conjunctival disorder - waldron Flashcards
what are pinguecula and pterygium
benign growths of the conjunctiva that can result from chronic actinic irritation
both typically appear adjacent to cornea at 3, 9 oclock or both
what is Pinguecula
raised yellowish white mass within the bulbar conjunctiva, adjacent to the cornea
dose not tend to grow onto cornea
may cause irritation or cosmetic blemish
treatment rarely necessary - can easily be removed
what is a Pterygium
fleshy triangular growth of bulbar conjunctiva that may spread across and distort the cornea, induce astigmatism, change refractive power of eye
symptoms: decreased vision and foreign body sensation
more common in sunny, hot, dry climates
what is the treatment of Pterygium
symptomatic relief: artificial tears or short period of treatment with corticosteroid drops/ointments
removal indicated for documented growth, cosmetic concerns, to reduce irritation to improve or preserve vision- surgical removal
what is conjunctivitis
inflammation or infection of conjunctiva
usually self limiting and rarely resulting in vision loss
essential to rule out other sight-threatening cause of red-eye
what is the conjunctiva composed of
bulbar conjuntiva - covers globe
tarsal (or palpebral) conjunctiva - which lines eyelid’s inner surface
what are the types of conjunctivitis
viral (80% of acute cases), allergic and bacterial
what are the most common cause of conjunctivitis
viral
allergic
bacterial
viral: Adenovirus, herpes simplex, herpes zoster, enterovirus
allergic: allergens, toxin, local irritants (m/c)
bacterial: adults: s. aureus, s. pneumonia, h. influenzae
kids: H. influenza, s. pneumoniae
neonates: N. gonorrhoeae
when are conjunctivitis common to present
kids: march/may
allergic: spring/summer
bacterial: december to april
what is viral conjunctivitis
children most susceptible
direct contact with virus or airborne transmission
most cases highly contageous for 10-14 days
washing hands and avoidance of eye contract key to preventing transmission
what is Picornaviruses
acute hemorrhagic conjunctivitis; highly infectious
RARE
what is HIV conjunctivitis
protracted course marked by irritation, redness and tearing
what is the clinical presention of viral conjunctivitis
presents with FB sensation, red eyes, itching, light sensitivity, burning, watery discharge
usu. hx of recent URI or sick contact
visual acuity usu. at or near their baseline
cornea can have subepithelial infiltrates; causes photophobia, diminished vision, glare
what is seen with viral conjunctivitis with HSV
vesicles may appear on face or eyelids and vision may be affected; corneal involvement possible
what is seen with viral conjunctivitis with Zoster
vesicular dermatomal pattern; conjunctiva usually red with mucopurulent discharge
how do you diagnose/work up viral conjunctivitis
lab testing not indicated unless: no resolving (>4wks, chlamydial infection concern, significant immunocompromised, excessive discharge, gonorrhea co-infection suspected)
ophthalmologist usually diagnose clinically
what is the treatment of viral conjunctivitis
symptomatic relief: artificial tears, cool compresses
resolution can take up to 3 weeks’ most resolve in 14 days
preventing spread
membrane peeled off with topical anesthetic, topical steroids, topical antivirals for HSV and Zoster
what is bacterial conjunctivitis
spread usually hand to eye or person to person via respiratory droplets
m/c causative in kids is H. influenza, adults is s. aureus
contact lens wearers: more susceptible to gram-negative
what is the clinical presentation of bacterial conjunctivitis
redness, tearing, discharge from one/both eyes (glued eyes)
duration divided into hyperacute, acute (3-4wks), chronic (>4wks)
conjunctival erythema, purulent discharge; may have mattering of eyelids upon waking
complete ocular examination
what should be assessed in kids with bacterial conjunctivitis
inquire about otic symptoms - children may have concurrent otitis media; otoscopic examination warranted
what is the work up for bacterial conjunctivitis
labratory/radiographs not required
cultures
what is the treatment of bacterial conjunctivitis
untreated will resolve within one week
if treat:
uncomplicated: topical abx or manage expectantly
complicated: topical abx
duration of treatment: generally 5-7 days
what are the abx of choice for bacterial conjunctivitis
aminoglycosides
polymyxin B combinations (polymyxin B/trimethoprim)
macrolides
fluoroquinolone
topical erythromycin
what are the topical exceptions for bacterial conjunctivitis
gonococcal or chlamydial infections require systemic treatment
- if gonorrhea: admit, single dose IV/IM ceftriaxone, eye irrigation until resolution
- if chlamydia: PO or IV erythromycin plus topical erythromycin for 14 days
oral abx indicated if concurrent acute otitis media
what can severe bacterial conjunctivitis result in
keratitis, corneal ulceration and perforation and blindness
what is keratoconjuncitivits
inflammatory process involving both conjunctiva and superficial cornea (keratitis)
usually occur in association with viral, bacterial, autoimmune, toxin, allergic etiologies
list of cases are extensive
unilat or bilat
what can cause keratoconjunctivitis
viral»_space; bacterial
epidemic keratoconjunctivitis (EKC) - adenovirus
non-infectious: allergic, toxic, immune-mediated
vernal keratoconjuncitivits (VKC) - sever allergic
superior limbic keratoconjunctivitis (SLK) - chronic inflammatory
what is keratoconjunctivitis siccca
dry eye syndrome (DES), various etiologies including several (primarily autoimmune), systemic conditions
what is the presentation of keratoconjunctivitis
eye discomfort, pruritis, light sensitivity, minor blurring, epiphora
conjunctival injection, conjunctival chemosis, eye discharge
what is the presentation of viral (epidemic)keratoconjunctivitis
initially unilat with spread to contralateral, usually. asymmetric findings
present with ocular discomfort/itching, light sensitivity
conjuncival injection and chemosis
follicular reaction, petechial hemorrhages, pseudo-membrane
lymphadenopathy and/or antecedent URI
may last 7-21 days, may remain infections for 10-14 days
what is the presentation of keratoconjuncitivitis sicca
chronic, usually intermittent, bilateraly (usu. asymmetric) burning, stinging, FB sensation, photophobia
eye fatigue, sense of heavy eyelids, pruritis, epiphora, watery discharge, blurred vision
blurring worse with reading, computer use, TV, or other electronics
what is found on exam with keratoconjunctivitis sicca
conjunctiva injection
eyelid margin telangiectasias
erythema
decreased tear lake
reduced tear production
what is the presentation of superior limbic keratoconjunctivitis
bilateral burning, irritation, FB sensation
usually chronic with gradual clearing - may have periods of remission
asymmetric involvement
watery discharge and epiphora, superior palpebral and bulbar conjunctival injection, chemosis
punctate epithelial erosions in upper third of cornea often present
how do you diagnose/work up keratoconjunctivitis
acuity, visual fields, pupillary reactions, motility
IOP
eyelid examination including eversion
fluorescein staining with wood’s lamp or slit lamp
refer to definitive diagnosis and mgmt
what is the treatment of epidemic keratoconjunctivitis
extremely contageous, prevent spread to others
incubation 5-12 days, contageous 10-14 days
no effective treatment exists
symptomatic tx: artificial tears, cool compresses, topical antihistamines
what is the treatment for keratoconjunctivitis sicca
initial: artificial tears, warm compresses, lid scrubs, oral flaxeed oil/fish oil supplement.
meds: typical cyclosporine A, tacrolimus, lifitegrast; steroid-sparing dampening agents
topical steroids
PO doxycycline (low dose)
procedural tx: punctal plus to prevent lacrimal drainage of tears
what is the treatment of superior limbic keratoconjunctivitis
first line: preservative-free artificial tears, gels, ointment
second line: topicals i.e. mast-cell stabilizers, ati histamines, vit A, NSAIDs
chemocautery with silver nitrate results in symptomatic relief 1-2 months
surgical conjunctival resection of affected/redundant conjunctiva
what is allergic conjunctiviits
common, benign process
rarely vision-threatening; can significantly decrease QOL
acute, seasonal and perennial wtih 4 primary fomrs
what is simple allergic conjunctivitis
secondary to simple allergen exposure
what is vernal keratoconjunctivitis
some combination of climate and allergen
what is atopic keratoocnjunctivitis
combination of allergen exposure, atopic dermatitis, and/or genetic predisposition
what is giant papillary conunctiviitis
allergen exposure and response secondary to ocular foreign body
What is the clinical presentation of allergic conjunctivitis
frequently accompanies seasonal allergy symptoms
itchiness and diffuse conjunctival injection are the most common symptoms and present in all subtypes
what is the workup for allergic conjunctivitis
based on torough history and classic PE findings
if concern, fluoroscein straining of cornea can ensure no corneal abrasion
