PANCE Blueprint EENT (7%)

Conjunctival disorders (PEARLS)

Conjunctivitis (ReelDx + Lecture) Viral conjunctivitis - copious watery discharge, scant mucoid discharge. Adenovirus (most common). Self-limiting associated with URI

Bacterial conjunctivitis - will present with purulent (yellow) discharge, crusting, usually worse in the morning. May be unilateral.

  • S. pneumonia, S. aureus – acute mucopurulent
  • M. catarrhalis, Gonococcal – copious purulent discharge, in a patient who is not responding to conventional treatment
  • Chlamydia– newborn, Giemsa stain - inclusion body, scant mucopurulent discharge

Allergic conjunctivitis - red eyes, itching and tearing, usually bilateral, cobblestone mucosa on the inner/upper eyelid

TX:

Bacterial: Treatment(s) in order of suggested use - the dose is 0.5 inch (1.25 cm) of ointment (preferable in children) deposited inside the lower lid or 1 to 2 drops instilled four times daily for five to seven days.

  1. Gentamicin/tobramycin (Tobrex): aminoglycoside antibiotic used for gram-negative bacterial coverage. Most cases of bacterial conjunctivitis will respond to this agent
  2. Erythromycin ointment (E-Mycin) Chlamydia for newborns
  3. Trimethoprim and polymyxin B (Polytrim) This combination is used for ocular infections, involving cornea or conjunctiva, resulting from strains of microorganisms susceptible to this antibiotic.
  4. Ciprofloxacin (Ciloxan)

Contact lenses use = pseudomonas tx=fluoroquinolone (ciprofloxacin / Ciloxan drops) 

  • Neisseria conjunctivitis warrants prompt referral and topical + systemic antibiotics
  • Chlamydial conjunctivitis systemic tetracycline or erythromycin x 3 weeks, topical ointments as well, assess for STD or child abuse

Viral: There is no specific antiviral agent for the treatment of viral conjunctivitis. Some patients derive symptomatic relief from topical antihistamine/decongestants. Warm or cool compresses may provide additional symptomatic relief.

Allergic conjunctivitis systemic antihistamines and topical antihistamines or mast cell stabilizers. (Naphcon-A, Ocuhist, generics)

  • epinastine (Elestat)
  • azelastine (Optivar)
  • Emedastine difumarate (Emadine)
  • Levocabastine (Livostin)
Brian Wallace PA-C Podcast: Disorders of the Eye Parts 1-3 (Prev Lesson)
(Next Lesson) Conjunctivitis (ReelDx + Lecture)
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