wk9: AED - Conjunctival Infections 1 [DG] Flashcards
Describe a non-infective reason why eyelids might be stuck together in the morning
Excess tearing from allergies can result in a crusty byproduct which will stick the lids together
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)
non-infectious: crusty byproduct sticking lids together
infectious: gooey byproduct sticking lids together
What are the general symptoms of conjunctivitis? (5)
Discomfort
Discharge
Increased redness
Variable vision loss due to discharge, tear film disruption
Mild photophobia due to PEE/SPK (bit questionable)
How can discomfort vary with conjunctivitis aetiology? (3)
Gritty/scratchy = bacterial, viral (dry eye) Itchy = allergic Burning = bacterial, viral (dry eye)
How can discharge vary with conjunctivitis? (3)
watery
mucoid
mucopurulent
What is a good question to ask when a patient presents with variable vision? (1)
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)
Does the “green-ness” of the discharge in conjunctivitis patients matter?
Not really
What are general signs of conjunctivitis? (6)
Conjunctival reaction Little or no corneal involvement Slight lid oedema Lymphadenopathy Pseudomembranes/membranes Discharge
(note patient won’t necessarily have all of these)
What sorts of conjunctival reaction might you get in a patient with conjunctivitis? (3)
Injection/hyperaemia (redness)
Chemosis (oedema/swelling)
Follicular/papillary? (i.e. need to identify which one it is)
How do you use conjunctivitis features to make a differential diagnosis? (5)
Type of discharge Type of conjunctival reaction (papillary or follicular) Pattern of hyperaemia Presence of pseudomembranes/membranes Presence/Absence of lymphadenopathy
What is the downside to patients physically pulling out mucoid ropey-like substance from their eye? (1)
This stimulates the eye to produce more mucoid. Problem not resolved
Instead of pulling out mucoid physically, how is mucoid best removed from the eye? (1)
Wash it out with saline. This means you won’t produce any more mucoid
What does the discharge from conjunctivitis consist of? (6)
Exudate from dilated conjunctival blood vessels Mucus from goblet cells Debris from dying or dead cells Tear overproduction WBCs (usually neutrophils) Microorganisms
What are the diagnostic rules of thumb for conjunctivitis discharge? (4)
Watery = viral/allergic
Mucoid (ropy) = allergic
Purulent = acute bacterial
Mucopurulent (ropy purulent) = mild/chronic bacterial or chlamydial
List the general aetiologies of conjunctivitis (7)
Viral Bacterial Allergic Toxic CL related Trauma Assoc. with lid and/or corneal pathology
How does inflammation of the eye affect goblet cells? (1)
causes them to overproduce
Name a condition where you can get follicles superiorly? (1)
Chlamydia
Is it normal to have a few follicles in the palpebral conjunctiva?
yep
When do follicles in the palpebral conjunctiva become apparent?
at 2 years old and older
Where are follicles most common? (1)
Forniceal conjunctiva
What do follicles near the lid margin or centre of tarsus suggest? (1)
suggests pathology
How do follicles look in terms of blood vessels? (1)
Blood vessels at base or surrounding
What causes follicles? Describe the mechanism (1)
Hyperplasia of lymphoid tissue in conjunctival stroma
How can the size of follicles in a follicular conjunctival reaction vary?
0.2-2mm depending on severity and duration of inflammation
Name the 3 main acute causes of follicular conjunctival reactions
viral infections
chlamydial infections
medication hypersensitivity
Which is more variable in appearance, follicular or papillary conjunctival reactions?
papillary
How would you describe a papillary reaction in the conjunctiva?
subepithelial fibrovascular core with surrounding oedema and cell infiltration
Where can a papillary conjunctival reaction occur? (2)
Palpebral conjunctiva
Bulbar conjunctiva at the limbus