Ophthalmology_Red Eye and Eye Pain and Conjuctivitis Flashcards
(34 cards)
What is the most common cause of red eye?
Conjuctivitis
Causes of red eye?
- Conjuctivitis
- Keratitis
- uveitis (iritis)
- scleritis
- episcleritis
- corneal abrasion
- glaucoma
- blepharitis
- subconjunctival hemorrhage
- foreign body
History of a Red Eye
- Symptom duration
- unilateral or bilateral involvement
- quality and quantity of discharge
- visual changes
- severity of pain
- photophobia
- history of recent eye infection/allergies and treatment
- personal or family history of autoimmune disease
- contact-lens use
Causes of conjuctivitis
- Infectious: bacterial, viral, chlamydial
- Noninfectious: allergies, irritants
A 15-year-old boy with asthma, eczema, and seasonal rhinitis presents with itchy , watery eyes. What is the most likely diagnosis?
- Allergic conjuctivitis
What nonpharmacologic measures can help manage allergic conjunctivitis?
- Allergen avoidance
- avoidance of rubbing eyes which can cause mechanical mast cell degranulation
- reduction of contact lens use (allergens can adhere to contact lens surfaces)
What kinds of eye drops help relieve allergic conjunctivitis?
- Artificial tears (dilute allergens)
- antihistamine eye drops (olopatadine)
What is the disadvantage of oral antihistamines versus antihistamine eye drops?
- The onset of action of oral antihistamines is longer than antihistamine eye drops
- oral antihistamines cause systemic side effects, such as drowsiness.
Although not always reliable, what differences in examination findings might you expect in bacterial versus viral conjunctivitis?
- Bacterial: opaque, thick, purulent discharge that reappears shortly after wiping the lids
- Viral: watery discharge
Causes of viral conjuctivitis
- Adenovirus (most common)
- enterovirus
- coxsackievirus
- varicellazoster virus
- Epstein-Barr Virus
- HSV
- Influenza
What physical exam findings suggest viral conjunctivitis?
- Minimal pain
- diffuse conjunctival injection
- mild itching
- watery discharge
- vision preserved
- unaffected pupils
- preauricular lymphadenopathy
What is the management of viral conjunctivitis?
- Patient education about transmission
- promote strict hand washing and discourage sharing of personal items
- supportive treatment with cold compresses and artificial tears
- topical antibiotics (rarely necessary because secondary bacterial infections are uncommon)
What is herpes zoster ophthalmicus?
- Vesicular rash, keratitis, and uveitis caused by herpes zoster.
- Unilateral pain and tingling precede conjunctivitis and dermatomal rash.
- Early diagnosis can prevent corneal involvement and potential vision loss.
In herpes zoster, what cranial nerve would have to be affected to impair the patient’s vision?
- The frontal branch of the first division of the trigeminal nerve (V1)
What physical exam finding makes you suspect zoster involvement of the frontal branch of V1?
- Vesicles involving the tip of the nose (Hutchinson sign)
What is the treatment of herpes zoster ophthalmicus?
- Antiviral therapy
- topical steroid drops to control keratitis and iritis
- typically treated by ophthalmology
What are the three subtypes of bacterial conjunctivitis?
- acute lasts up to 3-4 weeks.
- Chronic lasts > 4 weeks.
- Hyper acute - Sudden onset and rapid progres
What are the offending microorganisms responsible for acute and chronic bacterial conjunctivitis?
- In children- Streptococcus pneumoniae, Haemophilus influenza.
- In adults - S. aureus, Moraxella species, E coli Pseudomonas species.
What is the offending pathogen responsible for hyperacute bacterial conjunctivitis?
- Nesseria gonorhea
What is the best clinical predictor when considering a diagnosis of bacterial conjunctivitis?
- profuse, thick mucopurulent secretions.
What is the treatment of acute bacterial conjunctivitis?
- antibiotic eyedrops or ointment 4-6 times a day
- (studies however, have indicated that most cases are self limited)
- frequent handwashing to prevent spreading
- For cases lasting greater than four weeks referral to ophthalmology for management of chronic bacterial conductivitis
Sudden onset of perfuse mucopurulent discharge, accompanied by intense hyperemia of conjunctiva in a sexually active patient suggest what process?
- hyperacute gonococcal conjuctivitis
What is the treatment of hyper acute bacterial conjunctivitis?
- danger of rapid progression and potential corneal perforation requires aggressive management by an ophthalmologist and possible hospitalization
- systemic antibiotics+/- topical therapy
- Frequent eye irrigation.
A patient returns to your office with no response to standard antibacterial treatment for a suspected acute bacterial conjunctivitis. Given that the person is sexually active, what are the other diagnosis and treatment might you pursue at this stage?
- Chlamydia conjunctivitis (signs and symptoms which do not resolve whichstandard antibiotic therapy).
- Treat topically with erythromycin ophthalmic ointment.
- Treat possible genital infection with azithromycin or doxycycline
- encourage treatment for patient’s sexual partners.
