Copious overflowing discharge

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• Copious overflowing discharge
• Ballooning of lids
• Swollen nodes

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Hyperacute Bacterial Conjunctivitis

• Sexually active adults
• Neonates, 24-72 hours after birth
• Most common cause Neisseria Gonorrhoeae
• Urgent condition, can penetrate cornea!
• Theyer Martin culture
• Tx Ceftriaxone 1g IM, adults5days kids2days
• Also topical fluoroquinolone

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• Positive papillary response
• Beefy engorged vessels

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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

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• Inferior Papillae
• Wax/wane

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Chronic Bacterial Conjunctivitis

• Staph epi or Staph. Aureus
• Inferior papillae because it has had time to
  build up

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• Superior papillary response
• (-) lymphnode
• Edema gt injection

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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

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

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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

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

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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 doesnt work

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• wimpy conjunctivitis

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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

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• Follicular response
• Vesicles
• Tender nodes

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Primary Herpes Simplex Conjunctivitis

• Children
• 60 of population infected by age 5, 90 by 16
• Unilateral, other eye follows in a week
• Doesnt scar like zoster
• Foreign body sensation
• NO STEROIDS!
• Zirgan can be used instead of viroptic, doesnt
  damage cornea as much
• Treat dendritic keratitis with viroptic/vidarabine
  ointment/ganciclovir gel
• HSV dendrites Rose bengal stains edges

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Herpes Zoster Conjunctivitis

• Older patients (55)
• Hutchinsons 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

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

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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

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• Fever
• Conjunctivitis
• Sore Throat
• Tender nodes
• Follicles
• Chemosis
• Possible SEIs

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Pharyngoconjunctival Fever

• Kids between 5-15
• Swimming pool conjunctivitis
• Adenovirus 3
• Self limiting, 10-14 days
• Dont use aspirin for fever because kid
• SEI interfere with vision, but not a big deal in
  kids so dont treat with steroids

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• Fever
• Cough
• Coryza
• Conjunctivitis
• Kopliks spots
• Inferior follicles

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Rubeola

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

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

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Oculoglandular Syndrome

• Cat scratch is most common cause

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• Lymph node enlargement
• Lesion at site of scratch

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Cat Scratch Disease

• Young children about 10, girlsgtboys
• Bartonela Hensulae Bacillus
• Lesion at site of scratch appears 3 weeks later
• Self limiting
• May need oral tetracycline or macrolide

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• Fever
• Chills
• Malaise
• HA
• Nausea
• Conjunctivitis, necrotising granulomatous type

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Tularemia

• Rabbit Fever Franciella tularensis
• Lesion at site of organism entry with adenopathy
• Treat with streptomycin

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• Primary site in lungs

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Tuberculosis

• Central American, pacific rim
• Low income, inner city
• Mycobacterium
• Droplet spread
• Treatment rifampin

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• Chancre
• Local adenopathy
• Uveitis
• Argyl-robinson

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Syphilis

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

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

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Sporotrichosis

• Rose Gardeners Disease
• Sporothrix
• Fungus lives on vegetables or in soil
• Ulcerating nodules on extremeties and along lymph
  channels
• Tx localpotassium iodide
  Systemicketoconazole

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

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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

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

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Mononucleosis

• Young adults, uncommon in gt25
• Epstein-Barr Virus
• Acute episodes last from 1-3 weeks
• Self limiting
• Symptomatic relief
• Possible penicillin for related strep tonsillitis

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• Hamster face
• HA, myalgia, fever

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Mumps

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

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

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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

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• Lungs primary site
• Can involve liver, skin, eyes, parotid glands

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Sarcoid

• Most common in female african americans in US
• Granulomatas disease of unknown etiology
• Mild cases dont require therapy
• Remits spontaneously
• Oral steroids used in severe or chronic cases

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• Sometimes follicles, sometimes papillae

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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.

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• Chronic follicular conjunctivitis
• Upper tarsal involvement with follicles
• Conjunctival scarring
• Pannus
• Limbal follicles
• Herberts Pits

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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
• Herberts pit scarred limbal follicles
• Tx oral tetracyclines, macrolides for kids,
  triple sulfa is cant take first two

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

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Inclusion Conjunctivitis

• Women 15-24 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

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• Prominent limbal arcades
• Nodules near limbus

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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

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• Bullous blistering
• Symblepharon
• Keratinization of conjunctiva

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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

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• Blistering
• Skin lesions, black lips
• Papular skin eruptions

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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