Conjunctivitis physical examination: Difference between revisions

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==Overview==
==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 of patients with conjunctivitis  is usually remarkable for [[swollen]] [[eyelid]], [[epiphora]], [[hyperemia]], and muco-purulent or watery discharge.  
 


==Physical Examination==
==Physical Examination==
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*[[Corneal]] [[epithelial]] defect (severe cases)
*[[Corneal]] [[epithelial]] defect (severe cases)
===Acute Hemorrhagic Conjunctivitis===
===Acute Hemorrhagic Conjunctivitis===
Ophthalmologic examination of patients with [[acute]] hemorrhagic conjunctivitis is usually remarkable for:
Ophthalmologic examination of patients with [[acute]] hemorrhagic conjunctivitis is usually remarkable for:<ref name="pmid26077630">{{cite journal| author=Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB| title=Adenoviral keratoconjunctivitis. | journal=Surv Ophthalmol | year= 2015 | volume= 60 | issue= 5 | pages= 435-43 | pmid=26077630 | doi=10.1016/j.survophthal.2015.04.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26077630  }} </ref>
*[[Swollen]], Edematous [[Eyelid]]
*[[Swollen]], edematous [[eyelid]]
*Eye pain in [[palpation]]
*Eye pain in [[palpation]]
*[[Bulbar]] [[conjunctiva]] [[hemorrhage]]
*[[Bulbar]] [[conjunctiva]] [[hemorrhage]]
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===Allergic Conjunctivitis===
===Allergic Conjunctivitis===
Ophthalmologic examination of patients with allergic conjunctivitis is usually remarkable for:
Ophthalmologic examination of patients with allergic conjunctivitis is usually remarkable for:
*Bilateral conjunctival injection
*[[Bilateral]] conjunctival [[injection]]
*Chemosis,
*[[Chemosis]]]
*Watery discharge, or mild mucous discharge
*Watery [[discharge]], or mild mucous discharge
===Keratoconjunctivitis Sicaa===
===Keratoconjunctivitis Sicaa===
Examination should include evaluation of the face, eyelids, blinking patterns, eyelid margins, [[eyelashes]], [[conjunctiva]], [[cornea]], and tear film.
Examination of patients with keratoconjunctivitis sicaa is usually remarkable for:
*More or less pronounced [[conjunctival]] [[redness]]
*Damage to the ocular surface with punctate [[epithelial]] [[erosions]] (superficial punctate [[keratitis]]) 
*Thickened eyelid margins and [[telangiectasia]] (signs of meibomian gland dysfunction)
*[[Meibomian gland]] orifices are obstructed with a cloudy, granular or solid [[secretion]]  (expressed by exerting considerable pressure on the lower lid)
*[[Blepharitis]] (associated with meibomian gland dysfunction)
*Meibomitis ([[inflammation]] of the meibomian glands)


Redness
Burning
Stinging
Foreign body sensation
Pruritus
Photophobia.
More or less pronounced conjunctival redness and damage to the ocular surface with punctate epithelial erosions (superficial punctate keratitis) are typical in dry eye; temporal conjunctival folds parallel to the lid margin are indicative. The lower tear meniscus is reduced. In addition, there are often signs of meibomian gland dysfunction with thickened eyelid margins and telangiectasia. The meibomian gland orifices are obstructed with a cloudy, granular or solid secretion that can only be expressed by exerting considerable pressure on the lower lid (15). If the meibomian gland dysfunction is associated with inflammation, blepharitis (inflammation of the lid margin) or meibomitis (inflammation of the meibomian glands) is present
Ophthalmologic examination of patients with superior limbic keratoconjunctivitis is usually remarkable for:
===Superior Limbic Keratoconjunctivitis===
===Superior Limbic Keratoconjunctivitis===
Ophthalmologic examination of patients with superior limbic keratoconjunctivitis is usually remarkable for:
Ophthalmologic examination of patients with superior limbic keratoconjunctivitis is usually remarkable for:
*Micro-papillary reaction in the upper tarsal conjunctiva,  
*Micro-papillary reaction in the upper tarsal conjunctiva,  
Hyperemia  
*[[Hyperemia]]
Thickening of the superior bulbar conjunctiva
*Thickening of the [[superior]] [[bulbar]] [[conjunctiva]]  
Ciliary injection in the upper bulbar conjunctiva,
*Ciliary [[injection]] in the upper bulbar conjunctiva
Corneal erosions in the upper quadrants
*[[Corneal]] erosions in the upper quadrants
Diffuse superficial corneal erosions
*[[Diffuse]] [[superficial]] corneal erosions
Eyelid edema
*Eyelid [[edema]]  
 
[[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.
''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 cell]]s 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&mdash;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 [[iritis|anterior uveitis]].


===Images===
===Images===

Revision as of 12:16, 5 July 2016

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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

Physical examination of patients with conjunctivitis is usually remarkable for swollen eyelid, epiphora, hyperemia, and muco-purulent or watery discharge.


Physical Examination

Viral Conjunctivitis

Patients with viral conjunctivitis usually appear febrile, and they have Preauricular adenopathy. Ophthalmologic examination of patients with viral conjunctivitis is usually remarkable for:

Acute Hemorrhagic Conjunctivitis

Ophthalmologic examination of patients with acute hemorrhagic conjunctivitis is usually remarkable for:[1]

Bacterial Conjunctivitis

Ophthalmologic examination of patients with bacterial conjunctivitis is usually remarkable for:

Neonatal Conjunctivitis

Ophthalmologic examination of patients with neonatal conjunctivitis is usually remarkable for:

Allergic Conjunctivitis

Ophthalmologic examination of patients with allergic conjunctivitis is usually remarkable for:

Keratoconjunctivitis Sicaa

Examination should include evaluation of the face, eyelids, blinking patterns, eyelid margins, eyelashes, conjunctiva, cornea, and tear film. Examination of patients with keratoconjunctivitis sicaa is usually remarkable for:

Superior Limbic Keratoconjunctivitis

Ophthalmologic examination of patients with superior limbic keratoconjunctivitis is usually remarkable for:

Images

The following are gross images associated with rheumatic fever.[2]

  • One eye with conjunctivitis.
    One eye with conjunctivitis.
  • Bacterial Conjunctivitis
    Bacterial Conjunctivitis
  • Chemical Conjunctivitis
    Chemical Conjunctivitis

(Images shown below are courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)

  • Conjunctivitis: Note inflamed conjunctiva of sclera and reflection onto underside of eyelid.
    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: 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.
    Conjunctivitis: Inflammation of conjunctiva covering sclera and under surface of eyelid.

References

  1. ↑ Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB (2015). "Adenoviral keratoconjunctivitis". Surv Ophthalmol. 60 (5): 435–43. doi:10.1016/j.survophthal.2015.04.001. PMID 26077630.
  2. ↑ http://picasaweb.google.com/mcmumbi/USMLEIIImages/
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