Eye pain and discharge Flashcards
Inflammation of the bulbar and or palpebral
conjunctiva
Conjunctivitis
What is the pathophysiology of conjunctivitis?
Patho
- Alterations in the host defense, external contamination
(contact lens, swimming) –> bacterial/ viral infection
Etiology of Bacterial conjunctivitis
Etiology
- Nontypeable Haemophilus influenzae (60-80%),
Haemophylus aegyptius, S.pneumoniae, S.aureus,
M.catarrhalis
- Common <5yo
What are the clinical manifestations of conjucntivitis?
CM
1. Mucopurulent unilateral or bilateral discharge,
hyperemia, edema
2. Glued eyes (lids stuck after sleeping)
3. N vision
4. Photophobia, ocular pain and discomfort
What is the management of conjunctivitis?
Mgt
1. topical abx – Moxifloxacin (Vigamox) 0.5% ophthalmic
solution 1 qtts tidx7d
tobramycin (Tobrex) 0.3% eye drops, 1-2 qtts q4h
2. IV ceftriaxone 50-75 mkd IV q12 for gonococcus, HiB
3. Warm compress
What is the epidemiology of viral conjunctivitis?
Etiology
- Adenovirus, ECHO virus, coxsackievirus, HSV
- More common adults, >5yo
Clinical manifestations of viral conjunctivitis
CM
1. Conjunctival injection and chemosis
2. Gritty sensation
3. Watery discharge
4. Often unilateral
5. (+) periauricular LNE
Management of viral conjunctivitis
self-limited
Etiology of allergic conjunctivitis
- Seasonal pollens or allergen exposure
Clinical manifestations of allergic conjunctivitis
CM
1. Itching
2. Bilateral edema (chemosis) > erythema
3. Tarsal papillae
4. Clear watery discharge
Management of allergic conjunctivitis
Mgt
1. Cold compress
2. Antihistamines: Azelastine 0.05% solution, 1 drop each
eye q6-12h, Olapatadine 0.2% eye drops, 1 drop each
eye OD
3. Topical mast cell stabilizers or prostaglandin inhibitors
4. NSAID eye drops – Ketorolac eye drops
5. Steroids – fluocinolone, loteprednol eye drops
What is orbital cellulitis?
- Inflammation of tissues of the orbit
- Infection posterior to the orbital septum
- Usually 10mo-18 yo (mean 7yo)
Etiology
- S.aureus, MRSA, Haemophilus
Pathophysiology of orbital cellulitis
Patho
- Follow a direct infection of the orbit from a wound,
metastatic deposition of org during bacteremia, or
direct extension or venous spread of infection from
contiguous sites (lids, conjunctiva, globe, lacrimal
gland, nasolacrimal gland, ethmoid sinus)
- Paranasal sinusitis: most common cause in children
- More prevalent in children because:
o Thinner bony septa and sinus wall
o Greater porosity of bones
o Open suture lines
o Larger vascular foramina
What are the clinical manifestations of orbital cellulitis?
- proptosis, limitation of eye movt, ophthalmoplegia,
ocular pain - chemosis, inflammation and swelling of the eyelid,
warm, tender, erythematous lid swelling mucoid
discharge, conjunctival swelling - decreased VA
What are the complications of orbital cellulitis?
Complication
1. visual loss due to retinal artery occlusion or optic
neuritis
2. cavernous sinus thrombosis
3. meningitis
4. epidural or subdural empyema
Diagnostics for orbital cellulitis?
Dx
1. contrast CT of orbit – to r/o subperiosteal abscess,
orbital abscess, intracranial extension. Orbital fat
stranding, globe tenting is an adverse prognostic sign
2. CBC, BCS, eye discharge GS/CS – leukocytosis with left
shift
Management of orbital cellulitis
Mgt
1. Vancomycin 45-60 mkd IV q6/8
2. Cefotaxime 100-200 mkd q6/8 IV
3. Ceftriaxone 50-75 mkd IV q12/24
4. I&D – if with abscess
5. Refer to ophtha
What is preseptal cellulitis and give the etiology?
- Infection of soft tissues anterior to the orbital septum
- Form of facial cellulitis
Etiology:
- GAS, S.aureus, pneumococcus
What is the pathophysiology of preseptal cellulitis?
Patho
- Caused by sinusitis, trauma, infected wound,
bacteremia, abscess of lid or periorbital region
(pyoderma, hordeolum, conjunctivitis, insect bite) à
Inflammation of the lids and periorbital tissues without
signs of true orbital involvement
What are the clinical manifestations of preseptal cellulitis?
CM
1. Eyelid swelling
2. No proptosis or LOM of eye, N pupil function
3. Warm, tender, erythematous lid swelling, mucoid
discharge, conjunctival swelling
Diagnostics for preseptal cellulitis
Dx
Clinical
1. CT scan – consider for children with advanced infection
or suspicion of FB. edema of lids and adjacent
preseptal soft tissues, SC tissues, obliteration of fat
planes or details of the preseptal soft tissues, absence
of orbital inflammation
2. CBC, BCS, eye discharge GS/CS – leukocytosis with left
shift
Management of preseptal cellulitis
Mgt
1. Abx – Cotrimoxazole 8-12 mkd IV/po q12 /clindamycin
30 mkd q6/8 IV/po + Amoxicillin 25-50 mkd po q8/12
/Coamoxiclav 20-40 mkd po q8/12
2. WOF sx progression to orbital cellulitis
