Term
| Definition of Conjunctivitis |
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Definition
| Inflammation of the bulbar and/or palpebral conjunctiva < 4wks duration |
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Term
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Definition
| Thin, filmly membrane that lines surface of eyelids and covers sclera |
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Term
| What is the most common eye disorder? |
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Definition
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Term
| What portion of conjunctivitis cases are bacterial versus viral? |
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Definition
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Term
| What is the most common organism responsible for bacterial conjunctivitis in adults? |
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Definition
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Term
| What are the most common bacteria that infects children in conjunctivitis? |
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Definition
| Streptococci pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, and Moraxella catarrhalis |
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Term
| What are differential diagnoses for bacterial conjunctivitis? |
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Definition
| Uveitis, acute glaucoma, ocular trauma, keratitis, corneal ulcers/foreign body, dacryocystitis |
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Term
| Describe the pathophysiology of acute bacterial conjunctivitis. |
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Definition
- Bacteria induces antigen-antibody immune rxn and inflammation.
- Defenses: bacteriostatic lysozymes and immunoglbulins in tear film, shearing force of blink and colonozed non-pathogenic bacteria
- This causes self-eradication or infection |
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Term
| What are risk factors for bacterial conjunctivitis? |
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Definition
| Spread by direct contact or on fomites. Daycare or schools. Contact lens use. |
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Term
| Describe the clinical presentation for bacterial conjunctivitis. |
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Definition
| Injection, mucopurulent (thick and globular)discharge, matted eyelids and eyelashes, mild discomfort |
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Term
| Does conjunctivitis affect vision? |
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Definition
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Term
| If you wipe of eyelids in bacterial conjunctivitis, does it come back? |
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Definition
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Term
| Is bacterial conjunctivitis typically unilateral or bilateral? |
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Definition
| Usually unilateral, but can be bilateral |
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Term
| Should the cornea be clear in conjunctivitis? |
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Definition
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Term
| What should be done for irregular pupil? |
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Definition
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Term
| What is the prognosis for conjunctivitis? |
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Definition
| - resolves in 10-14 days if untreated and in 2-3 days if treated |
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Term
| What is used to treat bacterial conjunctivitis? |
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Definition
- Erythromycin opthalmic ointment (1/2 in. QID to bid X 5 days)
- Sulfa opthalmic drops (2 gtts q4h (while awake) X 5 days
- Bacitracin opthalmic ointment
- Sulfacetamide ointment
- Fluoroquinolone drops (more expensive)
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Term
| How would you educate a pt with bacterial conjunctivitis? |
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Definition
- Wash hands frequently
- Avoid rubbing eyes
- Don't share washcloths, towels, pillow cases
- Don't share eyedrops or cosmetics |
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Term
| What is the etiology of hyperacute conjunctivitis? |
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Definition
| Neisseria species; particularly N. gonorrhoeae |
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Term
| What is the clinical presentation of hyperacute conjunctivitis? |
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Definition
- Copious purulent discharge w/i 12 hrs of inoculation
- Rapidly progressive
- Includes redness, irritation, tenderness, lid swelling, and tender preauricular adenopathy |
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Term
| What is the tx of hyperacute conjuncitivitis? |
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Definition
- Copious irrigation w/ saline solution to dilute exotoxins
- Single 1-gram dose of ceftriaxone IM
- pt needs to be seen daily |
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Term
| What can hyperacute conjunctivitis lead to if not treated promptly? |
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Definition
| Perforation and/or blindness |
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Term
| What is the etiology of chlamydial conjunctivitis outside of the US? |
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Definition
| Trachoma - Chlamydia trachomatis serotypes A-C |
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Term
| What is the etiology of chlamydial conjunctivitis outside of the US? |
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Definition
| Inclusion conjunctivitis - Chlamydia trachomatis serotypes D-K |
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Term
| What is the epidemiology of Trachoma? |
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Definition
- Endemic in 48 countries
- Major cause of blindness worldwide
- 150M with active infxn
- 6M w/ blindness from corneal scarring |
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Term
| What is the clinical presentation of trachoma? |
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Definition
| Majority are asymptomatic |
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Term
| Explain the disease progression of trachoma. |
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Definition
- Repeated follicular inflammation leads to eyelid scarring
- Eyelid scarring leads to entropion and subsequent trichiasis
- Eyelash abrasion leads to corneal opacification and blindness |
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Term
| What is the treatment for trachoma? |
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Definition
- Azithromycin single oral dose 20 mg/kg
- Azithromycin eye drops bid X 2-3 d if oral not available
- Surgery
- Corneal transplant |
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Term
| What is the epidemiology of inclusion conjunctivitis? |
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Definition
- STD
- More women than men
- 3-4 M cases in US and 90M worldwide
- 1 in 300 with genital will develop it |
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Term
| What is the clinical presentation of inclusion conjunctivitis? |
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Definition
- Acute or chronic
- Usually unilateral
- Redness, discharge, irritation
- Preauricular lymphadenopathy
- Swollen lids
- Concurrent aysmptomatic urogenital infection
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Term
| How do you treat inclusion conjunctivitis? |
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Definition
- Doxycyline, tetracycline, eryhtromycin, or azithromycin.
- Need to assess genital involvement and co-infection |
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Term
| Define neonatal conjunctivitis. What is another name for it? |
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Definition
- Conjunctivitis in the first 4 wks of life
- Ophthalmia Neonatorum |
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Term
What is the etiology for neonatal conjunctivitis that occurs in the first 1-36 hrs of life?
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Definition
| Silver nitrate (chemical) |
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Term
| What is the etiology for neonatal conjunctivitis that occurs 24-48 hrs post partum? |
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Definition
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Term
| What is the etiology for neonatal conjunctivitis that occurs 2-5 days post partum? 3-15 days? |
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Definition
- Bacteria (Staph, Strep, Haemophilus)
- Virus (HSV types 1 & 2) |
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Term
| What is the most common cause of neonatal conjunctivitis? What is its time of onset? |
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Definition
| Chlamydia, 5-14 days post partum |
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Term
| What is considered the "gold standard" for diagnosis of neonatal conjunctivitis? |
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Definition
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Term
| What are others methods used to diagnose neonatal conjunctivitis? |
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Definition
| Gram stain, nucleic acid amplification tests, antigen detection, smear, and monoclonal antibody immunoassays |
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Term
| What is used to treat neonatal conjunctivitis caused by chlamydia? |
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Definition
| Oral erythromycin 50mg/kg/d in 4 doses X 14d |
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Term
| What is used to treat neonatal conjunctivitis caused by gram (+) bacteria? |
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Definition
| Eryhromycin 0.5% ointment QID |
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Term
| What is used to treat neonatal conjunctivitis caused by gram (-) bacteria (gonococcal)? |
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Definition
- Penicillin G drops 10,000-20,000 units q h
- IV penicillin G drops 100,000 units/kg/d in 4 doses X 7d.
- IV or IM ceftriaxone 25-50mg/kg/d qd X 7d. |
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Term
| What is used to treat neonatal conjunctivitis caused by gram (-) bacteria (others)? |
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Definition
| Gentamicin or tobramycin ointments |
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Term
| What is used to treat neonatal conjunctivitis caused by a virus? |
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Definition
| Trifluorothymidine drops q 2h X 7d |
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Term
| What is the epidemiology for viral conjunctivitis? |
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Definition
- Extremely common in the US
- Occurs equally in men and women
- Highly contagious |
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Term
| What is the etiology of viral conjunctivitis? |
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Definition
- PCF: Adenovirus type 3
- EKC: Adenovirus 8, 19, 29 and 37 |
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Term
| What are the 2 main types of viral conjunctivitis? |
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Definition
- Pharyngoconjunctival fever (PCF)
- Epidemic keratoconjunctivitis (EKC) |
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Term
| Describe the clinical presentation of PCF. |
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Definition
- Injection, watery or mucoid discharge, burning, gritty feeling in eye
- Tarsal conjunctiva may have follicular appearance
- May have viral prodome w/ adenopathy, fever, pharyngitis or malaise
- Palpable preauricular lymphadenopathy |
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Term
| Describe the clinical presentation of EKC. |
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Definition
- Injection, watery or mucoid discharge, swollen lids and burning sensation
- May have severe foreign body sensation
- Keratitis w/ corneal infiltrates that degrade acuity
- May have pseudo membrane |
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Term
| Do you need an Opthalmologist referral for PCF or EKC? What would they do? |
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Definition
| EKC - possible topical steroids to prevent scarring |
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Term
| What is the treatment for viral conjunctivitis and what is its prognosis? |
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Definition
- Symptomatic tx: cold compresses to soothe
- MOst reseolve spontaneously w/i 1-3 wks (avg. 10 days) |
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Term
| How would you educate and patient with viral conjunctivitis? |
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Definition
- Highly contagious for 1 to 2 wks
- Wash hands often
- Don't share towels or makeup |
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Term
| Describe the epidemiology for keratoconjunctivitis sicca. |
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Definition
| Very common, especially in elderly women |
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Term
| What is keratoconjunctivitis sicca? |
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Definition
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Term
| What is the etiology of dry eyes? |
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Definition
| Hypofunction of the lacrimal glands, excessive evaporation of tears, mucin deficiency, and HRT |
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Term
| What causes hypofunction of lacrimal glands? |
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Definition
- Loss of aqueous component of tears
- Occurs w/ aging
- Hereditary disorders, systemic disease, or systemic and topical drugs |
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Term
| What causes excessive evaporation of tears? |
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Definition
| Environmental factors, including hot, dry, or windy climates |
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Term
| What causes mucin deficiency? |
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Definition
| malnutrition, infection, burns, or drugs |
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Term
| What are the signs/symptoms of dry eyes? |
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Definition
| Dryness, redness, scratchy feeling, foreign body sensation, blurred vision |
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Term
| What can happen in severe cases of dry eyes? |
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Definition
| marked discomfort, photophobia, difficulty in moving the eyelids, and excessive mucus secretion |
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Term
| How is dry eye diagnosed? |
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Definition
| Normal exam, specialized ophthalmic exam techniques |
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Term
| What are complications of dry eyes? |
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Definition
| erosions and scarring of cornea |
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Term
| How do you treat dry eyes? |
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Definition
| Treat the cause, artificial tears, lacrimal punctal occlusion for severe cases |
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Term
| What is the epidemiology of allergic conjunctivitis? |
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Definition
| 20% of the population and increasing |
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Term
| What are the types of allergic conjunctivitis? |
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Definition
| Acute, seasonal, and perennial |
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Term
| Describe acute allergic conjunctivitis. |
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Definition
| Sudden onset hypersensitivity rxn caused by environmental exposure |
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Term
| Describe seasonal allergic conjunctivitis. |
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Definition
| Predictable, chronic course that corresponds to specific pollen seasons |
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Term
| Describe perennial allergic conjunctivitis. |
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Definition
| Mild, chronic environmental exposure, usually indoor |
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Term
| Describe the pathophysiology of allergic conjunctivitis. |
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Definition
- Classic Type I IgE-mediated hypersensitivity
- Mast cells interact w/ allergens and release chemical mediators (degranulation)
- Histamine (vasodilation, vascular permeability, itching, mucus secretion) - early phase, neutral proteases (inflammatory mediators), arachidonic acid |
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Term
| What is the clinical presentation of allergic conjunctivitis? |
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Definition
- Itching, tearing, burning
- Watery, mucoid, or stringy discharge
- Edematous eyelids
- Conjunctival injection and chemosis
- Large "cobblestone" papillae on upper tarsal conjunctiva
- Usually bilateral |
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Term
| What is the general management of allergic conjunctivitis? |
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Definition
- Do not rub eyes
- Allergen avoidance
- Treat dry eye if present
- Allergy evaluation and immunotherapy if severe
- Artificial tears to dilute allergens |
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Term
| How is acute allergic conjunctivitis treated? |
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Definition
- OTC topical antihistamine/vasoconstrictors (< 2 wks) - Naphcon-A, Opcon-A, Visine-A
- Topical antihistamine and mast cell stabilizer for frequent episodes - Pataday, Patanol, Alocril, Elestat |
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Term
| How is seasonal and perennial allergic conjunctivitis treated? |
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Definition
- Initiate tx 2 wks before onset of sx if possible
- 1st line agent: topical antihistamine/mast cell stabilizer (Patanol, Pataday, Optiver, Alocril, Elestat)
- 2nd line: add oral antihistamine (Allegra, Claritin, Clarinex, Zyrtec) |
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Term
| In which of the following conditions, conjunctivitis, iritis, acute glaucoma, or keratitis, would marked discharge be present? |
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Definition
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Term
| In which of the following conditions, conjunctivitis, iritis, acute glaucoma, or keratitis, would marked photophobia be present? |
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Definition
| Iritis, slight photophobia is present in glaucoma and keratitis |
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Term
| In which of the following conditions, conjunctivitis, iritis, acute glaucoma, or keratitis, would marked pain be present? |
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Definition
| Glaucoma and keratitis, slight pain in iritis |
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Term
| In which of the following conditions, conjunctivitis, iritis, acute glaucoma, or keratitis, is visual acuity reduced? |
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Definition
| Iritis and glaucoma, visual acuity varies in keratitis according to the site of the lesion |
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Term
| In which of the following conditions, conjunctivitis, iritis, acute glaucoma, or keratitis, would pupil size be changed? |
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Definition
large and fixed in glaucoma,
same or smaller in iritis and keratitis |
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Term
| What are red flags when a pt present with red eye? |
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Definition
| Vision change, diploplia, photophobia, severe pain, nausea, contact lenses, trauma, chemical in eye, limitation of eye movement, change in corneal clarity, hyphema, hypophon, sluggish or displaced pupil, altered fundus reflex |
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Term
| What do you do if any of these red flags are present? |
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Definition
| Re-evaluate in 24-48 hrs and refer if no improvement in that time |
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Term
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Definition
| Triangular, yellow/opaque patch of hypertrophied bulbar sunconjunctival tissue, extending from the medial angle of the eye to the border of the cornea and beyond |
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Term
| What is the epidemiology of pterygium? |
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Definition
| More likely in older people and in tropical regions. Prevalance varies from <1% to 25%. |
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Term
| What is the etiology of pterygium? |
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Definition
| Exposure to irritants (wind, dirt, dust, pollution, chemicals, allergens) |
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Term
| What is the pathophysiology of pterygium? |
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Definition
- Degeneration of conjunctival stroma replaced by thickened, tortuous elastic fibers
- Fibroblasts invade and fragment Bowman's layer
- Resembles actinic degeneration of the skin |
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Term
| Describe the clinical presentation of pterygium. |
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Definition
- Raised, white/yellow, triangular wedge
- 90% located nasally
- May be redness or irritation
- Unilateral or bilateral
- May induce astigmatism
- May reduce visual acuity |
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Term
| Describe the treatment for pterygium. |
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Definition
| Topical lubricants if small, surgical excision if vision affected. Steroids or decongestants don't work or slow progression. |
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Term
| What is the prognosis for pterygium? |
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Definition
| Recurrence rates are 30-50% or >, typically apparent by 4 mths post op |
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Term
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Definition
| A yellowish spot of proliferation in the bulbar conjunctiva near the sclerocorneal junction |
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Term
| Describe the pathophysiology of pinguecula. |
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Definition
| Caused by chronic solar radiation which alters collagen and elastic tissues of conjunctival stroma |
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Term
| What is the clinical presentation of pinguecula? |
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Definition
- Yellow, elevated nodule on either side of the cornea
- May become vascularized or inflamed |
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Term
| What is the etiology of pinguecula? |
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Definition
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Term
| How is pinguecula treated? |
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Definition
| topical lubricant, eyewear to block UV exposure, steroids, consult if uncertain dx |
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Term
| How would you educate a patient about pinguecula? |
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Definition
- Prevention
- Wear sunglasses (don't help once its already there) |
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Term
| Define subconjunctival hemorrhage? |
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Definition
| Bleeding underneath the conjunctiva |
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Term
| What is the etiology of subconjunctival hemorrhage? |
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Definition
| violent coughing, powerful sneezing, heavy lifting, vomiting |
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Term
| How does subconjunctival hemorrhage present? |
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Definition
| Bright red patch on sclera, possible scratchy feeling on eye surface, no vision change, pain, or discharge |
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Term
| What are the risk factors for sunconjunctival hemorrhage? |
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Definition
| HTN, blood thinning meds (some OTC herbal meds) |
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Term
| How is subconjunctival hemorrhage treated? |
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Definition
| No tx needed if risk factors are negative, blood reabsorbed in 10-14 days |
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