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HEENT > Conjunctivitis > Flashcards

Conjunctivitis Flashcards

1
Q

mucous membrane that lines the inside surface of the lids and covers the surface of the globe up to the junction of the sclera and cornea

A

Conjunctiva

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2
Q

Conjunctiva comprised of:
_______: Non, keratinized, containing goblet cells

______ ______: Layer of transparent fibrous connective tissue making up bulk of cornea. Highly vascularized. Site of immunologic activity

A

epithelium

substantia propria

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3
Q

What is the etiology of conjunctivitis?
1.
2.
3.

A

Bacterial
Viral
allergic

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4
Q

What type of conjunctiva is this: redness of eye, edema, pus?

a) bacterial
b) viral
c) Allergic

A

b) bacterial

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5
Q

What type of conjunctiva is this: redness of eye + lacrimation

a) bacterial
b) allergic
c) viral

A

c) viral

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6
Q

What type of conjunctiva is this: redness of eye, lacrimal, edema, itchy

a. bacterial
b. viral
c. allergic

A

allergic

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7
Q

Goals of Therapy

A 
Preserve eyesight
•Control infection
•Control inflammation
•Provide symptomatic relief
•Minimize duration of symptoms
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8
Q

Symptoms for referral

A

Reduction of visual acuity
Ciliary flush – redness is most pronounced in the ring of the limbus
Photophobia
Severe foreign body sensation that prevents patient from keeping eye open
Corneal opacity
Fixed pupil
Severe headache with nausea

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9
Q

What organisms cause bacterial conjunctivitis?

A

s. aureus
s. pneumoniae
h. influenzae
m. catarrhalis

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10
Q

How is bacterial conjunctivitis spread?

A

Direct Contact

  1. secretions
  2. contaminated objects or surfaces
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11
Q

How long does it take to typically resolve?

A

1-2 weeks

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12
Q 
3 types of bacterial conjunctivitis
1. acute 
2. hyperacute 
3. chronic 
Describe each one
A
  1. acute: common, self-limiting
  2. hyper acute: rapid onset, corneal perforation, compromised vision, N. gonorrhea, referall
  3. persistent > 4 weeks with relapses, referral needed
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13
Q

Clinical presentation of symptoms of bacterial conjunctivitis

A 
redness
edema
mucopurulent discharge (pus)
glued eyes 
NO itching 
mild-moderate stinging 
foreign body sensation --> feels like something is stuck in the eye
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14
Q

Although the disease is self limiting and does resolve in 1-2 weeks, what are the pros of antibiotic therapy?

A
  1. reduced transmission
  2. earlier return to school/work
  3. gets fixed in days vs weeks
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15
Q

There is no clear efficacy advantage of different topical antibiotics with the exception of one type class of antibiotic reserved for more serious cases

a) aminoglycosides
b) fluoroquinolone
c) macrolides
d) beta-lactam

A

b) fluoroquinalone

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16
Q

What are some risk factors for bacterial conjunctivitis treatment

A
  1. exposure to more bacteria( healthcare workers, senior homes)
  2. diabetes
  3. immunocompromised
  4. Contact lens wearers
  5. ocular surgery
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17
Q

What type of antibiotic is this?

MOA: disrupts folic acid synthesis by competing with para amino benzoic
acid (bacteriostatic against gram positive and negative)

A

Sulfacetamide

18
Q

MOA: compromises cell wall integrity through cationic detergent effect
What type of antibiotic is this?

A

Polymyxin B

19
Q

MOA: forms a channel in the bacterial cell membrane affecting the concentration of intracellular solutes
What antibiotic is this?

A

Gramicidin

20
Q

MOA: inhibits protein synthesis by blocking aminoacyl-tRNA transfer to protein
What antibiotic is this?

A

fusidic acid

21
Q

What form of medication is preferred for children?

a) solution
b) suspension
c) ointment

A

c) ointment

22
Q

What type of antibiotic should contact lens wearers use?

a) fusidic acid
b) polymyxin B
c) fluoroquinolone
d) macrolide

A

c) fluoroquinalone

23
Q

Which type of antibiotic has serious side effects such as blood disorders, stevens-johnson syndrome,?

a) fusidic acid
b) sulfacetamide
c) gramacidin
d) polymyxin b

A

b) sulfacetamide

24
Q

What viral organisms cause viral conjunctivitis?

A 
Adenovirus
Enterovirus
Coxsackievirus, 
VZV, HSV, 
Epstein-Barr virus, 
Influenza
25
Q

How is viral conjunctivitis spread?

A

direct contact

  1. contaminated surfaces
  2. secretions
26
Q

Does viral conjunctivitis affect one eye or both?

A

both eyes

27
Q

Clinical presentation of viral conjunctivitis

A 
Diffuse redness
– Minimal no pain/discomfort
– Gritty sensation
– Mild itchiness
– Watery/serous discharge
28
Q

4 types of treatment for viral conjunctivitis (antibiotic eyedrops don’t work)

A

Non-pharmacological
Ocular decongestants/ vasoconstrictors
Artificial Tears
Topical Antihistamines

29
Q
  1. Naphazoline
  2. Oxymetazoline
  3. Phenylephrine
  4. Tetrahydrozoline

This are

a) decongestants/vasoconstrictors
b) ocular lubricants
c) topical antihistamines

A

a) decongestants

30
Q

Side effects from using too much of ophthalmic decongestants and vasoconstrictors

A

cause rebound hyperemia, causes rebound vasodilation

31
Q

Herpes Zoster ophthalmicus calls for referral to ophthalmologist . T or F

A

True, it can lead to blindness

due to dormant chicken box virus

32
Q

What is allergic conjunctivitis caused by?

A

airborne allergens contacting the eye

33
Q

Clinical presentation of allergic conjunctivitis

A 
– Diffuse redness
– No corneal involvement
– Cobblestone papillae under the upper eyelid
– Blistered conjunctiva
– Bilateral
– Painless tearing
– Intense itchiness
– Stringy/ropy/watery discharge
34
Q

Treatment for allergic conjunctivitis

A 
Allergen avoidance
• Mast cell stabilizer
• Topical histamine H1 receptor antagonists (antihistamines)
• Topical decongestants/vasoconstrictors
• Ocular lubricants
35
Q
  1. Sodium cromoglycate
  2. Nedocromil
  3. Lodoxamide

These medications are what kind of medication?

a) topical antihistamines
b) mast cell stabilizers
c) ocular lubricants

A

mast cell stabizers

36
Q

Antazoline/ Naphazolin
Pheniramine/ Naphazoline
Ketotifen
Olopatadine

These medications are what kind of medication?

a) topical antihistamines
b) mast cell stabilizers
c) ocular lubricants

A

a) topical antihistamines (regularly)

37
Q

Carboxymethylcellulose
Dextran 70/ hypromellose
Polysorbate
Polyvinyl alcohol

A

These medications are what kind of medication?

a) topical antihistamines
b) mast cell stabilizers
c) ocular lubricants

38
Q

What ingredient in ocular lubricants can cause an allergic reaction?

a) EDTA
b) Benzalkonium chloride
c) Carboxymethylcellulose
d) Polyvinyl alcohol

A

b) Benzalkonium chloride

39
Q

What are some non-pharm measures for conjunctivitis?

A

Remove contact lenses until the problem resolves (glasses ok)
Avoid makeup, smoke, wind, and other irritants

Apply cold compresses for allergic and viral conjunctivitis;
Warm compresses for bacterial conjunctivitis

Practice lid hygiene for blepharitis (inflammation of eyelids):

Warm water compresses the closed eyelid for 5-10 mins, followed by
gentle scrubbing of lid margins with warm water. Repeat daily at bedtime

hand hygiene! (infectious causes are contagious and may spread to nonaffected eyes and to others)

Consider all shared objects that may contact infected eye(s) (eg. Facetowel)

40
Q

When can a child or adult return to work or school with viral/bacterial conjunctivitis?

A

a) until there’s no discharge

b) use 24 hours of antibacterial eye drops in for bacterial conjunctivitis

41
Q

Assume _____ unless mucopurulent discharge, eyelids matting together in AM, no itchiness, no history of conjunctivitis

a) bacterial
b) viral
c) allergic

A

b) viral

HEENT (14 decks)

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