MDT Eye Conjunctivitis

Question 1

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?

Answer 1

Conjunctivitis

Question 2

True/False
Conjunctivitis is most commonly infectious (viral or bacterial) or allergic, but can be caused by irritants.

Answer 2

True

Question 3

What is the most common cause of viral conjunctivitis?

Answer 3

Adenovirus

Question 4

True false
Viral conjunctivitis Infection spreads easily, like in clinics and contaminated swimming pools.

Answer 4

True

Question 5

Allergic Conjunctivitis is caused by what

Answer 5

……………
Caused by an allergen. Symptomatology is a reaction to the allergen

Question 6

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.

Answer 6

Viral Conjunctivitis

Question 7

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.

Answer 7

Allergic conjunctivitis

Question 8

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).

Answer 8

Bacterial conjunctivitis (nongonococcal)

Question 9

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.

Answer 9

Gonococcal conjunctivitis

Question 10

What are some ddx for Conjunctivitis?

Answer 10

(1) Acute uveitis
(2) Foreign body
(3) Chlamydial keratoconjunctivitis

Question 11

True/False
Conjunctival cultures/swabs are indicated for these issues:
(1) Viral conjunctivitis
(2) Allergic conjunctivitis

Answer 11

FALSE
No conjunctival cultures/swabs are indicated

Question 12

Labs/Studies/EKG:
Bacterial conjunctivitis (nongonococcal):

Answer 12

Send conjunctival scrapings for immediate Gram stain, culture and sensitivities

Question 13

Labs/Studies/EKG:
Gonococcal conjunctivitis

Answer 13

(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

Question 14

Treatment
Viral conjunctivitis
Mild:

Answer 14

Artificial tears or tear ointment

Question 15

Treatment
Viral conjunctivitis
Moderate:

Answer 15

Epinastine (Elestat) - Ophthalmic antihistamine for symptomatic relief
-0.05% solution 1 drop to affected eye BID

Question 16

Treatment
Viral conjunctivitis
Severe: If a membrane/pseudomembrane is present,

Answer 16

gently peel with a cotton-tip applicator.

Question 17

Treatment
Viral conjunctivitis
Severe with significant photophobia

Answer 17

Ophthalmic Corticosteroids
Consult ophthalmology BEFORE giving steroids

Question 18

Treatment for Allergic conjunctivitis
Mild:
Moderate:

Answer 18

Mild: Artificial tears four to eight times per day

Moderate: Patanol 0.1% BID or Epinastine 0.05% QID

Question 19

Treatment for Bacterial conjunctivitis (nongonococcal)

Answer 19

Topical antibiotic therapy
Trimethoprim/polymyxin B (Polytrim)
1 drop in affected eye Q 3 hours for 7-10 days.

Question 20

Treatment for Bacterial conjunctivitis (nongonococcal)
if your patient wears contact lenses

Answer 20

Ciprofloxacin (Ciloxan) or Ofloxacin (Ocuflox) – Fluoroquinolone antibiotic class.
-Dose: 0.3% Solution, use 1-2 drops in affected eye QID for 5-7 days.

Question 21

Treatment for Bacterial conjunctivitis (nongonococcal)
With associated dacryocystitis

Answer 21

Amoxicillin/Clavulanate (Augmentin)
Dose: 875/125 mg BID or 500/125 mg TID

Or
Cephalexin 500mg PO QID

Question 22

Treatment for Gonococcal conjunctivitis

Answer 22

Ceftriaxone 1 g IM, PLUS azithromycin 1 g PO both in a single dose.

Question 23

Treatment for Gonococcal conjunctivitis for patients with penicillin/cephalosporin allergy

Answer 23

Gentamicin 240mg IM x 1 dose PLUS Azithromycin 2mg PO x 1 dose.

Question 24

True/False
When treating a Gonococcal conjunctivitis patient you should get an optometry or ophthalmology consult due to high risk of corneal perforation.

Answer 24

True

Question 25

Treatment for Gonococcal conjunctivitis
If corneal involvement exists…

Answer 25

Hospitalize the patient

Question 26

Initial Care of the disease and Follow up:
Viral conjunctivitis

Answer 26

-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.

Question 27

Initial Care of the disease and Follow up:
Allergic conjunctivitis

Answer 27

(a) Eliminate the inciting agent.
(b) Cool compresses several times per day.

Question 28

Initial Care of the disease and Follow up:
Bacterial conjunctivitis (nongonococcal)

Answer 28

(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.

Question 29

Initial Care of the disease and Follow up:
Gonococcal conjunctivitis

Answer 29

Treat sexual partners with oral antibiotics for both gonorrhea and chlamydia

Question 30

What are some complications for conjunctivitis?

Answer 30

(1) Vision loss or blindness
(2) Orbital or systemic involvement