Conjunctivitis & Corneal Disorders Flashcards
What are the symptoms of viral conjunctivitis?
bilateral, copious watery, red discharge
highly contagious
foreign body sensation
follicles on inferior palpebral conjunctive surface
tender pre-auricular lymphadenopathy
What is the cause of viral conjunctivitis?
adenovirus
What is the treatment of viral conjunctivitis?
supportive treatment –> COLD compresses & artificial tears, NO steroid drops
counsel on contagiousness
What is the clinical presentation of HSV viral conjunctivitis?
Unilateral with lid vesicles, more likely to have complications, around eyelid –> into eye
What is the causation of HSV viral conjunctivitis?
HSV, varicella zoster, herpes zoster
What is the treatment of HSV viral conjunctivitis?
NO ABX, NO STEROIDS
topical ganciclovir (expensive and topical antiviral) and/or oral acyclovir/valacyclovir
What is the clinical presentation of bacterial conjunctivitis?
copious purulent discharge and eye matting, blurring of vision and discomfort
What bacteria causes bacterial conjunctivitis?
MRSA, strep, H.flu, pseudomonas contact lenses!!!!, moraxella
What is the treatment of bacterial conjunctivitis?
topical antibiotic –> trimethoprim with polymyxin B
severe cases – fluoroquinolones or pseudomonas (ciprofloxacin)
What is the clinical presentation of gonococcal conjunctivitis?
copious purulent discharge, like a LOT
chemosis (conjunctival edema), lid swelling, preauricular adenopathy
What is the cause of gonococcal conjunctivitis?
genital secretions
What are you looking for in diagnosis of gonococcal conjunctivitis?
smear: gram- of intracellular diplococci and polymorphonuclear leukocytes
What is the treatment for gonococcal conjunctivitis?
IM ceftriaxone 1g
EMERGENCY
What is the clinical presentation of chlamydia (inclusion) conjunctivitis?
acute redness, purulence/non-irritation, follicular involvement
What are the risk factors for chlamydia (inclusion) conjunctivitis?
sexual history
What is the cause of chlamydia (inclusion) conjunctivitis?
transmitted sexually
What diagnostic tests should you do if you suspect chlamydia (inclusion) conjunctivitis?
immunologic tests, PCR, check for other STIs
What is the treatment for chlamydia (inclusion) conjunctivitis?
Doxycycline PO, can do with gonococcal conjunctivitis IM ceftriaxone if concern
What is the clinical presentation of chlamydial conjunctivitis (trachoma)?
purulence or cloudiness, follicular inflammation on inside of eye, recurrent situation
What are risk factors for chlamydial conjunctivitis (trachoma)?
poverty, poor living conditions
What is the cause of chlamydial conjunctivitis (trachoma)?
recurrent infections through direct personal contact (MCC of infectious blindness)?
How do you treat chlamydial conjunctivitis (trachoma)?
single dose of oral azithromycin; may need surgical correction or corneal transplantation
What is the clinical presentation of allergic conjunctivitis?
itching, tearing, redness, stringy discharge
How to diagnose allergic conjunctivitis on an exam?
bumpy or follicular appearance to tarsal conjunctiva, cobblestoning, stringy discharge
What is the treatment of allergic conjunctivitis?
Cromolyn (MCS) or olopatadine (MCS/AH)
if this doesn’t work, upgrade to loratadine
What is the clinical presentation of keratoconjunctivitis sicca (dry eye)?
dryness, redness, foreign body sensation, variable vision
SEVERE: discomfort, photophobia, difficulty moving lids, excessive mucus
What are risk factors for keratoconjunctivitis sicca ?
older women (aging, hereditary diorders, systemic disease)
What is the common name for keratoconjunctivitis sicca?
dry eye
What is the causation of keratoconjunctivitis sicca?
hypofunction of lacrimal glands, excessive evaporation of tears
What helps diagnose keratoconjunctivitis sicca?
slit lamp, fluorescein stains to show damaged corneal and conjunctival cells; shirmer test
What is the treatment for keratoconjunctivitis sicca?
refer to opthamology
artificial tears; not visine, stop drying medications, use humidifiers
How do cataracts present?
bilateral opacities of lens, progressive vision blurring, glare in bright light/night driving
What are risk factors for cataracts?
age>60 years, smoking
What are causes of cataracts?
congenital (intrauterine infections, rubella/CMV), trauma, 2ndary disease, radiation
What are cataracts appearance upon exam?
fundus loses reflex and pupil appears white
What is the treatment of cataracts?
refer to ophthalmology and lens replacement
What are the symptoms of corneal abrasions?
severe pain, photophobia, foreign body sensation
What are causes of corneal abrasions?
trauma, foreign bodies, contact lens –> pseudomonas bacteria
How to diagnose corneal abrasion?
check visual acuity before numbing!
numb eye with tetracine:
fluorescein stain to look for abnormality, lid inversion to rule out foreign body
How do you treat corneal abrasion?
bacitaracin-polymyxin or erythromycin opthalmic OINTMENT is key
no contacts for a week
if pseudomonas: ciprofloxacin (if contact lens)
NOOO Steroids. Oral NSAIDS for comfort, may need cycloplegic drops and schedule a follow up
If a patient wears contact lens and presents with corneal abrasion, what should you assume the cause is and the subsequent treatment?
Pseudomonas, ciprofloxacin
What is the clinical presentation of corneal ulcers?
pain, photophobia, tearing, reduced vision, corneal injection, discharge?
Corneal CRATER
What is the causation of corneal ulcer?
infection or long term contacts use
How do you diagnose corneal ulcer?
always check visual acuity
Fluorescein stain to look for abnormality and lid inversion to rule out foreign body; tetracaine to numb
How do you treat a corneal ulcer?
refer urgently to opthalmology; prob need antibiotics
What is the usual cause of a foreign body in the eye?
construction or farming
What diagnosis process needs to be done for a foreign body in the eye?
check vision, may need fluorescein if you cannot see anything
if present wound , but cannot find object and there is vision loss, consider intraocular foreign body
How do you manage a foreign body in the eye?
remove with sterile wet qtip or 25g needle, bacitracin-polymyxin or erythromycin ophthalmic ointment
if intraocular, EMERGENT referral to opthalmology
What are the symptoms of bacterial keratitis?
corneal opacity/infiltrate with red eye, photophobia, foreign body sensation, purulent discharge
What is a risk factor for bacterial keratitis?
contact lens wearers
What are the causes of bacterial keratitis?
overnight use, trauma, staph, strep, pseudomonas aeruginosa, moraxella
What are you looking for in an exam for bacterial keratitis?
opacity (usually <.5) and pus in chamber
How do you treat bacterial keratitis?
emergent referral to ophthalmology
usually need topical antibiotic –> fluoroquinolone q1h
NO steroids, STOP contacts
What is the clinical presentation of viral keratitis?
red eye, photophobia, watery discharge,foreign body dendritic lesion for hsv
What is the cause of viral keratitis?
HSV
What is the treatment of viral keratitis?
antivirals + topical corticosteroids (refer to ophthalmology)
immunocomp will require more treatment; will reoccur when exposed to stressors and risk for corneal scarring
What is the clinical presentation of fungal keratitis?
feathery edges and “satellite” lesions; pus in chamber
What is the cause of fungal keratitis?
chronic ocular surface disease and contact lens wearers
What is the common cause of fungal keratitis?
plant material in agricultural setting
What are the diagnosing steps of fungal keratitis?
culture fungi
diagnose often delayed and treatment difficult
What is treatment like for fungal keratitis?
long term treatment
What is the clinical presentation of pinguecula?
yellow nodule on conjunctiva, bilateral
What is the cause of pinguecula?
degenerative; benign
What is the treatment of pinguecula?
NO treatment required, artificial tears may help or topical anti-inflammatories
What is the clinical presentation of pterygium?
fleshy TRIANGULAR conjunctival tissue, always on nasal side, bilateral
What is the cause of pterygium?
long term exposure to wind, sun, sand, dust
What is the treatment of pterygium?
artificial tears or topical NSAIDs, sometimes excised
What is the clinical presentation of iritis (anterior acute uveitis)?
unilateral eye pain, redness, tearing, photophobia, decreased vision, miosis, severe = hyponon
What are the risk factors for iritis?
history of eye trauma, systemic disease, autoimmune 25-64 years
What is the more specified name for anterior acute uveitis?
iritis
What is the causation of iritis?
trauma, infections, inflammation
What is extremely important to remember for iritis?
this is not common in children unless they are having rheumatoid arthritis. MUST test.
Lab testing is so important
What is the treatment for iritis?
refer to ophthalmology for any red eye AND vision loss, steroid and/or cycloplegics for comfort
What is the clinical presentation of intermediate/posterior uveitis?
altered vision, floaters, usually PAINLESS, some redness, tearing, usually bilateral onset, few vision complaints
What are the risks for intermediate/posterior uveitis?
same as irisitis –> history of eye trauma, systemic disease 25-64 years
What are the causations of intermediate/posterior uveitis?
trauma, infections, inflammation, toxoplasmosis*
How do you diagnose intermediate/posterior uveitis?
same reminder about children
traumatic: dilated fundoscopy, measure IOP
non traumatic: slit lamp and lab tests
What is the treatment for intermediate/posterior uveitis?
refer to ophthalmology for any red eye along with vision loss
topical steroids with or without cycloplegics (same as iritis)
What is the relative afferent pupillary defect?
ray in affected pupil it dilates
