INFECTIOUS EYE DISORDERS

Question 1

What are the etiologies of bacterial conjunctivitis ?

Answer 1

– Staphylococcus aureus
– Streptococcus pneumonia
– Haemophilus influenza
– Moraxella catarrhalis
– Chlamydia trachomatis
– Neisseria gonorrhoea

Question 2

What is the onset pattern of bacterial conjunctivitis ?

Answer 2

acute and chronic suggests Chlamydia

Question 3

What is the Hx of BC ?

Answer 3

Unilateral thick purulent discharge becoming bilateral, sticky and matted eyelashes in the morning.

Question 4

What are the PE findings in bacterial conjuntivitis ?

Answer 4

– Unilateral mucopurulent discharge
– Papillary folliculitis on palpebral conjunctiva
– Bulbar conjunctivae intensely hyperaemic and
oedematous
– Moderate eyelid oedema

Question 5

What is the Tx of bacterial conjuntivitis ?

Answer 5

• Self care and Abx only after 3 days, if the symptoms doesn’t resolve.
  The Abx are:
  *Cloramphenicol 0.5% drops, 2 drops every
  6 hours
  *Chloramphenicol 1% ointment, apply once
  every 6 hours
  *Fusidic acid 1% drops, 1 drop every 12
  hours.
• Treatment should continue until 48
  hours after symptom resolution

Question 6

what is the most common cause of follicular conjunctivitis?

Answer 6

Chalmydial with an incubation period of 7-14 days.

Question 7

What are the two types of chlamydial conjunctivitis ?

Answer 7

• Trachoma- The most common cause of blindness worldwide.
• Inclusion conjunctivitis – congenital and STI.

Question 8

What is the main Hx feature of chlamydial conjunctivitis ?

Answer 8

– Mild symptoms from weeks to months
– May have been recently treated for
bacterial conjunctivitis.

Question 9

what are the PE findings in chlamydial conjunctivitis ?

Answer 9

– Mucus discharge
– Conjunctival hyperaemia and
chemosis
– Folliculitis (cobblestoning) on
conjunctiva and semilunar folds

Question 10

What is the Dx work-up in chlamydial conjunctivitis ?

Answer 10

NAAT of Conjunctival scrapings.

Question 11

What is the Tx of chlamydial conjunctivitis ?

Answer 11

– Doxycycline 100 mg BID for 7 days (avoid in pregnancy)
OR
– Azithromycin 1 g stat followed by 500 mg daily for 2 days

Question 12

What is the presentation and risk of Goncoccal conjunctivitis ?

Answer 12

It presents with rapidly progressive conjunctivitis with Profuse mucopurulent discharge. It Can penetrate through cornea and cause corneal perforation within 48 hours, Endophthalmitis, Meningitis, and septicaemia. NAAT for Gonorrhoea is the Dx test of choice.

Question 13

What is the Tx of Goncoccal conjunctivitis ?

Answer 13

– Ceftriaxone 1 gm IM injection single dose
OR…
– Ciprofloxacin 500 mg BID for 1 day OR…
– Azithromycin 2 g once

Question 14

What is the most common cause of viral conjuntivitis ?

Answer 14

Adenovirus

Question 15

What is the incubation period and symptomatology of viral conjuntivitis ?

Answer 15

The incubation period is 5-12 days and the eye symptoms frequently precede symptoms of a common cold.

Question 16

What are the PE findings in viral conjuntivitis ?

Answer 16

– Conjunctival hyperaemia
– Enlarge follicles on palpebral conjunctiva
– Preauricular lymph node swelling
– Symptoms are self-limited, often resolving within
3-4 days

Question 17

What is the Tx of viral conjunctivitis ?

Answer 17

– Supportive measures, no antiviral options exist
– Cool compress to the affected eye
– Temporarily d/c contact lens use

Question 18

What is the pattern of corneal involvement in herpetic keratitis ?

Answer 18

– Initial infection involves superficial layer of cornea
– Reactivation involves deeper layers of the cornea leading to vision loss/blindness

Question 19

What is the Hx of herpetic keratitis ?

Answer 19

– Unilateral
– Red, painful eye
– Decreased sensation (reactivated disease)

Question 20

What are the PE findings in HSV keratitis ?

Answer 20

– Dendritic ulcer
– Corneal scaring (reactivated disease)
– Decreased corneal reflex (reactivated disease)

Question 21

What is the Tx of HSV keratitis ?

Answer 21

– Oral acyclovir (5 times a day) or valacyclovir (3
times a day) for two weeks.
OR
Topical acyclovir 3% ophthalmic ointment applied 5
times daily until 3 days after clearing of corneal
lesions.

Question 22

What is the presentation of periorbital or preseptal orbital cellulitis ?

Answer 22

It occurs due to Local spread of adjacent
sinusitis or dacryocystitis or following local trauma. It is limited to lid swelling, erythema; fever; and
eye pain. The Tx is amoxiclav 625 mg every 8
hours for 7-14 days.

Question 23

What is the presentation of post septal orbital cellulitis ?

Answer 23

It occurs in children due to extension of bacterial rhinosinusitis. They present with lid swelling, erythema; fever; and eye pain. The dangerous presentations are pain with eye movement, proptosis, opthalmoplegia with diplopia. The Dx is clinical, but CT head maybe needed to see the extension of the infection.

Question 24

What is the Tx of post septal orbital cellulitis ?

Answer 24

– IV Vancomycin + IV Ceftriaxone or IV Cefotaxime
– Switch to oral therapy when fever abates and eyelid swelling subsides

Question 25

What is dacryocystitis ?

Answer 25

Infants with brachycephaliy are at an increased risk of it and is caused by inflammation and obstruction of the nasolacrimal sac due to infection and can progress to abscess.

Question 26

What is the Hx in dacryocystitis ?

Answer 26

– Painful swelling and erythema along inferonasal
border of eye and lower lid.
– Epiphora (watery eyes) and tearing (chronic
dacryocystitis with occlusion of puncta).
– Purulent discharge from puncta.

Question 27

What is the PE in dacryocystitis ?

Answer 27

– Medial canthal swelling and erythema that is tender to palpation
– Purulent efflux with medial canthal massage
– Fever

Question 28

What is the Tx of dacryocystitis ?

Answer 28

– Acute: Oral antibiotics
– Chronic or Recurrent
* Surgical correction – dacryocystorhinostomy
* Decrease inflammation – topical corticosteroids
* Clear out obstruction – warm compress and lacrimal sac massage
* Periodic infection – topical antibiotics

Question 29

What is the presentation of infectious dacryoadenitis ?

Answer 29

• Acute onset and short duration
• Ascension of infectious agent from conjunctiva
• Aetiologies can be bacterial, viral or fungal

Question 30

What is the presentation of systemic dacryoadenitis ?

Answer 30

• Gradual onset and prolonged duration
• Pathophysiology not fully understood
• Sometimes seen in sarcoidosis, Graves’ disease, and Sjogren syndrome

Question 31

What is the Tx of dacryoadenitis ?

Answer 31

– Oral antibiotics (e.g., 3rd gen cephalosporin) if
purulent discharge
– Treat underlying condition for chronic disease