Conjunctivitis Flashcards
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
Conjunctiva
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
epithelium
substantia propria
What is the etiology of conjunctivitis?
1.
2.
3.
Bacterial
Viral
allergic
What type of conjunctiva is this: redness of eye, edema, pus?
a) bacterial
b) viral
c) Allergic
b) bacterial
What type of conjunctiva is this: redness of eye + lacrimation
a) bacterial
b) allergic
c) viral
c) viral
What type of conjunctiva is this: redness of eye, lacrimal, edema, itchy
a. bacterial
b. viral
c. allergic
allergic
Goals of Therapy
Preserve eyesight •Control infection •Control inflammation •Provide symptomatic relief •Minimize duration of symptoms
Symptoms for referral
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
What organisms cause bacterial conjunctivitis?
s. aureus
s. pneumoniae
h. influenzae
m. catarrhalis
How is bacterial conjunctivitis spread?
Direct Contact
- secretions
- contaminated objects or surfaces
How long does it take to typically resolve?
1-2 weeks
3 types of bacterial conjunctivitis 1. acute 2. hyperacute 3. chronic Describe each one
- acute: common, self-limiting
- hyper acute: rapid onset, corneal perforation, compromised vision, N. gonorrhea, referall
- persistent > 4 weeks with relapses, referral needed
Clinical presentation of symptoms of bacterial conjunctivitis
redness edema mucopurulent discharge (pus) glued eyes NO itching mild-moderate stinging foreign body sensation --> feels like something is stuck in the eye
Although the disease is self limiting and does resolve in 1-2 weeks, what are the pros of antibiotic therapy?
- reduced transmission
- earlier return to school/work
- gets fixed in days vs weeks
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
b) fluoroquinalone
What are some risk factors for bacterial conjunctivitis treatment
- exposure to more bacteria( healthcare workers, senior homes)
- diabetes
- immunocompromised
- Contact lens wearers
- ocular surgery
What type of antibiotic is this?
MOA: disrupts folic acid synthesis by competing with para amino benzoic
acid (bacteriostatic against gram positive and negative)
Sulfacetamide
MOA: compromises cell wall integrity through cationic detergent effect
What type of antibiotic is this?
Polymyxin B
MOA: forms a channel in the bacterial cell membrane affecting the concentration of intracellular solutes
What antibiotic is this?
Gramicidin
MOA: inhibits protein synthesis by blocking aminoacyl-tRNA transfer to protein
What antibiotic is this?
fusidic acid
What form of medication is preferred for children?
a) solution
b) suspension
c) ointment
c) ointment
What type of antibiotic should contact lens wearers use?
a) fusidic acid
b) polymyxin B
c) fluoroquinolone
d) macrolide
c) fluoroquinalone
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
b) sulfacetamide
What viral organisms cause viral conjunctivitis?
Adenovirus Enterovirus Coxsackievirus, VZV, HSV, Epstein-Barr virus, Influenza
How is viral conjunctivitis spread?
direct contact
- contaminated surfaces
- secretions
Does viral conjunctivitis affect one eye or both?
both eyes
Clinical presentation of viral conjunctivitis
Diffuse redness – Minimal no pain/discomfort – Gritty sensation – Mild itchiness – Watery/serous discharge
4 types of treatment for viral conjunctivitis (antibiotic eyedrops don’t work)
Non-pharmacological
Ocular decongestants/ vasoconstrictors
Artificial Tears
Topical Antihistamines
- Naphazoline
- Oxymetazoline
- Phenylephrine
- Tetrahydrozoline
This are
a) decongestants/vasoconstrictors
b) ocular lubricants
c) topical antihistamines
a) decongestants
Side effects from using too much of ophthalmic decongestants and vasoconstrictors
cause rebound hyperemia, causes rebound vasodilation
Herpes Zoster ophthalmicus calls for referral to ophthalmologist . T or F
True, it can lead to blindness
due to dormant chicken box virus
What is allergic conjunctivitis caused by?
airborne allergens contacting the eye
Clinical presentation of allergic conjunctivitis
– Diffuse redness – No corneal involvement – Cobblestone papillae under the upper eyelid – Blistered conjunctiva – Bilateral – Painless tearing – Intense itchiness – Stringy/ropy/watery discharge
Treatment for allergic conjunctivitis
Allergen avoidance • Mast cell stabilizer • Topical histamine H1 receptor antagonists (antihistamines) • Topical decongestants/vasoconstrictors • Ocular lubricants
- Sodium cromoglycate
- Nedocromil
- Lodoxamide
These medications are what kind of medication?
a) topical antihistamines
b) mast cell stabilizers
c) ocular lubricants
mast cell stabizers
Antazoline/ Naphazolin
Pheniramine/ Naphazoline
Ketotifen
Olopatadine
These medications are what kind of medication?
a) topical antihistamines
b) mast cell stabilizers
c) ocular lubricants
a) topical antihistamines (regularly)
Carboxymethylcellulose
Dextran 70/ hypromellose
Polysorbate
Polyvinyl alcohol
These medications are what kind of medication?
a) topical antihistamines
b) mast cell stabilizers
c) ocular lubricants
What ingredient in ocular lubricants can cause an allergic reaction?
a) EDTA
b) Benzalkonium chloride
c) Carboxymethylcellulose
d) Polyvinyl alcohol
b) Benzalkonium chloride
What are some non-pharm measures for conjunctivitis?
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)
When can a child or adult return to work or school with viral/bacterial conjunctivitis?
a) until there’s no discharge
b) use 24 hours of antibacterial eye drops in for bacterial conjunctivitis
Assume _____ unless mucopurulent discharge, eyelids matting together in AM, no itchiness, no history of conjunctivitis
a) bacterial
b) viral
c) allergic
b) viral
