PANCE Blueprint EENT (7%)

Conjunctival disorders (PEARLS)

Conjunctivitis (ReelDx + Lecture)
Patient will present as → a 6-year-old boy complaining of itchy eyes. The mother states that she has noted that he has been tearing and that both of his eyes have been red for the past 4 days. The patient denies any pain but has had a runny nose for the past week. The mother states that he has not had any sick contacts, and he has been home from school for summer vacation. On exam, there is marked redness, tearing, and eyelid edema of both eyes.

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 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 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 1-4 (Prev Lesson)
(Next Lesson) Conjunctivitis (ReelDx + Lecture)
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