Copious overflowing discharge Ballooning of lids Swollen nodes

1. Copious overflowing discharge • Ballooning of lids • Swollen nodes

2. Hyperacute Bacterial Conjunctivitis • Sexually active adults • Neonates, 24-72 hours after birth • Most common cause: Neisseria Gonorrhoeae • Urgent condition, can penetrate cornea! • Theyer Martin culture • Tx: Ceftriaxone 1g IM, adults=5days kids=2days • Also topical fluoroquinolone

3. Positive papillary response • Beefy engorged vessels

4. Acute Bacterial Conjunctivitis • Susceptible at any age • Staph. Aureus is most common cause • Steroids mask evolution of infection • Tx: 4th gen fluoroquinilone • Very contagious, stay home

5. Inferior Papillae • Wax/wane

6. Chronic Bacterial Conjunctivitis • Staph epi or Staph. Aureus • Inferior papillae because it has had time to build up

7. Superior papillary response • (-) lymphnode • Edema > injection

8. Allergic Conjunctivitis • Chemosis due to histamine breakdown • Hyperemia gets worse due to rubbing • Itching!!!! • PAC: Mast cell stabilizer then combo drug • SAC: Combo and sometimes mast cell stabilizer • Steroids great when allergen challenge increases

9. Giant Papillae upper lid • Trantas’ dots around limbus (not always)

10. Vernal Conjunctivitis • Kids, 90% gone by age 16 • 1st attack is worst • Males 2x more than females • Caucasians: palpebral form • AA/AI/Latinos: Limbal form • Bilateral • Sheild ulcer (uncommon) • Itching!!! • Mast cell stabilizer • Steroid great for first attack

11. Nodule, pinkish-white • Center of lesion necroses and turns gray

12. Phlyctenulosis • 60% are women and young children • Most likely Staph. Exotoxin from previous conjunctivitis • Big in 1950s due to Tb • Unilateral • Pain, #1 symptom • Inflammatory response, so steroids work • Topical antibiotic to treat conjunctivitis • Oral tetracyline if combo doesn’t work

13. “wimpy conjunctivitis”

14. Environmental Conjunctivitis • Inflammatory response • Multiple causes • Disease of exclusion • Can use mild steroid for a week to stop complaining, then artificial tear • Attempt to optimize tear quality by management of blapharitis and meibomitis

15. Follicular response • Vesicles • Tender nodes

16. Primary Herpes Simplex Conjunctivitis • Children • 60% of population infected by age 5, 90% by 16 • Unilateral, other eye follows in a week • Doesn’t scar like zoster • Foreign body sensation • NO STEROIDS! • Zirgan can be used instead of viroptic, doesn’t damage cornea as much • Treat dendritic keratitis with viroptic/vidarabine ointment/ganciclovir gel • HSV dendrites: Rose bengal stains edges

18. Herpes Zoster Conjunctivitis • Older patients (55+) • Hutchinson’s sign on nose • Triggered by stress or fatigue • May also cause keratitis and uveitis • Anti-virals w/in 72 hours then less chance of post herpetic neuralgia • Keratitis is Inflammatory, so treat with steroids (unlike HSV) • Psuedodendrites: Rose bengal stains middle

19. Inferior follicles • Subconjunctival or petechial hemorrhages (maybe) • SEIs • Pseudomembranes • Tender nodes

20. Epidemic Keratoconjunctivitis • Young adults • Adenovirus 8 (can last days on surfaces) • No systemic manifestations • Unilateral, then other follows in a week or less • R/O herpes, no vesicles or dermatomes • Consider any keratoconjunctivitis to be HSV or EKC until proven otherwise • Contagious • Betadine ophthalmic prep solution

21. Fever • Conjunctivitis • Sore Throat • Tender nodes • Follicles • Chemosis • Possible SEIs

22. Pharyngoconjunctival Fever • Kids between 5-15 • Swimming pool conjunctivitis • Adenovirus 3 • Self limiting, 10-14 days • Don’t use aspirin for fever because kid • SEI interfere with vision, but not a big deal in kids so don’t treat with steroids

23. Fever • Cough • Coryza • Conjunctivitis • Koplik’s spots • Inferior follicles

24. Rubeola • Children under 10 • Passed respiratory • Highly contagious • Paramyxovirus • Supportive treatment, no antiviral (it will tear up cornea)

25. Unilateral follicular conjunctivitis • Granulomas with follicles • Node enlargement • Chemosis • Lid swelling

26. Oculoglandular Syndrome • Cat scratch is most common cause

27. Lymph node enlargement • Lesion at site of scratch

28. Cat Scratch Disease • Young children about 10, girls>boys • Bartonela Hensulae Bacillus • Lesion at site of scratch appears 3 weeks later • Self limiting • May need oral tetracycline or macrolide

29. Fever • Chills • Malaise • HA • Nausea • Conjunctivitis, necrotising granulomatous type

30. Tularemia • “Rabbit Fever” Franciella tularensis • Lesion at site of organism entry with adenopathy • Treat with streptomycin

31. Primary site in lungs

32. Tuberculosis • Central American, pacific rim • Low income, inner city • Mycobacterium • Droplet spread • Treatment: rifampin

33. Chancre • Local adenopathy • Uveitis • Argyl-robinson

34. Syphilis • Primary: Chancre • Secondary: uveitis, skin rash, flu symptoms • Tertiary: neurosyphilis, argyl-robinson • Tx: penicillin or doxycycline

35. Conjunctiva shows red nodules that turn pink to purple to black and then necrose

36. Sporotrichosis • “Rose Gardeners Disease” • Sporothrix • Fungus lives on vegetables or in soil • Ulcerating nodules on extremeties and along lymph channels • Tx: local=potassium iodide Systemic=ketoconazole

37. 60% asymptomatic • 40% fever, myalgia, hilar adenopathy • May progress to chronic pneumonia

38. Coccidiodomycosis • San Joaquin Valley and Southwest US - immigrant farm workers (25-55 years old) • Airborne Fungus • ‘94 breakout after big earthquake • If accompanied by arthritis and erythema nodosa then called “valley fever syndrome: • Tx: amphotericin B (very toxic) or ketoconazole

39. Fever, HA, malaise, sore throat, white patches on back of throat

40. Mononucleosis • Young adults, uncommon in >25 • Epstein-Barr Virus • Acute episodes last from 1-3 weeks • Self limiting • Symptomatic relief • Possible penicillin for related strep tonsillitis

41. Hamster face • HA, myalgia, fever

42. Mumps • Kids • Myxovirus • Supportive therapy • Vaccination (MMR) at 15 months old

43. Hard lumps on face and neck • Fever, chills, reduced lung function, chest tightness, cough, weezing

44. Actinomycosis • Men 3x more than women • Little bug goes in face • Typically bad mouth hygiene • HX of dental extraction, abdominal trauma, sinus infection, chronic pneumonia • Tx: oral penicillin or erythromycin

45. Lungs = primary site • Can involve liver, skin, eyes, parotid glands

46. Sarcoid • Most common in female african americans in US • Granulomatas disease of unknown etiology • Mild cases don’t require therapy • Remits spontaneously • Oral steroids used in severe or chronic cases

47. Sometimes follicles, sometimes papillae

48. Toxic conjunctivitis • Common = sulfacetamide • Usually preservatives in meds (bilateral) • Viral toxins (unilateral) • Follicles not characteristic of all causative agents • Epinephrine causes adrenochrome deposits (black spots on palpebral conj) • TX: dicontinue all drops etc.

49. Chronic follicular conjunctivitis • Upper tarsal involvement with follicles • Conjunctival scarring • Pannus • Limbal follicles • Herbert’s Pits

50. Trachoma • Mainly children • Leading cause of blindness in the world because is scars the cornea • Eye is reservoir for C. Trachomatis • Make more susceptible to H. flu and strep pneumoniae • Advanced: basket weave of scarring on upper lid • Herbert’s pit = scarred limbal follicles • Tx: oral tetracyclines, macrolides for kids, triple sulfa is can’t take first two