Conuctivitis

Question 1

What is conjunctivitis?

Answer 1

The connective tissue lining the inner eyelids and outside of the eye

The bulbar conjunctiva is outside the eye and palpebral conjunctiva lines the eyelids.

Question 2

What is the bulbar conjunctiva?

Answer 2

outside the eye

Question 3

What is palpebral conjuctiva?

Answer 3

lines the eyelids

Question 4

What are the two main types of conjunctivitis?

Answer 4

• Infectious
• Non-infectious

Infectious conjunctivitis can be caused by bacteria, viruses, or allergens.

Question 5

What are the most common causes of conjunctivitis?

Answer 5

• Allergic conjunctivitis
• Bacterial conjunctivitis
• Viral conjunctivitis

In adults, viral conjunctivitis is more common; in children, bacterial conjunctivitis is more common.

Question 6

What are the infective causes of conjunctivitis commonly linked to?

Answer 6

URT infections

Bacterial causes include Staphylococcus aureus, Streptococcus pneumonia, and others.

Question 7

What is the aetiology of conjunctivitis?

Answer 7

• Staphylococcus aureus
• Streptococcus pneumonia
• Haemophilius influenza
• Malarhella catarrhalis

Question 8

Which bacteria is the most common cause of bacterial conjunctivitis in neonates?

Answer 8

Chlamydia trachomatis

Other causes include Neisseria gonorrhoeae and various streptococci.

Question 9

Which bacteria is the most common cause of conjunctivitis in children?

Answer 9

In childrrren, streptococcus pneumonia and haemophilius influenzae is most common cause of bacterial conjuctivitis.

Question 10

What is the most common cause of bacterial conjunctivitis in adults?

Answer 10

staphylococcus aureus

Question 11

What is the gonorrhea risk with conjunctivitis?

Answer 11

Risk factors are contact lens use, trauma, prior eye condition or direct/indirect contact with infected person.

Question 12

What are the clinical presentations of bacterial conjunctivitis?

Answer 12

• Eye redness
• Purulent eye discharge (white/green/yellow) that makes i feel glued shut

Discharge can make the eye feel ‘glued shut’.

Question 13

What is the presentation of bacterial keratitis?

Answer 13

Bacterial keratitis involves the cornea, with mild eye pain, foreign body sensation, blurred vision and photophobia and is associated with wearing contact lenses.. complications include vision loss in severe cases.

Question 14

What are the viral causes of conjunctivitis?

Answer 14

• Adenovirus
• Herpes simplex virus
• Varicella zoster virus
• Enterovirus
• Pox virus

Adenovirus is the most common cause.

Question 15

What are the clinical presentations of viral conjunctivitis?

Answer 15

• Itching with tearing and clear muco-serous watery discharge
  *Eye redness
• Follicles on the underside of eyelid
• Itching
• Tearing
• Watery/serous discharge
• pre-auricular lymphadenoapthy

Pre-auricular lymphadenopathy may be present.

Question 16

What are the risk factors of viral conjunctivitis?

Answer 16

direct/indirect contact with infected person and URTI. Bulbar/palberal conjuctiva can become inflamed.

Question 17

What is viral Keratoconjuctivitis?

Answer 17

both cornea and conjuctiva are involved. There will be vision loss/distortion, eye pain, increased eye redness and purulent discharge

Question 18

What type of reaction is allergic conjunctivitis?

Answer 18

Type 1 hypersensitivity reaction driven by histamine release and compensatory vasodilation in response to allergen.

Driven by histamine release and compensatory vasodilation.

Question 19

How does allergic conjunctivitis present?

Answer 19

Symptoms are bilateral and worse at certain times of year and in specific environments, with redness of eyes and conjunctival injection (blood vessels visible in conjuctiva)

Question 20

What are the discharge types associated with different types of conjunctivitis?

Answer 20

• Mucous discharge: allergic conjunctivitis
• Purulent discharge: bacterial conjunctivitis
• Mucopurulent discharge: Chlamydia/gonorrheal conjunctivitis or herpes zoster ophthalmicus
• Serous/watery discharge: viral conjunctivitis

Each type of discharge helps in diagnosing the cause.

Question 21

What causes purulent discharge?

Answer 21

bacterial conjunctivitis

Question 22

What causes serous/watery discharge?

Answer 22

viral conjunctivitis

Question 23

What causes much purulent discharge?

Answer 23

Chlamydia/gonorrheal conjcutivits or herpes zoster Opthalmicus

Question 24

What causes mucous discharge?

Answer 24

allergic conjunctivitis

Question 25

What are the **red flags** for more serious causes of a red eye?

Answer 25

* Reduced visual acuity * Marked eye pain * Photophobia * Red sticky eye in a neonate * History of trauma * Rapidly progressive discharge * Infection with herpes virus * Contact lens use * Pupil abnormalities Refer urgently to ophthalmology ## Footnote These signs warrant urgent referral to ophthalmology.

Question 26

How is **allergic conjunctivitis** diagnosed?

Answer 26

Superficial conjunctival scrapings showing high eosinophils ## Footnote It self-resolves but symptomatic relief can be provided.

Question 27

How is allergic conjunctivitis managed and disease course?

Answer 27

It self-resolves, but symptomatic relief can be given with nasal spray, antihistamines, cold compress, topical corticosteroids and artificial tears. Topical mast-cell stabilisers, e.g.sodium cromoglicateand nedocromil May be used.

Question 28

What is the treatment for **bacterial conjunctivitis**?

Answer 28

It is diagnosed with bacterial culture, conjunctival scrapings, gram stain showing high neutrophils * Broad spectrum antibiotic eye drops * Systemic antibiotics in severe cases ## Footnote Topical antibiotics like chloramphenicol and fusidic acid may be recommended.

Question 29

How is viral conjunctivitis diagnosed?

Answer 29

Viral conjuctivitis will show culture and conjunctival cytology smear for only severe, recurrent or refractory cases and will show high lymphocyte

Question 30

How does viral conjunctivitis run its course?

Answer 30

Viral conjuctivitis resolves spontaneously generally within 2 weeks.

Question 31

How is viral conjunctivitis managed?

Answer 31

Cold compress and artificial tears can be used for symptomatic relief. Ganciclovir and Aciclovir. → glucocorticoids are used in Keratoconjuctivitis.

Question 32

How is bacterial conjunctivitis run its course?

Answer 32

self-limitng and lasts 1-2 weeks

Question 33

What is the management of bacterial conjunctivitis?

Answer 33

Involves use of broad spectrum antibiotic eye drops. Systemic antibiotics are used only in severe cases, and in neonates and children with chlamydia or gonorrheal ifnection Topical antibiotics like chloramphenicol and fusidic acid may be recommended. ​

Question 34

How to adminster medication for conjunctivitis?

Answer 34

Chloramphenicol drops are given 2-3 hourly initially whereas chloramphenicol ointment is given qds initially

Question 35

Which medication is used for bacterial conjunctivitis in pregnant women?

Answer 35

topical fusidic acid is an alternative and should be used for pregnant women. Treatment is twice daily

Question 36

What should contact lens users do during an episode of **conjunctivitis**?

Answer 36

Stop wearing contact lenses until symptom resolution topical fluoresceins should be used to identify any corneal staining ## Footnote They should also avoid sharing towels.

Question 37

How to manage conjunctivitis associated with contact lenses use?

Answer 37

Aminoglycoside (e.g. gentamycin) or a quinolone (e.g. levofloxacin or moxifloxacin), to cover for gram -ve organisms.

Question 38

What are the **differentials** for conjunctivitis?

Answer 38

* Dry eyes * Corneal abrasion * Uveitis * Glaucoma ## Footnote Each condition presents with distinct symptoms.

Question 39

How to differentiate conjunctivitis from dry eyes?

Answer 39

presents with dryness, burning, a feeling of something in the eye

Question 40

How to differentiate conjunctivitis from corneal abrasion?

Answer 40

severe pain, photophobia, watering of the eye

Question 41

How to differentiate conjunctivitis from Uveitis?

Answer 41

eye pain, blurred vision, photophobia, floaters, redness

Question 42

How to differentiate conjunctivitis from Glaucoma?

Answer 42

severe eye pain, nausea, vomiting, blurred vision, halos around lights

Question 43

What is given to prevent neonatal conjunctivitis?

Answer 43

After baby is delivered, infants receive topical erythromycin/tetracycline/silver nitrate drops to prevent Opthalmic neonatorum AKA neonatal conjunctivitis.

Question 44

What is given to prevent gonorrhoeal induced conjunctivitis?

Answer 44

erythromycin or tetracycline

Question 45

what is the cause of neonatal conjunctivitis on day 0?

Answer 45

chemical aetiology from reaction to erythromycin or silver nitrate. Patient only requires eye irrigation with saline.

Question 46

what is the cause of neonatal conjunctivitis on day 2-21?

Answer 46

*Neisseria gonorrrohea * chlamydia trachomata’s * HSV

Question 47

What is the cause of neonatal conductivities in day 2-7?

Answer 47

initially with profuse purulent ocular discharge and swelling. Treatment is with ceftriaxone, third generation cephalosporin.

Question 48

what is the cause of neonatal conjunctivitis on day 7-21?

Answer 48

chlamydia trachomatis with watery or much purulent discharge. Treatment is with oral erhtomycin or Azithromycin macrolide.

Question 49

what is the cause of neonatal conjunctivitis past day 21?

Answer 49

herpes simplex virus with non-purulent ocular discharge, corneal ulceration and peri-ocular vesicles. Treatment is systemic Aciclovir or topical vidarabine. ​Vertical transmission with herpes simplex conjunctivitis can occur with vaginal delivery, therefore patients with this should have C-section to prevent this

Question 50

What is the treatment of chlamydia conjunctivitis?

Answer 50

treatment is oral erythromycin or Azithromycin which inhibit 50s ribosomal subunit.

Question 51

What is the prophylaxis of neonatal conjunctivitis?

Answer 51

For contacts like mother, patients should have oral erythromycin or amoxicillin for one week.

Question 52

How to treat conjuctivitis with purulent discharge?

Answer 52

Ceftriaxone IV, bacitracin ointment and hourly saline lavage

Question 53

How to treat conductivities with purulent discharge?

Answer 53

Topical chloramphenicol

Question 54

How to differentiate viral and allergic conjunctivitis?

Answer 54

Viral conjunctivitis is highly contagious with watery eyes, often starting in one eye and linked to colds, while allergic conjunctivitis is non-contagious, causes intense itching, affects both eyes, and involves clear, stringy discharge with other allergy symptoms like sneezing

Question 55

How to manage conjuctiva ties with contact lens use?

Answer 55

Do not wear contact lenses until symptoms have resolved. Clean the eyelids with a wet cloth and apply a cold compress as needed to relieve symptoms is correct