Eye 3: Red eye Flashcards
subconjunctival hemorrhage
-diffuse or localized area of blood under conjunctiva
-asymptomatic
-no pain
-pressure within the vessels -> hemorrhage
-idiopathic
-trauma, chronic cough, sneezing aspirin, HTN
-resolves within 10-14 days (self limited)
-warm compress
-resolves like a bruise
uvea
-part of eye consisting of:
-iris, choroid of eye, ciliary body
choroid of eye
-thin vascular middle layer of eye that is situated between sclera (white of the eye) and the retina
ciliary body
-body of tissue that connects iris with choroid includes a group of muscles which act on lens of eye to change it shape
acute conjunctivitis
-extremely common
-discharge- moderate to copious
-vision- no effect
-mild pain
-conjunctival injection- diffuse
-cornea- clear
-pupil size- normal
-pupillary light response normal
-intraocular pressure normal
-smear- causative organisms
acute anterior uveitis (iritis)
-incidence- common
-no discharge
-vision often blurred
-pain- moderate
-conjunctival injection- mainly circumcorneal
-cornea usually clear
-pupil size small
-pupillary light response poor
-intraocular pressure usually normal may be elevated
acute angle-closure glaucoma
-incidence is uncommon
-discharge- none
-vision- markedly blurred
-pain is severe
-conjunctival injection- mainly circumcorneal
-cloudy cornea
-pupil size moderately dilated
-pupillary light response - none
-intraocular pressure markedly elevated
corneal trauma or infection
-incidence- common
-discharge- watery or purulent
-vision- usually blurred
-pain- moderate to severe
-conjunctival injection- mainly circumcorneal
-cornea- clarity change related to cause
-pupil size- normal or small
-pupillary light response- normal
-intraocular pressure- normal
conjunctivitis
-conjunctiva helps keep eyelid and eye moist
-conjunctival inflammation
-pink eye
-most common non traumatic eye infection in children and adults
-cellular infiltrate and exudate
-highly contagious
-no age or race or sex predilection
-conjunctivitis of the newborn- term used by WHO for any conjunctivitis with discharge occurring during the first 28 days of life
hyperacute purulent conjunctivitis
-ophthalmia neonatorum was the term used to describe hyperacute purulent conjunctivitis
-usually caused by gonococci- first 10 days of life
-in this instance- transmission is vertical
causes of conjunctivitis
-infection- virus, bacteria, STIs, fungal, parasitic
-irritating substances- chemical, smoke etc.
-keratoconjunctivitis sicca- dryness
-allergens
conjunctivitis differential diagnosis
-corneal abrasion
-acute angle glaucoma
-herpes zoster- ophthalmic branch of trigeminal
-iritis and uveitis
-scleritis
-episcleritis
conjunctivitis signs and symptoms
-Redness
-↑tears
-Discharge
-Thick yellow discharge - crusts over the eyelashes, especially after sleep (bacteria)
-Green or white
-Itchy eyes (allergies)
-Burning eyes (chemicals and irritants)
-Blurred vision (normal acuity)
-Photophobia
viral conjunctivitis
-frequent hx of viral syndrome
-STD- herpes simplex virus or fever blister elicited (NO STERIODS)
-can aid in dx of condition
-any individual with follicular conjunctivitis (follicle inflammation) or preauricular adenopathy (lymph node in front of ear) with or without kertitis should be questioned about the possibility of STIs**
-high risk individuals should be treated empirically for chlamydia (treat gonococcal infection if suspected at same time)
HSV infection treatment
-(eg,ganciclovir0.15% gel) and/or systemic (eg, oralacyclovir,valacyclovir) antivirals is recommended
-no specific treatment for contagious viral conjunctivitis.
-Artificial tears and cold compresses may help reduce discomfort.
-use of topical antibiotics and steroids in the acute infection is discouraged
-Frequent hand and linen hygiene is encouraged to minimize spread.
3 major agents associated with conjunctivitis
-1. follicular conjunctivitis
-2. pre-auricular adenopathy
-3. superficial keratitis
-adenovirus
-chlamydia
-herpes simplex
viral conjunctivitis
-clear, watery discharge
-scanty exudate
-pruritus common
-occasionally severe photophobia and FB sensation
-pharyngitis, fever, malaise and preauricular adenopathy -> pharyngoconjunctival fever
-epidemic keratoconjunctivitis (EKC)- caused by adenovirus
-complication- visual loss
-cold compresses and sulfonamide therapy (secondary infection prevention)
bacterial conjunctivitis
-copious purulent discharge
-acute onset
-minimal pain
-occasional pruritus*
-no blurring of vision
-staphylococcal and streptococcal species
-self limiting
-lasts 10-14 days
-sulfacetamide ointment
-clean medial to lateral
chlamydial conjunctivitis
-chronic onset
-minimal pain level
-occasional pruritis
-can lead to scarring
-can be severe enough to cause lid derangement and ingrown eyelashes
-STD history- identify andg treat sexual partners
-trachoma is more chronic- insidious form -> major cause of blindness worldwide!
-rx- single dose therapy with oral azithromycin
-treat gonorrhea at same time -IM 1 gram ceftriaxone
gonococcal conjunctivitis
-neonate- purulent bacterial conjunctivitis -> neisseria gonorrhea
-ophthalmologic emergency - can cause blindness
-can be invasive and lead to rapid corneal perforation -> IV antibiotics
-have to open the eye to view
-IM 1 gram ceftriaxone
-treat chlamydia at same time azithromycin
allergic conjunctivitis
-acute or subacute onset
-seasonal
-no pain
-pruritis
-tearing
-redness
-stringy discharge
-occasional photophobia and visual loss from discharge (not from damage)
-hyperemia and edema (chemosis)
-large cobblestone papillae** if chronic
-mild to moderate
allergic conjunctivitis treatment
-numerous topical antimicrobial agents can be used
-broad spectrum antibiotics
-antimicrobials and symptomatic therapy recommended for all pts initially
-supportive- artificial tears (non preservatives) help discomfort of keratitis and photophobia // cold compresses help swelling and discomfort in lids
-antimicrobial drops- helps prevent secondary bacterial infection-> every 2 hours
-topical histamine H1 receptor blocker
-systemic antihistamines
-topical corticosteroids
-ointment used at night or every 4-6 hours throughout the day
-CAUTION:
-exclude herpes simplex infection
-best to reserve use by ophthalmologist
allergic conjunctivitis caution
- S/E of steroid therapy
-cataracts
-glaucoma
-exacerbation of herpes simplex
work up conjuncitivitis
-generally not needed
-dx on hx and physical exam
-swabs taken if no improvement in 48-72 hrs
-take swabs in all and immunosuppressed or when N. gonorrhoeae is suspected
-swabs taken from lower conjunctival fornix
-gram stain and Giemsa stain
