Differentials of Red Eyes, Conjunctiva Flashcards
Caused by direct contact w/ infected secretions
Bacterial Conjunctivitis
Caused most commonly by contact w/ respiratory or ocular secretions.. (adenoviruses)
Viral Conjunctivitis
Rhinoconjunctivitis is the most common form of this type of conjunctivitis; found in 20% of population
Allergic Conjunctivitis
Results from a reaction to an outside agent, typically ocular medication
Toxic Conjunctivitis (medicamentosa)
What type of discharge is found with viral conjunctivitis?
Watery
What type of discharge is found with bacterial conjunctivitis?
Mucous/Muco-purulent
What are the top 6 symptoms of conjunctivitis?
- lids stuck together
- bilateral or unilateral
- burning
- itching
- grittiness
- discharge
How long does it take for a bacterial conjunctivitis to resolve on it’s own?
5 days, self-limiting condition
What is the hallmark sign of a bacterial conjunctivitis?
Acute onset
What type of discharge does a bacterial conjunctivitis present with?
Begins as watery then becomes mucopurulent
What are the top 4 bacteria that cause conjunctivitis?
- H. influenza
- S. pneumoniae
- S. Aureus
- Moraxelis Catarrhalis
What are the top 4 signs of bacterial conj.?
- Diffuse injection, worse in bulbar
- Intense papillary rxn (blood vessels in the center)
- Watery than mucopurulent discharge
- corneal PEE’s
How do we treat bacterial conjunctivitis? What’s the dosing?
Topical antibiotics (gentamicin/polymyxin) OR steroid/antibiotics (tobradex, zylet)…
QID 5x7 days
What is the hallmark sign of viral conj.? Will there be pre-auricular lymphadenopathy?
Watering
Yes
Patients w/ viral conjunctivitis will most often report what?
Recently had common cold (bc of adenovirus)
What are the top 5 signs of a viral conjunctivitis?
- Follicles (blood vessel around it)
- Conj. hemorrhages
- Chemosis
- Pseudomembranes
- Keratitis
What is the tx for viral conj.?
No tx needed.
Can use steroid to stop inflammation and reduce redness
Allergic conjunctivitis will present as an _____,____ _____.
Transient, acute attack
What type of discharge is found in allergic. cong? What’s the most significant sign?
- Ropey discharge
- itching is most significant sign
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.
True
What is the tx for allergic conj.?
Mast cell stabilizer/antihistamine combo.
Can use steroid in severe cases
If dx is GPC, what are the top 3 things that should be done?
- D/c CL wear
- Begin MCS/AH combo (pataday qd)
- Maybe steroid qid
What are the main offenders of toxic conjunctivitis?
- Preservatives in glaucoma drops
2. Neomycin + Tobramycin
What type of discharge is found in toxic conj?
Watery discharge
What is the tx for toxic conj.?
- identify and d/c medication that’s causing it
2. Steroids QID x 7 days (pred forte/durazol)
This is an asymptomatic bubble on the bulbar conj. containing clear fluid
Retention of Inclusion Cyst
Retention/Inclusion Cyst are found in patients with?
extreme allergies to something (i.e. shrimp)
What is the tx for retention cysts?
may be punctured by a needle
This is often seen in darker-skinned individuals, results from additional melanin and stabilizes by early adulthood.
Epithelial Melanosis
Epithelial melanosis is usually benign, but if initially presents around age 30+, we must _____.
rule out malignancy
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.
Concretions
What is the tx for concretions
none necessary, but may be removed with needle or phenyl soaked cotton swab if irritating the patient
This is when conjunctival tissue becomes redundant and excessive. Found to be a normal aging change or related to lid margin disease/DES.
Conjunctivochalasis
What is the tx for conjunctivochalasis?
- Topical Lubricants
- Low Dose Doxy
- Surgical Resection
Pinguecula/itis can be tx’d with?
topical steroids if inflamed or ATs.
What’s better for a pinguecula, NSAIDs or Steroids? Why
NSAIDs - recurrence of inflammation is less when compared to steroids
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.
Pyogenic Granuloma
What is the tx for a pyogenic granuloma?
- Steroids
- Excision
- Cautery
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.
Symblepharon
What are the top 5 etiologies for a symblepharon?
- DES
- SJ syndrome
- Cicatricial Pemphigoid
- Chemical Injury
- EKC or other conj. infection complicated by scarring
What is the tx for a symblepharon?
Oculoplastics
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.
Conjunctival Dermoid
Where is a conj. dermoid usually found?
Inferotemporally w/ fine white hairs noted on SLE
What is the tx for a conj. dermoid?
1st = observation 2nd = excision for cosmesis
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
Bitot’s Spot
What is the name of the gas forming bacteria in a Bitot’s Spot?
Corynebacterium Xerosis
This is highly suggestive of Vitamin A deficiency and occasionally chronic conj. inflammation
Bitot’s spot
What is the tx for Bitot’s Spot?
Evaluate for Vit A Deficiency
Papillae present with BVs where?
In the center
Follicles present with BVs where?
surround the follicle
What is the only drop FDA approved for allergic conjunctivitis use? This is used for GPC
Alrex
