Conjunctivitis

Question 1

Bacterial conjunctivitis culprit agents

Answer 1

S. aureus, S. pneumoniae, H. influenzae, M. catarrhalis

Question 2

Clinical presentation of bacterial conjunctivitis

Answer 2

Starts in one eye but can spread to both
Morning crusting that continues throughout the day with thick “pus” that’s yellow, white, or green (the eye may be stuck shut in the morning)

Question 3

Bacterial conjunctivitis treatment: first-line treatment options

Answer 3

Erythromycin 5mg/g ointment; 1/2 inch QID x5-7 days

TMP/polymixin B 0.1%/10,000 units/g drops; 1-2 gtts QID x5-7 days

Question 4

Bacterial conjunctivitis treatment: treatment options for patients who wear contacts

Answer 4

Ofloxacin 0.3%; 1-2 gtts QID x5-7 days

Ciprofloxacin 0.3%; 1-2 gtts QID x5-7 days

Question 5

Allergic conjunctivitis symptoms

Answer 5

Intense itching, hyperemia, tearing, chemosis, eyelid edema

Question 6

Allergic conjunctivitis is what type of hypersensitivity reaction?

Answer 6

type I

Question 7

Acute allergic conjunctivitis (AAC) definition

Answer 7

Most common allergic type with fast onset symptoms within 30 minutes of exposure. When exposure ends, symptoms will resolve within 24 hours

Question 8

Seasonal allergic conjunctivitis (SAC) definition

Answer 8

AKA hay fever; symptoms similar to AAC plus rhinitis. Slower onset than AAC (often takes days to weeks) and associated with pollen season

Question 9

Perennial allergic conjunctivitis (PAC) definition

Answer 9

Mild chronic waxing and waning year-round symptoms, often indoor allergens such as mites, animal dander, and mold

Question 10

Allergic conjunctivitis nonpharmacologic treatment/prevention

Answer 10

Don’t rub eyes, frequent cleaning and vacuuming, limit outdoor exposure, use AC, close car and home windows during pollen season, replace/clean/cover pillows, blankets, mattresses, carpets, curtains; use cool compresses and avoid wearing contacts if possible, refrigerated artificial tears

Question 11

Allergic conjunctivitis medications

Answer 11

Naphazoline/pheniramine, azelastine, ketotifen, olopatadine

Question 12

Naphazoline/pheniramine drug class

Answer 12

Vasoconstrictor/antihistamine

Question 13

Naphazoline/pheniramine brand names

Answer 13

Naphcon-A, Opcon-A

Question 14

Naphazoline/pheniramine dosing

Answer 14

1-2gtts BID for up to 2 weeks

Question 15

Azelastine, ketotifen, olopatadine drug class

Answer 15

Antihistamines with mast cell stabilizing property

Question 16

Azelastine brand name

Answer 16

Optivar

Question 17

Ketotifen brand name

Answer 17

Zaditor

Question 18

Olopatadine brand name

Answer 18

Patanol

Question 19

Azelastine and Ketotifen dosing

Answer 19

1 gtt BID

Question 20

Olopatadine dosing

Answer 20

Varies by strength

Question 21

Why are mast cell stabilizers not preferred for allergic conjunctivitis treatment?

Answer 21

Long onset of action and used QID

Question 22

Allergic conjunctivitis medications: glucocorticoids

Answer 22

Can be used under ophthalmologist supervision in patients with glaucoma, cataracts, or secondary infection

Question 23

Allergic conjunctivitis medications: NSAIDs

Answer 23

Have lower efficacy (so not exactly the best treatment option)

Question 24

What is viral conjunctivitis caused by?

Answer 24

Mostly adenovirus

Question 25

Characteristics of viral conjunctivitis

Answer 25

Self-limiting (Sx will get worse before it gets better), will start in one eye and the second will be involved in 24-48 hours

Question 26

Symptoms of viral conjunctivitis

Answer 26

Watery, mucoserous discharge with morning crusting but scant mucous during the day; there can be profuse tearing as well, enlarged, tender, preauricular nodes

Question 27

Viral conjunctivitis treatment: supportive care

Answer 27

Cold compresses, non-ABX lubricating ointments

Question 28

Viral conjunctivitis Tx: OTC antihistamines/decongestant drops (what does it do?)

Answer 28

Only treats the symptoms

Question 29

Counseling for viral conjunctivitis

Answer 29

Sx will get worse before they get better, takes about 3 days and may persist

Question 30

Viral conjunctivitis is part of the viral prodrome, which includes what 3 things?

Answer 30

Fever, pharyngitis, URI

Question 31

Viral conjunctivitis pharmacologic treatment:

Answer 31

Same as allergic conjunctivitis- Naphazolone/pheniramine, azelastine, olopatadine, ketotifen

Question 32

Toxic conjunctivitis definition

Answer 32

Damage to ocular tissues from preservatives or meds

Question 33

Time it takes to develop toxic conjunctivitis

Answer 33

Days-years; dose-response relationship

Question 34

Causes of toxic conjunctivitis

Answer 34

Contact lens solution, artificial tears, topical eye meds, AG ABX, antiviral agents, glaucoma meds, topical anesthetics, makeup

Question 35

Symptoms of toxic conjunctivitis

Answer 35

Redness, edema, mucous discharge, swollen and thickened eyelids

Question 36

Diagnosis of toxic conjunctivitis

Answer 36

Injection in patients; toxic conjunctivitis is confirmed when the eye drops are D/C’ed and the symptoms resolve

Question 37

Toxic conjunctivitis treatment: non-pharmacological

Answer 37

D/C topical medications containing preservatives

Question 38

Toxic conjunctivitis treatment: pharmacological

Answer 38

Short-course loteprednol or other minimally preserved topical corticosteroids BID-QID; also use non-benzalkonium chloride-containing formulations of topical medications

Question 39

Overall prevention strategies for conjunctivitis

Answer 39

Wash hands, keep eyes clean, change pillowcases, towels, washcloths, pillows daily during infection and wash them separately, don’t share eye makeup, avoid allergens and rubbing eyes