Conjunctivitis

Question 1

mucous membrane that lines the inside surface of the lids and covers the surface of the globe up to the junction of the sclera and cornea

Answer 1

Conjunctiva

Question 2

Conjunctiva comprised of:
_______: Non, keratinized, containing goblet cells

______ ______: Layer of transparent fibrous connective tissue making up bulk of cornea. Highly vascularized. Site of immunologic activity

Answer 2

epithelium

substantia propria

Question 3

What is the etiology of conjunctivitis?
1.
2.
3.

Answer 3

Bacterial
Viral
allergic

Question 4

What type of conjunctiva is this: redness of eye, edema, pus?

a) bacterial
b) viral
c) Allergic

Answer 4

b) bacterial

Question 5

What type of conjunctiva is this: redness of eye + lacrimation

a) bacterial
b) allergic
c) viral

Answer 5

c) viral

Question 6

What type of conjunctiva is this: redness of eye, lacrimal, edema, itchy

a. bacterial
b. viral
c. allergic

Answer 6

allergic

Question 7

Goals of Therapy

Answer 7

Preserve eyesight
•Control infection
•Control inflammation
•Provide symptomatic relief
•Minimize duration of symptoms

Question 8

Symptoms for referral

Answer 8

Reduction of visual acuity
Ciliary flush – redness is most pronounced in the ring of the limbus
Photophobia
Severe foreign body sensation that prevents patient from keeping eye open
Corneal opacity
Fixed pupil
Severe headache with nausea

Question 9

What organisms cause bacterial conjunctivitis?

Answer 9

s. aureus
s. pneumoniae
h. influenzae
m. catarrhalis

Question 10

How is bacterial conjunctivitis spread?

Answer 10

Direct Contact

1. secretions
2. contaminated objects or surfaces

Question 11

How long does it take to typically resolve?

Answer 11

1-2 weeks

Question 12

3 types of bacterial conjunctivitis
1. acute 
2. hyperacute 
3. chronic 
Describe each one

Answer 12

1. acute: common, self-limiting
2. hyper acute: rapid onset, corneal perforation, compromised vision, N. gonorrhea, referall
3. persistent > 4 weeks with relapses, referral needed

Question 13

Clinical presentation of symptoms of bacterial conjunctivitis

Answer 13

redness
edema
mucopurulent discharge (pus)
glued eyes 
NO itching 
mild-moderate stinging 
foreign body sensation --> feels like something is stuck in the eye

Question 14

Although the disease is self limiting and does resolve in 1-2 weeks, what are the pros of antibiotic therapy?

Answer 14

1. reduced transmission
2. earlier return to school/work
3. gets fixed in days vs weeks

Question 15

There is no clear efficacy advantage of different topical antibiotics with the exception of one type class of antibiotic reserved for more serious cases

a) aminoglycosides
b) fluoroquinolone
c) macrolides
d) beta-lactam

Answer 15

b) fluoroquinalone

Question 16

What are some risk factors for bacterial conjunctivitis treatment

Answer 16

1. exposure to more bacteria( healthcare workers, senior homes)
2. diabetes
3. immunocompromised
4. Contact lens wearers
5. ocular surgery

Question 17

What type of antibiotic is this?

MOA: disrupts folic acid synthesis by competing with para amino benzoic
acid (bacteriostatic against gram positive and negative)

Answer 17

Sulfacetamide

Question 18

MOA: compromises cell wall integrity through cationic detergent effect
What type of antibiotic is this?

Answer 18

Polymyxin B

Question 19

MOA: forms a channel in the bacterial cell membrane affecting the concentration of intracellular solutes
What antibiotic is this?

Answer 19

Gramicidin

Question 20

MOA: inhibits protein synthesis by blocking aminoacyl-tRNA transfer to protein
What antibiotic is this?

Answer 20

fusidic acid

Question 21

What form of medication is preferred for children?

a) solution
b) suspension
c) ointment

Answer 21

c) ointment

Question 22

What type of antibiotic should contact lens wearers use?

a) fusidic acid
b) polymyxin B
c) fluoroquinolone
d) macrolide

Answer 22

c) fluoroquinalone

Question 23

Which type of antibiotic has serious side effects such as blood disorders, stevens-johnson syndrome,?

a) fusidic acid
b) sulfacetamide
c) gramacidin
d) polymyxin b

Answer 23

b) sulfacetamide

Question 24

What viral organisms cause viral conjunctivitis?

Answer 24

Adenovirus
Enterovirus
Coxsackievirus, 
VZV, HSV, 
Epstein-Barr virus, 
Influenza

Question 25

How is viral conjunctivitis spread?

Answer 25

direct contact 1. contaminated surfaces 2. secretions

Question 26

Does viral conjunctivitis affect one eye or both?

Answer 26

both eyes

Question 27

Clinical presentation of viral conjunctivitis

Answer 27

``` Diffuse redness – Minimal no pain/discomfort – Gritty sensation – Mild itchiness – Watery/serous discharge ```

Question 28

4 types of treatment for viral conjunctivitis (antibiotic eyedrops don't work)

Answer 28

Non-pharmacological Ocular decongestants/ vasoconstrictors Artificial Tears Topical Antihistamines

Question 29

1. Naphazoline 2. Oxymetazoline 3. Phenylephrine 4. Tetrahydrozoline This are a) decongestants/vasoconstrictors b) ocular lubricants c) topical antihistamines

Answer 29

a) decongestants

Question 30

Side effects from using too much of ophthalmic decongestants and vasoconstrictors

Answer 30

cause rebound hyperemia, causes rebound vasodilation

Question 31

Herpes Zoster ophthalmicus calls for referral to ophthalmologist . T or F

Answer 31

True, it can lead to blindness | due to dormant chicken box virus

Question 32

What is allergic conjunctivitis caused by?

Answer 32

airborne allergens contacting the eye

Question 33

Clinical presentation of allergic conjunctivitis

Answer 33

``` – Diffuse redness – No corneal involvement – Cobblestone papillae under the upper eyelid – Blistered conjunctiva – Bilateral – Painless tearing – Intense itchiness – Stringy/ropy/watery discharge ```

Question 34

Treatment for allergic conjunctivitis

Answer 34

``` Allergen avoidance • Mast cell stabilizer • Topical histamine H1 receptor antagonists (antihistamines) • Topical decongestants/vasoconstrictors • Ocular lubricants ```

Question 35

1. Sodium cromoglycate 2. Nedocromil 3. Lodoxamide These medications are what kind of medication? a) topical antihistamines b) mast cell stabilizers c) ocular lubricants

Answer 35

mast cell stabizers

Question 36

Antazoline/ Naphazolin Pheniramine/ Naphazoline Ketotifen Olopatadine These medications are what kind of medication? a) topical antihistamines b) mast cell stabilizers c) ocular lubricants

Answer 36

a) topical antihistamines (regularly)

Question 37

Carboxymethylcellulose Dextran 70/ hypromellose Polysorbate Polyvinyl alcohol

Answer 37

These medications are what kind of medication? a) topical antihistamines b) mast cell stabilizers c) ocular lubricants

Question 38

What ingredient in ocular lubricants can cause an allergic reaction? a) EDTA b) Benzalkonium chloride c) Carboxymethylcellulose d) Polyvinyl alcohol

Answer 38

b) Benzalkonium chloride

Question 39

What are some non-pharm measures for conjunctivitis?

Answer 39

Remove contact lenses until the problem resolves (glasses ok) Avoid makeup, smoke, wind, and other irritants Apply cold compresses for allergic and viral conjunctivitis; Warm compresses for bacterial conjunctivitis Practice lid hygiene for blepharitis (inflammation of eyelids): Warm water compresses the closed eyelid for 5-10 mins, followed by gentle scrubbing of lid margins with warm water. Repeat daily at bedtime hand hygiene! (infectious causes are contagious and may spread to nonaffected eyes and to others) Consider all shared objects that may contact infected eye(s) (eg. Facetowel)

Question 40

When can a child or adult return to work or school with viral/bacterial conjunctivitis?

Answer 40

a) until there's no discharge | b) use 24 hours of antibacterial eye drops in for bacterial conjunctivitis

Question 41

Assume _____ unless mucopurulent discharge, eyelids matting together in AM, no itchiness, no history of conjunctivitis a) bacterial b) viral c) allergic

Answer 41

b) viral