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Copious overflowing discharge

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Presentation on theme: "Copious overflowing discharge"— Presentation transcript:

1 Copious overflowing discharge
Ballooning of lids Swollen nodes

2 Hyperacute Bacterial Conjunctivitis
Sexually active adults Neonates, hours after birth Most common cause: Neisseria Gonorrhoeae Urgent condition, can penetrate cornea! Theyer Martin culture Tx: Ceftriaxone 1g IM, adults=5days kids=2days Also topical fluoroquinolone

3 Positive papillary response
Beefy engorged vessels

4 Acute Bacterial Conjunctivitis
Susceptible at any age Staph. Aureus is most common cause Steroids mask evolution of infection Tx: 4th gen fluoroquinilone Very contagious, stay home

5 Inferior Papillae Wax/wane

6 Chronic Bacterial Conjunctivitis
Staph epi or Staph. Aureus Inferior papillae because it has had time to build up

7 Superior papillary response
(-) lymphnode Edema > injection

8 Allergic Conjunctivitis
Chemosis due to histamine breakdown Hyperemia gets worse due to rubbing Itching!!!! PAC: Mast cell stabilizer then combo drug SAC: Combo and sometimes mast cell stabilizer Steroids great when allergen challenge increases

9 Giant Papillae upper lid
Trantas’ dots around limbus (not always)

10 Vernal Conjunctivitis
Kids, 90% gone by age 16 1st attack is worst Males 2x more than females Caucasians: palpebral form AA/AI/Latinos: Limbal form Bilateral Sheild ulcer (uncommon) Itching!!! Mast cell stabilizer Steroid great for first attack

11 Nodule, pinkish-white Center of lesion necroses and turns gray

12 Phlyctenulosis 60% are women and young children
Most likely Staph. Exotoxin from previous conjunctivitis Big in 1950s due to Tb Unilateral Pain, #1 symptom Inflammatory response, so steroids work Topical antibiotic to treat conjunctivitis Oral tetracyline if combo doesn’t work

13 “wimpy conjunctivitis”

14 Environmental Conjunctivitis
Inflammatory response Multiple causes Disease of exclusion Can use mild steroid for a week to stop complaining, then artificial tear Attempt to optimize tear quality by management of blapharitis and meibomitis

15 Follicular response Vesicles Tender nodes

16 Primary Herpes Simplex Conjunctivitis
Children 60% of population infected by age 5, 90% by 16 Unilateral, other eye follows in a week Doesn’t scar like zoster Foreign body sensation NO STEROIDS! Zirgan can be used instead of viroptic, doesn’t damage cornea as much Treat dendritic keratitis with viroptic/vidarabine ointment/ganciclovir gel HSV dendrites: Rose bengal stains edges


18 Herpes Zoster Conjunctivitis
Older patients (55+) Hutchinson’s sign on nose Triggered by stress or fatigue May also cause keratitis and uveitis Anti-virals w/in 72 hours then less chance of post herpetic neuralgia Keratitis is Inflammatory, so treat with steroids (unlike HSV) Psuedodendrites: Rose bengal stains middle

19 Inferior follicles Subconjunctival or petechial hemorrhages (maybe) SEIs Pseudomembranes Tender nodes

20 Epidemic Keratoconjunctivitis
Young adults Adenovirus 8 (can last days on surfaces) No systemic manifestations Unilateral, then other follows in a week or less R/O herpes, no vesicles or dermatomes Consider any keratoconjunctivitis to be HSV or EKC until proven otherwise Contagious Betadine ophthalmic prep solution

21 Fever Conjunctivitis Sore Throat Tender nodes Follicles Chemosis Possible SEIs

22 Pharyngoconjunctival Fever
Kids between 5-15 Swimming pool conjunctivitis Adenovirus 3 Self limiting, days Don’t use aspirin for fever because kid SEI interfere with vision, but not a big deal in kids so don’t treat with steroids

23 Fever Cough Coryza Conjunctivitis Koplik’s spots Inferior follicles

24 Rubeola Children under 10 Passed respiratory Highly contagious
Paramyxovirus Supportive treatment, no antiviral (it will tear up cornea)

25 Unilateral follicular conjunctivitis
Granulomas with follicles Node enlargement Chemosis Lid swelling

26 Oculoglandular Syndrome
Cat scratch is most common cause

27 Lymph node enlargement
Lesion at site of scratch

28 Cat Scratch Disease Young children about 10, girls>boys
Bartonela Hensulae Bacillus Lesion at site of scratch appears 3 weeks later Self limiting May need oral tetracycline or macrolide

29 Fever Chills Malaise HA Nausea Conjunctivitis, necrotising granulomatous type

30 Tularemia “Rabbit Fever” Franciella tularensis
Lesion at site of organism entry with adenopathy Treat with streptomycin

31 Primary site in lungs

32 Tuberculosis Central American, pacific rim Low income, inner city
Mycobacterium Droplet spread Treatment: rifampin

33 Chancre Local adenopathy Uveitis Argyl-robinson

34 Syphilis Primary: Chancre Secondary: uveitis, skin rash, flu symptoms
Tertiary: neurosyphilis, argyl-robinson Tx: penicillin or doxycycline

35 Conjunctiva shows red nodules that turn pink to purple to black and then necrose

36 Sporotrichosis “Rose Gardeners Disease” Sporothrix
Fungus lives on vegetables or in soil Ulcerating nodules on extremeties and along lymph channels Tx: local=potassium iodide Systemic=ketoconazole

37 60% asymptomatic 40% fever, myalgia, hilar adenopathy May progress to chronic pneumonia

38 Coccidiodomycosis San Joaquin Valley and Southwest US - immigrant farm workers (25-55 years old) Airborne Fungus ‘94 breakout after big earthquake If accompanied by arthritis and erythema nodosa then called “valley fever syndrome: Tx: amphotericin B (very toxic) or ketoconazole

39 Fever, HA, malaise, sore throat, white patches on back of throat

40 Mononucleosis Young adults, uncommon in >25 Epstein-Barr Virus
Acute episodes last from 1-3 weeks Self limiting Symptomatic relief Possible penicillin for related strep tonsillitis

41 Hamster face HA, myalgia, fever

42 Mumps Kids Myxovirus Supportive therapy
Vaccination (MMR) at 15 months old

43 Hard lumps on face and neck
Fever, chills, reduced lung function, chest tightness, cough, weezing

44 Actinomycosis Men 3x more than women Little bug goes in face
Typically bad mouth hygiene HX of dental extraction, abdominal trauma, sinus infection, chronic pneumonia Tx: oral penicillin or erythromycin

45 Lungs = primary site Can involve liver, skin, eyes, parotid glands

46 Sarcoid Most common in female african americans in US
Granulomatas disease of unknown etiology Mild cases don’t require therapy Remits spontaneously Oral steroids used in severe or chronic cases

47 Sometimes follicles, sometimes papillae

48 Toxic conjunctivitis Common = sulfacetamide
Usually preservatives in meds (bilateral) Viral toxins (unilateral) Follicles not characteristic of all causative agents Epinephrine causes adrenochrome deposits (black spots on palpebral conj) TX: dicontinue all drops etc.

49 Chronic follicular conjunctivitis
Upper tarsal involvement with follicles Conjunctival scarring Pannus Limbal follicles Herbert’s Pits

50 Trachoma Mainly children
Leading cause of blindness in the world because is scars the cornea Eye is reservoir for C. Trachomatis Make more susceptible to H. flu and strep pneumoniae Advanced: basket weave of scarring on upper lid Herbert’s pit = scarred limbal follicles Tx: oral tetracyclines, macrolides for kids, triple sulfa is can’t take first two

51 Papillary response Follicles upper and lower Micropannus Tender pre-auricular nodes Chronic presentation

52 Inclusion Conjunctivitis
Women most susceptible Also neonatal conjunctivitis Causes majority of infertility and need a slit lamp to diagnose! Related to venereal disease Neotnates will only have papillae since lymph tissue is not mature enough to make follicles Tx: Erythromycin 500mg PO, QID Other Tx: oral Tetracycline, Azithromycin Neonates: tetracycline ointment, oral erythromycin

53 Prominent limbal arcades
Nodules near limbus

54 Facial/Ocular Rosacea
Women 4x more than men 20-40s have to rule out dermatitis Nodules not an acute response, takes a few months Tx: Doxycyclone, Tetracyclines up to 8 weeks, more anti-inflammatory than steroids with meibomian gland problems and rosacea Very mild steroid for anti-angiogenesis May need indefinite maintenance therapy

55 Bullous blistering Symblepharon Keratinization of conjunctiva

56 Benign Mucous Membrane Pemphigoid
75% more females, older Unusual condition: 1 in 20,000 Type IV inflammatory reaction No explaination Possible mucoud membrane involvement elsewhere Diagnosis of exclusion Tx: ocular lubricants on regular basis Immunosupressive therapy: Dapsone

57 Blistering Skin lesions, black lips Papular skin eruptions

58 Erythema Multiforme Uncommon blistering disorder of skin and mucous membranes Probably immune complex mediated Kick off most commonly by HSV and sulfa meds Most severe: Stevens-Johnson Syndrome Tx: Immunosuppressants, Antobiotic for secondary infections: fluoroquinilone Self limiting condition

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