Conjunctivitis

Question 1

What is conjunctivitis?

Answer 1

inflammation of the conjunctiva caused by a bacterial/ viral infection

Question 2

What is the conjunctiva?

Answer 2

the external layer covering the outer surface of the globe and the inner surface of the eyelids.

Question 3

Give 5 general presentations associated with conjunctivitis:

Answer 3

1) red, bloodshot eye(s)
2) itchy or gritty sensation
3) discharge
4) chemosis
5) epiphora

Question 4

What is chemosis?

Answer 4

swelling of the conjunctiva

Question 5

What is epiphora?

Answer 5

Excessive watering of the eye

Question 6

What are the 2 classifications of conjunctivitis?

Answer 6

1. Non-infectious
2. Infectious

Question 7

Describe the discharge seen in bacterial conjunctivitis:

Answer 7

purulent (green/yellow) which is typically worse in the morning (the eyes may be stuck together)

Question 8

Describe the discharge seen in viral conjunctivitis:

Answer 8

clear discharge

Question 9

True or false: both bacterial and viral conjunctivitis are highly contagious

Answer 9

true

Question 10

What are 3 viral symptoms that often present alongside conjunctivitis?

Answer 10

1. Dry cough
2. Sore throat
3. Blocked nose

Question 11

What are most cases of viral conjunctivitis caused by?

Answer 11

adenovirus

Question 12

Does viral conjunctivitis tender to present unilateral or bilateral?

Answer 12

Bilateral

Question 13

What lymph nodes are tender in viral conjunctivitis?

Answer 13

pre-auricular (infront/above ear)

Question 14

True or false: conjunctivitis causes pain

Answer 14

false

Question 15

Name 5 viruses that can cause conjunctivitis:

Answer 15

1. Adenovirus
2. Herpes
3. Measles
4. Enterovirus
5. Coxsackie virus

Question 16

What two viruses cause acute haemorrhagic viral conjunctivitis?

Answer 16

1) enterovirus
2) coxsackie virus

Question 17

What are the two types of presentations of adenoviral conjunctivitis?

Answer 17

1. Pharyngoconjunctival fever
2. Epidemic keratoconjunctivitis

Question 18

How does pharyngoconjunctival fever present?

Answer 18

1. Pharyngitis
2. Conjunctivitis
3. Fever

Question 19

How does Epidemic keratoconjunctivitis present?

Answer 19

More severe, associated with corneal involvement and photophobia

Question 20

Give 3 bacterial genera that commonly cause conjunctivitis:

Answer 20

1) Staphylococcus
2) Streptococcus
3) Haemophilus

Question 21

Give two sexually transmitted bacteria that cause conjunctivitis typically in neonates:

Answer 21

1) Chlamydia trachomatis
2) Neisseria gonorrhoea

Question 22

What is opthalmia neonatorum?

Answer 22

N. gonorrhea vertical transmission during birth that leads to sticky eye discharge and may cause blindness

Question 23

What two conjunctivitis bacteria also cause reactive arthritis?

Answer 23

1) Chlamydia trachomatis
2) Neisseria gonorrhoea

Question 24

What is the triad of symptoms seen in reactive arthritis?

Answer 24

1. Arthritis
2. Conjunctivitis
3. Urethritis

Question 25

What is urethritis?

Answer 25

An inflammation of the urethra, the tube that carries urine from the bladder to the outside of the body.

Question 26

Give 3 presentations associated with bacterial conjunctivitis:

Answer 26

1. Unilateral 2. Sticky purulent discharge 3. Rapidly and very inflamed conjunctiva

Question 27

Which type of infection is associated with profuse discharge?

Answer 27

Gonococcal infections

Question 28

What type of conjunctivitis tends to be associated with follicles and pre-auricular lymphadenopathy?

Answer 28

chlamydial conjunctivitis

Question 29

What type of sensitivity reaction is allergic conjunctivitis?

Answer 29

type 1 hypersensitivity

Question 30

Give 3 presentations associated with allergic conjunctivitis:

Answer 30

1) bilateral 2) intense itching 3) examination of the eyelid will reveal papillae (cobblestone appearance)

Question 31

What are the 4 subtypes of allergic conjunctivitis?

Answer 31

1. Seasonal allergic conjunctivitis - secondary to hay fever, therefore most common in summer 2. Perennial allergic conjunctivitis - caused by allergens such as house dust mite 3. Vernal keratoconjunctivitis - most common in young males living in hot dry climates 4. Atopic keratoconjunctivitis - most common in middle aged men.

Question 32

What management can be given for viral conjunctivitis?

Answer 32

tends to be self- limiting and rarely requires treatment

Question 33

What investigations can be used for conjunctivitis?

Answer 33

Conjunctival scrape

Question 34

Name 3 groups of patients that may require a conjunctival scrape?

Answer 34

1. Immunosuppressed 2. Post-corneal transplant 3. Sexual active young people

Question 35

Severe cases of bacterial conjunctivitis may be treated with eye drops - give two examples of agents used in these eyedrops:

Answer 35

1) chloramphenicol 2) fusidic acid

Question 36

Give 3 hygiene measures used to decrease conjunctivitis transmission:

Answer 36

1) avoiding towel sharing 2) avoid close contact 3) regular handwashing

Question 37

True or false: neonates with conjunctivitis need urgent ophthalmology assessment

Answer 37

True

Question 38

What are complications of bacterial conjunctivitis?

Answer 38

Certain bacteria such as Neisseria have a propensity to invade the cornea, which can lead to keratitis and endophthalmitis. These conditions can subsequently cause reduced vision or blindness if not treated promptly.

Question 39

How can allergic conjunctivitis be treated?

Answer 39

Treatment includes allergen avoidance, topical and oral antihistamine as well as topical mast-cell stabilisers and occasionally, mild steroids