Faculty Comments - Vision Change Case 2 - Answer 8:


Question 8: Now that you have a diagnosis, how do you determine the TYPE of conjunctivitis?

Answer:

Comparing the most common types of conjunctivitis:

Acute Bacterial Viral Allergic
Pruritis minimal minimal severe
Tearing moderate profuse moderate
Exudate profuse, esp w/ Neisseria minimal none
U/L or B/L Usually U/L, at least initially Often B/L B/L
Also Often preauricular adenopathy Subconjuctival hemorrhage Associated viral sx Subepithelial cornealopacities  
w/ epidemia keratoconjuct  
Zoster rash w/ aphthalmic    branch of trigem’l nerve w/ varicella-zoster blepharoconjuct.
Measles’ rash/Koplik spots 		 Sneezing Vernal conj recurrent in  warm weather assoc’d w/ large “cobblestone papillae ”  Giant papillary conj has very similar appearance w/ less pruritis & also seen w/ soft contact use.
Causes Usually Staph a., Strep pneumo, H.flu, N.gonorrhoeae, N.meningiditidis Adenoviruses types 3,4,7 (pharyngitis&conjuct)
Adenoviruses types 8,19 (epidemic keratoconjunct.)
Adenovirus 11, Coxsackie 
   A24,enterovirus 70 (acute  
   hemorrhagic conjuctivitis) 
Herpes Simplex and Zoster
Coxsackievirus type A28
Molluscum contagiosum
Varicella
Measles 		Rhinoconjuctivitis (hay fever) Vernal conjunctivitis
Giant papillary conjunctivitis  
Delayed (cellular) 
    Autoimmune (Sjogren’s, pemphigoid, Wegener’s granulomatosis)
Other Misc Causes:
Rickettsial, fungal, parasitic, tuberculosis, syphilis, Kawasaki disease, thyroid disease, gout, carcinoid, sarcoidosis, psoriasis, Stevens-Johnson syndrome, Reiter's syndrome.
 Return to Vision Change Case 2, Question 8



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