eyelid/conjunctival disorder 2 Flashcards
what is the classification of conjunctival disorders?
. infections ( bacterial , viral and chlamydial ) . allergic/inflammatory disorders . subconjunctival haemorrhage . degenerations . mucu-cutaneous disorders . pigmented and non-pigmented lesions
why is conjunctiva vulnerable to microbial infection?
. due to its exposed position
what are the infections of the conjunctiva ?
. bacterial conjunctivitis
. viral conjunctivitis
. chlamydial conjunctivitis
what is bacterial conjunctivitis ?
. very common condition
. can occur at any age but occurs most frequent in children
. contagious
. mostly likely to occur in patients that are taking topical/systemic steroids or immunosuppressed and patients in poor general health
. usually bilateral ( one eye may precede the other )
what are the symptoms of bacterial conjunctivitis ?
. grittiness- like sand in the eye
. burning
. eyelids stuck together in the morning- due to dry pus
. blurred vision
why is bacterial conjunctivitis usually bilateral?
. in the early stages of the condition , before the symptoms become manifest, it’s common that patients would touch the other eye and will cross the infection to second eye
what are the clinical signs of bacterial conjunctivitis ?
. purulent( pus like discharge ) or mucopurulent( pus mixed with mucous ) discharge
. conjunctival hyperaemia maximal at the fornices
. lid crusting
. mild papillary reaction
. usually no corneal involvement
. usually no pre-auricular lymphadenopathy
what is a way to distinct between viral and bacterial conjunctivitis ?
.viral conjunctivitis have pre-auricular lymphadenopathy which means swollen lymph nodes
. swollen lymph node is an indication of viral infection
where are the regional lymph nodes for the ocular surface?
. in front of the ear- which are referred to as pre-auricular lymph nodes
what is the management for bacterial conjunctivitis?
. antibiotic drops: chloramphenicol or fusidic acid
. self-limiting condition: ( means gets better by itself, 80% gets better by it self ) consider no treatment or delayed treatment
. advise as to the contagious nature of the condition
. refer if the condition does not respond to treatment within 5-7 days if condition worsens
what is the aetiology/cause of viral conjunctivitis ?
- adenovirus( viruses that cause upper respiratory tract infections, colds and flu ) most common cause
- adenoviruses cause two ocular syndromes:
- PCF (pharyngoconjunctival fever)- inflammation of both the conjunctiva as well as the nasal pharynx (no cornea)
- EKC (epidemic keratoconjuncitivits) - occurs when people are in crowded spaces - contagious - associated with corneal involvement (cornea involved) - caused by airborne respiratory droplets or direct transfer of ocular secretions
- conjunctivitis is a rare manifestation of COVID 19 ( 3%)
what are the symptoms of viral conjunctivitis ?
. epiphora - watering of the eye
. discomfort ( burning and stinging )
. photophobia ( indicates corneal involvement )
. reduced acuity ( with corneal involvement )
. bilateral in 60% cases-
what are the sign of viral conjunctivitis ?
. conjunctival injection . swollen lids . serous discharge . conjunctival follicles . pre-auricular lymphadenopathy . pseudomembrane - accumulation of fibrin . keratitis ( more common in EKC 80% ) . epithelial lesion with or without subepithelial infiltrate -
what are the epithelial lesion found as a sign of viral conjunctivitis ?
. this is an inflammatory response of the cornea to the presence of the virus
. these are accumulation of inflammatory cells
what is the management of viral conjunctivitis ?
. self-limiting 1-3 weeks
. artificial tears may improve comfort
. antibiotics in children due to difficulty in distinguishing between bacterial and viral conjunctivitis
. refer if significant corneal involvement
. warn of highly contagious nature of condition
what is chlamydial conjunctivitis ?
. sexually transmitted disease
. caused by chlamydia
trachomatis
. patients usually young with concomitant genital infection
. follicular conjunctivitis with mucopurulent discharge
what is the classification of allergic eye disease?
. classified by wether the cornea is involved or not 1. atopic keratoconjunctivitis ( cornea is involved) - CHRONIC - AKC - atopic keratoconjunctivitis - VKC - vernal keratoconjunctivitis kerato(meaning viral too)
- allergic conjunctivitis
( cornea isn’t involved )
- seasonal allergic conjunctivitis (SAC)
- perennial allergic conjunctivitis ( PAC )- happens all year round
- acute allergic conjunctivitis (AAC)- sudden reaction of ocular surface to certain allergen
- giant papillary conjunctivitis ( GPC)
- contact dermatoconjunctivitis
what is the aetiology/cause of seasonal/perennial allergic conjunctivitis ?
intermittent
. seasonal: seasonal allergens
e.g. pollen
. perennial: allergens such as house dust mite symptoms throughout the year
what are the symptoms of seasonal/perennial allergic conjunctivitis?
. itching
. epiphora
what are the signs of seasonal/perennial allergic conjunctivitis ?
. hyperaemia . chemosis- swelling conjunctiva . redness . lid oedema . diffuse papillary reaction . no corneal involvement
what is the management of seasonal/perennial allergic conjunctivitis ?
. allergen avoidance
. cool compresses
. mast cell stabiliser e.g. sodium cromoglicate
. topical or systemic antihistamines
what is sub-conjunctival haemorrhage?
What is the management of this ?
. presents as a bright red patch under the conjunctiva caused by rupture of a small conjunctival vessel
. may arise spontaneously, following slight trauma, or as a result of raised central venous pressure due to coughing or sneezing
. the condition is usually unilateral
. can usually see posterior border ( excludes intracranial source )
. recurrent or bilateral haemorrhages suggests hypertension or coagulation disorder ( patient may be taking an anticoagulant )
. consider gp referral
. typically resolves in 5-10 days
. usually no treatment required
what are benign conjunctival degeneration?
. pterygium
. concretions
. pinguecula
what are concretions?
. benign conjunctival degeneration
. white lesions
. usually sitting under the surface - slightly raised- when pull the bottom eyelid down
- usually px doesn’t really notice them- but could cause a little corneal discomfort
what are pterygium?
. benign conjunctival degeneration
. common in px that lived in hot climate
. pterygium is an elevated superficial, external ocular mass that usually forms over the perilimbal conjunctiva and extends onto the corneal surface
. risk factor for pterygium include : increased exposure to uv light
. management : lubricants surgical excision
what is pinguecula ?
. pinguecula is a benign yellowish-white conjunctival lesions
. generally does not affect vision and usually does not require treatment
what are sight-threatening conjunctival disorders?
. cicatricial pemphigoid
. stevens- johnson syndrome- impacts mucous membrane
. conjunctival melanoma- pigmented cancer lesions or could be a nevus ( birthmark in eye)
