What is conjunctivitis? What are the broad categories?
Inflammation of the conjuntiva.
- Infectious (viral or bacterial)
- Non-infectious (allergic or non-allergic)
What are the viral agents that can cause conjunctivitis?
mainly adenoviruses, sometimes enteroviruses
What are the clinical manifestations of viral conjunctivitis?
Pharyngeal conjunctival fever:
- +/- preauricular LAD
- conjunctivitis with keratitis
- stronger foreign body sensation
- may have subconjunctival hemorrhages
What are the manifestations of conjunctivitis? How to tell allergic vs. viral vs. bacterial?
conjunctival hyperemia (engorgement of blood vessels)
discharge, morning crusting of eye
burning or itching
Bacterial: unilateral, purulent discharge predominate complaint
Viral: watery discharge, burning or gritty feeling primary complaint, usually 2nd eye involved in 1-2 days
Allergic: bilateral, watery discharge, history.
***normal visual acuity***
What is the treatment for viral conjunctivitis?
Supportive care, usually resolves in days to weeks.
Cold compresses, eye lubricant drops, eye decongestant drops.
Possibly exclude from work/school because it is highly contagious
What are the bacterial agents that can cause conjunctivitis?
- S. aureus
- S. pneumoniae
- S. pyogenes
- H. influenzae
- M. cattarhalis
- N. gonorrhoeae
- Chlamydia trachomatis
What is the pathogenesis of allergic conjunctivitis? What are possible etiologies of non-allergic conjunctivits?
- allergen in air causes IgE mediated immune response
- post foreign body irritation
What is the clinical presentation of hyperacute conjunctivitis? How is it contracted?
Conjunctivitis with profuse purulent discharge (e.g. streaming down the face)
N. gonorrhea is passed genitals-->hands--> eyes
How does chlamydial conjunctivits differ from acute bacterial conjunctivitis? Types of conjunctivits
There is a follicular response (the inside of the eyelid is bumpy), and the is not usually a lot of purulent discharge.
Trachoma: self-limited follicular conjunctivitis, usually seen in children.
Adult inclusion conjunctivitis: caused by sertain strains of C. trachomatis, that is chronic and unilateral. Doesn't respond to antibiotics.
What is the treatment for acute and hyperacute bacterial conjunctivitis?
- antibiotic eyedrops (e.g. azithromycin)
- systemic therapy to cover gonorrhea (ceftriaxone) and chlamydia (doxycycline)
Inflammation of the cornea
What is the pathophysiology of keratitis?
What are the risk factors fo keratitis?
Trauma to eye
What are the clinical manifestations of keratitis?
foreign body sensation
tearing and discharge
What are the infectious causes of keratitis? Can they be distinguished by presentation?
- S. aureus **
- S. pneumoniae
- S. pyogenes
**Can sometimes distinguish based on the pattern of corneal infiltrate**
What is the diagnostic approach to keratitis?
Referral to an opthamologist
Corneal scrapings (bacterial culture, viral culture +PCR, fungal cultura, wet mounts, culture for Acanthamoaeba, Giemsa stain)
What is the treatment for bacterial keratitis?
Non-contact lens wearers
- fluoroquinolone drops
Contact lens wearer
- have to cover for pseudomonas --> aminoglycoside + pipercillin
What is the treatment for HSV viral keratitis?
What is the treatment for fungal keratitis?
What is the treatment for parasitic keratitis?
- acyclovir drops
- natamycin or amphotericin
- propamidine + chlorohexidine
What is endophthalmitis? What are the 2 main types?
Infection of the aqueous +/- vitreous humour
- exogenous (organism introduced from outside the body--> trauma, surgery, extension of keratitis)
- endogenous (organism seeded from within the body
What are the clinical manifestions of endophthalmitis?
conjunctiva may be injected or edematous
What is the diagnostic approach to endopthalmitis?
S/S, physical exam
aspiration of vitreous humour --> bacterial and fungal cultures
What are the causative agents of endopthalmitis?
- S. aureus
- G(-) organisms
What is the treatment for endopthalmitis?
Intravitreal antibiotics (vancomycin + ceftazidime) for all
Vitrectomy in severe cases or if trauma related (removal of vitreous humor)
Systemic antibiotics if trauma realted, or endogenous
Define orbital and periorbital (preseptal) cellulitis
Periorbital (preseptal) cellulitis: inflammation of the anterior portion of teh eyelid
Orbital cellulitis: inflammation of the orbit (fat, ocular muscles)
What population are periorbital and orbital cellulitis most common in? Which is more comon?
Most common in children and periorbital is more common than orbital.
What some etiologies of periorbital cellulitis? Causative agents?
- insect bite, animal bite, foreign body, surgery
- tear duct infection (dacrocystitis)
S. aureus, S. pneumoniae, anaerobes, H. influenzae
What are the clinical manifestations of periorbital cellulits and what are the pertinent negatives?
no double vision
no increase in pain with eye movement
no eye bulging (proptosis)
What is the diagnostic approach to periorbital cellulitis?
S/S, history (e.g. insect bite)
Physical (no pain on eye movement)
If in doubt, perform CT of head
Treatment for periorbital cellulitis?
No topical antibiotics
Clindmycin OR Septra +Amoxil/clav
What are some etiologies of orbital cellulitis? Causative agents?
infection of teeth, middle ear, face
S. aureus, Streptococci, Anaerobes, H. influenzae
What are the clinical manisfestations of orbital cellulitis?
- pain with eye movement
- proptosis (bulging of eye)
- double vision
What are complications of orbital cellulitis?
loss of vision
What is the diagnostic approach to orbital cellulitis?
S/S, history (rhinosinusitis)
physical exam (pain on eye movement)
if unsure, do CT of orbit and sinuses
What is the treatment for orbital cellulitis?