Conjunctivitis Flashcards
Bacterial conjunctivitis culprit agents
S. aureus, S. pneumoniae, H. influenzae, M. catarrhalis
Clinical presentation of bacterial conjunctivitis
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)
Bacterial conjunctivitis treatment: first-line treatment options
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
Bacterial conjunctivitis treatment: treatment options for patients who wear contacts
Ofloxacin 0.3%; 1-2 gtts QID x5-7 days
Ciprofloxacin 0.3%; 1-2 gtts QID x5-7 days
Allergic conjunctivitis symptoms
Intense itching, hyperemia, tearing, chemosis, eyelid edema
Allergic conjunctivitis is what type of hypersensitivity reaction?
type I
Acute allergic conjunctivitis (AAC) definition
Most common allergic type with fast onset symptoms within 30 minutes of exposure. When exposure ends, symptoms will resolve within 24 hours
Seasonal allergic conjunctivitis (SAC) definition
AKA hay fever; symptoms similar to AAC plus rhinitis. Slower onset than AAC (often takes days to weeks) and associated with pollen season
Perennial allergic conjunctivitis (PAC) definition
Mild chronic waxing and waning year-round symptoms, often indoor allergens such as mites, animal dander, and mold
Allergic conjunctivitis nonpharmacologic treatment/prevention
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
Allergic conjunctivitis medications
Naphazoline/pheniramine, azelastine, ketotifen, olopatadine
Naphazoline/pheniramine drug class
Vasoconstrictor/antihistamine
Naphazoline/pheniramine brand names
Naphcon-A, Opcon-A
Naphazoline/pheniramine dosing
1-2gtts BID for up to 2 weeks
Azelastine, ketotifen, olopatadine drug class
Antihistamines with mast cell stabilizing property
Azelastine brand name
Optivar
Ketotifen brand name
Zaditor
Olopatadine brand name
Patanol
Azelastine and Ketotifen dosing
1 gtt BID
Olopatadine dosing
Varies by strength
Why are mast cell stabilizers not preferred for allergic conjunctivitis treatment?
Long onset of action and used QID
Allergic conjunctivitis medications: glucocorticoids
Can be used under ophthalmologist supervision in patients with glaucoma, cataracts, or secondary infection
Allergic conjunctivitis medications: NSAIDs
Have lower efficacy (so not exactly the best treatment option)
What is viral conjunctivitis caused by?
Mostly adenovirus
Characteristics of viral conjunctivitis
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
Symptoms of viral conjunctivitis
Watery, mucoserous discharge with morning crusting but scant mucous during the day; there can be profuse tearing as well, enlarged, tender, preauricular nodes
Viral conjunctivitis treatment: supportive care
Cold compresses, non-ABX lubricating ointments
Viral conjunctivitis Tx: OTC antihistamines/decongestant drops (what does it do?)
Only treats the symptoms
Counseling for viral conjunctivitis
Sx will get worse before they get better, takes about 3 days and may persist
Viral conjunctivitis is part of the viral prodrome, which includes what 3 things?
Fever, pharyngitis, URI
Viral conjunctivitis pharmacologic treatment:
Same as allergic conjunctivitis- Naphazolone/pheniramine, azelastine, olopatadine, ketotifen
Toxic conjunctivitis definition
Damage to ocular tissues from preservatives or meds
Time it takes to develop toxic conjunctivitis
Days-years; dose-response relationship
Causes of toxic conjunctivitis
Contact lens solution, artificial tears, topical eye meds, AG ABX, antiviral agents, glaucoma meds, topical anesthetics, makeup
Symptoms of toxic conjunctivitis
Redness, edema, mucous discharge, swollen and thickened eyelids
Diagnosis of toxic conjunctivitis
Injection in patients; toxic conjunctivitis is confirmed when the eye drops are D/C’ed and the symptoms resolve
Toxic conjunctivitis treatment: non-pharmacological
D/C topical medications containing preservatives
Toxic conjunctivitis treatment: pharmacological
Short-course loteprednol or other minimally preserved topical corticosteroids BID-QID; also use non-benzalkonium chloride-containing formulations of topical medications
Overall prevention strategies for conjunctivitis
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
