MDT Eye Conjunctivitis Flashcards
What is an inflammation of the conjunctive, presents with injected pink or red eye(s), eye discharge ranging from mild to purulent, eye discomfort or gritty sensation, and no vision loss?
Conjunctivitis
True/False
Conjunctivitis is most commonly infectious (viral or bacterial) or allergic, but can be caused by irritants.
True
What is the most common cause of viral conjunctivitis?
Adenovirus
True false
Viral conjunctivitis Infection spreads easily, like in clinics and contaminated swimming pools.
True
Allergic Conjunctivitis is caused by what
……………
Caused by an allergen. Symptomatology is a reaction to the allergen
What type of conjunctivitis ?
Symptoms: Itching, burning, tearing, gritty or foreign body sensation; history of recent upper respiratory tract infection or contact with someone with this issue.
Signs: Watery discharge, red and edematous eyelids, pinpoint subconjunctival hemorrhages, punctate keratopathy (epithelial erosion in severe cases), membrane/pseudomembrane (severe cases).
1) Critical signs: Inferior palpebral conjunctival follicles, tender palpable preauricular lymph node.
Viral Conjunctivitis
What type of Conjunctivitis
Symptoms: Itching, watery discharge, and a history of allergies are typical. Usually bilateral.
Signs: Chemosis (swollen conjunctiva), red and edematous eyelids, conjunctival papillae, periocular hyperpigmentation, no preauricular node.
Allergic conjunctivitis
What type of Conjunctivitis?
(a) Symptoms: Redness, foreign body sensation, discharge; itching is much less prominent.
(b) Often complain of having to wipe purulent exudate in morning.
(c) Signs:
1) Critical: Purulent white-yellow discharge of mild-to-moderate degree.
2) Other: Conjunctival papillae, chemosis, preauricular node typically absent (unlike gonococcal).
Bacterial conjunctivitis (nongonococcal)
What type of Conjunctivitis?
1) Critical: Severe purulent discharge, hyperacute onset (classically within 12 to 24 hours).
2) Other: Conjunctival papillae, marked chemosis, preauricular adenopathy, eyelid swelling.
Gonococcal conjunctivitis
What are some ddx for Conjunctivitis?
(1) Acute uveitis
(2) Foreign body
(3) Chlamydial keratoconjunctivitis
True/False
Conjunctival cultures/swabs are indicated for these issues:
(1) Viral conjunctivitis
(2) Allergic conjunctivitis
FALSE
No conjunctival cultures/swabs are indicated
Labs/Studies/EKG: Bacterial conjunctivitis (nongonococcal):
Send conjunctival scrapings for immediate Gram stain, culture and sensitivities
Labs/Studies/EKG:
Gonococcal conjunctivitis
(a) Eye examine the entire cornea for peripheral ulcers (especially superiorly)
(b) Gram stain: Gram-negative intracellular diplococci
(c) Send conjunctival scrapings for immediate culture and sensitivities
Treatment
Viral conjunctivitis
Mild:
Artificial tears or tear ointment
Treatment
Viral conjunctivitis
Moderate:
Epinastine (Elestat) - Ophthalmic antihistamine for symptomatic relief
-0.05% solution 1 drop to affected eye BID
Treatment
Viral conjunctivitis
Severe: If a membrane/pseudomembrane is present,
gently peel with a cotton-tip applicator.
Treatment
Viral conjunctivitis
Severe with significant photophobia
Ophthalmic Corticosteroids
Consult ophthalmology BEFORE giving steroids
Treatment for Allergic conjunctivitis
Mild:
Moderate:
Mild: Artificial tears four to eight times per day
Moderate: Patanol 0.1% BID or Epinastine 0.05% QID
Treatment for Bacterial conjunctivitis (nongonococcal)
Topical antibiotic therapy
Trimethoprim/polymyxin B (Polytrim)
1 drop in affected eye Q 3 hours for 7-10 days.
Treatment for Bacterial conjunctivitis (nongonococcal)
if your patient wears contact lenses
Ciprofloxacin (Ciloxan) or Ofloxacin (Ocuflox) – Fluoroquinolone antibiotic class.
-Dose: 0.3% Solution, use 1-2 drops in affected eye QID for 5-7 days.
Treatment for Bacterial conjunctivitis (nongonococcal)
With associated dacryocystitis
Amoxicillin/Clavulanate (Augmentin)
Dose: 875/125 mg BID or 500/125 mg TID
Or
Cephalexin 500mg PO QID
Treatment for Gonococcal conjunctivitis
Ceftriaxone 1 g IM, PLUS azithromycin 1 g PO both in a single dose.
Treatment for Gonococcal conjunctivitis for patients with penicillin/cephalosporin allergy
Gentamicin 240mg IM x 1 dose PLUS Azithromycin 2mg PO x 1 dose.
True/False
When treating a Gonococcal conjunctivitis patient you should get an optometry or ophthalmology consult due to high risk of corneal perforation.
True
Treatment for Gonococcal conjunctivitis
If corneal involvement exists…
Hospitalize the patient
Initial Care of the disease and Follow up:
Viral conjunctivitis
-Cool compresses several times per day.
-Counsel the patient
1) Is a self-limited condition that typically gets worse for the first 4 to 7 days
after onset and may not resolve for 2 to 3 weeks (potentially longer with corneal involvement).
2) Is highly contagious.
3) Avoid touching (eyes, shaking hands, sharing towels or pillows, etc.); restrict
work and school.
4) Frequent handwashing.
Initial Care of the disease and Follow up:
Allergic conjunctivitis
(a) Eliminate the inciting agent.
(b) Cool compresses several times per day.
Initial Care of the disease and Follow up: Bacterial conjunctivitis (nongonococcal)
(a) Follow-up every 2 to 3 days initially, then every 5 to 7 days when stable until resolved.
(b) Antibiotic therapy is adjusted according to culture and sensitivity results.
Initial Care of the disease and Follow up:
Gonococcal conjunctivitis
Treat sexual partners with oral antibiotics for both gonorrhea and chlamydia
What are some complications for conjunctivitis?
(1) Vision loss or blindness
(2) Orbital or systemic involvement
