PANCE Blueprint EENT (7%)

ReelDx Virtual Rounds (Conjunctivitis)

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. It 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 inches (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 antihistamines/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)

Subconjunctival hemorrhage is a benign condition characterized by a sudden onset of a unilateral bright red patch on the sclera due to the rupture of small blood vessels under the conjunctiva

• It can occur spontaneously or be triggered by coughing, sneezing, heavy lifting, vomiting, or even rubbing the eye too hard
• While it may look alarming, it typically causes no pain, no vision changes, and no discharge
• Risk factors include hypertension, diabetes, blood thinning medications, and certain blood clotting disorders

DX:

Diagnosis is primarily clinical, based on the characteristic appearance of a bright red or dark red patch on the sclera, with clear demarcation, and absence of other symptoms such as pain, vision loss, or discharge

• No specific tests are usually required unless recurrent hemorrhages suggest an underlying systemic condition

TX:

Treatment is generally not required as the condition resolves on its own within two weeks. Artificial tears can help with any mild irritation

Subconjunctival hemorrhage eye. Broken blood vessel.