Infections Flashcards
Conjunctivitis: Signs and Symptoms
Symptoms and signs
• sudden onset
• conjunctival redness
• discharge (type is important for differential diagnosis
Management
• Optometrist can usually treat by self or in conjunction with pharmacist/GP
Keratitis: Signs and Symptoms
Symptoms and signs
• similar to conjunctivitis
• pain
• photophobia
• reduced vision (depending upon location)
• Unilateral (not always)
• Corneal involvement (wide variation in appearance and severity)
Management
• Depends upon type (more detail to follow) • Likely managed by HES / IP Optom
When do Bacterial infections occur?
• barriers are compromised (opportunistic bacteria).
• disrupted tear film
• Immunosuppression
• injury
• surgery
• virulent pathogen is present & invades an uncompromised eye
Bacterial conjunctivitis: Risks and symptoms
Risks:
• Immunosuppression; elderly, young children, steroids, diabetes
• Infection; CL wear, trauma, systemic infection, blepharitis
Symptoms:
• Originally unilateral but can quickly become bilateral
• Redness
• Sticky discharge/pus; thick, white/yellow
• uncomfortable (gritty, burning)
• eyes stuck together on waking
Bacterial conjunctivitis: Signs
• Conjunctival injection/hyperaemia
• Crusted & oedematous lids
• Discharge
• purulent or mucopurulent
• Mild papillary reaction
• mild corneal involvement:
• superficial punctate epitheliopathy
• peripheral corneal infiltrates
Bacterial conjunctivitis: Management
• Self limiting 5-7says without treatment
• Bathe lids/hot compresses to remove crust
• Advise about contagious nature
- arvise px of red flags
• Antibiotics? - Stewardship guidelines
- Only consider if not better after 7 days
• Review
- if minor corneal involvement
Bacterial keratitis causes:
Causes
• Generally only caused by opportunistic bacteria if damaged ocular surface:
• contact lens wear
• injury
• dry eye
• Immune compromise
• blepharitis
Bacterial keratitis: Symptoms
Symptoms:
• Acute onset
• Usually unilateral
• Pain (moderate to severe)
• Redness
• Discharge
• Blurred vision
Bacterial keratitis: Signs
Signs
• Lid oedema
• Epiphora
• Discharge (purulent or mucopurulent)
• Conjunctival hyperaemia
• Central or mid peripheral corneal lesion
- Stromal infiltration & edema beneath lesion
• Anterior chamber activity; flare, cells, hypopyon
Bacterial keratitis: Management
• Emergency referral straight to HES
• CL wearers keep cases for culture
Fungal Infections: Describe
• Rare in healthy individuals
• Rare in UK (needs hot/humid climates)
• Compromised corneal epithelium
• Usually immune compromised
• Hx trauma organic material
• Usually only suspected if unresponsive to other treatment
Fungal Keratitis: Describe
• Similar signs to bacterial conjunctivitis, but slower
• Often misdiagnosed when not clear Hx
Non-Herpetic Viral conjunctivitis: Describe
• Most commonly Adenoviral
- spectrum of disease, mild - severe
• Less commonly enterovirus
Non-Herpetic Viral conjunctivitis: Causes and symptoms
Causes
• Recent cold/ upper respiratory infection
• Crowded conditions
• Eye clinics!
Symptoms
• Acute onset - red, watery, uncomfortable
• unilateral> bilateral
• Blurred vision
• Hx of cold type symptoms
• Tender pre-auricular lymphadenopathy
Non-Herpetic Viral conjunctivitis: Signs and Severe signs
• Watery discharge
• Eyelid oedema
• Conjunctival hyperaemia
• Follicles on palpebral conjunctiva
• Tender pre-auricular lymphadenopathy
If severe:
• Pin point Conjunctival haemorrhages
• Chemosis
• Pseudomembranes
Non-Herpetic Viral conjunctivitis: Management and referral
• Advise
- Highly contagious, self limiting 2-3weeks, should stay off school/work in this time, cold compresses for inflammation
• Pharmaological
- Artificial tears + lubricants, vasoconstrictors/antihistamines to prevent itching, antibacterials not effective, antivirals not affective
• Refer if:
- Pseudomembrane requiring removal
- Corneal involvement (IP may manage with mild steroid - FML)
Herpes simplex conjunctivitis: Signs/symptoms
• Common during primary infection (usually children)
• Watery discharge
• Follicles on conjunctiva
• Herpetic vesicles on skin
Follicles also appear with adevoviral, how to differentiate?
• Adenoviral usually bilateral
• HSV usually unilateral
Herpes simplex conjunctivitis: Management
• Cold compresses
• Artificial tears and lubricants
• Advice on hygiene and recurrence
Herpes Simplex Keratitis: Predisposing Factors
• Hx of herpes simplex infection
• Poor general health, immunodeficiency, fatigue
• Systemic or topical steroids, or other immunosuppressive drugs
• Possible aggravating factors; sunlight (UV), fever, extreme heat or cold, infection (systemic or ocular), trauma (ocular)
• Severe atopic disease
Herpes Simplex Keratitis: Symptoms
• May have hx of recurrent attacks
• Usually unilateral (bilateral in atopic px)
• Pain, photophobia, reduced VA, redness
• Severity of symptoms variable
Herpes Simplex Keratitis: Signs
• Reduced corneal sensitivity
• Most common is dendritic ulcer (in epithelium):
- initially a punctate or stellate pattern
- can develop into a linear branching ulcer
- larger geographic ulcer
• Can involve corneal stroma and endothelium (in more severe cases) and anterior chamber activity (heretic uveitis) and even the retina (viral retinitis)
Herpes Simplex Keratitis: Management
ENTRY LEVEL
ENTRY LEVEL PRACTITIONERS:
• Determine severity (depth of corneal involvement, A/C activity and IOP)
• Assess posterior pole - dilated fundus exam
- To rule out viral retinitis (emergency referral)
• Call CDU / ARC - emergency / urgent referral
Herpes Simplex Keratitis: Management
IP/ SHARE CARE
• Treatment with topical antivirals (aciclovir or ganciclovir gel) 5 times daily until resolved then 3x daily for further 7 days
• Only for epithelial defects. More severe cases involving deeper corneal layers require tx
• CL wearers must be referred to HES
• If px is contact lens wearer may be early acanthamoeba!!!
