eyes2

Question 1

what is blepharitis

Answer 1

inflammation of eyelid margins and eyelids

common

often chronic

Question 2

what are the 2 types of blepharitis

Answer 2

seborrheic- nonulcerative

ulcerative

Question 3

seborrheic blepharitis characteristics

Answer 3

• erythematous eyelid margins
• dry flakes, oily secretions
• cosmetics and chemicals aggrevate condition

Question 4

ulcerative blepharitis chracteristics

Answer 4

• Acute/chronic inflammation of glands of lid margins
• Staph aureus and epidermis are causative -mild ulcerations of lid margin
• Loss of lashes or broken lashes

Question 5

blepharitis hx

Answer 5

	Gritty, burning sensation 
	Crusted material on eyelids in a.m.
	Redness
	Swelling of lid margins
	Irritation and itching common
	Dry or greasy scales on lashes
	Mild conjunctival irritation and erythema

Question 6

blepharitis PE

Answer 6

	Erythematous eyelid margins
	Scaly lesions on lashes sclera – white
	Conjunctivae – usually clear
	Masses on lids/lid margins (palpate with gloves)
	Preauricular adenopathy
	Visual acuity (no change)
	No diagnostics indicated

Question 7

blepharitis differential dx

Answer 7

1. Conjunctivitis
2. Chronic chalazia
3. Sebaceous cell carcinoma –rare
4. Lice infestation

Question 8

blepharitis management/tx

Answer 8

 Warm water compresses
 Eyelid margin scrubs 2-4 x daily (follow with lid massage)
 Antibiotic ointment qid to lid margins for 7 days (e-mycin, sulfacetamide sodium)
 Doxycycline 100mg bid x 6 weeks for severe infection
 Treat co-existing seborrhea of face/scalp with selenium sulfide shampoo
 Good hygiene

Question 9

conjunctivitis is what

Answer 9

inflammation of conjunctiva

aka red eye or pink eye

most common eye disease in primary care- usually self limiting disorder

Question 10

conjunctivitis etiology

Answer 10

1. bacterial
2. viral
3. allergic
4. chlamydia/ trachoma
5. other

Question 11

bacterial conjunctivitis causes

Answer 11

–	Staphylococcus aureus
–	Streptococcus pneumoniae
–	Haemophilus influenzae
–	Pseudomonas ( common in contact wearers)
–	Neisseria gonorrhoeae

Question 12

viral conjunctivitis causes

Answer 12

– Adenovirus – most common
• Adenopharyngeal conjunctivitis – “swimming pool”
– Herpes simplex
– Herpes zoster

Question 13

allergic conjunctivitis causes

Answer 13

• environmental- sesasonal

- cosmetics

Question 14

other causes of conjunctivitis

Answer 14

1. trauma
2. contact lens wearer- more susceptible than most
3. foreign body
4. drug induced- silver nitrate, erythromycin, thimerosal
5. systemic illness

Question 15

conjunctivitis mode of transmission

Answer 15

direct contact with contagion or allergen

 Contaminated contact lens solution
 Mascara/eyeliner, makeup
 Exposure to chemical substance

Question 16

Conjunctivitis History

Answer 16

 Mild to moderate redness and irritation
 No acute change in visual acuity
 Absence of photophobia
 Mild discomfort/pain – associated with itching, burning or excessive tearing
 Watery to purulent discharge

Question 17

what is a red flag in conjunctivitis hx

Answer 17

changes in vision

Question 18

conjunctivitis dx tests and findings

Answer 18

 Usually none
 Immunofluorescence test for suspected herpes simplex or chlamydia
 Culture – only if chronic or if GC suspected
 Gram stain – only if GC suspected

Question 19

conjunctivitis differential dx

Answer 19

	Urgent ophthalmic conditions – refer
	Acute uveitis/iritis
	Acute glaucoma
	Corneal abrasion
	Foreign body

Question 20

bacterial conjunctivitis presentation

Answer 20

• Mucopurulent discharge
• Thick purulent crust in a.m.
• Unilateral initially

Question 21

bacterial conjunctivitis tx

Answer 21

• Self-limiting – 10-14 days without treatment, 2-4 with treatment
– E-mycin ointment – thin layer in lower lid qid x5-7d
– Tobramycin 0.3% or gentamycin 0.3% op. solution 1-2 drops qid x7d
– Sodium sulfacetamide 10% ophthalmic solution – 1-2 drops q 4hours or qid x5-7 days
– Ciprofloxacin 1-2 drops q 2-4 hours x 2 days; then 1-2 drops q 4 hours x 5 days

Question 22

when to refer to ophthalmologist with bacterial conjunctivitis

Answer 22

1. herpes
2. ulcerations
3. hemorrhagic conjunctivitis

Question 23

Chlamydia Conjunctivitis Management/Treatment

Answer 23

 Doxycycline 100mg orally bid x 14 days or Azithromycin 1Gm x1 dose
AND
 Erythromycin ointment

Question 24

Viral Conjunctivitis Management/Treatment

Answer 24

 Self-limiting
 Topical antibiotics – to prevent secondary bacterial infection
 Corticosteroids contraindicated

Question 25

Allergic Conjunctivitis Management/Treatment

Answer 25

 Topical vasoconstrictors/antihistamines
 Naphazoline HCL/pheniramine maleate (Naphcon-A) – 1-2 drops qid
 Oral antihistamines
 Allergen avoidance
 Topical antihistamine mast cell stabilizer
 Azelastine (Optivar) 0.05% 1drop bid
 Olopatadine (Patanol) 0.1% 1 drop bid
 NSAID-ophthalmic (for ocular pruritis) – ketorolac tromethamine (Toradol) 0.5% - 1drop qid

Question 26

Conjunctivitis Patient Education/Prevention

Answer 26

• Cool/warm compresses
• Frequent gentle eye wash to remove discharge
• Artificial tears
• Strict hand washing
• Use separate towels; avoid handshaking
• Contact lens care – clean or change; new solution, avoid tap water solutions
• Avoid eye cosmetics during infection (discard contaminated make-up )– change products frequently
• Refer if no improvement in 48 hours or if vision is impaired