Differentials of Red Eyes, Conjunctiva

Question 1

Caused by direct contact w/ infected secretions

Answer 1

Bacterial Conjunctivitis

Question 2

Caused most commonly by contact w/ respiratory or ocular secretions.. (adenoviruses)

Answer 2

Viral Conjunctivitis

Question 3

Rhinoconjunctivitis is the most common form of this type of conjunctivitis; found in 20% of population

Answer 3

Allergic Conjunctivitis

Question 4

Results from a reaction to an outside agent, typically ocular medication

Answer 4

Toxic Conjunctivitis (medicamentosa)

Question 5

What type of discharge is found with viral conjunctivitis?

Answer 5

Watery

Question 6

What type of discharge is found with bacterial conjunctivitis?

Answer 6

Mucous/Muco-purulent

Question 7

What are the top 6 symptoms of conjunctivitis?

Answer 7

1. lids stuck together
2. bilateral or unilateral
3. burning
4. itching
5. grittiness
6. discharge

Question 8

How long does it take for a bacterial conjunctivitis to resolve on it’s own?

Answer 8

5 days, self-limiting condition

Question 9

What is the hallmark sign of a bacterial conjunctivitis?

Answer 9

Acute onset

Question 10

What type of discharge does a bacterial conjunctivitis present with?

Answer 10

Begins as watery then becomes mucopurulent

Question 11

What are the top 4 bacteria that cause conjunctivitis?

Answer 11

1. H. influenza
2. S. pneumoniae
3. S. Aureus
4. Moraxelis Catarrhalis

Question 12

What are the top 4 signs of bacterial conj.?

Answer 12

1. Diffuse injection, worse in bulbar
2. Intense papillary rxn (blood vessels in the center)
3. Watery than mucopurulent discharge
4. corneal PEE’s

Question 13

How do we treat bacterial conjunctivitis? What’s the dosing?

Answer 13

Topical antibiotics (gentamicin/polymyxin) OR steroid/antibiotics (tobradex, zylet)…

QID 5x7 days

Question 14

What is the hallmark sign of viral conj.? Will there be pre-auricular lymphadenopathy?

Answer 14

Watering

Yes

Question 15

Patients w/ viral conjunctivitis will most often report what?

Answer 15

Recently had common cold (bc of adenovirus)

Question 16

What are the top 5 signs of a viral conjunctivitis?

Answer 16

1. Follicles (blood vessel around it)
2. Conj. hemorrhages
3. Chemosis
4. Pseudomembranes
5. Keratitis

Question 17

What is the tx for viral conj.?

Answer 17

No tx needed.

Can use steroid to stop inflammation and reduce redness

Question 18

Allergic conjunctivitis will present as an _____,____ _____.

Answer 18

Transient, acute attack

Question 19

What type of discharge is found in allergic. cong? What’s the most significant sign?

Answer 19

• Ropey discharge

- itching is most significant sign

Question 20

T or F: Seasonal allergies are worse in the spring and summer (hay fever)… Perennial allergies area throughout the year but worse in the autumn.

Answer 20

True

Question 21

What is the tx for allergic conj.?

Answer 21

Mast cell stabilizer/antihistamine combo.

Can use steroid in severe cases

Question 22

If dx is GPC, what are the top 3 things that should be done?

Answer 22

1. D/c CL wear
2. Begin MCS/AH combo (pataday qd)
3. Maybe steroid qid

Question 23

What are the main offenders of toxic conjunctivitis?

Answer 23

1. Preservatives in glaucoma drops

2. Neomycin + Tobramycin

Question 24

What type of discharge is found in toxic conj?

Answer 24

Watery discharge

Question 25

What is the tx for toxic conj.?

Answer 25

1. identify and d/c medication that's causing it | 2. Steroids QID x 7 days (pred forte/durazol)

Question 26

This is an asymptomatic bubble on the bulbar conj. containing clear fluid

Answer 26

Retention of Inclusion Cyst

Question 27

Retention/Inclusion Cyst are found in patients with?

Answer 27

extreme allergies to something (i.e. shrimp)

Question 28

What is the tx for retention cysts?

Answer 28

may be punctured by a needle

Question 29

This is often seen in darker-skinned individuals, results from additional melanin and stabilizes by early adulthood.

Answer 29

Epithelial Melanosis

Question 30

Epithelial melanosis is usually benign, but if initially presents around age 30+, we must _____.

Answer 30

rule out malignancy

Question 31

This is most commonly seen in the elderly or those with chronic inflammatory conjunctival disease. Presents as small, chalky-yellow deposits just beneath the conj surface.

Answer 31

Concretions

Question 32

What is the tx for concretions

Answer 32

none necessary, but may be removed with needle or phenyl soaked cotton swab if irritating the patient

Question 33

This is when conjunctival tissue becomes redundant and excessive. Found to be a normal aging change or related to lid margin disease/DES.

Answer 33

Conjunctivochalasis

Question 34

What is the tx for conjunctivochalasis?

Answer 34

1. Topical Lubricants 2. Low Dose Doxy 3. Surgical Resection

Question 35

Pinguecula/itis can be tx'd with?

Answer 35

topical steroids if inflamed or ATs.

Question 36

What's better for a pinguecula, NSAIDs or Steroids? Why

Answer 36

NSAIDs - recurrence of inflammation is less when compared to steroids

Question 37

This is an inflammatory lesion of the conj that generally appears after surgery or minor trauma to conj. Appears as fleshy, fast growing, red, pedunculated vascular mass and bleeds easily.

Answer 37

Pyogenic Granuloma

Question 38

What is the tx for a pyogenic granuloma?

Answer 38

1. Steroids 2. Excision 3. Cautery

Question 39

This occurs when the bulbar and palpebral conj stick together, preventing the eye from moving freely. Results in ocular motility disorders, diplopia, entropion and inadequate lid closure.

Answer 39

Symblepharon

Question 40

What are the top 5 etiologies for a symblepharon?

Answer 40

1. DES 2. SJ syndrome 3. Cicatricial Pemphigoid 4. Chemical Injury 5. EKC or other conj. infection complicated by scarring

Question 41

What is the tx for a symblepharon?

Answer 41

Oculoplastics

Question 42

This is a well-circumscribed, yellow-white solid mass that involves the bulbar conj at the corneoscleral limbus. Dense fibrous tissue lined by conjunctival epithelium and may contain hair follicles and sebaceous glands.

Answer 42

Conjunctival Dermoid

Question 43

Where is a conj. dermoid usually found?

Answer 43

Inferotemporally w/ fine white hairs noted on SLE

Question 44

What is the tx for a conj. dermoid?

Answer 44

``` 1st = observation 2nd = excision for cosmesis ```

Question 45

This is metaplasia of the conj epithelium and tangles of keratin mixed w/ gas forming bacteria. This appears as dry, scaly, foamy patches on the bulbar conj, eyes may burn

Answer 45

Bitot's Spot

Question 46

What is the name of the gas forming bacteria in a Bitot's Spot?

Answer 46

Corynebacterium Xerosis

Question 47

This is highly suggestive of Vitamin A deficiency and occasionally chronic conj. inflammation

Answer 47

Bitot's spot

Question 48

What is the tx for Bitot's Spot?

Answer 48

Evaluate for Vit A Deficiency

Question 49

Papillae present with BVs where?

Answer 49

In the center

Question 50

Follicles present with BVs where?

Answer 50

surround the follicle

Question 51

What is the only drop FDA approved for allergic conjunctivitis use? This is used for GPC

Answer 51

Alrex