Conjunctivitis Flashcards

1
Q

Define conjunctivitis (Acute and chronic)

A

Inflammation of the conjunctiva
Inflammation or infection → dilation of the conjunctival vessels → hyperaemia and oedema → discharge

Acute: persists < 4 weeks
Chronic: persists > 4 weeks

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2
Q

What are the causes of conjunctivitis

A

Bacterial or allergic most common in children
Be wary of sight-threatening conjunctivitis in neonates

Viral (80%)
- Adenovirus - MOST COMMON
- HSV, VZV, molluscum contagiosum, EBV, coxsackie, enteroviruses
Bacterial
- S. pneumoniae, H. influenzae, S. aureus
- Moraxella catarrhalis, C. trachomatis, N. gonorrhoea
Allergy
- Associated with IgE
- Seasonal, perennial
- vernal keratoconjunctivitis
- Atopic
Neoplasm
Contact with toxic substances
Mechanical irritation

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3
Q

What are the symptoms and signs of viral conjunctivitis

A

Acute onset conjunctival erythema
Eyelid eversion
Lid oedema
Pin-point/petechial subconjunctival haemorrhages
Pseudomembranes form on tarsal conjunctival surfaces
Discharge but not sticky
Pruritus
URTI + pre-auricular lymphadenopathy

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4
Q

What are the symptoms and signs of bacterial conjunctivitis

A

Painful, red eyes
Discomfort- ‘Grittiness’, ‘foreign body’, ‘burning’ sensation
Purulent/mucopurulent discharge
Crusting of the lids - may be stuck together on waking
Mild or no pruritis
Pre-auricular lymphadenopathy- (hyperacute bacterial conjunctivitis (N. gonorrhoea))
No VISUAL CHANGES

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5
Q

What are the symptoms and signs of allergic conjunctivitis

A

Bilateral
Itching (or burning or stinging sensation)
Watery or mucoid discharge
Conjunctival redness (hyperaemia injection), swelling (chemosis), papillary reaction
Eyelid oedema- periorbital in severe cases

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6
Q

What are the signs and symptoms of conjunctivitis caused by STIs

A

More severe, with prolonged mucopurulent discharge
C. trachomatis
- Chronic (> 2 weeks) low-grade irritation, mucous discharge
- Pre-auricular lymphadenopathy

N. gonorrhoea
- Rapidly develop (12-24 hours) with copious mucopurulent discharge
- Eyelid swelling, tender preauricular lymphadenopathy

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7
Q

What are the signs and symptoms of HSV conjunctivitis

A

Unilateral red eye with vesicular lesions on the eyelid
Watery discharge
Hutchinson’s sign: lesions present at the tip of the nose (Herpes zoster)

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8
Q

What are the differentials for conjunctivitis

A

Acute glaucoma
Scleritis
Episcleritis
Keratitis
Uveitis
Iritis
Corneal ulcers
Foreign body

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9
Q

What investigations should be done for conjunctivitis

A

Clinical diagnosis

If unresponsive:
Swab of discharge for MC&S
Swab for PCR

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10
Q

What is the management for viral and allergic conjunctivitis

A

Self-limiting, resolves within 2 weeks
Symptomatic relief:
- Clean with saline/ boiled water and cooled water away from the eye
- Cool compresses around the eye area
- Lubricating drops or artificial tears
ADVISE:
- It is contagious
- Use separate towels/ flannels
- Avoid close contact with others for up to 14 days of onset
- Seek help if symptoms persist > 7-10 days after treatment

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11
Q

What is the management for allergic conjunctivitis

A

Self-limiting, resolves within 2 weeks
Symptomatic relief:
- Clean with saline/ boiled water and cooled water away from the eye
- Cool compresses around the eye area
- Lubricating drops or artificial tears
ADVISE:
- Avoid triggers
- Seek help if symptoms persist > 7-10 days after treatment

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12
Q

What is the management for bacterial conjunctivitis

A

Self-limiting and resolves 5-7 days without treatment
Treatment with topical antibiotics if severe or symptoms have not resolved within 3 days

Staphylococcal or streptococcal infection (discharge/ redness): Chloramphenicol 0.5% / 1% ointment OR Fusidic acid 1% eye drops
Gonococcal infection (purulent discharge): IV 3rd generation cephalosporins
Chlamydia trachomatis (purulent discharge, eyelid swelling): PO erythromycin for 2 weeks

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13
Q

What are the complications of conjunctivitis

A

Viral: epidermic keratoconjunctivitis → subepithelial infiltrates → visual loss and light sensitivity
Bacterial: Keratitis, corneal perforation (gonorrhoea), trachoma (recurrent chlamydia)

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14
Q

What is the prognosis for conjunctivitis

A

Viral: resolves within 7 days, incubation 5-12 days
Bacterial: resolves within 5-10 days , greater risk of complications in contact lens-wearers and immunocompromised people

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15
Q

What is Ophthalmia neonatorum (ON) and what are the causes

A

Conjunctivitis within the first four weeks of life

Neisseria gonorrhoea
Chlamydia trachomatis
Haemophilus
Streptococcus
Staphylococcus
E. Coli

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16
Q

What are the signs of ophthalmia neonatorum

A

Chlamydial- watery or mucopurulent discharge, eyelid swelling about 5-14 days after birth
Gonococcal- first 5 days of life, but can present up to 3 weeks after, copious discharge and eyelid swelling
Viral- petechial or large subconjunctival haemorrhages and lymphadenopathy

17
Q

What investigations should be done for Ophthalmia neonatorum

A

Neonate gonococcal infection → gram stain, culture
Neonate chlamydia infection → immunofluorescent staining

18
Q

What are the complications and prognosis for Ophthalmia neonatorum

A

Most cases are mild, untreated can lead to complications:
Superficial corneal vascularisation
Conjunctival scarring
Pneumonia
Corneal scarring
Ulceration
Pan-ophthalmitis
Permanent visual impairment