pneumoniae

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18
Q

What is the most common cause of conjunctivitis in neonates

A

N. gonorrhea

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19
Q

What is the epidemiology with conjunctivitis

A

Varies by age, sex, and time of year

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20
Q

How much of the conjunctiva is involved with conjunctivitis

A

Entire conjunctiva, often with discharge

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21
Q

How long is viral conjunctivitis contagious

A

10-14 days

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22
Q

What is Picornavirus

A

acute hemorrhagic conjunctivitis
*highly infectious

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23
Q

What is HIV conjunctivitis

A

Protracted course marked by irritation, redness, and tearing

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24
Q

Which patient population is most susceptible to viral conjunctivitis

A

Peds

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25
Q

How will patients present with viral conjunctivitis

A

Foreign body sensation
red, itchy eyes
light sensitivity
burning
watery discharge

*Usually with a recent URI or sick contact

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26
Q

What occurs with HSV conjunctivitis

A

vesicles may appear on face/eyelids and vision changes and corneal involvement possible

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27
Q

What occurs if someone gets conjunctivitis with Zoster

A

vesicular dermatomal pattern with a red conjunctiva with mucopurulent discharge

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28
Q

What is the clinical presentation of viral conjunctivitis

A

Injected conjunctiva

small, dome shaped nodules without prominent central vessels on palpebral conjunctiva

Preauricular lymph nodes may be reactive and tender

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29
Q

What helps differentiate between bacterial and viral conjunctivitis

A

Preauricular lymph nodes being reactive and tender

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30
Q

When is lab testing indicated with viral conjunctivitis

A

not resolving
sus. chlamydial inf. (newborns)
Excesses amount of discharge
Sus. gonorrhea co-infection
immunocompromised

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31
Q

How long can it take for viral conjunctivitis to clear

A

up to 3 weeks
*generally within 14 days

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32
Q

What are some ophthalmologic interventions for viral conjunctivitis

A

Membrane / pseudo-membrane may be peeled off with cotton swab

Topical steroid (can cause prolonged viral shedding)

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33
Q

What are the common complaints with bacterial conjunctivitis

A

redness
tearing
discharge from 1 or both eyes
glued eyes

34
Q

When a child has conjunctivitis, what other symptoms should be checked

A

otic
may have a concurrent OM

35
Q

When are cultures drawn with bacterial conjunctivitis

A

Copious discharge (gonorrhea)
Ophthalmia neonatorium

inclusion bodies on immunofluorescents (Chlamydia)

36
Q

How do you treat bacterial conjunctivitis

A

Dont need treatment, will resolve in 1 week

*if complicated, can give topical antibiotics

37
Q

What are topical antibiotic choices for bacterial conjunctivitis

A

Polymyxin B/ Trimethoprim
Fluoroquinolones

38
Q

Which types of bacterial conjunctivitis require systemic treatment

A

gonococcal or chlamydial

39
Q

How do you treat ophthalmia neonatorium

A

Gonorrhea: admit, single dose IV/IM ceftriaxone and eye irrigation

Chlamydia: PO/IV erythromycin + topical erythromycin x14days

40
Q

What is Keratoconjunctivits

A

Inflammatory process involving both conjunctiva and superficial cornea

41
Q

What are the most common causes of keratoconjunctivitis

A

Viral and bacterial
Viral»Bacterial

42
Q

What is the cause of epidemic keratoconjunctivitis (EKC)

A

Adenovirus

43
Q

What causes vernal keratoconjunctivitis (VKC)

A

Severe allergic conjunctivitis

44
Q

What is superior limbic keratoconjunctivitis (SLK)

A

Chronic inflammatory condition

45
Q

Keratoconjunctivitis sicca (Dry eye syndrome - DES)

A

Various etiologies including primary autoimmune and systemic conditions

46
Q

What is SLK associated with

A

Thyroid disfunction and keratoconjunctivitis sicca

47
Q

What are the symptoms of keratoconjunctivitis

A

Eye discomfort/irritation
pruritis
light sensitivity
minor blurring
epiphora

48
Q

What are common signs of keratoconjunctivitis

A

Conjunctival injection
conjunctival chemises
eye discharge

49
Q

If someone presents with keratoconjunctivitis, what questions must be asked

A

Contact lenses?
Systemic conditions?

50
Q

What is viral conjunctivitis

A

Initially unilateral with spread to contralateral side

51
Q

How does viral conjunctivitis present

A

ocular discomfort/itching
light sensitivity
conjunctival injection
chemoses
watery discharge

52
Q

What occurs with the palpebral conjunctiva with viral keratoconjunctivitis

A

Follicular reaction
petechial hemorrhage
pseudomembrane

53
Q

How long to s/sx last with keratoconjunctivitis

A

7-21 days and may remain infectious for 10-14 days

54
Q

What occurs with keratoconjunctivits sicca

A

Chronic intermittent, bilateral burning, stinging, foreign body sensation, photophobia

55
Q

What is the symptoms with keratoconjunctivitis sicca

A

eye fatigue
sense of eyelid heaviness
pruritus
epiphoria
watery discharge
blurred vision

56
Q

What will be seen on exam with keratoconjunctivitis sicca

A

Conjunctival injection
eyelid margin telangiectasia
erythema
decrease tear lake and production

57
Q

What is SLK

A

Bilateral burning, irritation, foreign body sensation

asymmetric involvement

58
Q

What are characteristic findings of SLK

A

Watery discharge
epiphora
superior palpebral and bulbar conjunctival injection
chemosis

59
Q

What tests can be done for keratoconjunctivitis

A

Fluoroscein staining with woods lamp / slit lamp

60
Q

How do you workup keratoconjunctivitis

A

Acuity
motion
pupillary reaction
visual fields
IOP
Eyelid exam + eversion

61
Q

How do you treat keratoconjunctivitis sicca

A

artificial tear, gels, ointments
warm compress
lid scrub

62
Q

What are medications for keratoconjunctivitis sicca

A

topical cyclosporin / tacrolimus
Topical steroid (monitor IOP)
PO doxy

63
Q

What is a procedural treatment for keratoconjunctivits sicca

A

punctual plugs to prevent lacrimal drainage of tear film

64
Q

What is the first line treatment for SLK

A

Preservative free artificial tears, cells, ointments

65
Q

What is second line treatment for SLK

A

Mast cell stabilizers
antihistamines, Vit A, NSAIDS

66
Q

What are the 3 subtypes of allergic conjunctivitis

A

Acute
seasonal
perennial

67
Q

What is atopic keratoconjunctivits

A

Combination of allergen exposure and atopic dermatitis

68
Q

What is giant papillary conjunctivitis

A

Allergen exposure and response to ocular foreign body

69
Q

What population is simple allergic conjunctivitis most common in

A

<20y/o

70
Q

What population is vernal keratoconjunctivitis most common in

A

males in warm, dry climates
<10yo w/ hx atopy or asthma

71
Q

What population is atopic keratoconjunctivitis common in

A

30-50y/o males

72
Q

What patient population is giant papillary conjunctivitis most common in

A

teens / young adults

*generally seen 1-2 years after starting soft contact lenses

73
Q

What type of immune reaction is simple allergic conjunctivitis

A

IgE mediated hypersensitivity

74
Q

What type of immune reaction is atopic keratoconjunctivitis

A

combination of delayed type iV and immediate type I

75
Q

What is the most common symptoms of allergic conjunctivitis with all subtypes

A

Itchiness and diffuse conjunctival injection

76
Q

What is seen on physical exam with simple allergic conjunctivitis

A

clear, water discharge
bilateral
minimal crusting
chemosis and eyelid edema

77
Q

What is seen on physical exam with renal keratoconjunctivitis

A

thick mucus discharge
pain
photophobia
blurred vision
corneal ulcers

78
Q

What is seen on physical exam with renal keratoconjunctivitis

A

thick mucus discharge
pain
photophobia
blurred vision
corneal ulcers

79
Q

What is seen on physical exam with atopic keratoconjunctivitis

A

Perennial
pain
blurry vision
photophobia

80
Q

What is seen on physical exam with giant papillary conjunctivitis

A

Itch (worse than simple allergic)
Thick mucus discharge
worsening pain/ blurry vision

81
Q

What is the initial treatment for vernal and atopic keratoconjunctivitis

A

Topical combo of AH/mast cell stabilizer

HEENT Clin Med (7 decks)

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