Presentation on theme: "Conjuctivitis, glaucoma and fever of unkown origin."— Presentation transcript:
1 Conjuctivitis, glaucoma and fever of unkown origin. Abiola AkandeRoll number : 703
2 DefinitionConjunctivitis, also known as pinkeye. It is an inflammation of the conjunctiva. Conjunctiva: thin, translucent, elastic tissue layer with bulbar and palpebral portionsBulbar: lines the outer surface of the globe to the limbus (junction of sclera and cornea)Palpebral: covers the inside of the eyelidsTwo layers: epithelium, substantia propria
4 Types of conjunctivitis There are different types of conjuctivitis depending on the cause:Viral conjunctivitisBacterial conjunctivitisAllergic conjunctivitis
5 Viral conjunctivitisViral conjunctivitis is often associated with an infection of the upper respiratory tract, a common cold, and/or a sore throat. Viruses that can cause conjunctivitis include: adenovirus, enterovirus and coxsackie. It usually occurs in community epidemics (schools, workplace, physician’s office) It can be transmitted by contaminated fingers, medical instruments, swimming pool water.
6 Symptoms of viral conjunctivitis Unilateral or bilateral Redness(hyperaemia) Watering(epiphora), Itching, Mild mucoid discharge, Mild photophobia, Feeling of discomfort and foreign body sensation. The infection usually begins in one eye and involve the other within few days.
7 Treatment of Viral Conjunctivitis Topical antibiotics not necessary because secondary bacterial infection is uncommonReassurance that the symptoms may get worse for 3-5d before getting better and persist for 2-3 weeksSome relief from cold compresses and topical antihistamines/decongestantsDo not use topical corticosteroids due to risk of sight-threatening complications (scarring, corneal melting, perforation), especially if etiology is herpes simplex virus or bacterial keratitis
8 Bacterial conjunctivitis Bacterial conjunctivitis causes the rapid onset of conjunctival redness, swelling of the eyelid, and mucopurulent discharge.Bacterial conjunctivitis due to common pyogenic (pus-producing) bacteria causes marked grittiness/irritation and a stringy, opaque, greyish or yellowish mucopurulent discharge that may cause the lids to stick together, especially after sleep. Severe crusting of the infected eye and the surrounding skin may also occurBacterial meningitis could be acute, hyperacute or chronic.
9 Acute Bacterial Conjunctivitis Presentation: Unilateral or bilateral, red eye, mucopurulent or purulent discharge continuously throughout the day, burning, irritation, mild chemosisNeonates: symptoms appear 5-14d after birth (inclusion conjunctivitis of the newborn)Highly contagious: spread by direct contact or by contaminated objects
10 Hyperacute Bacterial Conjunctivitis Etiology: Neisseria species,most commonly N. gonorrhoeaePresentation: profuse, purulent discharge with rapidly progressive symptoms of marked conjunctival injection, irritation, tenderness to palpation, chemosis, lid swelling, and tender preauricular adenopathyOphthalmia neonatorum: gonococcal ocular infection with bilateral discharge 3-5d after birth from vaginal transmissionSexually active teens: transmitted from genitalia to hands to eyes, commonly see concurrent urethritisSight-threatening
11 Chronic Bacterial Conjunctivitis Most common etiology: Staphylococcus speciesMore common in adults and patients with acne rosacea or facial seborrheaPresentation varies: redness, itching, burning, foreign-body sensation, flaky debris, blepharitis (common), eyelash lossConcurrently see styes and chalazia of the lid margin from chronic inflammation of the meibomian glands
12 Treatment of Acute Bacterial Conjunctivitis Topical broad-spectrum antibiotics: erythromycin ointment, bacitracin-polymyxin B ointment (Polysporin), trimethropim-polymyxin B (Polytrim), sulfa dropsMost H. flu and S. pneumoniae resistant to macrolidesSulfa drops (Bleph-10): less effective and rare side effect of Stevens-Johnson syndromeRx: 1/2” ointment inside lower lid or 1-2 drops QID for 5-7 days (response seen typically within 1-2d)Inclusion Conjunctivitis of the Newborn: treat with 2 week course of erythromycin (50mg/kg/d po divided QID) or sulfisoxazole (150mg/kg/d po divided QID), topical unnecessary with systemic
13 Treatment of Hyperacute Bacterial Conjunctivitis Immediate ophthalmic referralSystemic and topical antibiotics and saline irrigationSystemic antibiotic of choice due to penicillin-resistant N. gonorrhoeae is single-dose Ceftriaxone (25-50mg/kg IV or IM, not to exceed 125mg) or single-dose Cefotaxime (100mg/kg IV or IM) in neonatesIf venereal disease present in teens, also treat with single-dose of azithromycin (1g) because over 30% of these patients will have concurrent chlamydial diseaseAAP and CDC recommendations for prevention of ophthalmia neonatorum: silver nitrate 1% aqueous solution (side effect of chemical conjunctivitis), erythromycin 0.5% ophthalmic ointment, tetracycline 1% ophthalmic ointment
14 Allergic conjunctivitis Allergic conjunctivitis is inflammation of the conjunctiva (the membrane covering the white part of the eye) due to allergy. Allergens differ among patients. Symptoms consist of redness (mainly due to vasodilation of the peripheral small blood vessels), oedema (swelling) of the conjunctiva, itching, and increased lacrimation (production of tears). If this is combined with rhinitis, the condition is termed "allergic rhinoconjunctivitis".The symptoms are due to release of histamine and other active substances by mast cells, which stimulate dilation of blood vessels, irritate nerve endings, and increase secretion of tears.
15 Treatment of Allergic Conjunctivitis Self-limitedAllergen avoidance, cold compresses, topical antihistamines/vasoconstrictors (do not use for greater than 2 weeks), artificial tears, topical NSAIDS (low efficacy)Prophylaxis: oral antihistamines (onset of action=days), mast cell stabilizers (onset of action=5-14d)
16 GlaucomaThis is a disease of progressive optic neuropathy with loss of retinal neurons and their axons (nerve fiber layer) resulting in blindness if left untreated. It may have a classical sign –elevated intraocular pressure
17 TypesThere are two types Open angle glaucoma Closed angle glaucoma Congenital glaucoma
18 Congenital Glaucoma Onset: antenatally to 2 years old Signs Elevated IOPBuphthalmosHaab’s striaeCorneal cloudingGlaucomatous cuppingField lossSymptomsIrritabilityPhotophobiaEpiphoraPoor visionHaab’s striae are found only in congenital glaucoma.
19 Buphthalmos and cloudy corneas Congenital GlaucomaBuphthalmos and cloudy corneasThe right eye in each patient has congenital glaucoma.
20 Narrow Angle Glaucoma Onset: 50+ years of age Symptoms Severe eye/headachepainBlurred visionRed eyeNausea and vomitingHalos around lightsIntermittent eye acheat nightSignsRed, teary eyeCorneal edemaClosed angleShallow ACMid-dilated, fixedpupil“Glaucomflecken”Iris atrophyAC inflammationThe classical signs and symptoms of narrow angle glaucoma.
22 Narrow Angle Glaucoma Mid-dilated, fixed pupil Mid-dilated, fixed pupils and cloudy corneas during an angle closure attack.
23 Open Angle Glaucoma Aka: chronic simple glaucoma (CSG) and primary open angle glaucoma (POAG) Risk Factors IOP Diabetes Age Myopia Race Gender Family history Cardiovascular Central corneal disease thickness Hormones
24 Open Angle Glaucoma Signs Elevated IOP Visual field loss Symptoms Onset: 50+ years of ageSignsElevated IOPVisual field lossGlaucomatous disk changesSymptomsUsually noneMay have loss of centraland peripheral visionlateRemember: most patients with open angle glaucoma have no symptoms. This is the best reason to have periodic eye examinations with pressure checks and optic nerve evaluations.
25 GLAUCOMA Medical Surgical Beta-blockers Carbonic anhydrase inhibitors TreatmentMedicalSurgicalMioticsBeta-blockersCarbonic anhydraseinhibitorsProstaglandinanaloguesAlpha-2 agonistsArgon laser trabeculoplastyTrabeculectomyFiltering procedureCyclocryotherapyCyclolaser ablationIridotomyNo treatment works all the time!
27 PUO Definition Fever Persisting for more than 3 weeks. Documented Temp above 101 F Several Occasions.Uncertain diagnosis after extensive evaluation in hospital for week.PUO of 2 weeks no diagnosis could be made.