module 1 conjunctivitis Flashcards
conjunctivitis
inflammation of the bulbar or palpebral conjunctiva
- commonly referred to at pink eye
Causes:
- Infectious: viral, bacterial
- Non-infectious: allergy, atopy, exposure to toxins
most common cause of infectious
adenovirus
most common cause of non-infectious
allergic conjunctivitis
viral conjunctivitis patho
spread by direct contact of by proximity to an infected person
acute allergic conjunctivitis patho
characterized by an immunoglobulin E mast cell-mediated hypersensitivity
vernal and atopic conjunctivitis patho
chronic, mast cell, and lymphocyte-mediated immune processes
- more severe and chronic forms of allergic conjunctivitis
medication conjunctivitis patho
typically occurs with long-term use of eye drops
- > 1 month
viral conjunctivitis physical exam
- recent URI or exposure to sick individuals
- acute onset of red eye with excessive watery discharge
- begins in one eye then migrates to other
- follicles, clear bumps ranging in size from pinpoint to 2mm, and overlying injected conjunctival vessels
- fever
- Sore throat
adenoviral conjunctivitis 3 forms
adenoviral
pharyngoconjunctival fever
epidemic keratoconjunctivitis
- palpate anterior cervical chain
pharyngoconjunctival fever s/s
ocular exam similar plus
- fever
- headache
- sore throat
epidemic keratoconjunctivitis
bilateral conjunctival hyperemia and chemosis
petechial and larger subconjunctival hemorrhages may be present
- may have corneal involvement
chemosis
swelling of bulbar conjunctiva
- looks like a big blister
bacterial conjunctivitis physical exam
Thick purulent discharge
both eyes are sticky or glued shut
- worse in the am
bacterial conjunctivitis patho
overproliferation of native flora or from direct spread from infected individual
acute conjunctivitis (bacterial) s/s
s/s manifest over days, usually last 7-10 days
- hyperemia
- chomsis
- photophobia
- blepharospasm
- tearing
- NO systemic s/s
Children: Hib and stretopcoccus pnue. most common causes
Adults: S. aureus most common cause
hyperacute onset (bacterial) s/s
s/s within 12-24 and severe purulent discharge
- consistent with Gonorrhoea
- seen in sexually active adults or neonates via maternal-neonate transmission
Cornea involvement can happen in less than 2 days -> permanent vision loss
chronic bacterial conjunctivitis s/s
lasting longer than 4 weeks
- chlamydial should be suspected
Acute Allergic conjunctivitis s/s
- headache and fatigue along with conjunctivitis
- occurs simultaneously in both eyes
- itching
- discharge: clear or stringy white
- Conjunctiva: boggy appearance (chemosis)
- periocular skin shows lid discoloration, thickening, and erythema
- dark circles under eyes
- Can lead to corneal ulceration
vernal and atopic conjunctivitis s/s
more severe s/s of severe itching, burning, and tearing
- blepharospasm
- photophobia
- discharge is white, thick, and ropy
- bilateral
Vernal: giant papillary conjunctivitis is hallmark
- upper lid with cobblestone pattern of large geometric bumps -> droopy eyelid
- corneal involvement
- shield ulcer
atopic conjunctivitis patient population
> 50
hx: asthma, allergic rhinitis, atopic dermatitis
vernal conjunctivitis patient population
childhood
primarily male
resolves by 3rd decade
medication toxicity s/s
contact dermatitis of the lower lids
thickening and scaling of the skin
viral tx
self-limiting
5-14 days
artificial tears
cool compress
- contagious as long as still tearing or for at least 1 week
2 sight threatening consequences of viral
corneal involvement -> dec. vision
conjunctival pseudomemebranes -> scarring and chronic dry eye
- follow up in 4 weeks if s/s not fully resolved
Bacterial tx
topical treatment with antibiotics
MUST be treated:
- H. influenzae
- gonococcal
- chlamydial
Acute allergic tx
allergens identified and removed
oral antihistamine
artificial tears
cool compress
removal of contact lens
vernal tx
mast cell stabilizers 2 weeks before the usual time of presentation
pericorneal
conjunctival disorders near the cornea (inc. redness near cornea)
- rosacea
- corneal lesions
- foreign body
- herpetic keratitis
ciliary
disorders of deeper tissues and intraocular structures
(red ring around iris)
- episcleritis
- scleritis
- disciform keratitis
- iritis
- cyclitis
mixed
corneal disorders with intraocular irritation
- corneal ulcerations
inclusion conjunctivitis
from chlamydial infections
- can occur in neonate or in persons at risk for STI
