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Duke Elder Exam Prep > Conjunctivitis > Flashcards

Conjunctivitis Flashcards

1
Q

What are the main causative organisms for acute bacterial conjunctivitis?

A

Staphylococcus aureus
Strep Pneumonia
Haemophilus influenza
Neisseria gonorrhoea (rarer)

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2
Q

give some symptoms of bacterial conjunctivitis?

A

Unilateral red eye which become bilateral
Redness grittiness and purulent discharge
‘sticky’ eye on wakening
Hyperaemia (conjunctival injection)
Gonococcal is more severe and can cause lid oedema and lymphadenopathy as well

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3
Q

When self limiting treatment fails, how is bacterial conjunctivitis managed?

A

Topical chloramphenicol or fusidic acid

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4
Q

What serological variants of chlamydia cause adult inclusion conjunctivitis?

A

D-K

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5
Q

What investigations are appropriate for adult inclusion conjunctivitis and what might they show?

A

Giemsa stain - shows basophilic intracytoplasmic inclusion bodies
Direct immunofluorescence staining - free elementary bodies
Swab for culturing

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6
Q

What is the treatment for adult inclusion conjunctivitis?

A

1gram of azithromycin or 100mg of doxycycline for 14 days 2x daily

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7
Q

What are some of the features of adult inclusion conjunctivitis?

A 
Red eye with mucopurulent discharge
preauricular lymphadenopathy
Follicles in inferior fornix
Epithelial keratitis and sub epithelial corneal infiltrates
Reiter syndrome
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8
Q

What is trachoma?

A

This is the lading cause of infectious blindness worldwide.

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9
Q

What serological variants cause trachoma?

A

A-C

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10
Q

What is the pathophysiology behind trachoma?

A

Type IV hypersensitivity
Active inflammatory stage and a cicatricial (scarring) chronic stage
Eventual blindness comes from the recurring infection and scarring.

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11
Q

What occurs in the active inflammatory phase of trachoma?

A

Follicular conjunctivitis

Vascularisation of the superior cornea

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12
Q

What occurs in the chronic cicatricial phase of trachoma?

A 
Herbert pits
Arlt's line
Trichiasis
Entropion
Eventually corneal opacities may develop
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13
Q

How is trachoma managed? (SAFE)

A

Surgery for trichiasis
Antibiotics
Facial cleanliness
Environmental improvement

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14
Q

Define Ophthalmia neonatorum:

A

This in conjunctival inflammation durng the first 30 days of life. Most common causes are chlamydia and gonorrhoea.
other causes include HSV and Staph Aureus

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15
Q

How do you treat neonatal conjunctivitis?

A

Chlamydia - oral erythromycin
Gonorrhoea - IM ceftriaxone
HSV - aciclovir IV
Staphylococcal - Topical chloramphenicol

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16
Q

What is the most common cause of viral conjunctivitis?

A

Adenovirus

Then
HSV and molluscum contagiosum

17
Q

What are the main types of viral conjunctivitis?

A 
Acute non-specific follicular conjunctivitis (ANFC) (most commonly seen)
Pharyngoconjunctival fever (PCF)
Epidemic keratoconjunctivitis (EKC)
18
Q

What adenoviral serotypes cause PCF and EKC

A

PCF - 3, 4, 7

ECK - 8, 19, 37

19
Q

What are the four types of allergic conjunctivitis?

A

Seasonal & perennial
Vernal keratoconjunctivitis
Atopic keratoconjunctivitis
Giant papillary conjunctivitis

20
Q

What causes seasonal and perennial allergic conjunctivitis and how is it managed?

A

Type 1 hypersensitivity IgE mediated response. Seasonal is worse in spring/summer while perennial is all year round
Avoid allergens
Anti histamines
Topical sodium Cromoglycate

21
Q

What is giant cell conjunctivitis

A

A type 1 and 4 hypersensitivity reaction to lens wearing. Causes increased ocular tiredness when wearing lenses and is associated with pruritic red eyes and mucous secretions.

22
Q

Define Pinguecula:

A

Bulbar conjunctival degeneration characterised by a white/yellow patch, commonly on the nasal limbus.
Never grows over the cornea
Risk factors - UV light and aging

23
Q

Define Pterygium:

A

This is bulbar conjunctival degeneration characterised by a pink fleshy triangular shaped vascular wedge, usually on the nasal limbus, causing destruction of bowman’s layer and grows over the cornea.

24
Q

What is a chronic blistering autoimmune disease which commonly affects elderly women, and is type 2 hypersensitivity response to autoantibodies attacking the basement membrane?

A

Ocular Mucous membrane pemphigoid

25
Q

Give some features of Ocular Mucous membrane pemphigoid ?

A 
Bilateral conjunctivitis
Symblepharon 
Dry eyes due to goblet cell destruction
Trichiasis
Blepharitis
Ankyloblepharon
Defects of cornea
26
Q

How is Ocular Mucous membrane pemphigoid investigated

A

Direct conjunctival immunofluorescence - shows liner bands of IgA and IgG deposits on the basement membrane

27
Q

How is Ocular Mucous membrane pemphigoid managed?

A

Dapsone or mild disease
Other immunomodulatory agents for severe cases e.g. methotrexate or azathioprine
Steroids can also be used acutely

28
Q

What is superior limbic keratoconjunctivitis?

A

An idiopathic chronic inflammatory condition affecting the superior bulbar conjunctiva limbus and cornea.
Common in females and associated with RA, sicca syndrome and TED.

29
Q

Give some features of superior limbic keratoconjunctivitis:

A

Gradual onset of foreign body, itching and burning associated with photophobia and pain.
Localised conjunctival hyperaemia and papillary reaction
Cornea - epithelial punctate and erosions

30
Q

What are some complications of Pterygium?

A

Obscuring optical access

Astigmatism

31
Q

Give some features of Pterygium:

A 
Stockers lines (epithelial iron deposits on cornea)
Fuchs' islets (white dots on cornea)
May cause ocular dryness, astigmatism or reduced vision
32
Q

How is Pterygium managed?

A

Conservatige management or surgical excision for visual interference
NOTE: recurrence is high

Duke Elder Exam Prep (18 decks)

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