Ophthalmology_Red Eye and Eye Pain and Conjuctivitis Flashcards
What is the most common cause of red eye?
Conjuctivitis
Causes of red eye?
- Conjuctivitis
- Keratitis
- uveitis (iritis)
- scleritis
- episcleritis
- corneal abrasion
- glaucoma
- blepharitis
- subconjunctival hemorrhage
- foreign body
History of a Red Eye
- Symptom duration
- unilateral or bilateral involvement
- quality and quantity of discharge
- visual changes
- severity of pain
- photophobia
- history of recent eye infection/allergies and treatment
- personal or family history of autoimmune disease
- contact-lens use
Causes of conjuctivitis
- Infectious: bacterial, viral, chlamydial
- Noninfectious: allergies, irritants
A 15-year-old boy with asthma, eczema, and seasonal rhinitis presents with itchy , watery eyes. What is the most likely diagnosis?
- Allergic conjuctivitis
What nonpharmacologic measures can help manage allergic conjunctivitis?
- Allergen avoidance
- avoidance of rubbing eyes which can cause mechanical mast cell degranulation
- reduction of contact lens use (allergens can adhere to contact lens surfaces)
What kinds of eye drops help relieve allergic conjunctivitis?
- Artificial tears (dilute allergens)
- antihistamine eye drops (olopatadine)
What is the disadvantage of oral antihistamines versus antihistamine eye drops?
- The onset of action of oral antihistamines is longer than antihistamine eye drops
- oral antihistamines cause systemic side effects, such as drowsiness.
Although not always reliable, what differences in examination findings might you expect in bacterial versus viral conjunctivitis?
- Bacterial: opaque, thick, purulent discharge that reappears shortly after wiping the lids
- Viral: watery discharge
Causes of viral conjuctivitis
- Adenovirus (most common)
- enterovirus
- coxsackievirus
- varicellazoster virus
- Epstein-Barr Virus
- HSV
- Influenza
What physical exam findings suggest viral conjunctivitis?
- Minimal pain
- diffuse conjunctival injection
- mild itching
- watery discharge
- vision preserved
- unaffected pupils
- preauricular lymphadenopathy
What is the management of viral conjunctivitis?
- Patient education about transmission
- promote strict hand washing and discourage sharing of personal items
- supportive treatment with cold compresses and artificial tears
- topical antibiotics (rarely necessary because secondary bacterial infections are uncommon)
What is herpes zoster ophthalmicus?
- Vesicular rash, keratitis, and uveitis caused by herpes zoster.
- Unilateral pain and tingling precede conjunctivitis and dermatomal rash.
- Early diagnosis can prevent corneal involvement and potential vision loss.
In herpes zoster, what cranial nerve would have to be affected to impair the patient’s vision?
- The frontal branch of the first division of the trigeminal nerve (V1)
What physical exam finding makes you suspect zoster involvement of the frontal branch of V1?
- Vesicles involving the tip of the nose (Hutchinson sign)
What is the treatment of herpes zoster ophthalmicus?
- Antiviral therapy
- topical steroid drops to control keratitis and iritis
- typically treated by ophthalmology
What are the three subtypes of bacterial conjunctivitis?
- acute lasts up to 3-4 weeks.
- Chronic lasts > 4 weeks.
- Hyper acute - Sudden onset and rapid progres
What are the offending microorganisms responsible for acute and chronic bacterial conjunctivitis?
- In children- Streptococcus pneumoniae, Haemophilus influenza.
- In adults - S. aureus, Moraxella species, E coli Pseudomonas species.
What is the offending pathogen responsible for hyperacute bacterial conjunctivitis?
- Nesseria gonorhea
What is the best clinical predictor when considering a diagnosis of bacterial conjunctivitis?
- profuse, thick mucopurulent secretions.
What is the treatment of acute bacterial conjunctivitis?
- antibiotic eyedrops or ointment 4-6 times a day
- (studies however, have indicated that most cases are self limited)
- frequent handwashing to prevent spreading
- For cases lasting greater than four weeks referral to ophthalmology for management of chronic bacterial conductivitis
Sudden onset of perfuse mucopurulent discharge, accompanied by intense hyperemia of conjunctiva in a sexually active patient suggest what process?
- hyperacute gonococcal conjuctivitis
What is the treatment of hyper acute bacterial conjunctivitis?
- danger of rapid progression and potential corneal perforation requires aggressive management by an ophthalmologist and possible hospitalization
- systemic antibiotics+/- topical therapy
- Frequent eye irrigation.
A patient returns to your office with no response to standard antibacterial treatment for a suspected acute bacterial conjunctivitis. Given that the person is sexually active, what are the other diagnosis and treatment might you pursue at this stage?
- Chlamydia conjunctivitis (signs and symptoms which do not resolve whichstandard antibiotic therapy).
- Treat topically with erythromycin ophthalmic ointment.
- Treat possible genital infection with azithromycin or doxycycline
- encourage treatment for patient’s sexual partners.
What are the three types of neonatal conjunctivitis?
- chemical (less than 24 hours old)
- Gonorrheal (2-5 days old).
- Chlamydial (5 to 14 days old)
Erythromycin ointment is given prophylactically to all newborns at birth to decrease the risk of what type of neonatal conjunctivitis?
Gonococcal conjuctivitis
12 hours after a newborn receives her erythromycin drops she develops redness in both eyes, and a nonpurulent discharge. What is the most likely diagnosis?
- Chemical conjunctivitis precipitated by the erythromycin drops
- will resolve in 48 hours.
What is the typical presentation of neonatal gonococcal conjunctivitis?
- prefuse purulent discharge and striking hyperaemia and edema 2-5 days after birth.
What is the treatment of neonatal gonococcal conjunctivitis?
- topical and systemic antibiotics
- penicillin
- ceftriaxone
- azithromycin
What is the most common cause of neonatal conjunctivitis?
- Chlamydia
- transmission during passage in birth canal.
What is the treatment for neonatal Chlamydial conjunctivitis? .
- topical tetracycline and oral erythromycin
What is the role of systemic antibiotics component of neonatal conjunctival therapy?
- to prevent chlamydia pneumonia.
What should you suspect in a school-aged child who presents with features of gonococcal conjunctivitis?
sexual abuse.
