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Conjunctiva
Jennifer Qayum, OD, FAAO
Christina Twardowski, OD, FAAO
“Red Eye” “Pink Eye”
• Viral Conjunctivitis
• Bacterial Conjunctivitis• Neonatal conjunctivitis• Blepharokeratoconjunctivitis
• Allergic Conjunctivitis
• Trauma• Subconjunctival hemorrhage• Conjunctival laceration
• Limbal Dermoid
• Conjunctival Pigmentation• Nevus• Melanosis
Viral Conjunctivitis
Viral Conjunctivitis
• Adenovirus
• Molluscum
• HSV
Adenovirus• Common case history
• Typically begins unilaterally
• worse for the first 4-7 days after onset
• may not resolve for 2-3 weeks
• Signs/Symptoms• Watery discharge, red and edematous eyelids,
pinpoint SCH, punctate keratopathy,
membrane/pseudomembrane
• Inferior palpebral conjunctival follicles
• Treatment and management• Hand hygiene/household hygiene
• Palliative care
• Topical Steroid?
• Return to school/daycare/work?
Viral Conjunctivitis
• Adenovirus
• Molluscum
• HSV
Molluscum
• Signs/Symptoms:
• Dome shaped, usually multiple, umbilicated shiny nodules on the
eyelid or eyelid margin
• Unilateral conjunctivitis
• Follicular conjunctival response
• Treatment and management:
• Removal of lesions by simple excision or incision and curettage
• Erythromycin ung on lesions to prevent shedding of viral particles
into the eye
• Time
Viral Conjunctivitis
• Adenovirus
• Molluscum
• HSV
HSV• Signs/symptoms:
• red eye (typically unilateral)
• pain
• photophobia
• tearing
• periocular vesicular rash sometimes present
• Recommended treatment:• Topical treatments?
• Topical anti-viral
• Topical steroid
• Oral acyclovir
Considerations - prescribing acyclovir
• First episode? Recurrent episode?
• Immunocompetent vs immunocompromised
• Active vs suppressive therapy• Will first treat for acute infection with acycylovir 400mg QID x 2 weeks
• Then to start suppressive therapy with acycylovir at 400mg BID, anticipated over next 6 months
E Chong, et al. “Herpes Simplex Virus Keratitis in Children.” American Journal of Ophthamology. 2004, 138:3 (474-475).
Bacterial Conjunctivitis
Bacterial Conjunctivitis
• History:• can be unilateral or bilateral
• Signs/Symptoms:• redness• white/yellow mucous discharge• watering
• Recommended Treatment• topical antibiotic
• Erythromycin ointment TID
• Polytrim solution QID
• Vigamox QID
Neonatal Conjunctivitis
• Infectious• Bacterial
• Gonorrhea
• ceftriaxone
• Chlamydia
• erythromycin
• Viral• HSV (type 2)
BKCBlepharokeratoconjunctivitis
BKC• History of styes/chalazia
• Blepharitis present• Anterior blepharitis• Posterior blepharitis
• Light sensitivity
• Often bilateral but asymmetric
• Treatment• Lid Hygiene• Erythromycin ophth ointment• Pred Forte ophth sol
Allergic Conjunctivitis
Allergic Conjunctivitis
• Typically bilateral
• Itchy, red, watery eyes• Conjunctiva may be mildly swollen
• History:• Seasonal
• Known exposure to allergen
Vernal Keratoconjunctivitis
• Severe itching
• More common amongst male
patients
• Palpebral involvement
• Giant papillae
• Thick discharge
• Limbal involvement
• Horner-Trantas Dots
Trauma
Conjunctival Laceration
Subconjunctival hemorrhage
Other conjunctival anomalies
Limbal dermoid
Conjunctival Nevus
Conjunctival Melanosis
“Red Eye” “Pink Eye”
Questions?