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Disorders of the Conjunctiva

Viral Conjunctivitis

Causes

• Typically the adenovirus 3,8 or 19
• Highly contagious

Clinical Presentation

• Acute onset of watery discharge
• Usually be bilateral
• Ipsilateral preauricular lymphadenopathy
• Photophobia

Labs and Studies

• Typically a clinical diagnosis

Treatment

• Preventative measures
  • Frequent hand washing
  • Frequent disinfection
  • Education
• Self limiting
• Cool or warm compresses to the eye for symptomatic relief
• Severe cases require topical steroids

Bacterial Conjunctivitis

Causes

• Organisms transmitted through direct contact and contaminated objects
  • Strep pneumoniae
  • Staph Aureus
  • Haemophilus
  • Moraxella
  • Chlamydia rare and more severe
  • Neisseria (consider sexual partner)

Clinical Presentation

• Acute onset of purulent discharge
• Significant edema
• Unilateral at first but may spread to both eyes
• Eye may feel stuck shut in the morning

Labs and Studies

• Typically this is a clinical diagnosis
• Gram stain may be helpful
• Giemsa stain for Chlamydia
• Culture on Chocolate agar for Neisseria

Treatment

• Preventative measures
  • Frequent hand washing
  • Frequent disinfection
  • Education
• Topical antibiotic therapy
  • moxifloxacin 0.5% drops for three days
• Chlamydia or Neisseria require oral antibiotics
  • Ceftiraxone 1g IM with azithromycin 1g orally

Disorders of the Cornea

Cataract

• Opacification of the lens obstructing the flow of light to the retina

Causes and Risk Factors

• Aging – proteins denature over time
• Trauma
• Sunlight and radiation exposure
• Genetic predisposition
• Smoking
• Steroid use
• Secondary to systemic disease such as DM

Clinical Presentation

• Difficulty seeing in low light
• Slow, progressive cloudy vision

Labs, Studies and Physical Exam Findings

• An eye exam with dilated pupils will often be enough to diagnose a cataract
• Slit lamp to confirm diagnosis

Treatment

• Prevention (avoid risk factors)
  • Sunglasses which are UV filtering
  • Quit smoking etc
• Behaviour modification
  • Glasses with proper prescription
  • Better lighting
  • Use of magnifying lenses
• Surgery
  • Removal and replacement of the lens

Pterygium

• A benign wedge shaped growth of conjunctiva
• It is very vascular and may grow over the cornea
• More common in sunny, hot climates

Risk factors

• Chronic irritation
  • Wind
  • Sun exposure
  • Sand

Treatment

• Artificial tears
• May be surgically removed if it is irritating or causes a visual disturbance

Pinguecula

• Not on the blueprint
• A white or yellowish deposit on the conjunctiva which does not grow over the cornea

Risk factors

• Chronic irritation
  • Wind
  • Sun exposure
  • Sand

Treatment

• No treatment is necessary, but it may be surgically removed

Keratitis

• A corneal infection
• Rare in the United Starts with out an ulcer
• May be caused by
  • Herpes
  • Lyme disease
  • Epstein-Barr
  • Syphilis

Clinical Presentation

• Varies depending on the causative agent
• Photophobia
• Pain
• Blurry vision

Labs Studies and Physical Exam Findings

• Slit lamp examination shows a cloudy cornea
• Blood tests for the most common causes

Treatment

• Treated by an ophthalmologist
• Topical steroids may play a role

Corneal Ulcer (Ulcerative Keratitis)

Cause

Most likely secondary to an infection

• Bacterial keratitis
  • Staph
  • Strep
  • E. coli
  • Pseudomonas
• Viral Keratitis
  • Herpes
• Fungal Keratitis

Clinical Presentation

• Extremely painful eye
• Tearing
• Vision loss
• Redness
• Foreing body sensation

Labs, Studies and Physical Exam Findings

• Aqueous flare – protein in the aqueous humor
• Small Pupil
• A slit lamp is used for diagnosis
• Fluorescein stain may help with visualization of the ulcer
• A dendritic ulcer is indicative of Herpes
• Corneal scraping for
  • Gram stain
  • KOH

Treatment

Depends on the causative agent

• Bacterial infection requires appropriate antibiotic therapy
• Fungal infections require intense topical treatment
• Viral infections require topical antiviral
• Surgical repair of the ulcer may be necessary

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