Presentation on theme: "Abiola Akande Roll number : 703. Conjunctivitis, also known as pinkeye. It is an inflammation of the conjunctiva. Conjunctiva: thin, translucent, elastic."— Presentation transcript:
Abiola Akande Roll number : 703
Conjunctivitis, also known as pinkeye. It is an inflammation of the conjunctiva. Conjunctiva: thin, translucent, elastic tissue layer with bulbar and palpebral portions Bulbar: lines the outer surface of the globe to the limbus (junction of sclera and cornea) Palpebral: covers the inside of the eyelids Two layers: epithelium, substantia propria
There are different types of conjuctivitis depending on the cause: Viral conjunctivitis Bacterial conjunctivitis Allergic conjunctivitis
Viral 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.
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.
Topical antibiotics not necessary because secondary bacterial infection is uncommon Reassurance that the symptoms may get worse for 3-5d before getting better and persist for 2-3 weeks Some relief from cold compresses and topical antihistamines/decongestants Do 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
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 occur Bacterial meningitis could be acute, hyperacute or chronic.
Presentation: Unilateral or bilateral, red eye, mucopurulent or purulent discharge continuously throughout the day, burning, irritation, mild chemosis Neonates: symptoms appear 5-14d after birth (inclusion conjunctivitis of the newborn) Highly contagious: spread by direct contact or by contaminated objects
Etiology: Neisseria species, most commonly N. gonorrhoeae Presentation: profuse, purulent discharge with rapidly progressive symptoms of marked conjunctival injection, irritation, tenderness to palpation, chemosis, lid swelling, and tender preauricular adenopathy Ophthalmia neonatorum: gonococcal ocular infection with bilateral discharge 3-5d after birth from vaginal transmission Sexually active teens: transmitted from genitalia to hands to eyes, commonly see concurrent urethritis Sight-threatening
Most common etiology: Staphylococcus species More common in adults and patients with acne rosacea or facial seborrhea Presentation varies: redness, itching, burning, foreign-body sensation, flaky debris, blepharitis (common), eyelash loss Concurrently see styes and chalazia of the lid margin from chronic inflammation of the meibomian glands
Topical broad-spectrum antibiotics: erythromycin ointment, bacitracin-polymyxin B ointment (Polysporin), trimethropim-polymyxin B (Polytrim), sulfa drops Most H. flu and S. pneumoniae resistant to macrolides Sulfa drops (Bleph-10): less effective and rare side effect of Stevens-Johnson syndrome Rx: 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
Immediate ophthalmic referral Systemic and topical antibiotics and saline irrigation Systemic 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 neonates If venereal disease present in teens, also treat with single-dose of azithromycin (1g) because over 30% of these patients will have concurrent chlamydial disease AAP 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
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.
Self-limited Allergen 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)
This 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
There are two types Open angle glaucoma Closed angle glaucoma Congenital glaucoma
Onset: antenatally to 2 years old Symptoms Irritability Irritability Photophobia Photophobia Epiphora Epiphora Poor vision Poor vision Signs Elevated IOP Buphthalmos Haab’s striae Corneal clouding Glaucomatous cupping Field loss
Buphthalmos and cloudy corneas
Onset: 50+ years of age Symptoms Severe eye/headache Severe eye/headache pain pain Blurred vision Blurred vision Red eye Red eye Nausea and vomiting Nausea and vomiting Halos around lights Halos around lights Intermittent eye ache Intermittent eye ache at night at night Signs Red, teary eye Red, teary eye Corneal edema Corneal edema Closed angle Closed angle Shallow AC Shallow AC Mid-dilated, fixed Mid-dilated, fixed pupil pupil “Glaucomflecken” “Glaucomflecken” Iris atrophy Iris atrophy AC inflammation AC inflammation
Mid-dilated, fixed pupil
Risk Factors IOP Diabetes Age Myopia Race Gender Family history Cardiovascular Central corneal disease thickness Hormones
Onset: 50+ years of age Symptoms Usually none Usually none May have loss of central May have loss of central and peripheral vision and peripheral vision late late Signs Elevated IOP Elevated IOP Visual field loss Visual field loss Glaucomatous disk changes Glaucomatous disk changes
PUO Definition Fever Persisting for more than 3 weeks. Documented Temp above 101 F Several Occasions. Uncertain diagnosis after extensive evaluation in hospital for. 1 week. PUO of 2 weeks no diagnosis could be made.