chapter 4 · 2015. 8. 26. · conjunctivitis conjunctival tumors criteria for d/d chapter 4 skills...
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Conjunctivitis
Conjunctival tumors
Criteria for D/D
Chapter 4
Skills 28-33
Slides edited by Argyrios Tzamalis, MD, PhD, MA, FEBO
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TS 28 : Conjunctivitis symptoms
Depends on the cause !!!
Conjunctivitis types • Infectious
• Bacterial • Viral
• Allergic
• Toxic (irritations)
Common symptoms Red eye, Chemosis, Pain
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TS 28 : Conjunctivitis symptoms
• Frequent involvement of Lid margins Blepharitis Cornea Keratitis
• Chronic conjunctivites… Dry eye-related Exacerbate with UV & dry environment Mucous discharge Do not interfere with vision
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Allergic conjunctivitis
Itchiness
Watery or mucous discharge
Conjunctival papillae
Seasonal distribution
Younger patients
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Mucopurulent discharge
Does not interfere with vision
Sticky eyelashes
Frequently unilateral
Antibiotics
Bacterial conjunctivitis
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• Epidemic (adeno-virus)
• Cornea is often affected
Pain/Photophobia/Blurry vision
• Very watery eye
• Fellow eye usually involved within the first week after initial appearance
Viral conjunctivitis
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Recurrent conjunctivitis
Unilateral in elderly
Chronic dacryocystitis- associated
Bilateral
Blepharitis-associated
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TS 29 : Conjunctivitis causes
Acute
• Infectious: Bacterial
Viruses (adenoviruses)-seasonal distribution
Chlamydia-end of summer
Mimics allergic conjunctivitis
• Allergic: Allergies during spring and
blooming seasons
Chronic
• Environmental-refractive errors:
Dry Eye, UV
Hyperopia, astigmatism, presbyopia
• Infectious: Local spreading and flare ups
Dacryocystitis
Blepharitis
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Newborns
1-3 days postnatal
Bilateral
Maternal genitourinary track contamination during delivery
Very rare in developed world
Penicillin fortified drops
TS 30 : Ophthalmia neonatorum
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• Contamination: Direct or indirect
• Incubation period: 3-7 days
lasting ≥ 2 weeks
• Watery discharge
• Fellow eye is affected 3-5 days after initial presentation
• Pre-auricular lymph node sensitive
• Symptomatic treatment
Keratoconjunctivitis epidemica
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• 1st line:
• Tobramycin
• Gentamycin
• Chloramphenicol
• 2nd line:
• Quinolones (1-2 drops every 4-6 hours)
• 5-7 days treatment at least!
• Caution: Not every acute conjunctivitis is bacterial in nature
TS 31 : Antibiotic eye drops
NB: Tobradex contains dexamethasone (steroid)
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Between:
i. Subconjunctival haemorrhage
ii. Conjunctivitis
iii. Scleritis
iv. Keratitis
v. Iritis
vi. Acute angle closure glaucoma
TS 32 : Criteria for D/D
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• Although impressive in appearance, condition is trivial
• Painless
• Visual acuity remains unaffected
• Hx: ? diabetes or BP
• Recurrences may be common
Hyposphagma - Subconjunctival hemorrhage
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• Local redness
• Deep pain, sensitivity
• Vision is not affected
• Autoimmune disease
affecting connective tissue
Scleritis
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• Acute superficial pain worsening during blinking
• Blurry vision/Photophobia
• Purulent discharge is associated with corneal ulcer
• Limbal injection
• Causes: CL, trauma, immuno-compromised patients
Keratitis
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• Redness, limbal injection
• Photophobia: light evokes miosis and causes slow, deep pain
• Infectious or systematic causes
• Blurry vision
Iritis
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• Deep slow pain, projecting to orbit
• Cloudy cornea
• Mid-dilated, non-reacting pupil
• Blurry vision, photophobia
Acute angle closure Glaucoma
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Benign degenerative changes
• Pterygium • Vascularized granulation
tissue that invades cornea
• Pingueculum • Triangular conj. patch
consisting of hyaline and elastotic degeneration
Differentiate from nevi, papillomas & malignancies (squamous cell Ca)
TS 33 : Conjunctival tumours
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Electronic Referrals - 4th Chapter
1. http://emedicine.medscape.com/article/797874-overview
2. http://emedicine.medscape.com/article/1191730-overview
3. http://emedicine.medscape.com/article/1191370-overview
4. http://emedicine.medscape.com/article/1191467-overview
5. http://webeye.ophth.uiowa.edu/eyeforum/cases/68-Adult-Chlamydial-Conjunctivitis-Red-Eyes-Chronic.htm
6. http://www.aafp.org/afp/2010/0115/p137.html
7. http://emedicine.medscape.com/article/1192190-overview
8. http://www.aoa.org/documents/CPG-11.pdf
9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776793/
10. http://emedicine.medscape.com/article/1192527-overview