Conjunctivitis (OP)

Question 1

Define conjunctivitis.

Answer 1

Inflammation of conjunctiva (mucus membrane lining inside of eyelids and sclera)

Question 2

What are some specific sub-categories of conjunctivitis? (2)

Answer 2

• keratoconjunctivitis - associated inflammation of cornea
• blepharoconjunctivitis - associated eyelid involvement

Question 3

What are the main types of conjunctivitis? (3)

Answer 3

• bacterial conjunctivitis (more common in children)
• viral conjunctivitis (more common in adults)
• allergic conjunctivitis

Question 4

What are some causes of conjunctivitis? (7)

Answer 4

• bacteria (more common in children)
• viruses (more common in adults)
• allergic reactions
• mechanical irritation
• medicines
• immune-mediated
• neoplastic

Question 5

Which bacteria commonly cause conjunctivitis? (4)

Answer 5

• S. aureus
• H. influenzae
• Pneumococcus
• Moraxella catarrhalis

Question 6

Which viruses commonly cause conjunctivitis? (7)

Answer 6

• adenovirus
• enteroviruses
• HSV
• EBV
• VZV
• Molluscum contagiosum
• Coxsackie

Question 7

How does conjunctivitis generally present?

Answer 7

Irritated red eye with watery/purulent discharge

Question 8

What are the clinical features of conjunctivitis? (6)

Answer 8

• red eye (due to ocular hyperaemia)
• discharge + crust formation
• itching (most intense in seasonal allergic conjunctivitis)
• eyelid swelling
• eyelids stuck together in morning
• photophobia (corneal involvement)

Question 9

What might you see on examination in conjunctivitis? (7)

Answer 9

• bloodshot eyes
• dilated conjunctival vessels
• conjunctival chemosis (swelling)
• conjunctival follicles (round collections of lymphocytes appearing as small dome-shaped nodules)
• conjunctival papillae (allergic)
• superficial punctate keratopathy
• palpable pre-auricular lymph nodes (bacterial, absent in viral)

Question 10

Is visual acuity affected in conjunctivitis?

Answer 10

No

Question 11

What can the nature of the red eye in conjunctivitis tell us about the cause?

Answer 11

• unilateral = bacterial
• bilateral = allergic

Question 12

What can the nature of the discharge in conjunctivitis tell us about the cause?

Answer 12

• bacterial - purulent (pus)
• viral - watery
• allergic - mucoid, sticky

Question 13

What do we see in bacterial conjunctivitis?

Answer 13

• unilateral redness + thick purulent discharge (yellow crusting)
• eyes may be stuck together in morning

Question 14

What do we see in viral conjunctivitis?

Answer 14

• bilateral (begins unilateral) redness + clear watery discharge
• recent URTI

Question 15

What do we see in allergic conjunctivitis?

Answer 15

• bilateral redness + sticky, mucoid discharge
• itchiness
• may be seasonal or due to specific allergens (patient will have Hx of atopy - eczema, asthma, hayfever)

Question 16

What are some risk factors for conjunctivitis? (7)

Answer 16

• exposure to infected person
• allergen exposure
• concurrent infection
• contact lens use
• topical medications - glaucoma meds, Abx, antivirals
• rosacea
• Hx atopy (eczema, asthma, hayfever)

Question 17

What are the main two investigations done for conjunctivitis?

Answer 17

• rapid adenovirus immunoassay
• cell culture & gram stain

Question 18

What are some differential diagnoses for conjunctivitis? (6)

Answer 18

• dry eyes (chronic, minimal discharge)
• blepharitis (chronic, minimal discharge)
• episcleritis (unilateral)
• scleritis (severe ocular pain on movement and redness, reduced visual acuity may be present)
• keratitis (intense pain, discharge, photophobia, lacrimation)
• uveitis (pain, red, no discharge, photophobia)

Question 19

How do we manage allergic conjunctivitis?

Answer 19

• mild - supportive (avoid allergen, cold compresses, artificial tears)
• moderate - mast cell stabiliser +/- topical antihistamine (sodium cromoglicate ophthalmic)
• severe - add topical corticosteroid (prednisolone) or ciclosporin, immunotherapy

Question 20

How do we manage bacterial conjunctivitis?

Answer 20

• mild/mod - topical broad-spectrum Abx (chloramphenicol or topic fusidic acid for pregnant women)
• mod/severe - topical fluoroquinolone (ciprofloxacin)
• hyperacute (gonococcal) - topical and systemic Abx (ceftriaxone, doxycycline/azithromycin, bacitracin)

Question 21

How do we manage viral conjunctivitis?

Answer 21

Topical antivirals, antihistamine drops, supportive care:

• adenovirus - topical antihistamine (epinastine), topical corticosteroid, topical ganciclovir
• HSV - observation +/- topical/oral antivirals
• VZV - refer to opthalmologist
• Molluscum contagiosum - observation and removal of lesions

Question 22

How do we manage chlamydial conjunctivitis?

Answer 22

Azithromycin

Question 23

How do we manage conjunctivitis due to contact lens?

Answer 23

Topical corticosteroids with fluoroquinolone, do not wear contacts during episode

Question 24

How do we manage mechanical conjunctivitis?

Answer 24

Supportive measures +/- surgery (full-thickness horizontal shortening of upper eyelid)

Question 25

What is some general advice for conjunctivitis? (2)

Answer 25

• do not wear contact lenses
• do not share towels

Question 26

What are some complications of conjunctivitis? (4)

Answer 26

• dry eyes
• keratitis
• subepithelial corneal infiltrates
• lacrimal drainage problems

Question 27

Describe the prognosis of conjunctivitis.

Answer 27

Mostly self-limiting