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