L7 Conjunctivitis

in both viral AND bacterial pathophysiology, it begins with exposure to pathogen through _____ contact or _____ of air bone particles

direct, inhalation

______ proliferates via colonization into conjunctival epithelium and adjacent tissue through break in the epithelium or ability to invade. whereas _____ proliferates multiplying within the cell of the conjunctival epithelium cell. When the cell dies and it releases it contents to continue replication

Bacterial, viral

in the pathophysiology of bacterial conjunctivitis, host immune system activates the ______ immune response. Similarly, the pathophysiology of viral conjunctivitis, the host immune system activates the ____

innate, innate

in the process of pathophysiology of the immune response of bacterial conjunctivitis, the innate response directly engulfs _____ and recruits other immune cells such as PMN and macrophages presenting as lid or conj. vascular dilation. whereas in viral conjunctivitis activation of the innate immune response would lead to _____ of cells via interferons and destroy infected cells via NK cells, macrophages & neutrophils causing similar presentation as lid/ conjunctival vascular dilation

bacteria, protection

bacterial conjunctivitis pathophysiology activates the innate response to activate the _____ system which leads to inflammation contributing to lid edema, papillae, conjunctival hyperemia and purulent discharge. On the other hand, innate immune system of viral conjunctivitis activates the _____ system which utilizes B and T cells

complement system, adaptive

In bacterial conjunctivitis when the complement system is activated it _____ outs pathogen and causes inflammation contributing to lid edema, papillae, conjunctival hyperemia and purulent discharge. when all this occurs, it creates risk for ____ of adjacent structures such as intraocularly or cornea

clears, infection

in viral conjunctivitis, adaptive system uses T and B cells. T cells are used to destroy __-__ cells whereas B cells are used to bind to free viral particles to ____ new host cell infection

virus- infected, prevent

pathophysiology of ____ conjunctivitis activates the innate system and using the interferons and NK cells. This leads to presentation of lid/ conj vascular dilation. it can worsen to appear as lid edema, follicles, conj hyperemia, conj chemosis and serous discharge and then worse of all have _____ involvement

viral, and corneal

follicles are seen in viral or bacterial conjunctivitis

viral

papillae are seen in bacterial or viral conjunctivitis

bacterial

papillary response will present in _____ conjunctivitis and _____ conjunctivitis

hyperacute, neonatal

hyperacute conjunctivitis includes Neisseria ____ and Neisseria _____

meningitis, gonorrhea

neonatal conjunctivitis includes Neisseria _____ and chemical trauma, bacterial such as _____, ____ and _____

gonorrhea, staph, strep, HSV

both hyperacute and neonatal conjunctivitis share ___ ___

Neisseria gonorrhea

inclusion conjunctivitis is

serovars D-K

trachoma is

serovars A-C

parinaud oculoglandular syndrome is

Serovars L1-L3

all of inclusion conjunctivitis, trachoma, parinaud oculoglandular syndrome is all considered

chlamydia trachomatis

FDA approved fluoroquinolones drugs for conjunctivitis consists of (6)

1. Besifloxacin 0.6%

2. moxifloxacin 0.5%

3. Gatifloxacin 0.5%

4. levofloxacin 0.5%

5. Ofloxacin 0.3%

6. ciprofloxacin 0.3%

FDA approved Macrolides drugs for conjunctivitis consists of (2)

azithromycin 1%

erythromycin ointment

FDA approved Aminoglycosides drugs for conjunctivitis consists of (2)

tobramycin 0.3%

gentamicin 0.3%

FDA approved combo drops drugs for conjunctivitis consists of (2)

10,000 u/g polymyxin/ bacitracin

polymyxin B / trimethoprim

Besifloxacin 0.6%

moxifloxacin 0.5%

dosing is

BID or TID x 5-7 days

Gatifloxacin 0.5% dosing is

BID or TID x 5 days

levofloxacin 0.5% dosing is

1 gtts Q2 hrs while awake for 2 days then QID for 5 days

Ofloxacin 0.3% is

Q2h x 2 days then QID for more days

ciprofloxacin 0.3% dosing is

1 gtts Q2 hrs while awake for 2 days then for 5 days

azithromycin 1% dosing is

BID for 2 days then once daily for 5 days

erythromycin ointment dosing is

4-6 times daily for 1 week

Tobramycin 0.3% dosing is

1 gtts Q1-4hrs depending on severity

ung: 1 gtts Q3-12 hrs until improved and then taper

gentamicin 0.3% dosing is

1 gtts Q1 1-4 hrs based on severity; ointment BID - TID

10,000 u/g polymyxin / bacitracin dosing is

Q3-6h x 7-10 days

polymyxin B / Trimethoprim dosing is

1 drop Q3- 4 hrs x 7-10 days

for papillary conjunctivitis, acute papillae tends to be ____ etiologies

infectious

bacterial conjunctivitis, hyperacute conjunctivitis and neonatal conjunctivitis are all ____ papillary conjunctivitis

acute

staph, strep, and Moraxella are all _____ conjunctivitis

bacterial

Neisseria spp. is ____ conjunctivitis

hyperacute

ophthalmia neonatorum is _____ conjunctivitis

neonatal

papillary conjunctivitis with presence of red eye can be considered

bacterial

papillary without the presence of red eye can be considered

allergic

_____ papillae tends to be due to inflammation, toxicity to by byproducts, and/or mechanical processes

chronic

chronic consists of (4)

lacrimal infections, floppy eyelid syndrome, keratoconjunctivitis sicca, blepharoconjunctivitis

fine papillae

giant papillae

bacterial infections, chronic inflammation, and allergic conditions will have _____ papillae

fine

_______ papillae presents with chronic CL over wear, VKC, and AKC

giant

the beam in slit lamp should be ___ ____ to see whether it is follicles or pappilae

optic section

papillae is uniform in size until it break then it is ______

GPC

_______ sit more medially compares to ______ that sit more inferior-temporally

papillae, follicles

_____ is the acute or hyper acute inflammation of the conjunctiva in newborns within the first 28 days of light because of the chemical insult or microbial infections

neonatal conjunctivitis or neonatal ophthalmia

which microbes causes neonatal conjunctivitis or neonatal ophthalmia (3-5)

N. gonorrhea, C. trachomatis, HSV orr staph/strep

____ can present with purulent discharge and eyelid edema

neonatal ophthalmia/ neonatal conjuctivitis

neonatal ophthalmia/ neonatal conjunctivitis

what tx method can be used to prevent neonatal ophthalmia/ neonatal conjunctivitis and what was it replaced by

silver nitrate replaced by erythromycin ung

what tx method can be used to manage neonatal ophthalmia/ neonatal conjunctivitis

infectious disease management

chlamydia _____ is the most common cause of neonatal conjunctivitis in U.S

trachomatis

to treat chemical (silver nitrate exposure) is done immediately after _____

delivery

neissera gonorrhea onset is from ____to ____days after delivery

birth to 5 days

herpes simplex virus occurs __ -___ weeks after delivery

1-2

_____ risk factors are conjunctivitis affects newborns, infected mothers, young females, and ocular trauma during delivery, and silver nitrate exposure

neonatal conjunctivitis

someone with neonatal conjunctivitis would experience (5)

pain, discharge, tenderness, redness, and eyelid crusting

a 22WF comes to you complaining of pain and tenderness. upon slit lamp you see redness, edematous lids, discharge and what looks to be some corneal involvement. what is your diagnosis?

neonatal conjunctivitis

to check if your diagnosis of neonatal conjunctivitis is correct what ancillary testing can you do? (3)

staining, culture or PCR

neonatal conjunctivitis tx if its chemical

avoid or discontinue offending agents. monitor for 2-4 days

neonatal conjunctivitis tx if its infectious

treat based on pathogen detected

what is the most common cause of hyperacute conjunctivitis

Neisseria gonorrhoeae

_____ is rapidly progressive severe conjunctivitis characterized by copious purulent discharge and lid edema accompanied by (+) ___ node

hyperacute conjunctivitis, PA

what happens to cornea in hyperacute conjunctivitis?

erosions, infiltrates, edema and ulceration

if the cornea is involved during hyperacute conjunctivitis you should

change tx and management

in hyperacute conjunctivitis, the presentation is

1. diffuse conjunctival hyperemia & chemosis

2.purulent discharge which is made of pathogen, wbc, dead cells

in hyperacute conjunctivitis, there is a risk of ___ and ____ which is the severe inflammation of the eye affecting all layers including retina, cornea, and sclera

perforation, panophthalmitis

hyperacute conjunctivitis

to test for hyperacute conjunctivitis, you can do (3)

gram stain, plate culture, and PCR

hyperacute conjunctivitis is in ages less than ___ as well concurrent ___ or more than sexual partner as well as MSM

25, STI

____ ___ sx include pain, significant white-green discharge, tenderness, blurry vision, photophobia, redness and eyelid crustins

hyperacute conjunctivitis

clinical signs for hyperacute conjunctivitis includes (7)

1. severe purulent discharge

2. + PA node

3. papillae

4. severe lid edema

5. SPK/erosions

6. infiltrates

7. risk for rapid corneal ulceration which lead to perforation

a patient comes in presenting with significant white discharge, tenderness, and photophobia. upon slit lamp you see SPK and infiltrates. you think its hyperacute conjunctivitis. what are some ancillary testing to confirm or deny this thought (3)

gram stain, geimsa stain, pcr

you want to treat a patient with hyperacute conjunctivitis. what is the drug of choice and dosing

1 gm ceftriaxone IM single dose

you want to treat a patient with hyperacute conjunctivitis. what is the conservative option

saline lavage + topical antibiotics such as fluoroquinolones

you want to treat a patient with hyperacute conjunctivitis but they have allergies to the drug of choice which is a cephalosporine group. what is the alternative

gentamicin 240 mg IM single dose

for tx of hyperacute conjunctivitis you should also tx the patient's __ ____ and consider ____ treatment with doxycycline 100mg po bid x7 days

sexual partners, chlamydial

what is the most common cause of acute bacterial conjunctivitis in adults

staph aureus

what is the most common cause of acute bacterial conjunctivitis in pediatrics

Hemophilus influenza

_____ ____ ____ is the sudden unilateral or bilateral with asymmetry rapid onset of inflammation of the conjunctiva caused by bacteria

acute bacterial conjunctivitis

acute bacterial conjunctivitis

what are most common microbes leading to acute bacterial conjunctivitis

staph. spp

strepto pn

hemo influenza

n/ gonorrhoeae, Corynebacterium dipertheria, strepto pyogense and B hemolytic strepto can produce conjunctival _____/_____

membranes, pseudomembranes

___ ___ ___ presents with beefy red injection (bacterial) and its greater on the palpebral and peripheral bulbar conj as well as scant discharge that can be purulent or mucopurulent

acute bacterial conj

the demographics for acute bacterial conjunctivitis is ____ less than 12 but common in __-___ yros. as well as contact lens users

peds, 0-4

acute bacterial conjunctivitis sx include (7)

1. irritation

2. pain

3. swelling

4. stuck eyelids

5. redness

6. photophobia

7. tearing

a patient comes to you experiencing pain, swelling, tearing and feels like their eyelids are stuck. under slit lamp, you see a variety of things red injection but other things like papillae, + pa node sign, pseudomembrane, and follicles. what is their ddx

acute bacterial conjunctivitis

a patient is diagnosed with acute bacterial conjunctivitis. what is their tx options

1. topical antibiotic therapy

and follow up

a patient is diagnosed with acute bacterial conjunctivitis. their pathogen is H. influenza. what is added to their tx plan

oral amoxicillin/clavulanate because their systemic involvement

what is the most common cause of chronic bacterial conjunctivitis

staph spp

___ ____ ___ is inflammation of the conjunctiva lasting longer than 3 weeks. often associated with blepharitis

chronic bacterial conjunctivitis

chronic bacterial conjunctivitis common microbes are(2)

staphylococcal aureus and Moraxella lacunata

chronic bacterial conjunctivitis

if you have blepharitis you can develop...?

chronic bacterial conjunctivitis

in addition to staph and moraxella, what are other microbes that can cause chronic bacterial conjunctivitis

enteric spp: proterus mirabilis, E.coli, Klebsiella pneumoniae, serratia marcescens

chronic bacterial conjunctivitis sx includes (7)

irritation

swelling, redness

FBS, eyelid crusting

photophobia and tearing