3.3.2 Eye - Conjunctivitis/Infalammatory Periocular Probs

Question 1

Conjunctivitis presents?

Answer 1

Redness of eye
Watery eye
Discharge

Question 2

How to classify conjunctivitis?

Answer 2

Infective
Allergic
Chemical
Special: neonatal
Associated with systemic disease

Question 3

Hx of conjunctivitis?

Answer 3

One or both eyes?
Discharge?
Systemic illness?

Question 4

If eye is itchy in conjunctivitis, most likely to be?

Answer 4

Allergic

Question 5

Examination of conjunctivitis?

Answer 5

Test vision
Look at conjunctiva
Look at cornea - flurocine
Skin rashes
Lymphadenopathy

Question 6

When do you need to investigate conjunctivitis?

Answer 6

Neonate
Chronic/recurrent
Suspected HSV 1/2
Atypical reaction

Question 7

Neonatal conjunctivitis, what bacteria on day 1?

Answer 7

Gonococcal

Question 8

Neonatal conjunctivitis wat bacteria on day 7-14?

Answer 8

Herpes simplex

Question 9

Neonatal conjunctivitis what bacteria on day 8-12?

Answer 9

Chlamydia

Question 10

Neonatal conjunctivitis what bacteria on day 4-6?

Answer 10

Strep/staph/haemopilus

Question 11

Management of Neonatal conjunctivitis?

Answer 11

Investigate:
Swab: M/C/S
Chlamydia culture/PCR
HSV PCR

Question 12

Neonatal conjunctivitis, how to treat chlamydia?

Answer 12

Erythromycin 5mg/kg/day

Question 13

Neonatal conjunctivitis how to treat gonococcus?

Answer 13

Penicillin

Question 14

Neonatal conjunctivitis don’t forget to treat?

Answer 14

The parents

Question 15

Bacterial conjunctivitis treat with

Answer 15

Topical chloramphenicol/tobramycin
Drops every 2-4 hours
Infectious

Question 16

Should you use steroid eye drops in children?

Answer 16

Nope, seldom used in kids

Question 17

If cornea involved in conjunctivitis what is it called?

Answer 17

Keratitis

Question 18

How to manage HSV conjunctivitis?

Answer 18

Examine cornea with fluroscein

HSV 1 and 2 PCR

Question 19

How to treat HSV conjunctivitis?

Answer 19

• Acyclovir/famvir systemic: reduced rate of recurrence
• Topical acyclovir ointment
• If immunocompromised: IV

Question 20

How to manage allergic conjunctivitis?

Answer 20

Avoid agent
Cool compress
Tears for 4-8 times per day - wash
Antihistamine
Corticosteroids if severe

Question 21

What is vernal keratoconjuntivitis?

Answer 21

Males
Spring/autumn
Tarsal conjunctiva (upper lid)
Get conjunctival papillae
Scratches cornea
Photophobia

Question 22

How to manage vernal keratoconjunctivitis?

Answer 22

Cool compress
Topical eye drops: antihistamine/lubricants
-use STEROIDS (FML/Maxidex) short term.
Dexamethasone drops. 4 times a days for 4 days, 3 times a day for 4 days, 2 times a day for 4 days, then once a day for 4 days.

Question 23

Complication of verbal keratoconjunctivitis?

Answer 23

Shield ulcer:
Needs to be scraped
Chloramphenicol
F/U in 1-3/7

Question 24

Acids damage what in eye?

Answer 24

Surfaces

Question 25

Alkali damage what in eye?

Answer 25

Penetrate and damage cornea

Question 26

Management of chemical conjunctivitis?

Answer 26

Tap water rinse - GP - local anaesthetic drop - Irrigate for 30 minutes with normal saline - remove particles - chloramphenicol - REFER to ED

Question 27

What is Stevens-Johnson syndrome?

Answer 27

Usually caused by medication or infection | Shedding of top layer of skin widespread, bulbous blisters around mouth, nose, eyes, genitals

Question 28

What is presentable cellulitis?

Answer 28

Usually unilateral Associated with systemic illness, insect bite, periocular infection Hospital IV Abx Image if no better in 48 hours

Question 29

How does a child with orbital cellulitis present?

Answer 29

Unwell, fevers miserable Limited eye movement Proptosis

Question 30

Where does the eye drain into?

Answer 30

Cavernous sinuses: ethmoid

Question 31

Orbital cellulitis management?

Answer 31

``` Emergency, refer Admit to hospital Needs IV Abx Imaging Drain abscess ```

Question 32

How to treat chalazion or Meibomian cyst?

Answer 32

Heat compress Abx Incise and curette under GA

Question 33

How to differentiate preseptal from orbital cellulitis?

Answer 33

Orbital: - proptosis, - movement restriction - unwell child