Allergic Conjunctivitis - ANSWER - Inflammation of the conjunctiva due to allergies is
common, occurring in up to 40% of the population. Itching is the most consistent sign of al-
lergic conjunctivitis; it is also characterized by red eyes and other allergic disease symptoms
such as sneezing.
- Symptoms: severe itching (MOST PROMINENT) , generalized hyperemia of the conjunctiva,
& mild-moderate tearing. Rubbing of eyelids can lead to eyelid edema and temporary hyper-
pigmentation (allergic shiners/raccoon eyes). Allergic conjunctivitis often accompanied by
s/s of allergic rhinitis, including the presence of a crease on the nose from frequent manipu-
lation (toddler salute).
- Treatment: Mild-moderate symptoms ma be managed with artificial tears and cool/cold
compresses. Severe s/s may require an ophthalmology consultation, and immune modula-
tion with topical antihistamine, mast cell stabilizer, or mild steroid.
Bacterial Conjunctivitis - ANSWER Bacterial conjunctivitis is the second most common
cause of infectious conjunctivitis, Red, itchy eyes are associated with this condition, as is pu-
rulent or mucopurulent discharge in one or both eyes.
- Symptoms: copious mucopurulent discharge (MOST PROMINENT), often unilateral (helps
distinguish from allergic/viral etiology) but may spread to both eyes via hands when rubbing
eyes, and pain/irritation with severe hyperemia. **There should be NO frank vision loss.**
- Treatment: Usually with topical antibiotic ointments or drops.
**Otherwise immunocompetent patients with unilateral disease may be treated empirically
with topical fluoroquinolones such as moxifloxacin or gatifloxixin. If no improvement within
48 hours, cultures should be repeated and ophthalmology should be consulted.
1
,Toxic Conjunctivitis - ANSWER - Inflammation of the conjunctiva due to medications,
chemicals, or toxins can cause red, itchy eyes.
Viral Conjunctivitis - ANSWER - Viral conjunctivitis is the most common cause of infec-
tious conjunctivitis. Red, itchy eyes are associated with this condition, as is a watery dis-
charge.
**65-90 % of viral conjunctivitis are caused by adenoviruses, which are highly contagious
and spread through direct contact. Communicability is estimated to be 10-14 days. Topical
ophthalmic antihistamines (preferably OTC) may be recommended to reduce itching and
soothe the eyes.
- Symptoms: Usually presents bilaterally, but symptoms often start in 1 eye 1-2 days prior.
Pain and burning are the MOST PROMINENT symptoms, and eyes are very red with copious
tearing. Preauricular lymph node may be palpated, which is relatively specific to viral etiol-
ogy. **Symptoms tend to worsen for the first few days, and generally resolve within 1-2
weeks.**
**Hand washing and contact precautions are imperative to prevent the spread of infec-
tion.** If hospital staff become infected, they will have to be off for 7 days after symptoms
start in SECOND eye.
Blepharitis - ANSWER - Blepharitis, or inflammation of the eyelids, is characterized by
redness at the margins of the eyelids. Symptoms of blepharitis include: dry, red, itchy eyelids
that may be crusted.
- TREAT - Treatment involves supportive care and antibiotics. Supportive care: Use warm
compresses to loosen the eyelid crusting. Gently scrub the eyelids with diluted baby sham-
poo at least twice daily. Use artificial tears to lubricate eyes as needed. Discontinue eye
make-up until condition resolves and then re-start with new products. Topical antibiotics:
Agents with gram positive coverage - erythromycin or ciprofloxacin ophthalmic ointment.
Corneal Abrasion - ANSWER - Corneal abrasion is characterized by an alteration in the
epithelial layer of the cornea due to trauma, foreign bodies, or chemical exposure. This
2
,condition is characterized by redness; however, pain, tearing, and sensitivity to light are the
more typical symptoms. Corneal abrasion is typically unilateral given the etiology.
- TREAT - Treatment involves removal of foreign body and supportive care. Discontinue con-
tact lens use. Consider topical ophthalmic antibiotics appropriate for the etiology of the
abrasion (i.e., organic material, finger cat scratch), such as erythromycin ointment or trime-
thoprim-polyumyxin B. Consider pseudomonas with contact lens, mascara, organic material
as a foreign body etiology: treat with topical fluoroquinolone. If evidence of bacterial kerati-
tis, corneal opacification, or corneal infection, or globe penetration, EMERGENT OPHTHAL-
MOLOGY CONSULTATION IS INDICATED.
Subconjunctival Hemorrhage - ANSWER Subconjunctival hemorrhage is bleeding be-
low the conjunctiva and is characterized by a red patch on the sclera of the eye, rather than
generalized redness and/or itching.
- TREAT - Treatment for subconjunctival hemorrhage is supportive care. Assess INR level if
patient is on warfarin.
Uveitis - ANSWER Inflammation of the uveal tract of the eye, including the iris, ciliary
body, and choroid. It may be characterized by an irregularly shaped pupil, inflammation
around the cornea, pus in the anterior chamber, opaque deposits on the cornea, pain, and
lacrimation. The most common form of uveitis is iritis. Symptoms include: redness, pain,
light sensitivity, blurred vision.
- REFER - Uveitis is associated with loss of vision from retinal scarring; referral to ophthalmol-
ogy is appropriate.
Chalazion - ANSWER An inflamed nodule (lump) that develops on the eyelid. Chalazia
are caused by the bacterial infection of glands in the eyelid. The infection may result from
poor hygiene or an existing skin condition affecting the face, such as rosacea. Chalazia vary
in size and location in the eyelid, depending on which type of gland is obstructed.
When a sebaceous gland in the eyelid becomes infected, bacterial and oily secretions initiate
an inflammatory response that blocks the gland and causes a rounded bump to form.
3
, Superficial chalazia form when glands along the edge of the eyelid become infected and
blocked.
Deep chalazia form when meibomian glands in the conjunctival portion of the eyelid (lid lin-
ing) become infected and blocked.
Chalazia are usually painless.
- TREAT - Treatment involves warm compresses and massage to promote drainage. Chalazi-
ons disappear without treatment within several weeks to a month, although they often re-
cur. Surgical excision may be required if not resolved or if complications are present.
Chalazion Etiology - ANSWER Caused by thickening of the fluid in the oil glands (mei-
bomian glands) of the eyelid. Most commonly occurs on the UPPER eyelid, but can also af-
fect the lower eyelid.
More common in adults than children; most frequently occurs in people 30-50
Chalazion HPI - ANSWER - Small red and swollen area of the eyelid forms a painless,
slow-growing lump the size of a pea.
- Gradual onset over several weeks.
- Tearing and mild irritation may result as the obstructed glands are needed for healthy
tears.
- Blurred vision occurs if the chalazion is large enough to press against the eyeball.
- Rarely, may be an indication of an infection or skin cancer.
- Risk Factors: Acne rosacea, chronic blepharitis, seborrhea, tuberculosis, and viral infection.
- Assess for symptoms and the presence of any possible contributing general health prob-
lems.
Chalazion Exam Findings - ANSWER - The eyelid will be diffusely swollen.
- Within 1-2 days, a small non-tender nodule or lump develops.
- A chalazion usually drains through the inner surface of the eyelid or is absorbed spontane-
ously over 2-8 weeks.
4
common, occurring in up to 40% of the population. Itching is the most consistent sign of al-
lergic conjunctivitis; it is also characterized by red eyes and other allergic disease symptoms
such as sneezing.
- Symptoms: severe itching (MOST PROMINENT) , generalized hyperemia of the conjunctiva,
& mild-moderate tearing. Rubbing of eyelids can lead to eyelid edema and temporary hyper-
pigmentation (allergic shiners/raccoon eyes). Allergic conjunctivitis often accompanied by
s/s of allergic rhinitis, including the presence of a crease on the nose from frequent manipu-
lation (toddler salute).
- Treatment: Mild-moderate symptoms ma be managed with artificial tears and cool/cold
compresses. Severe s/s may require an ophthalmology consultation, and immune modula-
tion with topical antihistamine, mast cell stabilizer, or mild steroid.
Bacterial Conjunctivitis - ANSWER Bacterial conjunctivitis is the second most common
cause of infectious conjunctivitis, Red, itchy eyes are associated with this condition, as is pu-
rulent or mucopurulent discharge in one or both eyes.
- Symptoms: copious mucopurulent discharge (MOST PROMINENT), often unilateral (helps
distinguish from allergic/viral etiology) but may spread to both eyes via hands when rubbing
eyes, and pain/irritation with severe hyperemia. **There should be NO frank vision loss.**
- Treatment: Usually with topical antibiotic ointments or drops.
**Otherwise immunocompetent patients with unilateral disease may be treated empirically
with topical fluoroquinolones such as moxifloxacin or gatifloxixin. If no improvement within
48 hours, cultures should be repeated and ophthalmology should be consulted.
1
,Toxic Conjunctivitis - ANSWER - Inflammation of the conjunctiva due to medications,
chemicals, or toxins can cause red, itchy eyes.
Viral Conjunctivitis - ANSWER - Viral conjunctivitis is the most common cause of infec-
tious conjunctivitis. Red, itchy eyes are associated with this condition, as is a watery dis-
charge.
**65-90 % of viral conjunctivitis are caused by adenoviruses, which are highly contagious
and spread through direct contact. Communicability is estimated to be 10-14 days. Topical
ophthalmic antihistamines (preferably OTC) may be recommended to reduce itching and
soothe the eyes.
- Symptoms: Usually presents bilaterally, but symptoms often start in 1 eye 1-2 days prior.
Pain and burning are the MOST PROMINENT symptoms, and eyes are very red with copious
tearing. Preauricular lymph node may be palpated, which is relatively specific to viral etiol-
ogy. **Symptoms tend to worsen for the first few days, and generally resolve within 1-2
weeks.**
**Hand washing and contact precautions are imperative to prevent the spread of infec-
tion.** If hospital staff become infected, they will have to be off for 7 days after symptoms
start in SECOND eye.
Blepharitis - ANSWER - Blepharitis, or inflammation of the eyelids, is characterized by
redness at the margins of the eyelids. Symptoms of blepharitis include: dry, red, itchy eyelids
that may be crusted.
- TREAT - Treatment involves supportive care and antibiotics. Supportive care: Use warm
compresses to loosen the eyelid crusting. Gently scrub the eyelids with diluted baby sham-
poo at least twice daily. Use artificial tears to lubricate eyes as needed. Discontinue eye
make-up until condition resolves and then re-start with new products. Topical antibiotics:
Agents with gram positive coverage - erythromycin or ciprofloxacin ophthalmic ointment.
Corneal Abrasion - ANSWER - Corneal abrasion is characterized by an alteration in the
epithelial layer of the cornea due to trauma, foreign bodies, or chemical exposure. This
2
,condition is characterized by redness; however, pain, tearing, and sensitivity to light are the
more typical symptoms. Corneal abrasion is typically unilateral given the etiology.
- TREAT - Treatment involves removal of foreign body and supportive care. Discontinue con-
tact lens use. Consider topical ophthalmic antibiotics appropriate for the etiology of the
abrasion (i.e., organic material, finger cat scratch), such as erythromycin ointment or trime-
thoprim-polyumyxin B. Consider pseudomonas with contact lens, mascara, organic material
as a foreign body etiology: treat with topical fluoroquinolone. If evidence of bacterial kerati-
tis, corneal opacification, or corneal infection, or globe penetration, EMERGENT OPHTHAL-
MOLOGY CONSULTATION IS INDICATED.
Subconjunctival Hemorrhage - ANSWER Subconjunctival hemorrhage is bleeding be-
low the conjunctiva and is characterized by a red patch on the sclera of the eye, rather than
generalized redness and/or itching.
- TREAT - Treatment for subconjunctival hemorrhage is supportive care. Assess INR level if
patient is on warfarin.
Uveitis - ANSWER Inflammation of the uveal tract of the eye, including the iris, ciliary
body, and choroid. It may be characterized by an irregularly shaped pupil, inflammation
around the cornea, pus in the anterior chamber, opaque deposits on the cornea, pain, and
lacrimation. The most common form of uveitis is iritis. Symptoms include: redness, pain,
light sensitivity, blurred vision.
- REFER - Uveitis is associated with loss of vision from retinal scarring; referral to ophthalmol-
ogy is appropriate.
Chalazion - ANSWER An inflamed nodule (lump) that develops on the eyelid. Chalazia
are caused by the bacterial infection of glands in the eyelid. The infection may result from
poor hygiene or an existing skin condition affecting the face, such as rosacea. Chalazia vary
in size and location in the eyelid, depending on which type of gland is obstructed.
When a sebaceous gland in the eyelid becomes infected, bacterial and oily secretions initiate
an inflammatory response that blocks the gland and causes a rounded bump to form.
3
, Superficial chalazia form when glands along the edge of the eyelid become infected and
blocked.
Deep chalazia form when meibomian glands in the conjunctival portion of the eyelid (lid lin-
ing) become infected and blocked.
Chalazia are usually painless.
- TREAT - Treatment involves warm compresses and massage to promote drainage. Chalazi-
ons disappear without treatment within several weeks to a month, although they often re-
cur. Surgical excision may be required if not resolved or if complications are present.
Chalazion Etiology - ANSWER Caused by thickening of the fluid in the oil glands (mei-
bomian glands) of the eyelid. Most commonly occurs on the UPPER eyelid, but can also af-
fect the lower eyelid.
More common in adults than children; most frequently occurs in people 30-50
Chalazion HPI - ANSWER - Small red and swollen area of the eyelid forms a painless,
slow-growing lump the size of a pea.
- Gradual onset over several weeks.
- Tearing and mild irritation may result as the obstructed glands are needed for healthy
tears.
- Blurred vision occurs if the chalazion is large enough to press against the eyeball.
- Rarely, may be an indication of an infection or skin cancer.
- Risk Factors: Acne rosacea, chronic blepharitis, seborrhea, tuberculosis, and viral infection.
- Assess for symptoms and the presence of any possible contributing general health prob-
lems.
Chalazion Exam Findings - ANSWER - The eyelid will be diffusely swollen.
- Within 1-2 days, a small non-tender nodule or lump develops.
- A chalazion usually drains through the inner surface of the eyelid or is absorbed spontane-
ously over 2-8 weeks.
4
