Conjunctiva

Jennifer Qayum, OD, FAAO

jvqayum@cmh.edu

Christina Twardowski, OD, FAAO

ctwardowski@cmh.edu

“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?

Thank you!jvqayum@cmh.edu

ctwardowski@cmh.edu