Disorders of the Conjunctiva: General & Bacterial Flashcards
what mucus membrane lines inner surface of eyelids
palpebral conjunctiva
what mucus membrane lines the anterior globe
bulbar conjunctiva
bulbar conjunctiva is continuous with & where
corneal epithelium at the limbus
list the layers of the conjunctiva from most superficial to deep
conjunctiva → anterior Tenon’s capsule → episclera → sclera
which conjunctival layer is the protective outer layer
epithelium
what does the epithelium contain
goblet cells & conjunctival associated lymphoid tissue (CALT)
which conjunctival layer is composed of loose vascularized tissue
stroma
what does the stroma contain
- accessory lacrimal glands
- sensory nerves
- lymphatic vessels
what is a conjunctival fold that allows the globe to move without stretching the conjunctiva
plica semilunaris
what is a small, fleshy nodular prominence
caruncle
what does the caruncle contain
- goblet cells
- sweat glands
- sebaceous glands
what is dilation of conjunctival vessels that leads to diffuse redness
hyperemia
how do hemorrhages appear on an inflamed conjunctiva
small “petechial” (pin-point)
what is translucent swelling of the conjunctiva
chemosis
which membrane is coagulated exudate that is adherent to inflamed conjunctival epithelium
pseudomembrane
which membrane is coagulated exudate & fibrin that is firmly attached to conjunctival epithelium
true membrane
do follicles or papillae appear translucent/whitish like “grains of rice”
follciles
are follicles or papillae associated with ipsilateral lymphadenopathy
follicles
are follicles or papillae caused by formation of a subepithelial lymphoid germinal center with lymphocytes
follicles
what are the typical causes of follicles
- viral
- chlamydial (inclusion)
- toxic
do follicles or papillae mainly develop in palpebral conjunctiva & potentially bulbar limbal conjunctiva
papillae
do follicles or papillae contain a central vascular channel, making it look “red & beefy”
papillae
are follicles or papillae composed of folds of hyperplastic epithelium with a fibrovascular core & stromal infiltration with inflammatory cells
papillae
what are the typical causes of papillae
- allergy
- bacteria
- CL wear
- floppy eyelid syndrome
what type of discharge would you see in viral & allergic conjunctivitis
serous
what type of discharge would you see in VKC or bacterial conjunctivitis
mucoid (stringy/ropy)
what type of discharge would you see in bacterial conjunctivitis
mucopurulent (pus-like)
what type of discharge would you see in a gonococcal conjunctivitis
severe purulent
what is the most common cause of bacterial conjunctivitis
S. aureus
what are less common causes of bacterial conjunctivitis
- S. pneumoniae
- H. influenzae
- Moraxella
what are rare causes of bacterial conjunctivitis
- N. meningitidis
- N. gonorrhea
these signs are indicative of what type of bacterial conjunctivitis:
- eyelid edema & erythema in a severe infection
- conjunctival hyperemia/injection & chemosis
- white-yellow mucopurulent discharge
- SPK
- conjunctival papillae
- usually bilateral
- absent preauricular lymphadenopathy
acute bacterial conjunctivitis
which bacterial conjunctivitis will have an acute onset of redness
acute bacterial conjunctivitis
what treatment will speed up recovery & prevent reinfection & transmission in acute bacterial conjunctivitis
topical antibiotic QID x 1 wk
what are some examples of topical antibiotics to treat acute bacterial conjunctivitis
- G+ ABX
- bacitracin
- vigamox (if severe)
when are systemic antibiotics indicated in acute bacterial conjunctivitis
when N. gonorrhea, N. meningitidis, or H. influenzae suspected
in acute bacterial conjunctivitis, does conjunctival hyperemia or injection & chemosis predominate
hyperemia
these signs are indicative of which bacterial conjunctivitis:
- 12-24hrs onset
- copious green-gray mucus discharge
- typically unilateral, but can be bilateral
- significant eyelid edema & conjunctival hyperemia
- lymphadenopathy
hyperacute bacterial conjunctivitis
what are the sequelae of hyperacute bacterial conjunctivitis
- corneal ulceration
- corneal perforation
- panophthalmitis
what organisms cause hyperacute bacterial conjunctivitis
- N. gonorrhea
- N. meningitidis
when treating hyperacute bacterial conjunctivitis, topical antibiotics are used in conjunction with
oral/IM/IV antibiotics
treatments are indicative of which type of bacterial conjunctivitis:
- infectious disease consult
- hospitalization may be required
- topical ABX & oral/IM/IV ABX
- continuous irrigation of discharge
- must report to government health agency
hyperacute bacterial conjunctivitis
which type of bacterial conjunctivitis is conjunctival inflammation that develops within the first month of life through transmission by mother during delivery
neonatal conjunctivitis (ophthalmia neonatorum)
these causes cause which type of bacterial conjunctivitis:
- chlamydia trachomatis
- neisseria gonorrhea
- herpes simplex virus 2
- a toxic reaction to silve nitrate prophylaxis (Crede prophylaxis)
neonatal conjunctivitis
what is the most common cause of neonatal conjunctivitis
chlamydia trachomatis
which cause of neonatal conjunctivitis has an onset within the first few days
toxic reaction
which cause of neonatal conjunctivitis has an onset during the 1st week
gonococcal
which cause of neonatal conjunctivitis has an onset within 1-2 weeks
HSV
which cause of neonatal conjunctivitis has an onset within 1-3 weeks
chlamydia
how do you treat neonatal conjunctivitis caused by HSV 2
IV acyclovir
how do you treat a chlamydial neonatal conjunctivitis
oral erythromycin
how do you treat a gonococcal neonatal conjunctivitis
hospital admission; IM/IV cephalosporin
which type of bacterial conjunctivitis is caused by chlamydia trachomatis
chronic bacterial conjunctivitis (inclusion conjunctivitis)
asymptomatic urethritis is a systemic symptom of chronic conjunctivitis in males or females
males
dysuria & discharge are systemic symptoms in chronic bacterial conjunctivitis in males or females
females
urethritis in males with chronic bacterial conjunctivitis can trigger what
Reiter syndrome
dysuria & discharge in females with chronic bacterial conjunctivitis can progress to what
pelvic inflammatory disease & risk of infertility
these symptoms are indicative of which type of bacterial conjunctivitis:
- typically unilateral chronic red eye, can be bilateral
- mucopurulent discharge
- chronic (3+ weeks)
chronic bacterial conjunctivitis (inclusion conjunctivitis)
what sign is characteristic for chronic bacterial conjunctivitis
large follicles in inferior fornix & follicles on bulbar conjunctiva
these signs are indicative of which type of bacterial conjunctivitis:
- tender preauricular lymphadenopathy
- large follicles in inferior fornix
- bulbar conjunctiva follicles
- SPK
- perilimbal subepithelial infiltrates appearing after 2-3 weeks
- improves with topical ABX, but returns once discontinued
chronic bacterial conjunctivitis
what is the preferred systemic antibiotic therapy for chronic bacterial conjunctivitis
azithromycin 1g PO, single dose
what systemic antibiotic therapies are used to manage chronic bacterial conjunctivitis
- azithromycin 1g PO, single dose
- doxycycline 100mg PO BID x 10 days
what is the leading cause of preventable blindness in the world that is associated with poverty, overcrowding & poor hygiene
trachoma
in trachoma, recurrent infections results in what
chronic immune response (type IV hypersensitivity) to chlamydial antigen
which stage of trachoma is most common in preschool children
active inflammatory stage
which stage of trachoma is prevalent in middle age
cicatricial chronic stage
which stage of trachoma has mixed follicular & papillary conjunctivitis & mucopurulent discharge
active inflammatory stage
which stage of trachoma has scarring of superior palpebral conjunctiva (Arlt’s line)
cicatricial chronic stage
which stage of trachoma has superior epithelial keratitis & pannus formation
active inflammatory stage
which stage of trachoma has trichiasis & cicatricial entropion
cicatricial chronic stage
which stage of trachoma has corneal opacification from continuous mechanical trauma
cicatricial chronic stage
what strategy is used to manage trachoma
SAFE strategy
in SAFE strategy, what does the S stand for
surgery for trichiasis
in SAFE strategy, what does the A stand for
antibiotics for active diseases
in SAFE strategy, what does the F stand for
facial hygiene
in SAFE strategy, what does the E stand for
environmental improvement
how can you improve the environment to manage trachoma
- access to clean water
- sanitation
- reduction in fly population
what is the vector for trachoma
flies