Disorders of the Conjunctiva: Viral & Allergic Flashcards
what is the most common organism to cause viral conjunctivitis
adenovirus
what viral conditions can cause viral conjunctivitis
- HSV, molluscum contagiosum
- mumps, measles
- flu
how does HSV & molluscum contagiosum cause viral conjunctivitis
secondary conjunctivitis from viral shedding
what type of viral conjunctivitis is the most common form caused by different serotypes
nonspecific acute follicular conjunctivitis
which type of viral conjunctivitis is usually accompanied by other symptoms of common cold
nonspecific acute follicular conjunctivitis
which type of viral conjunctivitis has relatively mild ocular symptoms
nonspecific acute follicular conjunctivitis
which organism causes pharyngoconjunctival fever
adenovirus
how is pharyngoconjunctival fever spread
by droplets within families with upper respiratory infection
in pharyngoconjunctival fever what presents along with conjunctivitis
prominent sore throat & petechial hemorrhages
epidemic keratoconjunctivitis (EKC) is caused by what organism & which serotypes
adenovirus 8, 19, 37
which viral conjunctivitis has the most severe ocular response to the virus
epidemic keratoconjunctivitis (EKC)
in epidemic keratoconjunctivitis, conjunctivis is commonly present along with
keratitis
in EKC, when is the infection very contagious
10-12 days from symptom onset while eyes are still red
in EKC, what forms at 7-14 days
subepithelial infiltrates & SPK
this signs are indicative of which viral conjunctivitis progression:
- pseudomembranes
- petechial hemorrhages
- significant palpebral & bulbar conjunctival injection
epidemic keratoconjunctivitis (EKC)
what is key for viral conjunctivitis
good hygiene
how do you treat the subepithelial infiltrates in EKC & give some examples
topical steroids:
- PredForte
- Durezol QID q2h if severe
what is used off-label to manage EKC
betadine protocol
what does betadine protocol do for EKC
shortens duration of virus replication & decrease severity of ocular sequelae
what is in Betadine protocol & what classification of medication is it
povidine iodine 5% (antiseptic)
what are the 3 instillations in Betadine protocol in order & what it does
1) instill 1 gtt proparacaine (topical anesthetic)
2) instill 1-2 gtt NSAID (for additional pain relief)
3) instill several gtts Betadine 5% solution
after 1 minute of instilling drops in Betadine protocol, what do you do
irrigate thoroughly with sterile saline solution
in EKC, if subepithelial infiltrates are present, what do you prescribe
topical steroid QID-6x/day
which type of viral conjunctivitis usually occurs in tropical areas
hemorrhagic conjunctivitis
what organisms frequently cause hemorrhagic conjunctivitis
enterovirus & coxsackle virus
these signs are indicative of which type of conjunctivitis:
- eyelid edema
- lymphadenopathy
- palpebral conjunctival hyperemia & follicles
- conjunctival hemorrhages & pseudomembrane formation if severe inflammation
- SPK
- subepithelial infiltrates
- conjunctival chemosis
- conjunctival injection
viral conjunctivitis
what is the prominent symptom in viral conjunctivitis
tearing (serous & some mucoid)
how do you manage viral conjunctivitis
- palliative care
- good hygiene
- self-resolving in 2-3 weeks
allergic conjunctivitis is what type of hypersensitivity reaction
type I
which immunoglobulin is immediately release when triggered by an environmental allergen
IgE
these signs are indicative of which type of conjunctivitis:
- conjunctival chemosis & hyperemia
- conjunctival papillae: tissue inflammation with eosinophils
- eyelid edema
- serous discharge
allergic conjunctivitis
which signs predominate in allergic conjunctivitis
conjunctival chemosis & serous discharge
what are the symptoms of allergic conjunctivitis, and which one predominates
itching (predominates), burning, tearing
which type of allergic conjunctivitis has severe itching, chemosis, tearing, lid edema & hyperemia
acute allergic conjunctivitis
which type of allergic conjunctivitis has an immediate onset after exposure to an environmental allergen
acute allergic conjunctivitis
when is acute allergic conjunctivitis resolved
within 24 hours of removal of antigen
what type of allergic conjunctivitis is more chronic & milder than acute allergic conjunctivitis
seasonal allergic conjunctivitis
seasonal allergic conjunctivitis is usually associated with
pollen, weeds & grass
which type of allergic conjunctivitis is chronic
perennial allergic conjunctivitis
perennial allergic conjunctivitis is associated with
allergens that usually can’t be avoided within a home (ie, dust, mites, mold)
what causes the immediate release of histamine
mast cell degranulation
itching & burning in allergic conjunctivitis occurs with what mechanism of action
H1 binds to nerve endings
vasodilation (hyperemia), increased vascular permeability, edema (chemosis) in allergic conjunctivitis occur with what mechanism of action
H2 binds to vessel walls
what drug has a delayed response & is given before an allergy starts
mast cell stabilizers
which type of allergic conjunctivitis can you use mast cell stabilizers to treat
seasonal allergic conjunctivitis
what drug has an immediate response and is given in acute allergic response
antihistamines
for severe symptoms in allergic conjunctivitis, what do you treat it with
topical steroids
when would you use oral antihistamines with allergic conjunctivitis
if accompanied by allergic rhinitis
what class of drugs are these & what do they treat:
- Alocril (nedocromil)
- Alomide (lodoxamide)
- Crolom (generic comolyn sodium)
which one is fast-acting
mast cell stabilizers → treat allergic conjunctivitis
Alocril is fast acting
what class of drugs are these & what do they treat:
- Optivar (generic azelastine)
- Patanol (olopatadine 0.1%)
- Pataday (olopatadine 0.2%)
- Pazeo (olopatadine 0.7%)
- Bepreve (betastine)
- Elestat (epinastine)
- Lastacaft (alcaftadine)
- Alaway, Zatidor (OTC ketotifen)
which ones are QD (vs. BID)
mast cell stabilizer + antihistamine combos → treat allergic conjunctivitis
Pataday, Pazeo, Alcaftadine
what conjunctivitis is a recurrent bilateral allergic disorder that is a IgE & cell-mediated immune reaction
vernal keratoconjunctivitis (VKC)
what type of hypersensitivity is vernal keratoconjunctivitis (VKC)
type I
is VKC more frequent in males or females
males
when is the onset & remission of VKC
onset at age 5 & remission in late teens (95% of pts)
what kind of climate is VKC common in & where is it rare
warm & dry
rare in temperate regions
when VKC present in temperate regions, what is it usually associated with
atopic conditions such as asthma or eczema
these symptoms are indicative of which type of allergic conjunctivitis:
- intense itching
- burning
- thick, ropy mucoid discharge
- blepharospasm
- photophobia
which symptom is the biggest symptom
VKC → intense itching is biggest symptom
these signs are indicative of what type of allergic conjunctivitis:
- superior tarsal papillae (“cobblestone”)
- eyelid edema
- ropy mucus deposition between giant papillae
- shield ulcer
- Horner-Trantas dots
- epithelial erosions
which sign is characteristic
VKC → superior tarsal papillae (“cobblestone”) is characteristic sign
what is an inflammatory cell plaque at the base of an epithelial defect
shield ulcer
what is a gelatinous limbal conjunctival papillae (accumulation of eosinophils)
Horner-Trantas dots
in VKC, what causes epithelial erosions
toxicity to inflammatory mediators & mechanical injury from giant papillae
VKC with micropapillae & no corneal changes is considered mild, moderate, or severe & how would you treat it
mild
- mast cell stabilizers
- antihistamines
- cool compresses
- artificial tears
VKC with macropapillae, mucus accumulation & corneal vascularization is considered mild, moderate, or severe & how do you treat it
moderate → topical steroids (pulse therapy)
- Durezol QID
VKC with macropapillae, macroerosion, shield ulcer, persistent severe inflammation is mild, moderate, or severe & how do you treat it
severe → pulse therapy or immunomodulators when steroids aren’t working
what type of allergic conjunctivitis is a rare bilateral disease that develops in adulthood
atopic keratoconjunctivitis
atopic keratoconjunctivitis follows a long history of what & what is commonly found in these patients
follows long history of atopic dermatitis (eczema)
asthma is commonly found in these patients
which type of allergic conjunctivitis is chronic & unremitting (perennial) that is usually worse in winter & has low expectation of resolution
atopic keratoconjunctivitis
what type of allergic conjunctivitis is a genetic predisposition combined with antigen sensitization
atopic keratoconjunctivitis
what type(s) of hypersensitivity is atopic keratoconjunctivitis
type I & IV
symptoms of atopic keratoconjunctivitis
are similar to VKC, but more severe & unremitting
these signs are associated with what type of allergic conjunctivitis:
- erythema
- dryness
- scaliness
- thickening of eyelid
- disruption of epidermal integrity: fissuring, scratches
atopic keratoconjunctivitis
these ocular findings are indicative of which type of allergic conjunctivitis:
- chronic staphylococcal blepharitis
- madarosis
- keratinization of eyelids
- conjunctival papillae (inferior palpebral > superior palpebral)
- SPK → persistent epithelial defects
- peripheral corneal vascularization & stromal scar formation
- predisposition to bacterial, fungal & HSV keratitis
- keratoconus in some patients
- anterior/posterior subcapsular cataracts
atopic keratoconjunctivitis
what class of medication can you use to treat atopic keratoconjunctivitis & give some examples
topical immunosuppressants → Restasis, Tacrolimus
