Red Eye Flashcards

Question

How can you determine the cause of conjunctivitis?

Answer 1

A history of infectious conjunctivitis and of itch both make current bacterial involvement less likely, as itch suggests allergic cause and recurrence suggests viral conjunctivitis. The absence of itch and the absence of a positive history of infective conjunctivitis make a diagnosis of bacterial conjunctivitis more probable. A purulent, sticky discharge suggests bacterial infection. Watery discharge is more suggestive of viral or allergic conjunctivitis. Preauricular lymph nodes are suggestive of viral conjunctivitis. Eyelids that are stuck together in the morning do not necessarily indicate the presence of a purulent discharge. Viral conjunctivitis and allergic conjunctivitis often cause lids to be matted shut on waking, due to drying of tears and serous secretions.

Answer 2

Discomfort - burning or gritty but not sharp. Significant pain suggests a more serious diagnosis. Vision is usually normal, although 'smearing', particularly on waking, is common. Discharge tends to be thick rather than watery. There may be mild photophobia. Significant photophobia suggests severe adenoviral conjunctivitis or corneal inflammation.

Answer 3

Red eye, with uniform engorgement of all conjunctival blood vessels. Typically causes a yellow-white mucopurulent discharge. Eyes may be difficult to open in the morning, with lids glued together by discharge. Bacterial conjunctivitis is usually bilateral (though often sequential). Visual acuity should be normal, other than the mild and temporary blur secondary to the discharge. There may be a conjunctival follicles, which are round collections of lymphocytes, most prominent in the inferior fornix, appearing as small, dome-shaped nodules, pale at the top and red at the base.

Answer 4

Simple bacterial conjunctivitis Gonococcal conjunctivitis Chylamydial infection Ophthalmia neonatorum

Answer 5

Causes include S.aureus, s. epidermidis and s.pneumoniae. Risk factors in children include nasolacrimal duct obstruction, concomitant otitis media or pharyngitis, and exposure to an affected individual. In adults, additional risk factors include lid malposition, severe tear deficiency, immunosuppression and trauma.

Answer 6

Causative organism is Neisseria gonorrhoeae. Risk factors include contact with infected individuals, and the presence of other STIs. Patients should be offered screening for other STIs, including chlamydia. Sexual partners should also be traced and treated as appropriate, which will usually necessitate a referral to local sexual health services

Answer 7

Ophthalmia neonatorum is any conjunctivitis within the first 28 days of life. May be chemically induced or arise as a result of infection through contamination from the maternal genital tract.

Answer 8

Most cases are self-limiting and management is supportive. Conjunctivitis caused by gonococcal or chlamydial infection should be treated with antibiotics. Advice to patients Many cases of conjunctivitis seen in primary care are viral. These cases will not benefit from the use of antibiotics. NICE suggests offering a topical ocular antibiotic to a person with infective conjunctivitis when the condition is severe, or likely to become severe, providing serious causes of a red eye can be confidently excluded. Chloramphenicol is the drug of choice for superficial eye infections. It is bacteriostatic, with a relatively broad spectrum of action against most Gram-positive and Gram-negative bacteria. Fusidic acid is useful for staphylococcal infections and is an alternative antibacterial agent to chloramphenicol.

Answer 9

Infective conjunctivitis is a self-limiting illness that usually settles without treatment within 1-2 weeks. If symptoms persist for longer than two weeks they should return for review. Seek medical attention urgently if marked eye pain or photophobia, loss of visual acuity, or marked redness of the eye develop. Remove contact lenses, if worn, until all symptoms and signs of infection have completely resolved and any treatment has been completed for 24 hours. Lubricant eye drops may reduce eye discomfort; these are available over the counter, as well as on prescription. Clean away infected secretions from eyelids and lashes with cotton wool soaked in water. Wash hands regularly, particularly after touching the eyes. Avoid sharing pillows and towels. It is not necessary to exclude a child from school or childcare if they have infective conjunctivitis, as mild infectious illnesses should not interrupt school attendance. An exception would be if there is an outbreak of infective conjunctivitis, when advice should be sought from the Health Protection Agency by the school. Adults who work in close contact with others, or with vulnerable patients, should avoid such contact until the discharge has settled.

Answer 10

It should be avoided in people who have experienced myelosuppression during previous exposure to chloramphenicol, in those who have a blood dyscrasia or who have a family history of blood dyscrasias and in patients who are concurrently with other myelotoxic drugs. It should be avoided in pregnant or breast-feeding women, as its safety has not been established. Prolonged use should be avoided, since this may increase the likelihood of sensitisation and resistance.

Answer 11

Corneal ulceration Blepharitis Otitis media

Answer 12

Adenoviral conjunctivitis accounts for 65-90% of viral conjunctivitis. This is a highly infectious condition (incubation: 3-29 days, infectious for a further two weeks) which can range from mild to severe. Causes follicular conjunctivitis but there are two presentation: Pharyngoconjunctival fever and epidemic keratoconjunctivitis (more severe)

Answer 13

Symptoms usually begin in one eye, becoming bilateral after a few days. There is commonly a history of upper respiratory tract infection or of close contact with someone with a red eye. There is a burning or gritty foreign body sensation. Patients notice morning crusting. Discharge is watery and mucoid rather than purulent and sticky.

Answer 14

The conjunctiva is typically very red and irritated. There may be pinpoint conjunctival haemorrhages. Eyelid redness and oedema are common. Preauricular lymphadenopathy is a classic sign. Follicles are typically seen, particularly on the inferior palpebral conjunctiva. Corneal involvement is seen in epidemic keratoconjunctivitis but usually not in pharyngoconjunctival fever.

Answer 15

Management is essentially supportive. Cool compresses and artificial tears used several times daily may improve comfort. Viral conjunctivitis can last 4-6 weeks and can get worse before it gets better. Contact lenses should not be worn until all symptoms and signs of infection have completely resolved and any treatment has been discontinued for 24 hours. Lubricant eye drops may reduce eye discomfort; these are available over the counter, as well as on prescription.

Answer 16

Ocular herpes simplex requires urgent referral to ophthalmology for exclusion of uveitis.. Topical antiviral treatment, such as aciclovir, is the usual treatment. Contact lens wear should be discontinued until symptoms have settled and treatment is complete. If the keratitis extends deep into the stroma, topical steroids may be used under specialised supervision to prevent scarring. Some patients with recurrent HSV keratitis are kept on long-term prophylactic oral antivirals

Red Eye Flashcards

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