Conjunctivitis Flashcards
Define conjunctivitis (Acute and chronic)
Inflammation of the conjunctiva
Inflammation or infection → dilation of the conjunctival vessels → hyperaemia and oedema → discharge
Acute: persists < 4 weeks
Chronic: persists > 4 weeks
What are the causes of conjunctivitis
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
What are the symptoms and signs of viral conjunctivitis
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
What are the symptoms and signs of bacterial conjunctivitis
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
What are the symptoms and signs of allergic conjunctivitis
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
What are the signs and symptoms of conjunctivitis caused by STIs
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
What are the signs and symptoms of HSV conjunctivitis
Unilateral red eye with vesicular lesions on the eyelid
Watery discharge
Hutchinson’s sign: lesions present at the tip of the nose (Herpes zoster)
What are the differentials for conjunctivitis
Acute glaucoma
Scleritis
Episcleritis
Keratitis
Uveitis
Iritis
Corneal ulcers
Foreign body
What investigations should be done for conjunctivitis
Clinical diagnosis
If unresponsive:
Swab of discharge for MC&S
Swab for PCR
What is the management for viral and allergic conjunctivitis
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
What is the management for allergic conjunctivitis
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
What is the management for bacterial conjunctivitis
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
What are the complications of conjunctivitis
Viral: epidermic keratoconjunctivitis → subepithelial infiltrates → visual loss and light sensitivity
Bacterial: Keratitis, corneal perforation (gonorrhoea), trachoma (recurrent chlamydia)
What is the prognosis for conjunctivitis
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
What is Ophthalmia neonatorum (ON) and what are the causes
Conjunctivitis within the first four weeks of life
Neisseria gonorrhoea
Chlamydia trachomatis
Haemophilus
Streptococcus
Staphylococcus
E. Coli
