Conjunctivitis

Question 1

Aetiology of conjunctivitis?

Answer 1

-Infectious (b/v/chlamydial, fungal, parasitic)
-Non infectious
>allergic
>toxic
>2” to another disorder (dacrocystitis, dacroadenitis, cellulitis, Kawasaki’s disease).

Question 2

Drainage of conjunctival lymphatics?

Answer 2

• Temporal conjunctival lymphatics –> preauricular nodes.

- Nasal conjunctival lymphatics –> submandibular nodes.

Question 3

Toxic causes of conjunctivitis?

Answer 3

Irritants, dust, smoke, irradiation.

Question 4

Clinical features of conjunctivitis?

Answer 4

• Red eye
• Chemosis
• Subepithelial infiltrates
• Itching, foreign body sensation, tearing, discharge
• Crusting of lashes
• Draining node enlargment
• Follicles
• Papillae

Question 5

What are follicles?

Answer 5

Pale lymphoid elevations of the conjunctivae. Usually seen in viral and chlamydial conjunctivitis.

Question 6

What are papillae?

Answer 6

Fibrovascular elevations of the conjunctiva with central network of finely branching vessels (cobblestone appearance). Usually seen in allergic and bacterial conjunctivitis.

Question 7

Associations of atopic allergic conjunctivitis?

Answer 7

A/w rhinitis, asthma, dermatitis, hay fever.

May be seasonal (pollens, grass etc)

Question 8

Clinical features allergic atopic conjunctivitis?

Answer 8

Small papillae, chemosis, thickened and erythematous lids, corneal neovascularisation.

Question 9

Treatment of allergic atopic conjunctivitis?

Answer 9

Cool compresses, antihistamines, mast cell stabiliser (e.g. ketotifen, olopatadine)

Question 10

What is giant papillary conjunctivitis?

Answer 10

Immune reaction to mucous debris on lenses in contact lens wearers. Large papillae form on superior palpebral conjunctiva

Question 11

Treatment giant papillary conjunctivitis?

Answer 11

Clean, change or discontinue use of contact lens.

Question 12

What is vernal conjunctivitis?

Answer 12

Large papillae (cobblestones) form on superior palpebral conjunctiva with corneal ulcers and keratitis. Seasonal (warm weather).

Question 13

Aetiology of viral conjunctivitis?

Answer 13

Usually adenovirus; highly contagious for up to 12d

Question 14

Rx viral conjunctivitis?

Answer 14

Cool compresses, topical lubrication. Usually self limiting.

Question 15

Clinical features of bacterial conjunctivitis?

Answer 15

Purulent discharge, lid swelling, papillae, conjunctival injection, chemosis.

Question 16

Common etiologic agents bacterial conjunctivitis?

Answer 16

• S. aureus,
• S. pneumoniae,
• H. influenzae,
• M. catarrhalis.
• Neonates/sexually active: consider N. gonorrhoea

Question 17

Most common cause bacterial conjunctivitis in neonates?

Answer 17

Chlamydia trachomatis (neonates d3 -5).

Question 18

Rx bacterial conjunctivitis?

Answer 18

• Topical broad spectrum Ab

- Systemic ABx if indicated (esp neonates and children)

Question 19

What does chlamydial conjunctivitis cause?

Answer 19

Trachoma and inclusion conjunctivitis.

Question 20

What is trachoma?

Answer 20

Leading infectious cause of blindness.

Severe keratoconjunctivitis leads to corneal abrasion, ulceration and scarring.

Question 21

Treatment chlamydial conjunctivitis?

Answer 21

Topical and systemic tetracycline.