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General Medicine & Family Medicine > Ophthalmology_Red Eye and Eye Pain and Conjuctivitis > Flashcards

Ophthalmology_Red Eye and Eye Pain and Conjuctivitis Flashcards

1
Q

What is the most common cause of red eye?

A

Conjuctivitis

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2
Q

Causes of red eye?

A
  • Conjuctivitis
  • Keratitis
  • uveitis (iritis)
  • scleritis
  • episcleritis
  • corneal abrasion
  • glaucoma
  • blepharitis
  • subconjunctival hemorrhage
  • foreign body
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3
Q

History of a Red Eye

A
  • 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
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4
Q

Causes of conjuctivitis

A
  • Infectious: bacterial, viral, chlamydial
  • Noninfectious: allergies, irritants
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5
Q

A 15-year-old boy with asthma, eczema, and seasonal rhinitis presents with itchy , watery eyes. What is the most likely diagnosis?

A
  • Allergic conjuctivitis
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6
Q

What nonpharmacologic measures can help manage allergic conjunctivitis?

A
  • 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)
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7
Q

What kinds of eye drops help relieve allergic conjunctivitis?

A
  • Artificial tears (dilute allergens)
  • antihistamine eye drops (olopatadine)
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8
Q

What is the disadvantage of oral antihistamines versus antihistamine eye drops?

A
  • The onset of action of oral antihistamines is longer than antihistamine eye drops
  • oral antihistamines cause systemic side effects, such as drowsiness.
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9
Q

Although not always reliable, what differences in examination findings might you expect in bacterial versus viral conjunctivitis?

A
  • Bacterial: opaque, thick, purulent discharge that reappears shortly after wiping the lids
  • Viral: watery discharge
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10
Q

Causes of viral conjuctivitis

A
  • Adenovirus (most common)
  • enterovirus
  • coxsackievirus
  • varicellazoster virus
  • Epstein-Barr Virus
  • HSV
  • Influenza
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11
Q

What physical exam findings suggest viral conjunctivitis?

A
  • Minimal pain
  • diffuse conjunctival injection
  • mild itching
  • watery discharge
  • vision preserved
  • unaffected pupils
  • preauricular lymphadenopathy
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12
Q

What is the management of viral conjunctivitis?

A
  • 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)
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13
Q

What is herpes zoster ophthalmicus?

A
  • 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.
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14
Q

In herpes zoster, what cranial nerve would have to be affected to impair the patient’s vision?

A
  • The frontal branch of the first division of the trigeminal nerve (V1)
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15
Q

What physical exam finding makes you suspect zoster involvement of the frontal branch of V1?

A
  • Vesicles involving the tip of the nose (Hutchinson sign)
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16
Q

What is the treatment of herpes zoster ophthalmicus?

A
  • Antiviral therapy
  • topical steroid drops to control keratitis and iritis
  • typically treated by ophthalmology
17
Q

What are the three subtypes of bacterial conjunctivitis?

A
  1. acute lasts up to 3-4 weeks.
  2. Chronic lasts > 4 weeks.
  3. Hyper acute - Sudden onset and rapid progres
18
Q

What are the offending microorganisms responsible for acute and chronic bacterial conjunctivitis?

A
  • In children- Streptococcus pneumoniae, Haemophilus influenza.
  • In adults - S. aureus, Moraxella species, E coli Pseudomonas species.
19
Q

What is the offending pathogen responsible for hyperacute bacterial conjunctivitis?

A
  • Nesseria gonorhea
20
Q

What is the best clinical predictor when considering a diagnosis of bacterial conjunctivitis?

A
  • profuse, thick mucopurulent secretions.
21
Q

What is the treatment of acute bacterial conjunctivitis?

A
  • 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
22
Q

Sudden onset of perfuse mucopurulent discharge, accompanied by intense hyperemia of conjunctiva in a sexually active patient suggest what process?

A
  • hyperacute gonococcal conjuctivitis
23
Q

What is the treatment of hyper acute bacterial conjunctivitis?

A
  • danger of rapid progression and potential corneal perforation requires aggressive management by an ophthalmologist and possible hospitalization
  • systemic antibiotics+/- topical therapy
  • Frequent eye irrigation.
24
Q

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?

A
  • 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.
25
Q

What are the three types of neonatal conjunctivitis?

A
  1. chemical (less than 24 hours old)
  2. Gonorrheal (2-5 days old).
  3. Chlamydial (5 to 14 days old)
26
Q

Erythromycin ointment is given prophylactically to all newborns at birth to decrease the risk of what type of neonatal conjunctivitis?

A

Gonococcal conjuctivitis

27
Q

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?

A
  • Chemical conjunctivitis precipitated by the erythromycin drops
  • will resolve in 48 hours.
28
Q

What is the typical presentation of neonatal gonococcal conjunctivitis?

A
  • prefuse purulent discharge and striking hyperaemia and edema 2-5 days after birth.
29
Q

What is the treatment of neonatal gonococcal conjunctivitis?

A
  • topical and systemic antibiotics
    • penicillin
    • ceftriaxone
    • azithromycin
30
Q

What is the most common cause of neonatal conjunctivitis?

A
  • Chlamydia
    • transmission during passage in birth canal.
31
Q

What is the treatment for neonatal Chlamydial conjunctivitis? .

A
  • topical tetracycline and oral erythromycin
32
Q

What is the role of systemic antibiotics component of neonatal conjunctival therapy?

A
  • to prevent chlamydia pneumonia.
33
Q

What should you suspect in a school-aged child who presents with features of gonococcal conjunctivitis?

A

sexual abuse.

34
Q
A

General Medicine & Family Medicine (150 decks)

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