Eye Conditions

Question 1

Clinical Findings of Viral Conjunctivitis

Answer 1

• tearing with profuse, clear, water discharge
• can have crusting in morning but mostly watery discharge
• burning, sandy gritty feeling in one eye
• fever, HA, anorexia, fatigue, URI symptoms
• adenovirus has triad of pharyngitis, conjunctivitis, and fever
• pharyngitis
• enlarged preauricular lymphadenopathy
• photophobia

Question 2

Treatment for Viral Conjunctivitis

Answer 2

• no antivirals needed; self-limiting
• NO steroids!!
• topical antihistamines olopatadine
• warm or cool compresses
• OTC ophthalmic lubricants (refresh, genteal)
• may take 2-3 wks to resolve
• could get worse before it gets better

Question 3

Clinical Findings of Allergic Conjunctivitis

Answer 3

• bilateral redness
• watery stringy discharge
• itching (cardinal sign)
• “shiners” (dark circles)
• conjunctival edema which can cause bulging or conjunctiva past lid margins
• rubbing eye worsens symptoms
• hx of seasonal allergies
• sneezing, nasal congestion, wheezing

Question 4

Treatment of Allergic Conjunctivitis

Answer 4

• removal of allergens
• cool compresses
• OTC artificial tears (refrigerate them)
• topical antihistamine/decongestants (ketoifen, naphacon A - use on > 3 yo; olopatadine, lodoxamine)
• no topical NSAIDs
• no topical steroids
• may use OTC systemic antihistamines if demonstrate sneezing, nasal congestion

Question 5

Causes of Bacterial Conjunctavitis

Answer 5

• H. influenzae most common in kids greater than 7
• S. aureus
• S. pneumoniae
• Moraxella catarrhalis
  ** most common in winter

Question 6

Clinical Findings of Bacterial Conjunctivitis

Answer 6

• complaints of redness and discharge in one eye but can also be bilateral
• affected eye is “stuck shut” in the AM, foreign body sensation, photophobia
• prurulent discharge , sticky
• discharge is white, yellow, or green and thick and globular
• discharge reappears within minutes after wiping lids

Question 7

Treatment of Bacterial Conjunctivitis

Answer 7

• broad spectrum abx
• trimethorprim polymixin B sulfate (> 2 months age) QID for 5-7 days
• azithromycin (> 1 yo) BID for 2 days, QD for 5 days
• fluoroquinolones (-floxacin) for severe cases, must be > 12 months old
• aminoglycosides (tobramycin) 1-2 drops q4h; if severe 1-2 drops qh and then taper

Question 8

Clinical Findings of Hordeolum

Answer 8

• AKA “stye”
• acute inflammation or infection of the oil gland (meibomian gland) causing red, tender bump in lid
• painful
• tender, swollen furuncle seen
• may look like a pimple
• usually caused by S aureus

Question 9

Treatment for Hordeolum

Answer 9

• keep lids clean
• hygiene important
• gently shampoo lids
• warm compresses QID
• bacitracin or erythromycin ophthalmic ointment q4h for 10 days
  ** Refer if it enlarges and furuncle does not rupture on own or if multiple, recurrent hordeolum seen

Question 10

Clinical Findings of Chalazion

Answer 10

• painless, mildly erythematous with slight welling to eyelid, looks like rubbery nodule
• after a few days, swelling respolves and a slow-growing, round, nonpigmented, painless mass remains, can be size of pea
• may persist for a long time

Question 11

Treatment of Chalazion

Answer 11

• most resolve over a few days to few weeks
• warm compresses 15 min QID
• Refer if lesions are presistent

Question 12

What is Blepharitis?

Answer 12

• acute or chronic inflammation of eyelash follicles, usually bilateral
• blocks the oil glands in the eyelids
• more common in kids with DM or rosacea

Question 13

Treatment of Blepharitis

Answer 13

• scrub eyelashes or lids with gentle shampoo to debride scales
• warm compress 5-10 min BID-QID, and wipe
• massage meibomian secretions if its the cause
• lash lice treated with petroleum jelly and permethrin shampoo

Question 14

What is a pterygium?

Answer 14

• fibrovascular mass of thickened bulbar conjunctiva that extends beyond the limbus onto the cornea
• triangular in shape
• more commonly found on nasal side of orbit

Question 15

Causes of pterygium

Answer 15

Caused by irritation from sunlight, wind, dust, fumes, or airborne allergens

Question 16

Clinical Findings of Pterygium

Answer 16

• painless, may itch, complaints of blurred vision if enlarges and extends into cornea

Question 17

Treatment of Pterygium

Answer 17

Refer

Question 18

Clinical Findings of Ocular/Corneal Abrasions

Answer 18

• sensation of a foreign body in eye
• erythema to conjunctiva
• severe pain and photophobia
• tearing and blepharospasm
• disrupted tear film over corneal epithelium

Question 19

Treatment of Ocular/Corneal Abrasions

Answer 19

• refer if possible subepithelial damage
• refer if contact lens wearer
• E-mycin ointment preferred
• polymixin/trimethoprim, ciprofloxin, or ofloxacin QID for 3-5 days
• oral analgesics
• dont rub eyes

Question 20

Clinical Findings of Periorbital Cellulitis

Answer 20

• acute febrile illness
• swelloing/erythema of tissues around eye
• deep red eyelid
• bacteremia/sinusitis symptoms
• orbital discomfort, proptosis, paralysis of extra-ocular muscles

Question 21

Diagnostic Studies for Periorbital Cellulitis

Answer 21

• CBC
• blood cultures
• LP if < 1 year
• CT to r/o sinusitis, orbital cellulitis, subperiosteal abscess
• visual acuity, extra-ocular movement, pupillary reaction testing

Question 22

Management of Periorbital Cellulitis

Answer 22

• if mild, oral abx and warm soaks
• if moderate to severe they need to be hospitalized with IV abx