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Introduction to Eye Disease - Year 2 > Conjunctival disorders > Flashcards

Conjunctival disorders Flashcards

1
Q

What are some examples of microbial caused conjunctival infections?

A

Bacterial conjunctivitis

Viral conjunctivitis

Chlamydial conjunctivitis

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2
Q

What is the most common ocular condition GPs tend to manage and see in the ocular community?

A

Bacterial Conjunctivitis

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3
Q

In which type of people does bacterial conjunctivitis appear most frequently?

A

Most common in children (but can occur at any age).

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4
Q

Is bacterial conjunctivitis contagious?

A

Yes

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5
Q

What type of patients are more susceptible to bacterial conjunctivitis?

A

Patients taking: topical/ systemic steroids

Immunocompromised patients

Patients in poor general health

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6
Q

Is bacterial conjunctivitis usually bilateral and if so why/why not?

A

It is usually bilateral - because in early stages before symptoms and signs manifest it is very common patients shall touch the other eye and so cross contamination occurs.

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7
Q

What is the overriding symptom of bacterial conjunctivitis?

A

‘Gritty’ Eyes - often described by patients as feeling like they have sand in their eye. (this can also be described as a burning or stinging sensation)

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8
Q

What are symptoms of bacterial conjunctiva?

A

‘Gritty’ eyes / burning sensation

Blurred vision because of epiphora

Eyelids stuck together in the morning (pus).

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9
Q

Why is the eyelids being stuck together a symptom of bacterial conjunctivitis?

A

Bacteria generate pus.

This pus dries out and matts between the eyelids, making it difficult for patients to open their eyes.

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10
Q

What are clinical signs of bacterial conjunctivitis?

A

Purulent (pus) or mucopurulent discharge (mucus and pus discharge)

Conjunctival hyperaemia (shown as redness) maximal at the fornices (tarsal conjunctiva)

Lid crusting

Mild papillary reaction

Usually no corneal involvement

Usually no pre-auricular lymphadenopathy (this is basically swollen lymph nodes infront of the ear- this is sometimes present in viral conjunctivitis though)

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11
Q

How do we manage bacterial conjunctivitis in a patient?

A

Dilemma as to whether we should tbh.

It is a self-limiting condition - it will get better by itself. 80% of cases resolve themselves in a week.

You should advise patient on the contagious nature of the disease.

Refer if condition does not get better after a week or worsens - as diagnosis may have been wrong.

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12
Q

What is the aetiology of viral conjunctivitis?

A

Adenovirus is the most common cause. Caused by airborne respiratory droplets (landing on ocular surface) or direct transfer of ocular secretions.

Conjunctivitis is a rare manifestation of COVID19 (incidence approx, 3%)

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13
Q

What two ocular syndromes do adenoviruses cause?

A
  • Pharyngoconjunctival fever (PCF) - inflammation of both the conjunctiva and nasal pharynx. Don’t tend to have corneal involvement.
  • Epidemic keratoconjunctivitis (EKC) - a type of conjunctivitis which tends to occur when people are in crowded spaces - it tends to be associated with corneal involvement.
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14
Q

What are the symptoms of viral conjunctivitis?

A

Epiphora

Discomfort (Mild)

Photophobia - if corneal involvement is present

Reduced acuity (with corneal involvement)

Bilateral in 60% of cases from cross infection by patient.

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15
Q

What are signs of viral conjunctivitis?

A

Conjunctival injection Swollen lids Serous (serum) discharge

Conjunctival follicles - as seen in image of inner tasal conjunctiva

Pre-auricular lymphadenopathy

Pseudomembrane - accumulation of fibrin on tarsal conjunctiva

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16
Q

What does pre-auricular lymphadenopathy look like?

A

Its the swollen lymph node next to the ear

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17
Q

What does the appearance of a pseudomembrane in viral conjunctivitis look like?

A
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18
Q

What are signs of viral conjunctivitis?

A

Keratitis (more common in EKC (80%))

Epithelial lesions with or without subepithelial infiltrates (which in this case can be seen in the image - those infiltrates are accumulations of inflammatory cells).

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19
Q

How do we manage viral conjunctivitis?

A

Self-limiting 1-3 weeks Cool Compress may help Artificial tears may improve comfort Antibiotics in children due to difficulty in distinguishing between bacterial and viral conjunctivitis - this advice is aimed at GPs though who don’t have access to slit lamps. Refer if significant corneal involvement. Warn of highly contagious nature of condition ( to adults if the patient is a child).

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20
Q

What is the most common aetiology by which patients acquire chlamydial conjunctivitis?

A

Caused by Chlamydia Trachomatis (sexually transmitted disease)

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21
Q

What is usually paired with chlamydial conjunctivits?

A

Naturally associated with an ongoing genital infection

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22
Q

What do you have to look out for while diagnosing Chlamydial Conjunctivitis?

A

In the early stages it often gives the appearance of bacterial conjunctivitis and if people don’t take a good history or aren’t careful with clinical examination it may get confused with bacterial conjunctivitis.

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23
Q

What are the signs of Chlamydial conjunctivitis?

A

Follicular conjunctivitis with mucopurulent discharge.

24
Q

How do we manage Chlamydial Conjunctivitis?

A

Need specific antibiotic for Chlamydial Conjunctivitis Refer as the associated ongoing genital infection needs to be treated too.

25
Q

What is a type of non-microbial conjunctivitis?

A

Allergic Conjunctivitis

26
Q

How do we group and classify allergic eye diseases?

A

If the cornea is involved they are grouped under keratoconjunctivitis. (The two types are Atopic Keratoconjunctivitis (AKC) and Vernal Keratoconjunctivitis (VKC)). If the patient is in contact with the allergen all year round then we refer to it as Perennial allergic conjunctivitis (PAC). If the patient is in contact with the allergen seasonally we refer to it as Seasonal Allergic Conjunctivitis (referred to as hay fever conjunctivitis). Acute allergic conjunctivitis - is when there is a very sudden reaction to an allergen - this resolves quickly though. Then Giant Papillary conjunctivitis and contact dermatoconjunctivitis are grouped miscellaneously.

27
Q

What is the aetiology in Seasonal/Perennial conjunctivitis?

A

Type I Hypersensitivity - mast cell mediated. Aetiology for Seasonal Conjunctivitis would be seasonal allergens e.g. pollen Aetiology for Perennial Conjunctivitis would be allergens such as house dust mite as a result symptoms would last all year.

28
Q

Define Predisposing

A

make someone liable or inclined to a specified attitude, action, or condition. i.e. make you more susceptible.

29
Q

What are predisposing factors for Seasonal/Perennial Allergic Conjunctivitis?

A

Family history

30
Q

What are (the most common) symptoms of Seasonal/Perennial Allergic Conjunctivitis?

A

Epiphora

Itching

31
Q

What are signs of Seasonal/Perennial Allergic Conjunctivitis?

A

Hyperaemia - maximal at fornices (tarsal conjunctiva) Chemosis Lid oedema Diffuse papillary reaction

No corneal involvement

May have rhinitis ( inflammation of nasal passages)

32
Q

What is chemosis?

A

Chemosis is the swelling (or edema) of the conjunctiva.

33
Q

How do we manage Seasonal/Perennial Allergic Conjunctivitis?

A

In an ideal world you get the patient to avoid the allergen. Cool compresses Mast cell stabiliser e.g. sodium cromoglicate - this stabilises membrane of mast cell reducing degranulation Topical or systemic antihistamines

34
Q

What is a subconjunctival haemorrhage and how does it present?

A

Presents as a bright red patch under the conjunctiva caused by rupture of a small conjunctival vessel.

35
Q

Is a subconjunctival haemorrhage normally unilateral or bilateral?

A

Unilateral

36
Q

How may a subconjunctival Haemorrhage arise?

A

May arise spontaneously, following slight trauma, or as a result of raised central venous pressure due to coughing or sneezing.

37
Q

In which patients in subconjunctival haemorrhaging more likely to occur?

A

In patients taking blood thinning drugs such as warfarin or anticoagulants.

38
Q

When would you refer in the case of Subconjunctival Haemorrhaging?

A

If it is reocurring.

39
Q

What should you do if your patient shows Subconjunctival Haemorrhaging?

A

Check you can see posterior border of the retina ( i.e. the white beyond the red - this would be done by getting the patient to look in extreme positions - e.g. far up , far down, far right , far left) as to check that its not the rare case of trauma to the head and the blood having backtracked into the eye.

40
Q

How do you manage a patient with a Subconjunctival Haemorrhage?

A

Recurrent or bilateral haemorrhages suggests hypertension or coagulation disorder (patient may be taking an anticoagulant) thus consider GP referral Typically resolves in 5-10 days Usually no treatment required

41
Q

What are some examples of benign conjunctival degenerations?

A

Pterygium

Concretions

Pinguecula

42
Q

Where are concretions most likely to be found?

A

Lower conjunctiva

43
Q

Is the patient likely to be aware of concretions?

A

Patients are not commonly aware

44
Q

In which patients are concretions more likely?

A

Elderly Patients

45
Q

In what cases would you refer a patient who has concretions?

A

If they are complaining of discomfort you can refer the patient to have them removed.

46
Q

What is a Pterygium?

A

A pterygium is an elevated, superficial, external ocular mass that usually forms over the perilimbal (means around limbus) conjunctiva and extends onto the corneal surface.

47
Q

In which patients is Pterygium more common?

A

Patients that have lived in hot dusty environments for a significant period of time.

48
Q

What are the risk factors for Pterygium?

A

Exposure to UV light

49
Q

How may we manage Pterygium?

A

lubricants surgical excision - if it grows close to pupil plane like in image attached (or if patient is EXTREMELY worried about cosmetic appearance)

[May need a topical steroid if it becomes inflamed ever.- but this is rare].

50
Q

What is Pinguecula and does it affect vision?

A

Pinguecula is a benign yellowish-white conjunctival lesion. It generally does not affect vision and usually does not require treatment

51
Q

Does a Pinguecula require treatment?

A

It usually does not require treatment. (only if it gets inflamed in which case short course of steroid will do the trick)

52
Q

What are examples of sight threatening conjunctival disorders?

A

Cicatricial pemphigoid

Stevens-Johnson syndrome

Conjunctival melanoma (These are rare)

53
Q

What is Stevens-Johnsons syndrome?

A

This is a syndrome that can affect mucus membranes such as the conjunctiva.

54
Q

What is Cicatricial pemphigoid and what treatment does it require?

A

A group of autoimmune disorders that affect mucus membranes - in the conjunctiva it causes adhesions between the bulbar and tarsal conjunctiva . It requires specialist management

55
Q

What is Conjunctival melanoma?

A

Cancerous pigmented lesion of conjunctiva.

56
Q

What does a diffuse papillary reaction look like?

A

Small bumps - see picture

Introduction to Eye Disease - Year 2 (40 decks)

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