conjunctivitis

Question 1

inflammation of mucous membrane that lines surface of eyeball and inner eyelids

Answer 1

conjunctivitis (pink eye)

Question 2

other causes of conjunctivitis

Answer 2

keratoconjunctivitis sicca
allergy
chemical irritants
trauma

Question 3

causes of conjunctivitis

Answer 3

direct contact with contaminated fingers or objects

respiratory secretions

contaminated eye drops

Question 4

conjunctivitis differentials

Answer 4

acute uveitis
acute glaucoma
corneal disorders

Question 5

usually bilateral* with copious watery discharge*
crusty in morning but goes away through the day*
may have foreign body sensation
can get follicles on inferior on inferior palpebral conjunctival surface
highly contagious
disease usually lasts about 10-14 days
pharyngitis, fever, malaise, periauricular adenopathy may occur with certain types of adenovirus

Answer 5

viral conjunctivitis

Question 6

MC of viral conjunctivitis

Answer 6

adenovirus

Question 7

viral conjunctivitis can also be due to

Answer 7

HSV
varicella zoster
herpes zoster

(often unilateral with lid vesicles)

Question 8

viral conjunctivitis treatment

Answer 8

cold compress and artificial tears

Question 9

is viral conjunctivitis contagious?

Answer 9

yes highly
avoid sharing linens, good hand hygiene, etc

Question 10

viral conjunctivitis treatment if HSV, shingles, or chickenpox infection

Answer 10

topical ganciclovir 0.15% gel
and/or oral acyclovir or valacyclovir
optho consult and follow up

Question 11

MC organisms of bacterial conjunctivitis

Answer 11

staph (MRSA)
streptococci (strep pneumo)
haemophilus species
pseudomonas (contacts)
moraxella

Question 11

copious purulent discharge and eye matting*
blurring of vision and discomfort (mild)
self limited (10-14 days if untreated)

Answer 11

bacterial conjunctivitis

Question 12

bacterial conjunctivitis treatment

Answer 12

topical antibiotic (trimethoprim with polymyxin B or azithromycin)

fluoroquinolones for moderate/severe cases or contact lens wearers (ciprofloxacin)

Question 13

usually acquired through contact with genital secretions (usually hands to eyes)

EMERGENCY!

Answer 13

Gonococcal conjunctivitis

Question 14

Gonococcal conjunctivitis diagnosis is confirmed by

Answer 14

stained smear and culture of discharge

Question 14

why is Gonococcal conjunctivitis an opthalmologic emergency

Answer 14

corneal involvement may rapidly lead to corneal perforation and can lead to vision loss

Question 15

Gonococcal conjunctivitis symptoms

Answer 15

copious purulent discharge (striking amount)
chemosis (conjunctival edema)
lid swelling
preauricular adenopathy

Question 16

Gonococcal conjunctivitis smear shows

Answer 16

gram negative intracellular diplococci and polymorphonuclear leukocytes

Question 17

Gonococcal conjunctivitis treatment

Answer 17

IM ceftriaxone 1 g as single dose*

topical antibiotics (erythromycin and bacitracin)

eye irrigation

other STDs should be considered for treatment (chlamydia)

all partners must be notified and treated

Question 18

after contact with contaminated genital secretions

acute redness, purulent vs sometimes non purulent, irritation, follicular involvement

immune stimulation causes the lymphoid follicles on the eye to become enlarged causing raised follicles

not always acute and can present as a chronic, indolent conjunctivitis

mild keratitis

nontender preauricular lymph node may be palpated

Answer 18

chlamydia conjunctivitis/ inclusion conjunctivitis

Question 19

how is chlamydia conjunctivitis/ inclusion conjunctivitis diagnosis confirmed

Answer 19

immunologic tests or PCR on conjunctival samples

Question 20

chlamydia conjunctivitis/ inclusion conjunctivitis treatment

Answer 20

doxycycline 100 mg PO BID x 7 days

check for genital infection; treat other possible STIs

all partners must be notified and treated

Question 21

MC infectious cause of blindness worldwide

chronic keratoconjunctivitis from recurrent infection with

Answer 21

chlamydial conjunctivitis/ trachoma

Question 22

is chlamydial conjunctivitis/ trachoma sexually transmitted

Answer 22

NO, not sexually transmitted strain of chlamydia

Question 22

how is trachoma shared

Answer 22

direct personal contact shared towels and cloths flies that have come in contact with the eyes or nose of an infected person

Question 22

how to confirm chlamydial conjunctivitis/ trachoma

Answer 22

immunologic tests or PCR on conjunctival samples

Question 23

recurrent episodes of infection (trachoma) in childhood goes through stages that result in

Answer 23

corneal scarring cloudy cornea

Question 24

chlamydial conjunctivitis/ trachoma treatment

Answer 24

single 1 gram dose of oral azithromycin surgical treatment, if needed: - correction of lid deformities - corneal transplantation improve hygiene/living conditions

Question 25

benign disease usually occurs in late childhood and early adulthood may be seasonal-- hay fever conjunctival hyperemia and chemosis itching, tearing, redness, stringy discharge* bilateral

Answer 25

allergic conjunctivitis

Question 26

how does allergic conjunctivitis look on an exam

Answer 26

bumpy or follicular appearance to tarsal conjunctiva

Question 27

allergic conjunctivitis treatments

Answer 27

antihistamines (levocabastine solution, emedastine solution) mast cell stabilizers (cromlyn) combined antihistamines and mast cell stabilizers (olopatadine) lubricating eye drops systemic antihistamines: loratadine 10 mg daily

Question 28

what should you avoid with allergic conjunctivitis

Answer 28

triggers

Question 29

dryness, redness, foreign body sensation Common and chronic disorder severe cases --> persistent marked discomfort, with photophobia, difficulty in moving the lids, excessive mucus secretion

Answer 29

keratoconjunctivitis sicca

Question 30

hypofunction of lacrimal glands

Answer 30

loss of aqueous component of tears

Question 31

hypofunction of lacrimal glands may be caused by

Answer 31

aging hereditary disorders systemic disease (sjogren syndrome) systemic drugs

Question 32

excessive evaporation of tears

Answer 32

environmental factors excessive screen time windy climate

Question 33

keratoconjunctivitis sicca inspection

Answer 33

usually normal

Question 34

keratoconjunctivitis sicca slit lamp

Answer 34

abnormalities of tear film stability and volume severe: loss of corneal luster and ulcers

Question 35

keratoconjunctivitis sicca fluorescein

Answer 35

stains damaged corneal and conjunctival cells

Question 36

keratoconjunctivitis sicca schirmer test

Answer 36

determines amount of tears; overproduction/underproduction

Question 37

keratoconjunctivitis sicca treatment

Answer 37

artificial tears (but preservatives can cause reactions that mimic dry eyes) visine not recommended stop potentially drying medications humidifiers blink more optho may recommend occasional short term topical steroid use but there are risks such as developing a cataract or glaucoma