Full transcript
0:00hi everyone this lesson is on acute
0:01conjunctivitis so q conjunctivitis if we
0:04were to actually break down the word
0:05conjunctivitis the prefix conjunctive
0:08refers to the conjunctiva of the eyes
0:10and the suffix itis refers to
0:12inflammation so acute conjunctivitis is
0:14an inflammation of the conjunctiva of
0:16the eye and acute conjunctivitis is also
0:19known as pink eye and it's known as pink
0:21eye because this condition is
0:23characterized by a red or a pink eye but
0:26not all red or pink eyes are
0:28conjunctivitis so that's also important
0:30to make note of as well now there are
0:31many different causes of acute
0:33conjunctivitis we can break down causes
0:36of conjunctivitis into two main
0:38categories infectious and non-infectious
0:41so infectious are going to be
0:43viral and bacterial conjunctivitis and
0:45non-infections are going to include
0:46allergic and other causes including such
0:49things as chemicals that get into
0:51contact with the conjunctiva and also
0:53mechanical irritation or injury to the
0:56conjunctiva these are also causes of
0:58non-infectious conjunctivitis but the
1:00main causes or the three most common
1:02causes of acute conjunctivitis are
1:05allergic conjunctivitis bacterial
1:07conjunctivitis and viral conductivitis
1:09so we're going to talk about these three
1:11types in this lesson
1:13now the most common type of acute
1:15conjunctivitis is a viral conjunctivitis
1:17and viruses account for approximately 80
1:20of all cases of acute conjunctivitis and
1:22although this is considered the most
1:24common type there are differences
1:26depending on the population that we look
1:29at for instance in children bacterial
1:31conjunctivitis is more common
1:33whereas in adults viral conductivities
1:35is going to be more common and acute
1:37conjunctivitis is going to be a very
1:40common condition and is going to account
1:42for up to one percent of all primary
1:44care visits so before we get into the
1:47causes and the signs and symptoms of
1:49conjunctivitis let's talk about the
1:50anatomy of the conjunctiva of the eye so
1:54the conjunctiva is connective tissue
1:56that lines the outside of the eye and
1:58into the inner eyelids so it overlays
2:01the outside of the eye and then folds in
2:04and covers the inside of the eyelids so
2:07the conjunctive is actually a
2:08transparent and lubricating layer now
2:11there are actually two types or two
2:13layers of the conjunctiva one is known
2:15as the bulbar conjunctiva this is what
2:18layers the outside of the eyeball itself
2:21and then there is the palpebral
2:23conjunctiva that lines the inside of the
2:25eyelid and then there are accessory
2:27lacrimal glands or accessory tear glands
2:30that are located in the conjunctiva and
2:32help to lubricate the conjunctiva and
2:34then the conjunctiva and other parts of
2:36the surface of the eye are colonized by
2:39normal flora including species of
2:41streptococci staphylococci and criney
2:44bacteria so this layer of normal flora
2:47can help reduce some infection by other
2:50pathogenic types of organisms so what
2:53are some of those infective organisms
2:55some of them are going to include
2:56bacteria like staphylococcus aureus
2:59streptococcus pneumoniae hemophilus
3:01influenza or h flu more accelecatoralis
3:04so these three are going to be important
3:07causes of other upper respiratory tract
3:09infections and middle ear infections for
3:11instance
3:12chlamydia trachomatis is also going to
3:14be another important bacteria that
3:15causes bacterial conjunctivitis and
3:18chlamydia trachmatis is actually one of
3:19the most common cause in neonates and
3:22then the other important bacteria that
3:24can cause bacterial conjunctivitis is
3:25niceria gonorrhea so chlamydia
3:27trachmatis and niceri gonorrhea are
3:29going to be sexually transmitted
3:30infections the viruses that cause
3:33conjunctivitis include adenovirus now
3:35adenovice is going to be the most common
3:37cause of a viral conjunctivitis herpes
3:40simplex virus is also another important
3:42cause of conjunctivitis we can also see
3:44varicella or virus causing
3:46conjunctivitis as well
3:47some other viruses that are less common
3:49include enterovirus 70 and some pox
3:52viruses like molluscum contagiosum virus
3:55and then there are other organisms that
3:56can infect the conjunctiva we're not
3:58going to talk about those in this lesson
4:00and these include fungi and protozoa as
4:03well so we'll now briefly talk about the
4:05pathophysiology so again we split it
4:08into the different categories of causes
4:09we talked about before again allergic is
4:12one of those types of conjunctivitis we
4:14talked about so in allergic
4:15conjunctivitis it's not going to be an
4:17infective organism that we had listed in
4:19the previous slide it's going to be an
4:20allergic response so it's going to be an
4:22allergic response to some allergen like
4:25dust or pollen those types of allergens
4:27and there's going to be an allergic
4:29response and there's going to be
4:30histamine release and vasodilation in
4:32response to the allergen itself so
4:34that's going to cause those symptoms of
4:36allergic conjunctivitis and then with
4:38regards to infective organisms there's
4:40going to be alteration or disruption of
4:43the normal floor in some way and then
4:44there can be adherence of pathogenic
4:47organisms to the conjunctiva so again
4:49remember that we've got this normal
4:51flora of organisms that reside or
4:54colonize the conjunctiva in other parts
4:57of the eye and these can help to compete
5:00against those pathogenic organisms but
5:02in some cases there can be some
5:03alteration or disruption of those normal
5:05flora
5:06and then there can be infection or
5:08adherence of those other pathogenic
5:10organisms like we talked about in the
5:12last slide to the conjunctiva those
5:14organisms can then multiply and
5:16overwhelm the host immunity leading to
5:17signs and symptoms
5:19now looking at those infective
5:20conjunctivitis conditions more
5:22specifically
5:23in bacterial conjunctivitis it's going
5:24to be caused by an infection with one of
5:26those bacteria we talked about in the
5:28last slide and typically if it is an
5:30infection with a gram-negative bacteria
5:32it's going to be more virulent or the
5:34condition is going to be more severe so
5:35gram-negative bacteria are going to
5:37include chlamydia trachomatis nicer
5:39gonorrhea and
5:40marxalicatoralis some risk factors for
5:43getting bacterial conjunctivitis are
5:44going to include direct and indirect
5:46contact with an infected individual so
5:48direct meaning that you have a direct
5:51contact with that individual or if it's
5:53indirect it could be where the infected
5:55individual has touched their eyes and
5:57touched other objects in the environment
5:59and then that person comes along and
6:00touches those same objects and then
6:02touches their eyes that could be a way
6:04to get this indirectly contact lens use
6:07is going to be another risk factor for
6:09getting a bacterial conjunctivitis and
6:11then we can also see it with prior
6:13trauma trauma to the eye or a prior eye
6:15condition and with viral conjunctivitis
6:17this is going to be highly contagious
6:19it's going to be even more contagious
6:20than bacterial conjunctivitis and it's
6:23actually going to be contagious as long
6:25as the eyes are red so this condition
6:28can be contagious for weeks and again
6:30the risk factors are going to include
6:32direct and indirect contact with an
6:33infected individual so this is going to
6:35be even more key with viral
6:38conjunctivitis and if a patient has an
6:40upper respiratory tract infection like a
6:41common cold or they're in contact with
6:44someone with an upper respiratory tract
6:45infection this also is a risk factor as
6:47well as upper respiratory tract
6:49infections are associated with viral
6:51conjunctivitis and then once a patient
6:53has that allergic response or gets
6:56infected with a pathogenic organism the
6:59bulber and or palpebral conjunctive are
7:01going to become inflamed so this is
7:03going to be an acute conjunctivitis
7:04condition so let's talk about the
7:06symptoms we're going to break down the
7:08symptoms depending on the type of
7:10conjunctivitis the first type we're
7:12going to talk about is allergic
7:13conjunctivitis so allergic
7:15conjunctivitis is going to occur
7:17bilaterally this is going to be a
7:18systemic condition the patient's going
7:20to have more systemic signs and symptoms
7:22like sneezing runny nose because it's
7:25going to be an allergic response and
7:26because of that they're going to have
7:28both of their eyes being affected so
7:30they're going to have it bilaterally
7:33so they're going to have eye redness and
7:35they may have some conjunctival
7:36injection this is where we see blood
7:38vessels in the whites of the eye and
7:40what's going to be key with allergic
7:42conjunctivitis is itching so itching is
7:44going to be the hallmark finding because
7:46this is an allergic response with
7:48histamine release it's going to be very
7:49itchy for the patient so they're going
7:50to be scratching their eyes and they
7:52could also be rubbing their nose or
7:53sneezing as well and this allergic
7:56conjunctivitis is going to have tearing
7:58and runny eyes
8:00and the discharge is going to be clear
8:01or watery they may also have chemosis
8:04chemosis is where the conjunctiva itself
8:06becomes edematous so there's swelling or
8:08edema so you can see in this image here
8:10the conjunctivity becomes swollen
8:13and they may have a little bit of eye
8:15burning perhaps from the rubbing or from
8:17the itching but there's no pain
8:19and then there's again associated
8:21symptoms because this is due to allergic
8:24responses to some allergen so they're
8:26going to have mucus production and
8:27sneezing and the associated conditions
8:29with allergic conjunctivitis include
8:31allergic rhinitis so hay fever asthma
8:34and atopic dermatitis so these are going
8:36to be the atopic triad now moving on to
8:39bacterial conjunctivitis symptoms
8:41bacterial conjunctivitis is more likely
8:43to be unilateral although it could be
8:44bilateral in some cases so again we're
8:47going to see eye redness
8:48and we can see conjunctival injections
8:50so we can see these blood vessels
8:53here's another image of bacterial
8:55conjunctivitis with chlamydia
8:56trachomatis infection there can also be
8:59itching in some cases so it's not going
9:01to be a hallmark finding like we see in
9:02allergic conductivities they may have
9:04some tearing as well and they're going
9:06to have eye discharge that is going to
9:08be more purulent so
9:10purulent meaning that it's going to be
9:12pus-like so it's going to be white green
9:14and yellow in appearance and there can
9:16be so much eye discharge that a patient
9:18when they fall asleep and they wake up
9:20in the morning
9:21their eyelids can be stuck together or
9:24what we would call glued shut in the
9:26morning so all of that discharge can get
9:28hardened when they're sleeping and their
9:30eyelids get stuck together and they
9:32can't open their eyes their eyes get
9:34glued shut so this is going to be a key
9:36finding with bacterial conjunctivitis
9:38and then if you're to actually zoom in
9:40on some of this discharge it can be more
9:42globular as well there's another form of
9:45bacterial conjunctivitis that's more
9:47severe and this is going to be bacterial
9:49keratitis this is where the cornea
9:51becomes involved this is going to be
9:52more common in people who wear contact
9:55lenses and in this bacterial keratitis
9:58they may have eye pain blurred vision in
10:01photophobia or light sensitivity so
10:03these are going to be more
10:04characteristic findings of a bacterial
10:06keratitis
10:07and then there can be even other
10:09complications of bacterial
10:10conjunctivitis as well including vision
10:12loss and blindness that may occur in
10:14very severe cases and then in some cases
10:16ocular perforations
10:18some of these more severe complications
10:20can occur in chlamydia and gonorrheal
10:23conjunctivitis cases now let's talk
10:25about viral conjunctivitis the signs and
10:27symptoms of viral conjunctivitis can
10:29occur unilaterally or bilaterally so
10:31they can occur on one side of the other
10:33one eye or both eyes so again we're
10:35going to see eye redness
10:37and with viral conjunctivitis we're
10:39going to more commonly see follicles so
10:42follicles are going to be these little
10:44elevated areas that we see so these
10:46little bums so we can see this in viral
10:49conjunctivitis but we could also see it
10:50in allergic inductivity as well there
10:52may be some itching although again this
10:54is going to be a less common finding
10:57there can also be tearing
10:59and what's going to be important here is
11:00that there's going to be a foreign body
11:02sensation so oftentimes patient is going
11:04to feel burning or a gritty sensation
11:07like sand in the eyes so this can be
11:09something that can be noted as well and
11:11then the discharge in viral
11:13conjunctivitis is going to be watery or
11:15serous and in some patients this eye
11:17discharge can lead to some eyelid
11:19stickiness as well so like bacterial
11:21conjunctivitis the eyelids can start to
11:23stick together especially in the morning
11:25when they first wake up but the eyelids
11:27are not going to be as stuck as they are
11:29in bacterial conjunctivitis so there can
11:30be a little bit of stickiness but not as
11:32bad as bacterial conjunctivitis and we
11:34can also see pre-auricular
11:36lymphadenopathy this is going to be a
11:38common finding in viral conjunctivitis
11:40so pre-auricular lymphadenopathy is a
11:44swollen tender lymph node in the front
11:46of the ear this is the pre-auricular
11:48lymph node in this location here so that
11:50could also be
11:51swollen and tender as well in viral
11:53conjunctivitis and there may be eye pain
11:56or irritation especially if the viral
11:58conjunctivitis is caused by herpes
12:00simplex fires but most of the time is
12:02not going to have eye pain or irritation
12:05except for that burning sensation or
12:07gritty sensation we can see with the
12:10foreign body sensation and as we
12:12mentioned before viral conjunctivitis
12:14may be associated with an upper
12:16respiratory tract infection so it could
12:18be that a patient has a viral
12:20conjunctivitis first and then they go on
12:23to having a upper respiratory tract
12:25infection like a common cold or they may
12:27have already had an uprespiratory tract
12:29infection and then once that has
12:31resolved then they have this viral
12:32conjunctivitis after so this is again
12:35associated with an upper respiratory
12:36tract infection and another important
12:38point to note is that there is a more
12:40severe form of viral conjunctivitis and
12:42that is known as viral
12:44keratoconjunctivitis so viral
12:45keratoconjunctivitis is where the
12:47conjunctive and the cornea are involved
12:50so once the cornea becomes involved
12:52there can be some other signs and
12:54symptoms as well these include eye pain
12:56vision loss or vision distortion
12:58photophobia like light sensitivity so
13:00these are going to be similar to the
13:02bacterial keratitis we saw before
13:05increased eye redness so it's going to
13:06be more inflammatory there's going to be
13:08more inflammation and the discharge here
13:10may become purulent so the discharge can
13:13be more purulent in a viral
13:15keratoconjunctivitis
13:17and viral keratoconjunctivitis is going
13:19to be very important because there is
13:21potential for vision loss from it and
13:23it's going to be caused by infection
13:25with adenovirus serotypes 8 11 19 and 37
13:29and herpes simplex fires
13:31so a quick way to remember the different
13:33types of conjunctivitis can be by the
13:35discharge that we can see from the
13:37conjunctivitis
13:38so with allergic conjunctivitis this is
13:40going to be an easy one to spot because
13:42it is due to some allergen and there's
13:44going to be associations with sneezing
13:47mucus production and other atopic triad
13:50conditions so the discharge is going to
13:52be watery or cirrus or mucoceros so this
13:55can be something that can be noted in a
13:57larger connectivity in bacterial
13:59conjunctivitis the discharge is going to
14:01be purulent so we can see this purulent
14:04white yellow or green discharge and the
14:07eyelids are going to be glued together
14:09in the morning in chlamydia and
14:11gonorrheal conjunctivitis we didn't talk
14:13about this in much detail but the
14:15discharge is going to be slightly
14:16different it's going to be mucopurulent
14:18so it's going to be mucusy and purulent
14:20so there's going to be a combination of
14:22the two
14:23and then in viral conjunctivitis it's
14:25going to be serous and watery and in
14:27some cases if it is due to herpes zos or
14:31virus we didn't talk about this before
14:32but if it is due to herpes osteovirus it
14:35can be mucopurulent and if it is a viral
14:38keratoconjunctivitis we may see a more
14:40purulent discharge as well let's talk
14:42about how the different types of
14:44conjunctivitis are diagnosed most of
14:45them are going to be by clinical
14:47diagnosis so just looking at the history
14:49and physical examination the clinician
14:51can often make a diagnosis of the
14:53different types of conjunctivitis but
14:55more specifically if we're to actually
14:56do some different tests and procedures
14:59with allergic conjunctivitis superficial
15:01conjunctival scrapings may be utilized
15:04and this may help in the diagnosis of
15:06allergic conjunctivitis in bacterial
15:08conjunctivitis it could be again by
15:10clinical diagnosis or could be by a
15:12bacterial culture conjunctival scrapings
15:15a gram stain so the gram stain can help
15:16determine if it is caused by a gram
15:18positive or a gram negative bacteria a
15:21gem sustain can be used to detect
15:24intracellular inclusion bodies from
15:26chlamydia so if there is some question
15:28of whether or not this is a chlamydial
15:29conjunctivitis a gem sustain is going to
15:31be important and with bacterial
15:33conjunctivitis we're going to see high
15:34neutrophils when we look at some of
15:36those scrapings
15:37and i didn't mention this before but in
15:39allergic conductivities we're going to
15:40see high levels of eosinophils
15:43and then in viral conjunctivitis we can
15:45also do a culture in conjunctival
15:47cytology smear only usually in severe
15:50recurrent or refractory cases and then
15:52there is a kit that can be used called
15:54adenoplus amino acid to detect for
15:58adenoviral conjunctivitis again this is
16:00going to be the most common type of
16:01conjunctivitis and then we can also use
16:03a fluorescein stain if there is viral
16:06kerato-conjunctivitis so this can help
16:07determine the involvement of the cornea
16:09this fluorescein stain and we can see
16:11high lymphocytes in the conjunctival
16:13smear in viral conjunctivitis so how are
16:16these types of conjunctivitis treated so
16:18again the treatment depends on the
16:20underlying cause if it is an allergic
16:22conjunctivitis allergic conjunctivitis
16:24is going to be seasonal it's going to
16:25occur at different seasons or different
16:27times of the year and it's going to
16:28resolve on its own when the allergen has
16:30been removed in some cases though if a
16:33patient needs symptom relief or if they
16:36are continuously exposed to those
16:38allergens nasal sprays can help
16:40especially with some of those associated
16:42symptoms antioxidants can help as well
16:44cold compress so cold compression of the
16:46eyes can help with some of those
16:48symptoms topical corticosteroids may be
16:50used in some cases in an artificial
16:52tears
16:53with regards to viral conductivitis
16:55viral conjunctivitis usually resolves
16:57spontaneously within two weeks and it
16:59could be up to four weeks and in the
17:01meantime cold compressed and artificial
17:03tears can be a supportive treatment in
17:05some cases though if it is going to be
17:07caused by herpes simplex virus or some
17:10other more severe virus or causes a more
17:13severe case of viral conjunctivitis
17:15ganciclovir and acyclovir may be used in
17:17those cases and then glucocorticoids may
17:19be used in the case of
17:21keratoconjunctivitis especially if there
17:23is a lot of inflammation due to that
17:25viral keratoconus vitis
17:28and with regards to bacterial
17:29conjunctivitis again this is usually a
17:31self-limiting infection lasting one to
17:33two weeks
17:34but what's going to be most helpful is
17:36if the patient gets broad spectrum
17:38antibiotic eye drops so these are going
17:40to be topical antibiotic eye drops that
17:43are used this can help resolve the
17:45bacterial conductivities quite quickly
17:47and then in some very severe cases if
17:50there are systemic signs and symptoms
17:53from this bacterial infection systemic
17:55antibiotics may be used and again it's
17:57going to occur in severe cases or in
17:59cases involving neonates in children and
18:02especially for chlamydial and
18:03gonorrhoeal infections again these are
18:05going to be the causes of very severe
18:07complications in some individuals i hope
18:09you found this lesson helpful if you did
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