what is blepharoconjunctivitis?
secondary to lid disease = secondary bacterial conjunctivitis
if a non-pediatric or non-geriatric patient presents with true primary bacterial conjunctivitis in the absence of lid disease - what are some causes?
overstressed lifestyle, acquired immune dysfunction, acquired immune deficiency (HIV, AIDS) or an oddball unusual microbe
what are some symptoms of blepharoconjunctivitis?
burn, itch, red, watery/tearing, lids mattered shut in AM, scratchy, FB sensation and swollen
what are some signs of blepharoconjunctivitis?
red/edematous eyelids, interpalpebral injection, NaFl staining SPK near lid margins, papillae, chemosis, mucopurulent discharge, -PAN
what are some of the eye's defenses to prevent bacterial invasion of conjunctiva from lid infections?
bacteriostatic lysozymes and immunoglobulins in tear film, blink force and immune system in general
what organism causes blepharoconjunctivitis and where do they colonize?
staphylococci lid margins, conjunctiva, and meibomian glands
what is the goal of blepharoconjunctivitis treatment?
complete eradication is impossible - need to control amount of staph but maintain its position in anterior segment's normal flora **focus on lid disease**
what is the initial treatment for blepharoconjunctivitis?
aggressive initial therapy = lid hygiene at least daily, topical antibiotic (AzaSite) BID for several weeks then Besivance TID (Durasite) soaks/scrubs/massage/ATs
how do you alter the treatment for blepharoconjunctivitis after the lid disease is under control?
alternate antibiotic ointments to reduce the chance of resistance - Polysporin and erythromycin
what are some treatment options for blepharoconjunctivitis in resistant cases?
AzaSite and Doxycycline 50-100mg PO x 3 weeks or more, Dicloxacillin, erythromycin ethylsuccinate (EES if allergic to PCN)
when is Dicloxacillin contraindicated?
if patient is allergic to penicillin/cephalosporins or newborns (children are ok)
when is doxycycline contraindicated?
children under 8-12 years old, pregnant or lactating females
when is erythromycin ethylsuccinate (EES) contraindicated?
patient with impaired hepatic function - ok in children and pregnant/lactating females
how do you treat blepharoconjunctivitis when you suspect an oddball bacterial infection?
culture/sensitivity testing - strong antibiotic drop = Besifloxacin suspension
gentamicin, trimethoprim, vancomycin = MRSA
which two drugs are no longer the "big guns" and resistance has become a problem?
moxifloxacin (Vigamox) and gatifloxacin (Zymar)
what is the great antibiotic is too dangerous to legally prescribe?
chloramphenicol - a few premature infants have died from aplasitc enemia with topical use
what information should you provide another provider when referring a patient?
detailed documentation of your treatment and the lack of resolution of the patient's symptoms and signs
who typically develops true primary bacterial conjunctivitis?
pediatric (immune system is still developing) and geriatric (immune system is in decline)
what organisms cause primary bacterial conjunctivitis?
staph aureus, staph epidermidis, strep pneumoniae, and haemophilus influenzae
what are the various topical antibiotics used to treat bacterial conjunctivitis?
*aminoglycosides are not first choice* fluoroquinolones, polymyxin B combinations, and others (AzaSite, Ilotycin, Bacitracin)
what does epidemic history, petechial hemorrhages with scant discharge suggest in bacterial conjunctivitis?
if a patient has copious discharge in bacterial conjunctivitis - what organism might they have?
what type of treatment should you use in children with bacterial conjunctivitis?
amoxicillin/clavulanate (Augmentin) PO for H.flu and small children may respond better to ung than gtt - start with Polytrim gtt
what are some additional treatments for bacterial conjunctivitis besides antibiotic drops?
warm compresses, irrigation, lid hygiene, no school or work
what are some symptoms of viral conjunctivitis/epidemic keratoconjunctivitis (EKC)?
watery/tearing, scratchy, FB sensation, lids mattered shut in AM, itchy, red, swollen
what are some signs of viral conjunctivitis/EKC?
follicles, watery/mucus discharge, red/edematous eyelids, +PAN, pinpoint subconjunctival hemorrhages, pesudomembrane, +URI, subepithelial infiltrates
what is the pathophysiology for viral conjunctivitis/EKC?
adenovirus - search for memory B cells
what is the typical course for viral conjunctivitis?
Hx of recent URI/red eye - starts with one eye and moves to other within days - begins with hyperemic and congestive conjunctival reaction, within days - follicles, serous discharge, +PAN, +SEI, fibrinous pseudomembrane
what is the treatment for typical viral conjunctivitis?
cool compress and AT's (PF), may need vasoconstrictor/antihistamine (Naphcon-A), low dose steroids (fluorometholone alcohol or prednisolone phosphate 0.125%) for pseudomembrane or SEI
what else could any follicular conjunctivitis or keratoconjunctivitis also be?
EKC or herpes simplex keratitis (HSK) - rule out punctate epithelial lesions and avoid steroids