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Acute Conjunctivitis


Presentation

  • It typically presents in the primary or urgent care setting as a red eye with discharge.[contemporaryclinic.pharmacytimes.com]
  • 3 factors were present, 76.4% of patients had a negative culture, and when 4 factors were present, 92.3% of patients had a negative culture result. [1] Bilateral versus unilateral disease Bilateral disease is typically infectious or allergic.[emedicine.medscape.com]
  • The total number of sufferers and the age-wise distribution of the organisms-present group and no-organisms group is shown in [Table - 1] and [Figure - 5].[ijo.in]
  • Snapshot A 24-year-old man presents to his primary care phyisician for discomfort and redness in his eyes. He notes these symptoms began 2 days prior to presentation and is associated with a "sandy" or "gritty" sensation in his eyes.[step2.medbullets.com]
  • Bacterial conjunctivitis was present in about one third (32.47% to 36.04%) of the patients with acute infective conjunctivitis, and it was more common in children.[nepjol.info]
Fishing
  • The patient has a past medical history of asthma, and his current medications include albuterol, fluticasone, fish oil, and whey protein supplements.[step2.medbullets.com]
Recent Upper Respiratory Infection
  • A history of a recent upper respiratory infection (URI) is typically associated with a viral cause.[emedicine.medscape.com]
Sputum
  • A cluster of 10 severe cases of nosocomial bacterial keratitis in three intensive care units showed almost identical bacterial growth in cultures from eye and sputum ( Hilton et al. 1983 ). All the patients had required frequent tracheal suctioning.[onlinelibrary.wiley.com]
Hypertension
  • His past medical history is significant for hypercholesterolemia, type II diabetes mellitus, and hypertension for which he takes atorvastatin, metformin, and lisinopril.[step2.medbullets.com]
Skin Lesion
  • VZV (herpes zoster ophthalmicus): severe pain and skin lesions in a dermatomal pattern involving the ophthalmic division of the trigeminal nerve. Conjunctival injection, redness and serous or purulent discharge. Preauricular adenopathy is common.[hopkinsguides.com]
  • Viral conjunctivitis The onset is acute usually 1-14 days after birth: unilateral/bilateral serosanguinous discharge vesicular skin lesions. Uncommonly it can also lead to systemic infection. 4.4.[intechopen.com]
Photosensitivity
  • Photosensitivity. Tobramycin May damage corneal epithelium. Alternative to gentamicin. Use in treating specific gram negatives and S. aureus.[hopkinsguides.com]
Corneal Deposit
  • Unlike bacterial conjunctivitis, which is usually self-limiting, acute conjunctivitis is associated with significant morbidity such as: Decreased visual acuity or light sensitivity from persistent subepithelial infiltrates (inflammatory corneal deposits[quidel.com]
Distractibility
  • He states that it is very distracting and is making it hard for him to work. The patient denies any recent sick contacts and lives alone. He works as a machinist and is currently struggling with his finances.[step2.medbullets.com]
Neglect
  • Identification of acute bacterial conjunctivitis Clinical features The clinical syndrome ranges from mild redness of the conjunctivae to corneal infiltration and visual disturbances in neglected cases. A purulent exudate is almost always present.[www2.health.vic.gov.au]
Stroke
  • Lee EC, Leem J, Hong YC, Kim H, Kim HC (2008) Effects of Asian Dust Storm Events on Daily Admissions for Asthma and Stroke in Seven Metropolitans of Korea. Epidemiology 19: S145 110.1097/1001.ede.0000339954.0000355923.cc.[journals.plos.org]

Workup

Hypercholesterolemia
  • His past medical history is significant for hypercholesterolemia, type II diabetes mellitus, and hypertension for which he takes atorvastatin, metformin, and lisinopril.[step2.medbullets.com]
Cytoplasmic Inclusion Bodies
  • Smears and conjunctival scrapings should be examined microscopically and stained with Gram stain to identify bacteria and stained with Giemsa stain to identify the characteristic epithelial cell basophilic cytoplasmic inclusion bodies of chlamydial conjunctivitis[msdmanuals.com]
  • Giemsa stain: helpful to identify epithelial cell basophilic cytoplasmic inclusion bodies of chlamydial conjunctivitis (adult inclusion conjunctivitis, usually chronic unilateral, hyperemia and mucopurulent discharge).[hopkinsguides.com]

Treatment

  • Bacterial conjunctivitis: The most common treatment for bacterial conjunctivitis is an antibiotic eye drop or ointment.[quidel.com]
  • The two treatments were found to be equally effective. Leibowitz HM. Antibacterial effectiveness of ciprofloxacin 0.3% ophthalmic solution in the treatment of bacterial conjunctivitis. Am J Ophthalmol. 1991;112(4 Suppl):29S-33S.[hopkinsguides.com]
  • treatment of this disease.[onlinelibrary.wiley.com]
  • Infections that develop despite this treatment require systemic treatment. For gonococcal infection, ceftriaxone 25 to 50 mg/kg IV or IM (not exceeding 125 mg) is given as a single dose.[msdmanuals.com]
  • Nonsteroidal anti-inflammatory agents (NSAIDs) are used for the treatment of allergic conjunctivitis.[emedicine.medscape.com]

Prognosis

  • Administration of topical steroids during the first week following disease onset greatly improves the visual prognosis.[iovs.arvojournals.org]
  • Complications Acute bacterial conjunctivitis is almost invariably a disease with a highly favourable prognosis.[onlinelibrary.wiley.com]
  • Prognosis of viral conjunctivitis Viral conjunctivitis is extremely contagious and remains so for 14 days, which also is often how long the symptoms remain. The prognosis is very good for viral conjunctivitis.[intechopen.com]
  • Prognosis of viral conjunctivitis is very good as most patients will have spontaneous resolution in two weeks.[mcw.edu]

Etiology

  • This review covers the etiology, epidemiology, pathogenesis, diagnosis, and therapy of conjunctivitis in infants and children. Etiology Neonatal conjunctivitis occurs in 1.6% to 12% of newborns during the first month of life.[pedsinreview.aappublications.org]
  • A thorough history and physical examination can generally reliably diagnose acute conjunctivitis and determine its etiology to guide treatment.[contemporaryclinic.pharmacytimes.com]
  • The etiology often can be distinguished on clinical grounds. In keratoconjunctivitis, an associated corneal involvement is present.[emedicine.medscape.com]
  • Differentiating Features in Acute Conjunctivitis Etiology Discharge/Cell Type Eyelid Edema Node Involvement Itching Bacterial Purulent/polymorphonuclear leukocytes Moderate Usually none None Viral Clear/mononuclear cells Minimal Often present None Allergic[msdmanuals.com]
  • Discharge Discharge Associated with Conjunctivitis Etiology Serous Mucoid Mucopurulent Purulent Viral Chlamydial Bacterial Allergic Toxic - - - - - - - - - - Present; - absent. Adapted with permission from Jackson WB.[slideshare.net]

Epidemiology

  • This review covers the etiology, epidemiology, pathogenesis, diagnosis, and therapy of conjunctivitis in infants and children. Etiology Neonatal conjunctivitis occurs in 1.6% to 12% of newborns during the first month of life.[pedsinreview.aappublications.org]
  • The epidemiology of acute bacterial conjunctivitis in Australia due to causes other than trachoma and gonococcal infection is not well documented. Infections are most common in children under five years of age, and incidence decreases with age.[www2.health.vic.gov.au]
  • Epidemiology and diagnosis of acute conjunctivitis at an inner-city hospital. Ophthalmology. 1989;96(8):1215-20. [PMID:2797725] Comment: Johns Hopkins study examined epidemiology of acute conjunctivitis in an inner city population.[hopkinsguides.com]
  • Epidemiology 19: S145 110.1097/1001.ede.0000339954.0000355923.cc. View Article Google Scholar 3.[journals.plos.org]
  • Mycotic keratitis: epidemiology, diagnosis and management. Clin Microbiol Infect 2013;19:210-20. Ong HS, Fung SS, Macleod D, Dart JK, Tuft SJ, Burton MJ.[nps.org.au]
Sex distribution
Age distribution

Prevention

  • Control measures for acute bacterial conjunctivitis Preventive measures Preventative measures include careful treatment of affected eyes and personal hygiene, particularly handwashing.[www2.health.vic.gov.au]
  • Prevention Acute conjunctivitis is a highly infectious disease, capable of spreading widely in the community. The most effective way to prevent acute conjunctivitis is to maintain good personal hygiene.[chp.gov.hk]
  • Treatment includes measures to prevent spread and antibiotics (topical, such as a fluoroquinolone, for causes except gonococcal and chlamydial). Click here for Patient Education[msdmanuals.com]
  • Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1-137.[hopkinsguides.com]
  • Wear sunglasses if eyes are light sensitive Throw away old makeup to prevent re-infection Avoid wearing contact lenses while feeling discomfort, especially if the eyes remain red.[quidel.com]

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