Conjunctivitis and Keratitis

Question 1

what bacteria can cause bacterial conjunctivitis in neonates

Answer 1

staph aureus, neisseria gonorrhoea, chlamydia trachomatis

Question 2

what type of conjunctivitis must always be referred to an ophthalmologist

Answer 2

bacterial conjunctivitis in neonates

Question 3

what types of bacteria commonly cause bacterial conjunctivitis

Answer 3

staph aureus(most common), strep pneumoniae, haemophilus influenzae(esp in children)

Question 4

describe the appearance of bacterial conjunctivitis

Answer 4

red eye with lots of discharge

Question 5

what is involved in the treatment of bacterial conjunctivitis

Answer 5

swab, topical antibiotic,

Question 6

what antibiotic is usually used for bacterial conjunctivitis and what bacteria does it work for

Answer 6

chloramphenicol qds, effective against strep, staph, haemophilus but not pseudomonas

Question 7

when should chloramphenicol be avoided in bacterial conjunctivitis

Answer 7

if history of aplastic anaemia, or be wary if symptoms continue to worsen

Question 8

what are the common types of viral conjunctivitis

Answer 8

adenovirus, herpes simplex, herpes zoster

Question 9

describe the appearance of adenoviral conjunctivitis

Answer 9

“pink” eye, watery discharge

don’t need to stay off school

Question 10

describe the presentation of chlamydial conjunctivitis

Answer 10

often chronic history, unresponsive to treatment, suspect in bilateral conjunctivitis in young adult, may/may not have symptoms uveitis/vaginitis

Question 11

what can chlamydial conjunctivitis lead to and what follow up must be done

Answer 11

can lead to subtarsal(under eyelid) scarring, and need contact tracing

Question 12

what clinical feature is often seen with bacterial keratitis

Answer 12

hypopyon, collection of white pus at bottom of lens, very obvious

Question 13

what treatment is needed for bacterial keratitis and what is it often associated with

Answer 13

need admission for hourly eye drops, daily review(never managed in community)
usually association with corneal pathology or contact lens wearer
(very rare)

Question 14

what is keratitis

Answer 14

inflammation of the cornea

Question 15

describe the presentation of viral herpetic keratitis

Answer 15

very painful, can be recurrent, dendritic ulcer, may have reduced corneal sensation if recurrent

Question 16

what treatment is involved for viral herpetic keratitis

Answer 16

topical antiviral ganciclovir, if treated with steroids can cause corneal melt

Question 17

describe herpes zoster keratitis compared to herpetic keratitis

Answer 17

similar, but dendritic ulcer typically has multiple branches in herpes zoster

Question 18

describe the presentation of adenoviral keratitis

Answer 18

bilateral, usually follow URTI/conjunctivitis, may affect vision, subepithelial infiltrates over cornea

Question 19

describe the presentation of fungal keratitis

Answer 19

often chronic history, seen in those who work outside/have ocular surface disease, often corneal lesions more defined than bacterial, can have hypopyon

Question 20

what treatment is used for fungal keratitis

Answer 20

topical anti-fungals

Question 21

describe the presentation of acanthamoeba in keratitis

Answer 21

extremely painful, can be diagnosed late after treatment for other cause doesn’t work, white lesion on cornea, contact lens wearer