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Pharm 129 > Conjunctivitis > Flashcards

Conjunctivitis Flashcards

1
Q

What is conjunctivitis

A
  • Inflammation of conjunctiva
  • Most common cause of red eye worldwide
  • Inflammation can be hyperacute, acute or chronic
  • Acute (less than 3-4 weeks) vs chronic (> 4 weeks)
  • Usually self limiting
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2
Q

What is the most common cause

A

Viruses (80%)
• Peak prevalence in summer
• Adenovirus infections most common (65-90%) followed by herpes simplex
• Other viruses: varicella zoster, Molluscum contagiousum
• Many viral conjunctivitis cases are misdiagnosed as bacterial conjunctivitis

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3
Q

What is the second most common cause

A

Bacterial
• 50-75% cases in children in winter months
• Staphylococcal species most common followed by Streptococcus pneumoniae and Haemophilus influenza
• Neisseria gonorrhoeae or Chlamydia rachomatic cause a more serious hyperacute infection

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4
Q

When does allergic conjunctivitis occur and how does it occur

A
  • Peak in spring and summer
  • Immediate hypersensitivity, allergy to seasonal pollens or allergic reactions to eye products
  • Chemical or irritative causes include dry eyes, drug-induced dry eye
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5
Q

What is the clinical presentation of viral conjunctivitis

A 
redness
serous (watery) discharge
burning
foreign body sensation 
itching
unilateral symptoms initially that may progress bilaterally

adenovirus is more severe (fever, large lymph nodes, etc)

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6
Q

What is the clinical presentation of bacterial conjunctivitis

A

redness
purulent (viscous, yellow/green colour) secretion
sticky eyelids in the morning
minimal itching

• Hyperacute bacteria conjunctivitis (caused by N gonorrhoea) symptoms include rapid onset, purulent discharge, diminished visual acuity, eye tenderness and swollen lymph nodes

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7
Q

What is the clinical presentation of allergic conjunctivitis

A 
Mild to severe ocular itching
redness 
watery or mucoid discharge
mild eyelid swelling 
bilateral presentation
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8
Q

How to differentiate between Viral, Bacterial & Allergic Conjunctivitis

A
  • Allergic has SEVERE itching (others have minimal)
  • bacterial has purulent discharge
  • sore throat and fever most common in viral
  • lymphadenopathy most common in viral
  • viral usually occurs in one eye only
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9
Q

What are the Risk factors for Conjunctivitis

A

● Exposure to someone infected with active viral or bacterial conjunctivitis
● Contact lens use, poor contact lens hygiene
● Foreign body exposure
● Use of contaminated cosmetic eye products
● Chronic dry eye or blepharitis
● Use of ophthalmic or other medications that might cause allergic reactions or dry eyes
● Immunosuppression, rheumatological disease, allergic rhinitis

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10
Q

What is S in SCHOLAR

A 
S: 
redness
discharge (purulent or watery)
itching (severe or minimal)
fever, sore throat
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11
Q

What is C in SCHOLAR

A

C: water, serous, purulent, mucopurulent, hyperpurulent discharge

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12
Q

What is H in SCHOLAR

A

History of contact lens use, exposure to person with red eye, URI, exposed to allergens, past history of conjunctivitis

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13
Q

what is O in SCHOLAR

A

O: acute presentation 1-2 days vs chronic

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14
Q

what is L in SCHOLAR

A

L: conjunctiva vs eyelid or around the eye

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15
Q

What is A in SCHOLAR

A

A: risk factors for dry eyes, blunt trauma, chemical exposure

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16
Q

what is R in SCHOLAR

A

R: what has been tried before

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17
Q

what is H in HAMS

A

H: history of ocular disease, intermittent episodes of red eye, history of atopy, current URI, Sjogren’s, rheumatoid arthritis, thyroid disorder, rosacea
history of herpes (herpes conjunctivitis)
STI

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18
Q

what is A in HAMS

A

A: allergies to medications or environment

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19
Q

what is M in HAMS

A

M: medications with anticholinergic side effects, beta blockers, hormone-based therapy (common causes of dry eye), antineoplastics (cause allergic reactions), allergy medications, nonprescription or natural medications, recreational drugs/opiates

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20
Q

what is S in HAMS

A

S: history of smoking, alcohol use and caffeine use, hobbies, travel, sexual history, use of illicit drugs

21
Q

Red flags

A

● Contact lens wearer due to the high risk of corneal ulcer
● Visual loss, blurred vision, halos
● Moderate to severe pain or ocular trauma
● Severe or hyperpurulent discharge or any corneal involvement
● Photophobia or coloured halos around lights
● Irregular pupils-fixed, smaller, larger
● Visible corneal opacity or haze
● Rash +/- blisters around eye or redness at the corneoscleral junction, ciliary flush
● Foreign body sensation
● Severe headache with nausea, vomiting
● Bacterial ophthalmic infections in children

22
Q

What to do during assess phase of PPCP

A
  1. ascertain symptoms align with conjunctivitis and differentiate between viral, bacterial, allergic
  2. identify red flags and refer
  3. refer if differential diagnosis
23
Q

What is dry eye (differential diagnosis)

A

Burning, foreign body sensation
Rule out medication caused
non urgent referral

24
Q

What is blepharitis (differential diagnosis)

A

Similar to dry eye disease
Redness greater at eyelid margins

Non urgent referral

25
Q

What is uveitis (differential diagnosis)

A

Photophobia, pain, blurred vision

Urgent referral

26
Q

What is angle closure glaucoma (differential diagnosis)

A

Headaches, nausea, vomiting, ocular pain, decreased vision, light sensitivity, halos

Urgent referral

27
Q

What is carotid cavernous fistula (differential diagnosis)

A

Chronic red eye, may have history of head trauma

Urgent referral

28
Q

What is endophthalmitis (differential diagnosis)

A

Severe pain, photophobia

Urgent referral

29
Q

What is cellulitis (differential diagnosis)

A

Pain, double vision, fullness

Urgent referral

30
Q

What is anterior segment tumors (differential diagnosis)

A

Symptoms vary

Urgent referral

31
Q

What is scleritis (differential diagnosis)

A

Decreased vision, moderate to severe pain

Urgent referral

32
Q

What is subconjunctival hemorrhage (differential diagnosis)

A

May have foreign body sensation

Urgent referral

33
Q

Goals of therapy

A
  • Eliminate or reduce signs and symptoms
  • Restore or maintain normal vision
  • Prevent complications (preserve eyesight)
  • Prevent recurrence
  • Cure or control infection where present and prevent transmission of infection to others
34
Q

Non-Pharm Recommendations

A
  • Cold compresses for allergic or viral conjunctivitis
  • Warm compresses or soak for bacterial conjunctivitis
  • Sterile saline irrigation or refrigerated commercial eye wash
  • Eyelid wipes for blepharitis
  • Infection prevention and control measures
  • Contact lens wears should stop using contact lens and seek medical advice
  • Avoid environmental triggers for allergic conjunctivitis
  • Encourage proper use of eye drops and recommend discarding contaminated or older eye drop bottles
  • Discard old eye cosmetic/eye make up products being used
  • Review use of other medications that can worsen eye conditions
35
Q

What is the pharm treatment for viral conjunctivitis

A

No proven treatment for virus
Adenoviral conjunctivitis is usually self limiting (within 5-14 days, refer if after 14 days)
Can use supportive therapies (artificial tears, ophthalmic decongestants, antihistamine/decongestant combinations

36
Q

What are examples of artificial tears (optical lubricants) and what is the dosing

A

Carboxymethylcellulose, polyvinyl alcohol, carbomer 940, polyethylene glycol, sodium hyaluronate
Preferable to use preservative free
1-2 drops TID to QID

37
Q

What are examples of ophthalmic vasoconstrictors and what is the dosing

A

Naphazoline, oxymetazoline, phenylephrine, tetrahydrozoline
1-2 drops every 3 to 4 hours
are meant for occasional and short-term use (3/4 times a month or 3 days in a row)

38
Q

What are examples of antihistamine/decongestants combinations and what is the dosing

A

Antazoline/naphazoline, Pheniramine/naphazoline

1-2 drops every 3 to 4 hours
are meant for occasional and short-term use (3/4 times a month or 3 days in a row)

39
Q

What is the pharm treatment for Bacterial Conjunctivitis

A

usually self-limiting and resolves within 7 to 10 days
• Refer children to primary care provider or optometrist

mild infection (small amounts of discharge, tearing mild burning) can use OTC treatment
moderate infection (copious amounts of discharge and tearing, moderate burning) can use Rx treatment
40
Q

OTC treatment for bacterial conjunctivitis

A

Polymyxin B gramicidin eye/ear drops
1-2 drops 4-6 times per day for 5 to 7 days
If no improvement in 2 days, refer

41
Q

Rx treatment for bacterial conjunctivitis

A

Erythromycin 0.5% ointment
Fusidic acid 1% viscous eye drops
Trimethoprim/polymyxin B 0.1%- 10,000 units/ml
Tobramycin 0.3% ophthalmic drops
Fluoroquinolones: Besifloxacin 0.6%, Ciprofloxacin 0.3%,
Gatifloxacin 0.3%, Moxifloxacin 0.5%, Ofloxacin 0.3%

42
Q

What is the Pharm treatment for allergic conjunctivitis

A
  • First line treatment is to identify and remove allergens
  • OTC Treatment options
    * Artificial tears or saline solution
    * Antihistamine/decongestant drops (like viral)
    * Mast cell stabilizers
  • Rx treatment options
    * Dual acting antihistamines with mast cell stabilizing properties if OTC products have failed
43
Q

Mast cell stabilizer for OTC treatment

A

Sodium cromoglycate 2%
1-2 drops QID
Takes 2-3 days to see improvement. Age > 5 yrs

44
Q

Rx treatment for allergic conjunctivitis

A

Dual acting with antihistamine and secondary mast cell stabilizing properties
Ketotifen 0.025%
Olopatadine 0.1% (also 0.2% and 0.7% available)

45
Q

When should a child return to school if they have bacterial conjunctivitis

A

Return to school 24 hours after starting treatment for bacterial injections

46
Q

When should a child return to school if they have viral conjunctivitis

A

Viral conjunctivitis is contagious

Return to school once there is no discharge (min 1 week)

47
Q

When should you follow up for bacterial conjunctivitis

A

2 days

48
Q

When should you follow up for allergic conjunctivitis

A

3 days

49
Q

When should you follow up for viral conjunctivitis

A

1 week

Pharm 129 (14 decks)

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