conjunctivitis Flashcards
inflammation of mucous membrane that lines surface of eyeball and inner eyelids
conjunctivitis (pink eye)
other causes of conjunctivitis
keratoconjunctivitis sicca
allergy
chemical irritants
trauma
causes of conjunctivitis
direct contact with contaminated fingers or objects
respiratory secretions
contaminated eye drops
conjunctivitis differentials
acute uveitis
acute glaucoma
corneal disorders
usually bilateral* with copious watery discharge*
crusty in morning but goes away through the day*
may have foreign body sensation
can get follicles on inferior on inferior palpebral conjunctival surface
highly contagious
disease usually lasts about 10-14 days
pharyngitis, fever, malaise, periauricular adenopathy may occur with certain types of adenovirus
viral conjunctivitis
MC of viral conjunctivitis
adenovirus
viral conjunctivitis can also be due to
HSV
varicella zoster
herpes zoster
(often unilateral with lid vesicles)
viral conjunctivitis treatment
cold compress and artificial tears
is viral conjunctivitis contagious?
yes highly
avoid sharing linens, good hand hygiene, etc
viral conjunctivitis treatment if HSV, shingles, or chickenpox infection
topical ganciclovir 0.15% gel
and/or oral acyclovir or valacyclovir
optho consult and follow up
MC organisms of bacterial conjunctivitis
staph (MRSA)
streptococci (strep pneumo)
haemophilus species
pseudomonas (contacts)
moraxella
copious purulent discharge and eye matting*
blurring of vision and discomfort (mild)
self limited (10-14 days if untreated)
bacterial conjunctivitis
bacterial conjunctivitis treatment
topical antibiotic (trimethoprim with polymyxin B or azithromycin)
fluoroquinolones for moderate/severe cases or contact lens wearers (ciprofloxacin)
usually acquired through contact with genital secretions (usually hands to eyes)
EMERGENCY!
Gonococcal conjunctivitis
Gonococcal conjunctivitis diagnosis is confirmed by
stained smear and culture of discharge
why is Gonococcal conjunctivitis an opthalmologic emergency
corneal involvement may rapidly lead to corneal perforation and can lead to vision loss
Gonococcal conjunctivitis symptoms
copious purulent discharge (striking amount)
chemosis (conjunctival edema)
lid swelling
preauricular adenopathy
Gonococcal conjunctivitis smear shows
gram negative intracellular diplococci and polymorphonuclear leukocytes
Gonococcal conjunctivitis treatment
IM ceftriaxone 1 g as single dose*
topical antibiotics (erythromycin and bacitracin)
eye irrigation
other STDs should be considered for treatment (chlamydia)
all partners must be notified and treated
after contact with contaminated genital secretions
acute redness, purulent vs sometimes non purulent, irritation, follicular involvement
immune stimulation causes the lymphoid follicles on the eye to become enlarged causing raised follicles
not always acute and can present as a chronic, indolent conjunctivitis
mild keratitis
nontender preauricular lymph node may be palpated
chlamydia conjunctivitis/ inclusion conjunctivitis
how is chlamydia conjunctivitis/ inclusion conjunctivitis diagnosis confirmed
immunologic tests or PCR on conjunctival samples
chlamydia conjunctivitis/ inclusion conjunctivitis treatment
doxycycline 100 mg PO BID x 7 days
check for genital infection; treat other possible STIs
all partners must be notified and treated
MC infectious cause of blindness worldwide
chronic keratoconjunctivitis from recurrent infection with
chlamydial conjunctivitis/ trachoma
is chlamydial conjunctivitis/ trachoma sexually transmitted
NO, not sexually transmitted strain of chlamydia
how is trachoma shared
direct personal contact
shared towels and cloths
flies that have come in contact with the eyes or nose of an infected person
how to confirm chlamydial conjunctivitis/ trachoma
immunologic tests or PCR on conjunctival samples
recurrent episodes of infection (trachoma) in childhood goes through stages that result in
corneal scarring
cloudy cornea
chlamydial conjunctivitis/ trachoma treatment
single 1 gram dose of oral azithromycin
surgical treatment, if needed:
- correction of lid deformities
- corneal transplantation
improve hygiene/living conditions
benign disease
usually occurs in late childhood and early adulthood
may be seasonal– hay fever
conjunctival hyperemia and chemosis
itching, tearing, redness, stringy discharge*
bilateral
allergic conjunctivitis
how does allergic conjunctivitis look on an exam
bumpy or follicular appearance to tarsal conjunctiva
allergic conjunctivitis treatments
antihistamines
(levocabastine solution, emedastine solution)
mast cell stabilizers
(cromlyn)
combined antihistamines and mast cell stabilizers
(olopatadine)
lubricating eye drops
systemic antihistamines: loratadine 10 mg daily
what should you avoid with allergic conjunctivitis
triggers
dryness, redness, foreign body sensation
Common and chronic disorder
severe cases –> persistent marked discomfort, with photophobia, difficulty in moving the lids, excessive mucus secretion
keratoconjunctivitis sicca
hypofunction of lacrimal glands
loss of aqueous component of tears
hypofunction of lacrimal glands may be caused by
aging
hereditary disorders
systemic disease (sjogren syndrome)
systemic drugs
excessive evaporation of tears
environmental factors
excessive screen time
windy climate
keratoconjunctivitis sicca inspection
usually normal
keratoconjunctivitis sicca slit lamp
abnormalities of tear film stability and volume
severe: loss of corneal luster and ulcers
keratoconjunctivitis sicca fluorescein
stains damaged corneal and conjunctival cells
keratoconjunctivitis sicca schirmer test
determines amount of tears; overproduction/underproduction
keratoconjunctivitis sicca treatment
artificial tears
(but preservatives can cause reactions that mimic dry eyes)
visine not recommended
stop potentially drying medications
humidifiers
blink more
optho may recommend occasional short term topical steroid use but there are risks such as developing a cataract or glaucoma
