Conjunctivitis resident survival guide: Difference between revisions
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{{familytree | | | | | | | | | I01 | | | | I02 | | | I01=<div style="float: left; text-align: center; width: 14em; padding:1em;"> [[Allergic conjunctivitis]] | I02=<div style="float: left; text-align: center; width: 14em; padding:1em;"> [[Viral conjunctivitis]] </div>}} | {{familytree | | | | | | | | | I01 | | | | I02 | | | I01=<div style="float: left; text-align: center; width: 14em; padding:1em;"> [[Allergic conjunctivitis]] | I02=<div style="float: left; text-align: center; width: 14em; padding:1em;"> [[Viral conjunctivitis]] </div>}} | ||
{{familytree/end}} | {{familytree/end}} | ||
===Differential diagnosis=== | |||
{| class="sortable" border="1" cellpadding="5" cellspacing="0" align="center" style="text-align:center;" | |||
|- | |||
!Differentail diagnosis | |||
!Manifestation | |||
!Examination findings | |||
|- | |||
|[[Blepharitis]] | |||
|Burning and foreign-body sensation, symptoms worse with prolonged reading or watching | |||
|[[Bilateral redness]] | |||
|- | |||
|[[Uveitis]] | |||
|[[Photophobia]], pain, [[blurred vision]] | |||
|Decreased vision, poorly reacting pupils, constant eye pain radiating to temple and brow, [[red eye]] | |||
|- | |||
|[[Angle closure glaucoma]] | |||
|Headache, [[nausea]], [[vomiting]], ocular pain, decreased vision, light sensitivity | |||
|Firm eye on palpation, [[ocular]] redness, steamy cornea | |||
|- | |||
|[[Endophthalmitis]] | |||
|Severe pain, [[photophobia]] | |||
|[[Red eye]], pus in the anterior chamber, history of eye surgery or ocular trauma | |||
|- | |||
|[[Scleritis]] | |||
|Decreased vision, moderate to severe pain | |||
|Redness, bluish [[sclera]] | |||
|- | |||
|[[Subconjunctival hemorrhage]] | |||
|foreign-body sensation and tearing or be asymptomatic | |||
|Blood under the conjunctival membrane | |||
|- | |||
|} | |||
==Treatment== | ==Treatment== | ||
Revision as of 10:04, 10 September 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Conjunctivitis is the most common eye infection causing dilation of conjunctival blood vessels and results in inflammation. The most common cause of conjunctivitis is infection of which viral infections are the commonest cause, followed by bacterial. The non-infection forms are allergic, mechanical, toxic and neoplastic. Among noninfectious conjunctivitis, the allergic form is more common. Infectious conjunctivitis can be presented with red eye, foreign body sensation, itching, light sensitivity, burning, and watery discharge in viral conjunctivitis and mucopurulent discharge in bacterial form. Regarding the onset and severity of clinical symptoms, conjunctivitis is classified as acute, chronic, and recurrent. Most cases of infectious conjunctivitis are considered as acute conjunctivitis. Allergic conjunctivitis can be chronic while it can be present with acute exacerbations related to seasonal factors or contact lens use. It is important to differentiate conjunctivitis from other sight-threatening eye diseases that have similar clinical presentation.
Causes
Life Threatening Causes
Most cases of conjunctivitis are relatively mild and will not cause eye damage of any sort. However, if it left untreated it can lead to sight-treathening complications including:[1]
Viral conjunctivitis
- Adenoviruses are the most common cause of viral conjunctivitis[2]
- Herpes simplex virus (HSV)
- Varicella zoster virus (VZV)
- Picornaviruses
Bacterial conjunctivitis
Diagnosis
Some initial diagnosis should be excluded for which physicians should manage patients by a systematic approach.[4]
Suspected acute conjunctivitis (<4 weeks duration) | |||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||
Ophthalmology referral | Any discharge | ||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||
Ophthalmology referral | |||||||||||||||||||||||||||||||||||||||||||||
Itiching | |||||||||||||||||||||||||||||||||||||||||||||
Ophthalmology referral | Yes | No | |||||||||||||||||||||||||||||||||||||||||||
Differential diagnosis
| Differentail diagnosis | Manifestation | Examination findings |
|---|---|---|
| Blepharitis | Burning and foreign-body sensation, symptoms worse with prolonged reading or watching | Bilateral redness |
| Uveitis | Photophobia, pain, blurred vision | Decreased vision, poorly reacting pupils, constant eye pain radiating to temple and brow, red eye |
| Angle closure glaucoma | Headache, nausea, vomiting, ocular pain, decreased vision, light sensitivity | Firm eye on palpation, ocular redness, steamy cornea |
| Endophthalmitis | Severe pain, photophobia | Red eye, pus in the anterior chamber, history of eye surgery or ocular trauma |
| Scleritis | Decreased vision, moderate to severe pain | Redness, bluish sclera |
| Subconjunctival hemorrhage | foreign-body sensation and tearing or be asymptomatic | Blood under the conjunctival membrane |
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ Epling J (2012). "Bacterial conjunctivitis". BMJ Clin Evid. 2012. PMC 3635545. PMID 22348418.
- ↑ Yeu E, Hauswirth S (2020). "A Review of the Differential Diagnosis of Acute Infectious Conjunctivitis: Implications for Treatment and Management". Clin Ophthalmol. 14: 805–813. doi:10.2147/OPTH.S236571. PMC 7075432 Check
|pmc=value (help). PMID 32210533 Check|pmid=value (help). - ↑ Azari AA, Arabi A (2020). "Conjunctivitis: A Systematic Review". J Ophthalmic Vis Res. 15 (3): 372–395. doi:10.18502/jovr.v15i3.7456. PMC 7431717 Check
|pmc=value (help). PMID 32864068 Check|pmid=value (help). - ↑ Varu, Divya M.; Rhee, Michelle K.; Akpek, Esen K.; Amescua, Guillermo; Farid, Marjan; Garcia-Ferrer, Francisco J.; Lin, Amy; Musch, David C.; Mah, Francis S.; Dunn, Steven P. (2019). "Conjunctivitis Preferred Practice Pattern®". Ophthalmology. 126 (1): P94–P169. doi:10.1016/j.ophtha.2018.10.020. ISSN 0161-6420.