Conjunctivitis physical examination: Difference between revisions
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==Physical Examination== | ==Physical Examination== | ||
Physical examination of patients with [[viral]] conjunctivitis is usually remarkable for preauricular [[adenopathy]], [[epiphora]], [[hyperemia]], [[chemosis]], subconjunctival hemorrhage, follicular conjunctival reaction, and occasionally a pseudomembranous or [[cicatricial conjunctival reaction]].The eyelids often are edematous and ecchymotic. In severe cases, there can be a corneal epithelial defect. | |||
'''Acute hemorrhagic conjunctivitis''' starts unilaterally but rapidly involves the fellow eye within 1 or 2 days. Physical examination of patients with '''Acute hemorrhagic conjunctivitis''' is usually remarkable for [[swollen]], [[edematous]] [[eyelid]] and pronounced [[hemorrhage]] beneath the [[bulbar]] [[conjunctiva]]. | |||
[[Redness]] of the [[conjunctiva]] on one or both eyes should be apparent, but may be quite mild. Except in obvious pyogenic or toxic/chemical conjunctivitis, a [[slit lamp]] (biomicroscope) is needed to have any confidence in the diagnosis. Examination of the tarsal conjunctiva is usually more diagnostic than the bulbar conjunctiva. | |||
'''Allergic conjunctivitis'''shows pale watery swelling or [[edema]] of the conjunctiva and sometimes the whole eyelid, often with a ropy, ''non-purulent'' mucoid discharge. There is variable redness. | '''Allergic conjunctivitis'''shows pale watery swelling or [[edema]] of the conjunctiva and sometimes the whole eyelid, often with a ropy, ''non-purulent'' mucoid discharge. There is variable redness. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Infection (redness) of the conjunctiva on one or both eyes should be apparent, but may be quite mild. Except in obvious pyogenic or toxic/chemical conjunctivitis, a slit lamp (biomicroscope) is needed to have any confidence in the diagnosis. Examination of the tarsal conjunctiva is usually more diagnostic than the bulbar conjunctiva.
Physical Examination
Physical examination of patients with viral conjunctivitis is usually remarkable for preauricular adenopathy, epiphora, hyperemia, chemosis, subconjunctival hemorrhage, follicular conjunctival reaction, and occasionally a pseudomembranous or cicatricial conjunctival reaction.The eyelids often are edematous and ecchymotic. In severe cases, there can be a corneal epithelial defect.
Acute hemorrhagic conjunctivitis starts unilaterally but rapidly involves the fellow eye within 1 or 2 days. Physical examination of patients with Acute hemorrhagic conjunctivitis is usually remarkable for swollen, edematous eyelid and pronounced hemorrhage beneath the bulbar conjunctiva.
Redness of the conjunctiva on one or both eyes should be apparent, but may be quite mild. Except in obvious pyogenic or toxic/chemical conjunctivitis, a slit lamp (biomicroscope) is needed to have any confidence in the diagnosis. Examination of the tarsal conjunctiva is usually more diagnostic than the bulbar conjunctiva.
Allergic conjunctivitisshows pale watery swelling or edema of the conjunctiva and sometimes the whole eyelid, often with a ropy, non-purulent mucoid discharge. There is variable redness. Viral conjunctivitis, commonly known as "pink eye", shows a fine diffuse pinkness of the conjunctiva which is easily mistaken for the 'ciliary infection' of iritis, but there are usually corroborative signs on biomicroscopy, particularly numerous lymphoid follicle12:02, 22 January 2008 (EST)12:02, 22 January 2008 (EST)~~s on the tarsal conjunctiva, and sometimes a punctate keratitis.
Pyogenic bacterial conjunctivitis shows an opaque purulent discharge, a very red eye, and on biomicroscopy there are numerous white cells and desquamated epithelial cells seen in the 'tear gutter' along the lid margin. The tarsal conjunctiva is a velvety red and not particularly follicular. Non-pyogenic infections can show just mild injection and be difficult to diagnose. Scarring of the tarsal conjunctiva is occasionally seen in chronic infections, especially in trachoma.
Irritant or toxic conjunctivitis show primarily marked redness. If due to splash injury, it is often present only in the lower conjunctival sac. With some chemicals—above all with caustic alkalis such as sodium hydroxide—there may be necrosis of the conjunctiva with a deceptively white eye due to vascular closure, followed by sloughing of the dead epithelium. This is likely to be associated with slit-lamp evidence of anterior uveitis.
Images
The following are gross images associated with rheumatic fever.[1]
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One eye with conjunctivitis. -
Bacterial Conjunctivitis -
Chemical Conjunctivitis
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(Images shown below are courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
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Conjunctivitis: Note inflamed conjunctiva of sclera and reflection onto underside of eyelid. -
Conjunctivitis: Marked bilateral inflammation involving conjunctiva that covers sclera and under surface of eyelid. Thick exudate can also be seen. -
Conjunctivitis: Inflammation of conjunctiva covering sclera and under surface of eyelid.
