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OD2 S2 > wk9: AED - Conjunctival Infections 1 [DG] > Flashcards

wk9: AED - Conjunctival Infections 1 [DG] Flashcards

1
Q

Describe a non-infective reason why eyelids might be stuck together in the morning

A

Excess tearing from allergies can result in a crusty byproduct which will stick the lids together

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2
Q

How does a non-infectious cause of eyelids sticking together in the morning differ from an infectious cause? (in terms of the reason they are sticking together) (1.5)

A

non-infectious: crusty byproduct sticking lids together
infectious: gooey byproduct sticking lids together

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3
Q

What are the general symptoms of conjunctivitis? (5)

A

Discomfort
Discharge
Increased redness
Variable vision loss due to discharge, tear film disruption
Mild photophobia due to PEE/SPK (bit questionable)

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4
Q

How can discomfort vary with conjunctivitis aetiology? (3)

A

Gritty/scratchy = bacterial, viral (dry eye)
Itchy = allergic
Burning = bacterial, viral (dry eye)

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5
Q

How can discharge vary with conjunctivitis? (3)

A

watery
mucoid
mucopurulent

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6
Q

What is a good question to ask when a patient presents with variable vision? (1)

A

Does blinking clear up your vision? (i.e. b/c when you blink you create a new tear film layer, so this can help you see if tear film disruption is a problem, in which blinking should make it clearer for a bit)

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7
Q

Does the “green-ness” of the discharge in conjunctivitis patients matter?

A

Not really

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8
Q

What are general signs of conjunctivitis? (6)

A

Conjunctival reaction
Little or no corneal involvement
Slight lid oedema
Lymphadenopathy
Pseudomembranes/membranes
Discharge

(note patient won’t necessarily have all of these)

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9
Q

What sorts of conjunctival reaction might you get in a patient with conjunctivitis? (3)

A

Injection/hyperaemia (redness)
Chemosis (oedema/swelling)
Follicular/papillary? (i.e. need to identify which one it is)

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10
Q

How do you use conjunctivitis features to make a differential diagnosis? (5)

A

Type of discharge
Type of conjunctival reaction (papillary or follicular)
Pattern of hyperaemia
Presence of pseudomembranes/membranes
Presence/Absence of lymphadenopathy

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11
Q

What is the downside to patients physically pulling out mucoid ropey-like substance from their eye? (1)

A

This stimulates the eye to produce more mucoid. Problem not resolved

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12
Q

Instead of pulling out mucoid physically, how is mucoid best removed from the eye? (1)

A

Wash it out with saline. This means you won’t produce any more mucoid

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13
Q

What does the discharge from conjunctivitis consist of? (6)

A

Exudate from dilated conjunctival blood vessels
Mucus from goblet cells
Debris from dying or dead cells
Tear overproduction
WBCs (usually neutrophils)
Microorganisms

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14
Q

What are the diagnostic rules of thumb for conjunctivitis discharge? (4)

A

Watery = viral/allergic
Mucoid (ropy) = allergic
Purulent = acute bacterial
Mucopurulent (ropy purulent) = mild/chronic bacterial or chlamydial

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15
Q

List the general aetiologies of conjunctivitis (7)

A

Viral
Bacterial
Allergic
Toxic
CL related
Trauma
Assoc. with lid and/or corneal pathology

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16
Q

How does inflammation of the eye affect goblet cells? (1)

A

causes them to overproduce

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17
Q

Name a condition where you can get follicles superiorly? (1)

A

Chlamydia

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18
Q

Is it normal to have a few follicles in the palpebral conjunctiva?

A

yep

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19
Q

When do follicles in the palpebral conjunctiva become apparent?

A

at 2 years old and older

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20
Q

Where are follicles most common? (1)

A

Forniceal conjunctiva

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21
Q

What do follicles near the lid margin or centre of tarsus suggest? (1)

A

suggests pathology

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22
Q

How do follicles look in terms of blood vessels? (1)

A

Blood vessels at base or surrounding

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23
Q

What causes follicles? Describe the mechanism (1)

A

Hyperplasia of lymphoid tissue in conjunctival stroma

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24
Q

How can the size of follicles in a follicular conjunctival reaction vary?

A

0.2-2mm depending on severity and duration of inflammation

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25
Q

Name the 3 main acute causes of follicular conjunctival reactions

A

viral infections
chlamydial infections
medication hypersensitivity

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26
Q

Which is more variable in appearance, follicular or papillary conjunctival reactions?

A

papillary

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27
Q

How would you describe a papillary reaction in the conjunctiva?

A

subepithelial fibrovascular core with surrounding oedema and cell infiltration

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28
Q

Where can a papillary conjunctival reaction occur? (2)

A

Palpebral conjunctiva
Bulbar conjunctiva at the limbus

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29
Q

What is a hallmark characteristic feature of papillae? (that can be used to distinguish them from follicles) (1)

A

characteristic central blood vessel (sometimes difficult to see in large papillae)

30
Q

Describe the general appearance of a papillary reaction

A

Fine mosaic pattern of elevated polygonal hyperaemic areas often described as being like cobblestones

31
Q

Can individual papillae vary in size? How?

A

Yes. Individual papillae can increase in size with more intense reactions

32
Q

Name 4 common causes of a papillary conjunctival reaction

A

chronic blepharitis
allergic disease
bacteria-related infection
contact lens related problems

33
Q

How can you further classify conjunctivitis with follicles present? (2) [usefull table]

A

With swelling of pre-auricular lymph node
Without swelling of pre-auricular lymph node

34
Q

Where are the pre-auricular lymph nodes?

A

located just in front of your ears

35
Q

Where are the submandibular nodes?

A

Located under mandible, basically they are on the upper part of your neck close to centre. You can feel them pretty easily

36
Q

How can you further classify conjunctivitis with follicles present and swollen pre-auricular nodes? (2) [useful table]

A

Herpetic signs present (e.g. dendrites, skin vesicles)
Herpetic signs not present

37
Q

Assume you have a patient with conjunctivitis with follicles, pre-auricular node swelling and herpes signs present. What is the likely aetiology diagnosis? [useful table]

A

HSV

38
Q

Assume you have a patient with conjunctivitis with follicles, pre-auricular node swelling and no signs of herpes. What is the aetiological diagnosis? (2) [useful table]

A

Adenoviral or Chlamydia

39
Q

What is the diagnosis for a patient with conjunctivitis with follicles and no pre-auricular node swelling? (3) [useful table]

A

toxic conjunctivitis
molluscum
pediculosis

40
Q

How can you classify papillary conjunctivitis? (3) [useful table]

A

Classify based on type and amount of discharge:
Severe purulent
Scant purulent
Watery or Mucoid

41
Q

What is the likely diagnosis for a papillary conjunctivitis with severe purulent discharge? (1) [useful table]

A

GPC

42
Q

What is the likely diagnosis for a papillary conjunctivitis with scant purulent discharge? (1) [useful table]

A

Bacterial other than GC

43
Q

What is the likely diagnosis for a papillary conjunctivitis with watery or mucoid discharge? (2) [useful table]

A

Allergic
Atopic

44
Q

How common are membranes/pseudomembranes?

A

Relatively rare, may see one in clinic every 8 weeks or maybe only a few times a year

45
Q

What is a pseudomembrane?

A

coagulated fibrinous exudate lightly adherent to inflamed conjunctiva

46
Q

What happens to the conjunctival epithelium when you peel the pseudomembrane off?

A

Remains intact. (Pseudomembrane can be peeled without bleeding)

47
Q

Name the 3 main causes of pseudomembranes

A

adenoviral infection
gonococcal conjunctivitis
alkali burns

48
Q

Which is worse, acid burns or alkali burns. Why?

A

Alkali burns are worse, because while an acid burn is an “event”, an alkali burn “keeps going for an extended time”, so it lasts longe

49
Q

What is a true membrane?

A

coagulated fibrous exudate anchored to the inflamed conjunctival epithelium (rare)

50
Q

How does peeling of a true membrane compare to peeling of a pseudomembrane?

A

peeling of a true membrane is more difficult and rips the conjunctival epithelium, causing bleeding from conjunctival vessels

51
Q

Name 4 common causes of true membrane formation

A

Beta-haemolytic streptococci
Diphtheria (corynebacterium)
Gonococcal
Autoimmune conjunctivitis

52
Q

Why do membranes and pseudomembranes have to be removed?

A

To stop scarring of underlying tissue

53
Q

Are true membranes and pseudomembranes safe to remove?

A

Both are safe to remove

54
Q

What MUST we do to confirm if somebody has adenovirus? (1)

A

Lymphadenopathy

55
Q

What does lymphadenopathy involve?

A

Feeling the different lymph nodes to check for swelling/see if they are raised

56
Q

What lymph nodes are we particularly interested in during lymphadenopathy? (2)

A

pre-auricular nodes
submandibular nodes

57
Q

What 3 infections is lymphadenopathy commonly performed for?

A

Viral infection (adenovirus)
Chlamydial infection
Severe gonococcal infections

58
Q

When performing lymphadenopathy as an optometrist, should you keep the patient’s shirt on? ;)

A

Yes you should

59
Q

Why is gonococcus dangerous?

A

Because it can get through intact cornea

60
Q

In regards to non-gonococcal bacterial conjunctivitis, describe the following:
A: How common?
B: Acute or chronic?
C: Do they persist or are they self-limiting?

A

A: very common
B: acute
C: usually self-limiting within 10-14 days

61
Q

In regards to non-gonococcal bacterial conjunctivitis:
D: Unilateral or bilateral?
E: Symmetrical or Asymmetrical?

A

D: Bilateral
E: Asymmetrical - with onset over a couple of days (usually starts in one eye then transfers)

62
Q

Name 4 common pathogens that can cause non-gonococcal bacterial conjunctivitis

A

Staph aureus
Staph epidermidis
Strep pneumoniae
Haemophillus influenzae (kids)

63
Q

List the symptoms of non-gonococcal bacterial conjunctivitis (5)

A

Acute onset of: redness, gritty/burning, sticky discharge
Eyelids frequently stuck together on waking
May have mild photophobia due to SPK

64
Q

Why would someone with bacterial conjunctivitis acquire SPK? (1)

A

Due to the endotoxins released from the bacterium damaging/breaking down the epithelium

65
Q

Can Darryl Guest think of a bacterial infection that ISN’T an acute onset?

A

No he can’t. So all bacterial infection = acute onset.

66
Q

What 3 factors make the perfect environment for bacteria? (3)

A

Moist
Dim
Anaerobic

67
Q

What is the most common cause of conjunctivitis presentation in eye clinics?

A

Viruses. By far

68
Q

What are the signs of bacterial conjunctivitis? (5.5)

A

Conjunctival hyperaemia, especially in fornices
Mild SPK
Mild papillary reaction
Mucopurulent discharge
Crusting on lids, phlyctenules, corneal marginal infiltrates

69
Q

What are phlyctenules?

A

A small vesicle or postule especially: one on the conjunctiva or cornea of the eye

70
Q

What ddx exist for bacterial conjunctivitis? (3)

A

Viral conjunctivitis
Allergic conjunctivitis
Gonococcal conjunctivitis

OD2 S2 (63 decks)

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