Conjunctivitis

Question 1

What is Conjunctivits?

Answer 1

Inflammation of the conjunctiva (lining of eyelid)

Question 2

What is the epidemiology of Conjunctivitis?

Answer 2

• 13-14/1.000 (1% of primary care presentations)
• All gender, any age
• Incidence higher in fall and early spring (allergic)

Question 3

What are possible causes for Conjunctivits?

Answer 3

1. Viral (80% of causes)
   
   1. adenovirus (and others)
2. Bacterial (50-75% of conjunctivitis in children)
3. Other

• Allergic conjunctivitis
• Contact lenses
• Mechanical irritation
• Toxins/chamicals

Question 4

What are the presenting symptoms of a patient of conjunctivits

Answer 4

• Burning/foreign body sensation
• Photopia (if cornea involved)
• Itching
• Eyelids stuck together in morning
• Picture: viral conjunctivitis

Question 5

What are risk factors for the development of conjunctivits?

Answer 5

• Wearing of contact lenses
• Exposure to infected person and crowded plces (e.g. miltary base, swimming pool)
• Atopy and Allergen exposure
• Exposure to environmental irritants
• Mechanical irritation

Question 6

What are signs on examination in a person with conjunctivitis?

Answer 6

• Occular hyperaemia (increased blood flow) with vasodilation causing red eye
• Discharge
  
  • Watery Discharge (viral)
  • Mucoid discharge (allergic)
  • Purulent discharge (bacterial)
• Chemosis: oedema of eylid or conjunctiva
• Tender pre-auricular lymphadenopathy (more common in viral)

Question 7

Which investigations would you order in a patient with suspected conjunctivitis?

Answer 7

Otherwise: Examination of eye

• Inspection
  
  • Infection, swelling, follicles (small yellowish elevations of lymphocytes), papillae (small conjunctival elevations with central vessels)
• Pupils
  
  • Rule out red flags i.e. abnormalities with pupils/ anterior uveitis
• Visual accuity + visual fields
  
  • normal (might be blurred due to discharge)
• Regional Lymphadenopathy

Question 8

What are red flags that you should refere someone with suspected conjunctivits (or other resions) to an ophtalmologist?

Answer 8

• Reduced visual acuity.
• Marked eye pain, headache or photophobia — always consider serious systemic conditions such as meningitis in a person presenting with photophobia.
• Red sticky eye in a neonate (within 30 days of birth).
• History of trauma (mechanical, chemical or ultraviolet) or possible foreign body.
• Copious rapidly progressive discharge — may indicate gonococcal infection.
• Infection with a herpes virus.
• Soft contact lens use with corneal symptoms (such as photophobia and watering)