Ophthalmology - Conjunctivitis, Blepharitis Flashcards
Conjunctivitis - what is conjunctivitis, and what are teh three main categories?
Conjunctivitis refers to inflammation of the conjunctiva and is commonly split into 3 categories:
- Bacterial, infective
- Viral, infective
- Allergic
Conjunctivitis - what is conjunctiva?
The conjunctiva is a thin layer of tissue that covers to inside of the eyelids and the sclera of the eye
Conjunctivitis - how do all three types commonly present?
In all types, patients may present with itchy, irritated eyes that lacrimate excessively
Common PC is that eyelids feel ‘stuck’ together in the morning
- Unilateral or bilateral
- Red eyes
- Bloodshot
- Itchy or gritty sensation
- Discharge from the eye
Conjunctivitis - what does it NOT cause?
Conjunctivitis does NOT cause pain, photophobia or reduced visual acuity
Vision may be blurry when eye is covered with discharge, however when discharge is cleared, acuity should be normal
Conjunctivitis - how does bacterial conjunctivitis present?
Presents with:
PURULENT discharge
Worse in morning - eyes stuck together
Starts in 1 eye, highly contagious
Conjunctivitis - how does viral conjunctivitis present?
Presents with:
SEROUS discharge - clear
Recent URTI
Preauricular lymph nodes - tender, front of ears
Conjunctivitis - Management of infective conjunctivitis?
- normally a self-limiting condition that usually settles without treatment within 1-2 weeks
- topical antibiotic therapy in bacterial conjunctivitis is commonly offered to patients, e.g. Chloramphenicol
- topical fusidic acid is an alternative and should be used for pregnant women. Treatment is twice daily
- school exclusion is not necessary
Conjunctivitis - management of infective conjunctivitis in pregnant women?
Topical fusidic acid
Conjunctivitis - what is allergic conjunctivitis, what are the clinical features and management?
Allergic conjunctivitis may occur alone but is often seen in the context of hay fever
Clinical Features:
- Bilateral symptoms conjunctival erythema, conjunctival swelling (chemosis)
- Itch - prominent
- Swollen eyelids
- May be seasonal (due to pollen) or perennial (due to dust mite, washing powder)
Management of allergic conjunctivitis
- first-line: topical or systemic antihistamines
- second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil
Conjunctivitis - what are hygiene measures, and do they need to be excluded from school if they have infective conjunctivitis?
- contact lens should not be worn during an episode of conjunctivitis
- advice should be given not to share towels
School exclusion not necessary
Conjunctivitis - what should you do if a patient 1 month old or less has conjunctivitis?
Need urgent ophthalmology review as neonatal conjunctivitis can be associated gonococcal infection, can cause loss of sight and more severe complications such as pneumonia
Blepharitis - what is it?
Inflammation of the eyelid margins
Blepharitis - what are the most common causes?
It may due to either meibomian gland dysfunction (common, posterior blepharitis)
seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis)
Rosacea
Blepharitis - what are the meibomian glands?
Meibomian glands are oil glands along the edge of the eyelids where the eyelashes are found
These glands make oil that is an important part of the eye’s tears
The meibomian glands secrete oil on to the eye surface to prevent rapid evaporation of the tear film, any problem affecting the meibomian glands (as in blepharitis) can hence cause drying of the eyes which in turns leads to irritation
Blepharitis - are symptoms usually unilateral or bilateral?
Usually bilateral
