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
Chemical conjunctivitis treatment
- Flush eyes immediately
- Artificial tears as needed
What should the provider do if the patient was exposed to a toxic substance that is causing severe pain and visual disturbance?
Refer immediately
Vernal versus atopic conjunctivitis
Vernal - seen during childhood, spring time
Atopic - seen in adults over 50 years old with history of atopy
Symptoms of vernal and atopic conjunctivitis
- Bilateral itching
- Burning
- Tearing
How would the provider treat vernal and atopic conjunctivitis? Is a referral warranted?
Treatment
- Mass or cell stabilizer
- Ophthalmic drops
Refer to ophthalmology (non emergent)
What is the pathophysiology of dry eye syndrome?
Complex pathophysiology - most commonly due to lacrimal or meibomian gland dysfunction (like Sjogrens)
Dry eye syndrome symptoms
- Dryness
- Foreign body sensation
- Scratchy/grittiness
- Burning
- Stinging
- Tearing
What tests can the provider use to diagnose dry eye syndrome?
- Schirmer test
- Helps differentiate between evaporative dry eye versus lacrimal problem
- Questionnaires
How would the provider manage dry eye syndrome?
Educate the patient to avoid causative meds (e.g. anticholinergics, diuretics), air conditioning, fans
What is the first line treatment (prescription) used for dry eye syndrome?
Preservative-free lubricants
- Cyclosporin drops (restasis) can be prescribed by ophthalmologist
What is subjunctival hemorrhage?
Bleeding between conjunctiva and sclera
Are subconjuctival hemorrhages a medical emergency?
No - normally asymptomatic and benign
What causes subjunctival hemorrhages? What are some risk factors?
Increased pressure in capillaries
- Coughing
- Sneezing
- Straining
Other risk factors
- Blood thinners
- HTN
- DM
When do subjunctival hemorrhages normally resolve?
2 weeks
