ophtho lec 2

what are essentials of dx for allergic conjunctivitis?

seasonal typically in spring and summer, bilateral conjunctiva hyperemia, stringy discharge

what are risk factors for allergic conjunctivitis?

PMHx / FMHx of seasonal allergies, asthma, allergic rhinitis, atopic dermatitis

What are sx of allergic conjunctivitis?

clear to white stringy discharge, sometimes photophobia, itching, tearing, redness, FB sensation

What rx for allergic conjunctivitis?

cromolyn sodium 4% soln - mast cell stabilizer

essentials of dx for vernal keratoconjunctivitis

hx of chronic allergic conjunctivitis with cobblestone upper tarsal conjunctiva

what are risk factors for vernal keratoconjunctivitis

chronic seasonal allergies

what are sx of vernal keratoconjunctivitis?

large cobblestone papillae, watery to mucoid discharge, FB sensation, itching, burning, no visual sx

What rx for vernal keratoconjunctivitis?

cromolyn sodium 4% soln

What are the most common causes of bacterial conjunctivitis?

Staphylococcus aureus

streptococcus pneumoniae

hemophilus influenzae

moraxella catarrhalis

essentials of dx bacterial conjunctivitis?

mucoprulent discharge, sudden onset

what are sx of bacterial conjunctivitis?

mucopurulent discharge, FB sensation, mild discomfort, could be unilateral or bilateral, no blurred vision

What should you consider when dx bacterial conjunctivitis?

gonorrhoeae conjunctivitis

What rx for bacterial conjunctivitis?

erythromycin 0.5% ointment

non-pharm tx for bacterial conjunctivitis?

warm compress to infected eye

essentials of dx bacterial, gonorrhoeae conjunctivitis

copious mucopurulent discharge, sudden onset

What are important questions to ask someone with bacterial, gonorrhoeae conjunctivitis?

sexual hx: sexually active, new partners, number of partners, protection, dysuria, discharge (vagina/penis)

What bacteria causes gonorrhoeae conjunctivitis?

neisseria gonorrhoeae

What are sx of bacterial, gonorrhoeae conjunctivitis?

copious mucopurulent discharge, FB sensation, no blurring of vision, mild discomfort, positive sex hx of partner w/ STI

DX studies for bacterial, gonorrhoeae conjunctivitis

STAT gram stain and culture, report to public health, offer STI workup and pregnancy test

Referral for bacterial gonorrhoeae conjunctivitis

urgent ophtho 1-2 days

Health maintenance for bacterial gonorrhoeae conjunctivitis

contagious until cleared x48 hrs, must tell partners and report to public health

Rx for bacterial gonorrhoeae conjunctivitis

ceftriaxone 500 mg or 1 gm IM AND doxy 100 mg PO

OR

azithromycin 1 gm PO at visit AND bacitracin ointment

What rx do you give for gonorrhoeae conjunctivitis if there is PCN allergy?

azithromycin 2gm PO AND ciprofloxacin 500 mg PO (avoid ceftriaxone)

essentials of dx bacterial chlamydia conjunctivitis

erythema, clear to mucopurulent discharge, gradual onset 1-4 weeks, highly contagious

What is bacteria that causes chlamydia conjunctivitis?

chlamydia trachomatis

sx of bacterial chlamydia conjunctivitis

redness, clear to mucopurulent discharge, FB sensation, photophobia, no blurring of vision, mild discomfort, re-infections common

What are complications of bacterial chlamydia conjunctivitis?

epithelial keratitis, corneal neovascularization, palpebral conjunctivitis, corneal scarring, blindness

dx studies for chlamydia conjunctivitis

swab discharge and culture, report to public health, offer STI workup and pregnancy test

What is rx for chlamydia conjunctivitis if NKDA?

azithromycin 1 gm PO now and bacitracin ointment

what bacteria causes? contact lens conjunctivitis

pseudomonas aeruginosa

sx of contact lens conjunctivitis

FB sensation, no blurring of vision, possible mild discomfort

Dx studies for contact lens coniunctivitis

fluorescein stain to r/o corneal abrasion or corneal ulcer (pooling of stain)

complications of contact lens conjunctivitis

corneal abrasion or corneal ulcer

1st line rx for contact lens conjunctivitis

ciprofloxacin HCL (ciloxan) 0.3% soln

sx of fungal conjunctivitis

pain, redness, tearing, FB sensation

Dx studies for fungal conjunctivitis

fluorescein stain to r/o corneal abrasion or corneal ulcer;

fungal wet mount and culture

1st line rx for fungal conjunctivitis

natamycin 5% suspension

essentials of dx for non herpetic viral conjunctivitis

FB sensation, copious clear watery discharge

risk factors for non herpetic viral conjunctivitis

public places

epidemiology for non herpetic viral conjunctivitis

adenovirus

sx of non herpetic viral conjunctivitis

FB sensation, copious clear watery discharge

What is a complication for non herpetic viral conjunctivitis?

can get secondary bacterial conjunctivitis

Rx for non herpetic viral conjunctivitis

none- self limiting

When to f/u for non herpetic viral conjunctivitis

if sx turn to white discharge or not resolved in 1 week

sx for viral covid conjunctivitis

acute conjunctivitis sx, eye redness, ocular irritation, eye soreness, FB sensation, tearing, mucoid dc, eyelid swelling, congestion, chemoses

essentials of dx herpetic viral conjunctivitis

pain, visual blurring, watery discharge, injection near limbus, dendrites on fluorescein stain on cornea

epidemiology for viral herpetic conjunctivitis

herpes simplex 1

sx of viral herpetic conjunctivitis

pain, visual blurring, watery discharge, injection near limbus, redness, FB sensation, photophobia

dx studies for herpetic viral conjunctivitis

fluorescein stain with dendrites on cornea

what would a fluorescein stain show for herpetic viral conjunctivitis?

dendrites on cornea

what are complications for herpetic viral conjunctivitis?

herpes zoster ophthalmicus, corneal ulcer, corneal opacities

What medications are contraindicated for viral herpetic conjunctivitis patients?

all steroids

rx for viral herpetic conjunctivitis

trifluridine 1% solution (viroptic)

essentials of dx for herpetic zoster ophthalmicus

CN V (trigeminal ophthalmic branch), extremely painful, unilateral, hutchinson sign (lesions on nose)

what are risk factors for herpetic zoster ophthalmicus?

hx of varicella infection, over 50, stress, immunosuppression

epidemiology for herpetic zoster ophthalmicus

contagious, varicella zoster virus (VSV)

sx of herpetic zoster ophthalmicus

CN V, extremely painful, photophobia, tearing, ocular redness, blurred vision, prodromal: fever, malaise, HA, eye pain prior to vesicles; hutchinson sign - lesions on nose

dx studies for herpetic zoster ophthalmicus

tzanck smear or PCR or direct fluorescent antibody (DFA)

what are complications of herpetic zoster ophthalmicus

vision loss, herpes zoster postherpetic neuralgia

prevention for herpetic zoster ophthalmicus

zoster vaccine- shingrix at 50 or older

input or outpt for herpetic zoster ophthalmicus

inpatient

RX for herpetic zoster ophthalmicus

IV acyclovir (zovirax) 10 mg/kg/dose or valacyclovir 1g PO

what is dry eye disease

keratoconjunctivitis sicca

essentials of dx for keratoconjunctivitis sicca (KCS)

chronic dryness of eyes

risk factors for keratoconjunctivitis sicca

PMHx/FMHx sjogren’s syndrome (can also have dry mouth)

epidemiology for Keratoconjunctivitis sicca

autoimmune inflammatory disorder

sx of Keratoconjunctivitis sicca

chronic bilateral dry eyes and mouth

dx studies for KCA

schirmer test x 5 min

tx for KCS

OTC artificial tears

essentials of dx for keratitis

redness, painful, corneal opacity

epidemiology for keratitis

viral, bacterial- s. aureus, pseudomonas aerginosa, staphylococcus, streptococcus pneumoniae; fungal, or parasites

sx of keratitis

FB sensation, redness, pain, photophobia, corneal opacity

essentials of dx pinguecula

yellow bump/growth on conjunctiva of eye, rarely grows (does not cross into cornea )

epidemiology of pinguecula

deposit of protein, fat, or calcium caused by aging

sx of pinguecula

yellow growth on conjunctiva of eye that doesn’t cross into iris, common in patients older than 35

essentials of dx pterygium

triangular wedge on conjunctiva that crosses cornea

risk factors for pterygium

increased sun, dust, sand exposure

sx of pterygium

triangular wedge on conjunctiva that crosses cornea

essentials of dx corneal abrasion

FB sensation, severe pain, photophobia

risk factors for corneal abrasion

trauma, contacts, FB

sx for corneal abrasion

FB sensation, severe pain, photophobia, pt keeps eyelid closed

dx studies for corneal abrasion

fluorescein stain w/ positive uptake - cobalt blue light/woods lamp

rx for corneal abrasion (if FB or trauma)

erythromycin 0.5% ointment

complications for corneal abrasion

corneal ulcer

essentials of dx corneal ulcer

acute painful red eye with corneal abnormality; hazy cornea

risk factors for corneal ulcer

contact leans wearer esp overnight, corneal trauma including refractive surgery

epidemiology for corneal ulcer

pseudomonas aeruginosa, moraxella catarrhalis, s,. aureus

sx of corneal ulcer

pain, photophobia, tearing, reduced vision, hazy cornea

dx studies for corneal ulcer

fluorescein stain positive uptake (pooling)

rx for corneal ulcer

levofloxacin 0.5% soln (Quixin) and tetanus booster if not current

epidemiology UV keratitis (actinic keratitis)

burns to cornea

sx for actinic keratitis / UV keratitis

severe pain, severe photophobia, not aware of UV exposure until 6-12

risk factors actinic keratitis / UV keratitis

sunlamps, welding, skiing, snow blindness, solar eclipse

dx studies for uv keratitis

fluorescein - diffuse punctate staining to both cornea

essentials of dx dacryocystitis

infection of lacrimal sac

epidemiology for dacryocycstitis

s. aureus

sx of dacryocystitis

unilateral pain, swelling, tenderness, redness, purulent discharge

complication of dacryocystitis

orbital cellulitis

essentials of dc non traumatic cataracts

gradually progressive blurred vision, no pain or redness, lens opacities

risk factors for non traumatic cataract

DM, steroid use, statin use, sunlight, smoking; common in >60