conjunctivitis and retinitis pigmentosis

Question 1

conjunctivitis

Answer 1

inflammation of the conjunctiva

Question 2

what is the conjunctiva

Answer 2

thin layer of tissue that covers inside of the eyelids and sclera

causes:
bacterial, viral, allergy, dry eyes, foreign body, toxic, chemical, thermal, neoplasm, factitious, idiopathic, uveitis, keratitis, corneal ulcer, acute angle closure glaucoma, episcleritis, scleritis

Question 3

three main types of conjunctiva

Answer 3

Bacterial
Viral
Allergic

Question 4

symptoms of conjunctivitis

Answer 4

Unilateral or bilateral
Red eyes
Bloodshot
Itchy or gritty sensation
Discharge from the eye

• no pain
• no photophobia
• no reduced visual acuity

vision can be blurry when covered with discharge

bacterial: purulent discharge and inflamed conjunctiva, worse in morning (eyes stuck together) highly contagious
viral: clear discharge. dry cough, sore throat, blocked nose. tender pre auricular lymph nodes, contagious

Question 5

differential diagnosis of acute red eye

Answer 5

painless:
Conjunctivitis
Episcleritis
Subconjunctival Haemorrhage

painful:
Glaucoma
Anterior uveitis
Scleritis
Corneal abrasions or ulceration
Keratitis
Foreign body
Traumatic or chemical injury

Question 6

how is conjunctivitis managed?

Answer 6

usually resolves without tx in 1-2 weeks

good hygine
avoid spreading (sharing towels / rubbing eyes / wash hands)
avoid contact lenses
clean eyes with cooled boiled water and cotton wool to clear discharge

bacterial= antibiotic eye drop. chloramphenicol, fuscidic acid

<1 month age need urgent opthalmology review as neonatal conjunctivitis can be associated with gonnoccocal infection and can cause loss of sight / pneumonia

Question 7

allergic conjunctivitis

Answer 7

contact with an allergen
swelling of conjunctival sac and eye lid
significantly watery discharge and itch

mx: antihistamines, mast-cell stabilisers if ironic-seasonal

Question 8

what is retinitis pigments

Answer 8

a congenital inherited condition where there is degeneration of the rods and cones in the retina

some causes or ‘isolated’ retinas pigementosa but others have systemic disease associated

rods generate more than cones which causes night blindness and also decreased central and peripheral vision

Question 9

how might retinas pigments present?

Answer 9

night blindness (first symptom)
loss of peripheral vision
then loss of central vision

Question 10

fundoscopy findings of retinitis pigmentosa

Answer 10

‘bone spicule’ pigmentation (sharp pointed object) (looks.similar to the networking of a bone matrix)

pigmentation is concentrated around mid-peripheral area of the retina and can be associated with narrowing arterioles and waxy or pale appearance of optic disc

Question 11

systemic diseases that are associated with retinitis pigmentosa

Answer 11

Usher’s Syndrome causes hearing loss plus retinitis pigmentosa
Bassen-Kornzweig Syndrome is a disorder of fat absorption and metabolism causing progressive neurological symptoms and retinitis pigmentosa
Refsum’s Disease is a metabolic disorder of phytanic acid causing neurological, hearing and skin symptoms and retinitis pigmentosa

Question 12

management for retinitis pigmentosa

Answer 12

• ophthalmology referral
• genetic counselling
• vision aids
• sunglasses (protect)
• DVLA
• regular follow up

Vitamin and antioxidant supplements
Oral acetazolamide
Topical dorzolamide
Steroid injections
Anti-VEGF injections

gene therapy

Question 13

bacterial conjunctivitis in pregnant lady

Answer 13

topical fusidic acid is FIRST line for pregnant women as chloramphenicol should be avoided unless essential (neonatal grey baby syndrome in third trimester)

Question 14

opthalmo neonatorum

Answer 14

baby <4 weeks old
unilateral conjunctivitis
discharge and inflammation
bilateral swelling of eyelids

causes: gonorrhoea, chlamdyia, HSV

can lead to perforation of eye and corneal ulceration

tx: cefrixme
if gonoccocal- chloramphenicol, benzylpenicillin

if chlamydia
risk of blindness
erythromycin and oral macrolide

pseudomonas- systemic fluoroquinolone

HSV- acyclovir

Question 15

vernal keratoconjunctivitis hypersensitivity type 1

Answer 15

recurrent episodes of conjunctivitis
chmeosis
watery discharge / tearing
itchy
hx of eczema and rhintis

if turn eyelid upside down- cobblestone papillae and blob around iris. can crease corneal ulcers and permanent scarring

tx: steroids (can become recurrent)