Conjunctivitis resident survival guide: Difference between revisions
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==Do's== | ==Do's== | ||
* The | * In assessment of a person presenting with [[red eye]], serious causes (such as [[acute glaucoma]], [[keratitis]], [[iritis]] and [[trauma]]) must be excluded.<ref name="pmid15186569">{{cite journal| author=Owen CG, Shah A, Henshaw K, Smeeth L, Sheikh A| title=Topical treatments for seasonal allergic conjunctivitis: systematic review and meta-analysis of efficacy and effectiveness. | journal=Br J Gen Pract | year= 2004 | volume= 54 | issue= 503 | pages= 451-6 | pmid=15186569 | doi= | pmc=1266207 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15186569 }} </ref><ref name="pmid10922425">{{cite journal| author=Leibowitz HM| title=The red eye. | journal=N Engl J Med | year= 2000 | volume= 343 | issue= 5 | pages= 345-51 | pmid=10922425 | doi=10.1056/NEJM200008033430507 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10922425 }} </ref> | ||
* Urgent referral to ophthalmology should be arranged if the person has: | |||
** A red flag indicating a serious cause of [[red eye]] | |||
** Suspected [[gonococcal]] or [[chlamydial conjunctivitis]] | |||
** Suspected [[periorbital]] or [[orbital cellulitis]] | |||
** Had recent [[intraocular]] surgery | |||
** [[Conjunctivitis]] associated with a severe systemic condition or is [[immunocompromised]] | |||
** [[Corneal]] involvement | |||
** Possible [[herpes infection]] | |||
* Reassuring the person that most cases are self-limiting. | |||
* Advising self-care measures such as cleaning the [[eyelids]], cool compresses, [[lubricating drops]] or [[artificial tears]] and avoidance of [[contact lenses]]. | |||
* In most cases of [[bacterial conjunctivitis]], observation can be the only option because they often resolve spontaneously and no treatment is necessary. However, using [[topical antibiotics]] is are effective in reducing the duration of [[conjunctivitis]]. | |||
* [[Topical antihistamines]] and [[mast cell stabilizers]] in [[allergic conjunctivitis]] is recommended. | |||
* In cases of severely [[purulent conjunctivitis]] [[bacterial culture]] is useful. | |||
* | |||
==Don'ts== | ==Don'ts== | ||
Revision as of 13:46, 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[5] | Burning and foreign-body sensation, symptoms worse with prolonged reading or watching | Bilateral redness |
| Uveitis[6] | Photophobia, pain, blurred vision | Decreased vision, poorly reacting pupils, constant eye pain radiating to temple and brow, red eye |
| Angle closure glaucoma[7] | Headache, nausea, vomiting, ocular pain, decreased vision, light sensitivity | Firm eye on palpation, ocular redness, steamy cornea |
| Endophthalmitis[8] | Severe pain, photophobia | Red eye, pus in the anterior chamber, history of eye surgery or ocular trauma |
| Scleritis[9] | Decreased vision, moderate to severe pain | Redness, bluish sclera |
| Subconjunctival hemorrhage[10] | 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
- In assessment of a person presenting with red eye, serious causes (such as acute glaucoma, keratitis, iritis and trauma) must be excluded.[11][12]
- Urgent referral to ophthalmology should be arranged if the person has:
- A red flag indicating a serious cause of red eye
- Suspected gonococcal or chlamydial conjunctivitis
- Suspected periorbital or orbital cellulitis
- Had recent intraocular surgery
- Conjunctivitis associated with a severe systemic condition or is immunocompromised
- Corneal involvement
- Possible herpes infection
- Reassuring the person that most cases are self-limiting.
- Advising self-care measures such as cleaning the eyelids, cool compresses, lubricating drops or artificial tears and avoidance of contact lenses.
- In most cases of bacterial conjunctivitis, observation can be the only option because they often resolve spontaneously and no treatment is necessary. However, using topical antibiotics is are effective in reducing the duration of conjunctivitis.
- Topical antihistamines and mast cell stabilizers in allergic conjunctivitis is recommended.
- In cases of severely purulent conjunctivitis bacterial culture is useful.
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.
- ↑ Amescua, Guillermo; Akpek, Esen K.; Farid, Marjan; Garcia-Ferrer, Francisco J.; Lin, Amy; Rhee, Michelle K.; Varu, Divya M.; Musch, David C.; Dunn, Steven P.; Mah, Francis S. (2019). "Blepharitis Preferred Practice Pattern®". Ophthalmology. 126 (1): P56–P93. doi:10.1016/j.ophtha.2018.10.019. ISSN 0161-6420.
- ↑ Harthan JS, Opitz DL, Fromstein SR, Morettin CE (2016). "Diagnosis and treatment of anterior uveitis: optometric management". Clin Optom (Auckl). 8: 23–35. doi:10.2147/OPTO.S72079. PMC 6095364. PMID 30214346.
- ↑ Weinreb RN, Aung T, Medeiros FA (2014). "The pathophysiology and treatment of glaucoma: a review". JAMA. 311 (18): 1901–11. doi:10.1001/jama.2014.3192. PMC 4523637. PMID 24825645.
- ↑ Callegan MC, Engelbert M, Parke DW, Jett BD, Gilmore MS (2002). "Bacterial endophthalmitis: epidemiology, therapeutics, and bacterium-host interactions". Clin Microbiol Rev. 15 (1): 111–24. doi:10.1128/cmr.15.1.111-124.2002. PMC 118063. PMID 11781270.
- ↑ Al Barqi M, Behrens A, Alfawaz AM (2015). "Clinical features and visual outcomes of scleritis patients presented to tertiary care eye centers in Saudi Arabia". Int J Ophthalmol. 8 (6): 1215–9. doi:10.3980/j.issn.2222-3959.2015.06.25. PMC 4651892. PMID 26682176.
- ↑ Tarlan B, Kiratli H (2013). "Subconjunctival hemorrhage: risk factors and potential indicators". Clin Ophthalmol. 7: 1163–70. doi:10.2147/OPTH.S35062. PMC 3702240. PMID 23843690.
- ↑ Owen CG, Shah A, Henshaw K, Smeeth L, Sheikh A (2004). "Topical treatments for seasonal allergic conjunctivitis: systematic review and meta-analysis of efficacy and effectiveness". Br J Gen Pract. 54 (503): 451–6. PMC 1266207. PMID 15186569.
- ↑ Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.