Exam 1 - Non-painful red eye Flashcards
What is conjunctivitis?
Inflammation of the bulbar and palpebral conjunctiva
- Commonly referred to as “pink eye”
Symptoms of viral (adenoviral) conjunctivitis
- Red eye with tearing
- Watery discharge
- Itching or irritation
- Unilateral or bilateral
Can viral conjunctivitis present with viral URI?
Yes - recent or concurrent viral URI
How long does viral conjunctivitis last?
5-14 days
Highly contagious
What other physical exam findings could be seen with viral conjunctivitis?
- Eyelid edema
- Preauricular adenopathy
- Follicles on palpebral conjunctiva
Viral conjunctivitis: management (both conservative and pharmacological)
- Cool compresses
- Good hand hygiene
- Avoid touching eyes
- Don’t share towels
- Wash pillowcases
- Lubricating drops
Viral conjunctivitis: patient education
- When does it get better?
Prevent transmission (highly contagious)
- Gets better in 1-2 weeks
Causative organisms of bacterial conjunctivitis (two groups)
- Gradual or sudden onset?
Gradual onset
- H. influenzae
- Strep pneumoniae
- S. aureus
Sudden onset
- Gonorrhea
- Chlamydia
Bacterial conjunctivitis symptoms
- Unilateral or bilateral
- Moderate or severe conjunctival injection
- Thick, purulent discharge
- Sticky eyes
- Preauricular adenopathy
How would the provider manage bacterial conjunctivits in adults who are immunocompetent?
According to AAO, mild infection may resolve spontaneously –> observation
Is topical treatment warranted for bacterial conjunctivitis in adults?
Yes - topical treatment is empiric
- Gentamicin
- Ciprofloxacin
- Azithromycin
- Erythromycin
- Sulfacetamide
- Trimethoprim/polymyxin B
What is the usual duration of topical antibiotic treatment for bacterial conjunctivitis in adults?
One week
If the cause of the patients bacterial conjunctitivis is d/t CT/GC in adults, what should the provider do?
Refer to CDC treatment guidelines
If the cause of older children/adolescent bacterial conjunctivitis is d/t anything other than CT/GC, what should the provider do in terms of management?
Can be treated conservatively
What ophthalmic ointments can be prescribed to treat bacterial conjunctivitis in children?
- Trimethoprim sulfate + polymyxin B sulfate ophthalmic solution
- Erythromycin 0.5% ophthalmic ointment (all ages)
- Fluoroquinolone or azithromycin over 12 months
How would the provider manage otitis conjunctivitis syndrome in children?
Treat with oral amoxicillin-clavulanate (if not allergic)
Can bacterial conjunctivitis self resolve? When would the patient see improvement?
Typically self resolves by 1 week, regardless of antibiotic treatment
Improvement seen by day 3; if not, refer to ophthalmology
Can patients with bacterial conjunctivitis return to school?
Return to school is controversial
Allergic conjunctivitis symptoms
Seasonal and perennial
- Bilateral
- Pruritus
- Clear or white stringy discharge
Allergic conjunctivitis physical exam findings
- Allergic shiners (dark circles under eyes)
- Boggy conjunctiva
When is allergic conjunctivitis usually diagnosed?
Usually diagnosed in late childhood
Allergic conjunctivitis management: both conservative and pharmacological
- Identify and avoid allergens
- Cold compresses
- Artificial tears
- Oral antihistamines (if systemic allergy symptoms)
- Ocular mast cell stabilizer, antihistamine, or dual therapy
- Example: ketotifen (>3 years)
What causes chemical conjunctivitis?
Exposure to fumes, smoke, liquids, chemicals such as chlorine
Chemical conjunctivitis symptoms
Redness and irritation
