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RED EYE (Conjunctivitis) Flashcards

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1
Q

Conjunctiva

A

Translucent mucous membrane which lines the post surface of the eyelids and ant aspect of eyeball

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2
Q

Functions of conjunctiva

A
  1. Produce mucus & tear to maintain lubrication
  2. Prevent eye irritation by reducing friction btwn eyelid & eyeball
  3. Helps maintain aseptic environment in eye by preventing entry of pathogenic microbes, dust, dirt & debris
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3
Q

Conjunctivitis

A

Inflammation of conjunctiva, conjunctiva hyperaemia associated with discharge which may be watery, mucoid, mucopurulent or purulent

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4
Q

Acute conjunctivitis

A
  • viral
  • herpes simplex
  • pediculosis
  • gonococcal
  • allergic
  • vernal/atopic
  • meningococcal
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5
Q

Chronic conjunctivitis

A
  • chlamydial inclusion
  • trachoma
  • molluscum contagiosum
  • microsporadial kerato conjunctivitis
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6
Q

Bacterial conjunctivitis is characterized by?

A
  • bilateral conjunctiva hyperemia
  • rapid in onset
  • lid edema
  • mucopurulent discharge
  • 2nd eye infected 1-2 days after
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7
Q

Predisposing factors of bacterial conjunctivitis?

A
  • flies
  • poor hygienic condition
  • hot dry climate
  • poor sanitation
  • dirty habits
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8
Q

Common organisms in acute bacterial conjunctivitis?

A
  • strep pneumoniae
  • staph aureus
  • h influenzae
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9
Q

Symptoms of acute bacterial conjunctivitis

A

Bilateral involvement
1. Acute onset of redness
2. Grittiness
3. Burning
4. Discharge
5. Eyelids gets stuck frequently

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10
Q

Causative organisms in hyperacute conjunctivitis?

A
  • neisseria gonorrhoeae
  • neisseria meningitidis
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11
Q

Causative organisms in chronic conjunctivitis?

A
  • staphylococcus aureus
  • moraxella lacunata
  • enteric bacteria
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12
Q

Signs of bacterial conjunctivitis

A
  • eyelid edema & erythema (gonococcal)
  • conjunctival injection (blood shot eyes)
  • discharge = watery -> mucopurulent (mimicking viral conjunctivitis)
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13
Q

Investigation for bacterial conjunctivitis

A
  1. Binocular conjunctival swabs & scrapings taking for gram staining - to exclude gonococcal & meningococcal
  2. PCR - to rule out chlamydial & viral infection
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14
Q

Treatment for bacterial conjunctivitis

A
  • resolves within 5 days w/o treatment (60%)
  • topical antibiotics (4x daily)
  • systemic antibiotics
  • irrigation to removed excessive discharge
  • contact lens discontinue for at least 48 hrs (after resolution of symptoms)
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15
Q

Topical antibiotics used?

A
  1. Fluoroquinolones
    - moxifloxacin, ciprofloxacin, ofloxacin
  2. Aminoglycoside
    - tobramycin, gentamicin
  3. Macrolides
    - erythromycin
    - azithromycin
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16
Q

Systemic antibiotics used in which conditions?

A
  • Gonococcal conjunctivitis
  • Chlamydial conjunctivitis
  • Preseptal or orbital cellulitis
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17
Q

Systemic antibiotics used for gonococcal conjunctivitis?

A

Ceftriaxone
Alt - cefotaxime

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18
Q

Systemic antibiotics used for chlamydial conjunctivitis?

A

Azithromycin
Alt. Azithromycin

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19
Q

Systemic antibiotics used for preseptal or orbital cellulitis?

A
  • amoxicillin clavulanate
  • cefuroxime
  • levofloxacin
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20
Q

hyperacute bacterial conjunctivitis caused by?

A

Neisseria gonorrhea

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21
Q

hyperacute bacterial conjunctivitis seen in?

A

Neonates
Sexually active young adults

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22
Q

hyperacute bacterial conjunctivitis transmitted via?

A

Contact with infected urine/genital secretions

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23
Q

C/F of hyperacute bacterial conjunctivitis?

A
  • painful hyperemia
  • severe yellow green purulent discharge
  • marked lid swelling & chemosis
  • preauricular lympadenopathy
  • tenderness
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24
Q

Pseudomembrane keratitis in hyper acute bacteria conjunctivitis?

A

Marginal ulceration that progress rapidly resulting in ring ulcer, perforation & endopthalmitis

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25
Investigations done for hyper acute bacteria conjunctivitis
- conjunctival scraping/swabs for gram staining, culture
26
Treatment for hyper acute bacteria conjunctivitis
Topical antibiotic = - ofloxacin, ciprofloxacin, tobramycin (eye drops) - bacitracin/erythromycin (eye ointment) Keratitis = Ceftriaxone, topical antibiotics and saline irrigation
27
Mode of transmission for chlamydial conjunctivitis (in sexually active young people)
- to eyes by oral-genital sexual practices/hand to eye transmission
28
Mode of transmission for chlamydial conjunctivitis (in newborns)
Direct contamination of conjunctiva with cervical secretion
29
Symptoms of chlamydial conjunctivitis
1. Unilateral/bilateral redness 2. Discharge If untreated -> becomes chronic
30
Signs of chlamydial conjunctivitis
1. Water/mucopurulent discharge 2. Superficial punctate keratitis 3. Tender preauricular lympadenopathy 4. Large follicles 5. If chronic -> less prominent follicles with mild scarring & superior corneal pannus
31
Lab investigations to do for chlamydial conjunctivitis
Conjunctival scraping for 1. Giemsa staining 2. McCoy’s cells culture 3. Direct immunofluroescence
32
Systemic therapy for chlamydial conjunctivitis
1. Azithromycin 1g 2. Doxycycline 100mg BD for 10 days Alt = erythromycin, amoxicillin, ciprofloxacin
33
Organism that causes trachoma?
Chlamydia trachomatis
34
Trachoma is a
Chronic keratoconjunctivitis
35
Trachoma is characterized by
Mixed follicular & papillary response for conjunctival tissue
36
Trachoma is common in
- poverty - overcrowding - poor hygiene - dry, hot climate
37
Trachoma primarily affects
Superficial epithelium of conjunctiva & cornea
38
What is the reservoir & vector for trachoma?
Reservoir = children Vector = flies
39
How can trachoma lead to blindness?
Recurrent infection -> chronic immune response -> blindness
40
WHO classification (TF)
Trachomatous inflammation: follicular - >5 follicles on upper tarsus
41
WHO classification (TI)
Trachomatous inflammation (intense) - tarsal inflammation sufficient to obscure >50% of tarsal vessels
42
WHO classification (TS)
Trachomatous scarring - conjunctival scarring
43
WHO Classification (TT)
Trachomatous trichiasis - trichiasis
44
WHO classification (CO)
Corneal opacity - involves at least part of pupillary margin
45
C/F for trachoma (in pre schools children)
1. Mixed follicular/papillary conjunctivitis with mucopurulent discharge 2. Sup epithelial keratitis & pannus formation 3. Circatricial trachoma
46
C/F for trachoma (middle age group)
1. Linear/stellate conjunctival scares 2. Broad confluent scars
47
C/F for trachoma (severe case)
1. Herbert pits (due to resolved superior limbal follicles) 2. Trichiasis, Distichiasis, corneal vascularization, circatricial 3. Entropion 4. Severe corneal opacity 5. Dry eyes
48
Lab investigation for Trachoma
1. Culture 2. Giemsa staining - dark purple/blue cytoplasmic masses that cap the nucleus of epithelial cells) 3. Fluorescent antibody stains 4. Enzyme immunoassay test
49
Complications of Trachoma
- conjunctival scarring - inward deviation of individual lashes - corneal ulceration - bacterial corneal infections - corneal scarring - ptosis - lacrimal duct obstruction
50
Treatment for Trachoma (SAFE)
S = surgery for trichiasis & entropion A = antibiotics F = facial hygiene E = environmental improvements
51
Antibiotics used for trachoma
1. Tetracycline for 3-4 weeks 2. Doxycycline for 3 weeks OR erythromycin for 3-4 weeks
52
Ophthalmia Neonatorum
Conjunctivitis that occurs within 1st month of life
53
Risk factors of Ophthalmia Neonatorum
Presence of STD in mother, so acquired from birth canal
54
What are the 2 types of Ophthalmia Neonatorum?
1. Gonococcal neonatal conjunctivitis 2. Chlamydial neonatal conjunctivitis
55
C/F of Ophthalmia Neonatorum
1. Pain & tenderness of eyeball 2. Conjunctival discharge 3. Lid edema 4. Conjunctival hyperemia & chemosis
56
Treatment for Ophthalmia Neonatorum (topical)
1. Saline lavage hourly till discharge eliminated 2. Bacitracin eye ointment 4 times/day 3. Atropine sulphate (if cornea involved)
57
Treatment for Ophthalmia Neonatorum (systemic)
For gonococcal - ceftriaxone 75-100mg/kg/day IV or IM
58
Course of viral conjunctivitis
- gets worst in 1st 4-7 days - more than 2-3 weeks to resolve (if cornea involved) - highly contagious for 10-12 days from onset
59
Symptoms of viral conjunctivitis
1. Itching 2. Burning 3. Tearing 4. Gritty 5. Foreign body sensation 6. h/o recent URTI 7. h/o sick contact
60
Signs of viral conjunctivitis
1. Watery discharge 2. Red & edematous lids 3. Pinpoints conjunctival hemorrhage 4. Pseudomembranes
61
Investigations for viral conjunctivitis
1. Giemsa stain 2. Nucleic acid amplification 3. Viral culture 4. Point of care immunochromatography 5. Serology (IgM/rising IgG)
62
Treatment for viral conjunctivitis
1. Resolves spontaneously within 2-3 weeks 2. Topical steroids (prednisolone 0.5% 4 times daily) **for pseudomembranous adenoviral** 3. Monitor Intraocular pressure
63
Other managements for viral conjunctivitis
1. Reduction of transmission (hand hygiene, avoid eye rubbing) 2. Discontinue contact lense 3. Artificial tears (4 times daily) 4. Cold/warm compresses
64
Allergic conjunctivitis
Mild, non specific IgE mediated type 1 hypersensitivity reaction
65
Symptoms of allergic conjunctivitis
Itching Watery discharge
66
Sign of allergic conjunctivitis
1. Chemosis 2. Red & edematous eyelids 3. Conjunctival papillae
67
Treatment for allergic conjunctivitis
1. Eliminate triggering agents 2. Cool compression 3. Topical drops 4. Oral antihistamine 5. Cool compression to reduce pain/swelling
68
Seasonal allergic conjunctivitis
- worse during the spring & summer - allergens: tree & grass pollens
69
Perennial allergic conjunctivitis
generally worse in the autumn when exposed to house dust mites, animal dander & fungal allergens
70
Symptoms of Seasonal/Perennial allergic conjunctivitis
- transient acute/subacute attacks of redness - watering - itching - sneezing - nasal discharge
71
Signs of Seasonal/Perennial allergic conjunctivitis
- conjunctival hyperemia with relatively mild papillary reaction - variable chemosis - lid edema
72
Treatment of Seasonal/Perennial allergic conjunctivitis
Artificial tears Mast cell stabilizers Antihistamines
73
Treatment of Seasonal/Perennial allergic conjunctivitis (Mast cell stabilizers)
sodium cromoglicate, nedocromil sodium, lodoxamide - used for a few days before exerting maximal effect, but are suitable (except lodoxamide) for long-term use if required.
74
Treatment of Seasonal/Perennial allergic conjunctivitis (Antihistamines)
- symptomatic exacerbations: emedastine, epinastine, levocabastine, bepotastine - azelastine, ketotifen, olopatadine (acts rapidly) - Combined preparation of an antihistamine & vasoconstrictor (e.g. antazoline with xylometazoline).
75
Vernal keratoconjunctivitis
Chronic inflammation of outer lining of eyes due to allergic reaction
76
Incidence of Vernal keratoconjunctivitis
- affects young male - occurs in spring & summer - personal family h/o allergic rhinitis, eczema, asthma
77
Types of Vernal keratoconjunctivitis
1. Palpebral 2. Limbal
78
Symptoms of Vernal keratoconjunctivitis
1. Burning, watery, itchy eyes 2. Photophobia 3. Thick mucus discharge 4. Heaviness of eyelids
79
Management of Vernal keratoconjunctivitis
1. cold compress & avoid rubbing eyes 2. lubricating drops 3. Anti-histamines 4. Mild steroids
80
Signs of limbal Vernal keratoconjunctivitis
1. Thickening & opacification of limbus 2. Limbal nodules - mucoid nodules (gelatinous, elevated) 3. Horner Trantas dots - eosinophils & epithelial debris
81
Atopic keratoconjunctivitis
Hypersensitivity reactions associated with type 1 & 4 causing inflammatory changes of conjunctiva & cornea
82
C/F of Atopic keratoconjunctivitis in periorbital region
1. Linear lid folds secondary to chronic eye rubbing (Dennie Morgan fold) 2. Absence of lateral eyebrow (hertoghe sign)
83
C/F of Atopic keratoconjunctivitis in eyelids
1. Thickening 2. Edema 3. Ptosis
84
C/F of Atopic keratoconjunctivitis in conjunctiva
1. Hyperemia 2. Edema 3. Limbal trantas dots = clusters of eosinophils, neutrophils & epithelial cells
85
Prophylactic therapy of Atopic keratoconjunctivitis
1. Mast cell stabilizer (azelastine, ketotifen, olopatadine) 2. Anti-histamines
86
Immediate control of symptoms of Atopic keratoconjunctivitis
1. Anti-histamines 2. Steroids
87
Contact dermatoconjunctivitis
Allergy involving conjunctiva & eyelid skin to medication (neomycin) or other cosmetic products
88
C/F of Contact dermatoconjunctivitis
1. Conjunctiva = diffusely red 2. Eyelid skin = red, thickened, coarse
89
Management of Contact dermatoconjunctivitis
•Discontinue of causative agents •Topical steroid eye drop •Steroid ointment involve surrounding area
90
Giant capillary conjunctivitis
Contact lense induced
91
C/F of Giant capillary conjunctivitis
1. Exposed ocular suture 2. Elevated corneal ulcer 3. Ocular itching 4. Mucus discharge in tears 5. Blurred vision 6. Conjunctival injection 7. Papillary hypertrophy
92
Management of Giant capillary conjunctivitis
1. Topical steroid 2. Contact lense hygiene
93
Organism causing Bacterial corneal ulcers
Staphylococci (common) Pseudomonas (contact lense) Streptococcus pneumoniae Enterobacteriaceae Neisseria
94
Symptoms of Bacterial corneal ulcers
1. Pain & foreign body sensation 2. Watering 3. Photophobia 4. Blurred vision 5. Redness of eyes
95
Signs of Bacterial corneal ulcer
1. Swelling of lid 2. Blepharospasm 3. Conjunctiva: hyperaemia & ciliary congestion 4. Ulcer: epithelial defect associated with greyish-white circumscribed infiltrate
96
Investigations of Bacterial corneal ulcer
1. Routine laboratory investigations 2. Gram & Giemsa stain 3. Culture on blood agar medium 4. Diffuse light examination 5. Regurgitation test & syringing to rule out lacrimal sac infection.
97
Treatment of Bacterial corneal ulcer
1. Topical antibiotics 2. Cycloplegic drugs 3. Systemic analgesics & anti-inflammatory drugs relieve the pain & decrease oedema. 4. Vitamin (A, B-complex and C): early healing of ulcer
98
Organisms causing Viral corneal ulcer
- herpes simplex virus (HSV) - constitute herpetic keratoconjunctivitis & iritis.
99
Systemic C/F of Viral corneal ulcer
1. mild fever 2. malaise 3. non-suppurative lymphadenopathy 4. Can cause encephalitis
100
Skin lesions of Viral corneal ulcer
Vesicular lesions involving skin of face, lips, lids, periorbital region & lid margin
101
Ocular lesions of Viral corneal ulcer
1. Acute follicular conjunctivitis with regional lymphadenitis 2. Keratitis
102
Treatment for Viral corneal ulcer
Topical trifluridine/vidarabine OR Oral acyclovir For limiting corneal involvement
103
Scleritis
inflammation of the sclera proper - occurs in elderly patients (40-70 years); F>M
104
Symptoms for Scleritis
1. Pain - deep, boring in character 2. Ocular pain - radiate to jaw & temple 3. Redness 4. Photophobia 5. Lacrimation 6. Diminution of vision
105
Episcleritis
benign, recurrent, inflammation of the episclera, involving the overlying Tenon's capsule but not the underlying sclera - affects young adults
106
Symptoms of Episcleritis
1. redness 2. mild ocular discomfort described as gritty, burning or foreign body sensation 3. Mild photophobia, lacrimation
107
Investigations for EPISCLERITIS
1. TLC, DLC and ESR. 2. Serum levels of complement (C3), immune complexes, rheumatoid factor, antinuclear antibodies 3. FTA-ABS, VDRL for syphilis. 4. Serum uric acid for gout 5. Urine analysis 6. Mantoux test 7. X-rays of chest, paranasal sinuses, sacroiliac joint and orbit
108
Treatment for EPISCLERITIS
1. Topical NSAIDs, e.g. ketorolac 0.3% 2. Topical mild corticosteroid eye drops, e.g. fluorometholone or loteprednol instilled 2- 3 hourly 3. Topical artificial tears, e.g. 0.5% carboxy methyl cellulose 4. Cold compression & NSAIDs

Ophthal (18 decks)

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