Week 2 - B - Ophthalmology 1 - Conjunctivitis and Keratitis Flashcards
How does bacterial conjunctivitis present?
Presents with redness of the eye
Purulent discharge
Itching of the eyes
May have a photophobia also
How is bacterial and viral conjunctivitis differentiated? What can be taken due to the discharge?
Bacterial presents with purulent discharge - viral doesnt
Take swabs from the discharge to identify the organism
Conjunctivitis tends to resolve within 14 days but if there it is severe or last longer (usually if bacterial) antibiotics can be given What is the 1st line choice of treatment for bacterial conjunctivitis (covers most organism)?
Chloramphenicol
What are some potential side effects of chloamphenicol?
Some side effects are
Irreversible aplastic anaemia
Worsening symptoms if allergic
Grey baby syndrome
What is aplastic anaemia?
An impairment of bone marrow function which causes failure to produce all three blood cell typess :
anaemia (low RBC),
leukopenia (Low WBC),
thrombocytopaenia (low platelets)
What is given as treatment if the bacterial organism causing cojunctivitis is staph aureus?
Give fusidic acid eye drops
If the organism causing conjunctivitis is pseudomonas aerguinosa, what eye drops are given?
Give gentamicin eye drops
What is a key sign to remember in conjunctivitis that helps differentiate from other causes of red eye?
Vision is unaffected in conjunctivitis
If a patient presents with allergic conjunctivitis, what is the usual treatment?
Application of cold compresses to the eyes (for 5–10 minutes once or twice daily) to relieve symptoms.
Application of ocular surface lubricants such as saline solution or artificial tears If non-pharmacological measures do not provide adequate relief:
* Consider prescribing a topical antihistamine or
dual action mast cell stabilizer and topical antihistamine
What are the usual causes of follicular conjunctivitis?
Chlamydial infection
Viral infection eg HSV, Adenovirus
What may follicular conjunctivitis be secondary to in children? Usually presents as small firm umbilicated papules
Molluscum contagiosum
How are viral conjunctiivits treated?
Usually self limiting
Patients should be advised to take precautions to avoid spread to others ie. stay home from school while discharge and redness persist, frequent hand-washing, avoid sharing towels/cosmetics, avoid eye-rubbing.
ADVISE COOL COMPRESS / LUBRICANTS
In patients presenting with vesicular crusting on the tip of the nose, what do you think is the cause of this and what is this known as?
Hutchison’s sign - causes vesicles on the tip of the nose - think herpes zoster virus
Eye involvement as the nasociliary branch of the opthalmic nerve supplies the tip of the nose
What is the treatment of herpes zoster conjunctiviits?
Give the patient oral acyclovir
What are causes of conjunctivitis in neonates?
Staph aureus, and STD related conjunctiviis - chalmydial trachomatis, neisseria gonorrhea
How does chlamydial conjunctivits present?
Usually presents as bilateral conjunctivitis with eye pain and discharge coming from the eye
Also have follicles on the inner eyelid
Can get it via STDD transmission, eg birth canal or unprotected sex or from infected swimming areas in poor countries eg africa
In adults, what other non-eye related symptoms can come with chlamydial conjunctivitis?
Burning sensation when peeing
What is the treatment fro chlamdyial conjunctivitis? (what may also be given to adults if they have a genital infection?)
Topical oxytetracycline
Adults may also need oral azithromycin for genital infection
So for all types of conjunctivitis, how are cultures taken? (if there is any discharge)
Swabs are taken for cultures to identify the organism
What is keratitis and who is it associated with?
Inflammation of the cornea
Associated with contact lens wearers
What is the inflammatory exudate seen in the anterior chamber of the eye known as? it is seen in keratitis Why does it settle at the bottom of the eye?
It is known as a hypopyn
Settles at the bottom of the eye due to gravity
How is the causative organism in keratitis diagnosed?
By taking a corneal scraping
What two types of organisms are found in contact lens wearers?
Pseudomonas aerguinosa and acanthomoeba
What is the first line treatment for keratitis?
A 4-quinolone (the second generation which are mostly prescribed are fluoroquinolones) - oflaxacin drops (covers most organisms)
Treats most gram negative coliforms including H.influenza and pseudomonas
What bacteria is oflaxacin not active against?
Not active against strep pneumoniae
What combination of antibiotics covers most gram positive and negative organisms and can be used in keratitis management?
Use gentamicin and cefuroxime
What is the usual cause of a dendritic ulcer of the cornea?
Herpetic keratitis caused by HSV
Why are steroids not given to treat herpetic keratitis?
Topical steroids can cause a corneal melt
How does herpetic keratitis present?
Dendritic ulcer, very painful and can lead t blindness
What do you stain with to see the dendritic ulcer? What is the treatment of herpetic keratitis?
Stain with fluoroscein dye
Treat with oral acyclovir
