NR569 Differential Diagnosis In Acute Care Final Study
Guide Questions With 100% Correct Answers
1. Allergic Conjunctivitis: - Inflammation of the conjunctiva due to allergies is
common, occurring in up to 40% of the population. Itching is the most
consistent sign of allergic 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 hyperpigmentation (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 manipulation
(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 modulation with topical antihistamine, mast cell
stabilizer, or mild steroid.
2. Bacterial Conjunctivitis: Bacterial conjunctivitis is the second most
common cause of infectious conjunctivitis, Red, itchy eyes are associated
with this condition, as is purulent 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.
3. Toxic Conjunctivitis: - Inflammation of the conjunctiva due to
medications, chemicals, or toxins can cause red, itchy eyes.
4. Viral Conjunctivitis: - Viral conjunctivitis is the most common cause of
infectious conjunctivitis. Red, itchy eyes are associated with this condition, as
is a watery discharge.
**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.
,NR569 Differential Diagnosis In Acute Care Final Study
Guide Questions With 100% Correct Answers
- 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 etiology. **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 infection.** If hospital staff become infected, they will have to be
off for 7 days after symptoms start in SECOND eye.
5. Blepharitis: - 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 shampoo 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.
, 6. Corneal Abrasion: - Corneal abrasion is characterized by an alteration in the
epithelial layer of the cornea due to trauma, foreign bodies, or chemical
exposure. This 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 contact 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 trimethoprim-polyumyxin B.
Consider pseudomonas with contact lens, mascara, organic material as a
foreign body etiology: treat with topical fluoroquinolone. If evidence of
bacterial keratitis, corneal opacification, or corneal infection, or globe
penetration, EMERGENT OPHTHALMOLOGY CONSULTATION IS INDICATED.
7. Subconjunctival Hemorrhage: Subconjunctival hemorrhage is bleeding
below 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.8. Uveitis: 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,
Guide Questions With 100% Correct Answers
1. Allergic Conjunctivitis: - Inflammation of the conjunctiva due to allergies is
common, occurring in up to 40% of the population. Itching is the most
consistent sign of allergic 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 hyperpigmentation (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 manipulation
(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 modulation with topical antihistamine, mast cell
stabilizer, or mild steroid.
2. Bacterial Conjunctivitis: Bacterial conjunctivitis is the second most
common cause of infectious conjunctivitis, Red, itchy eyes are associated
with this condition, as is purulent 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.
3. Toxic Conjunctivitis: - Inflammation of the conjunctiva due to
medications, chemicals, or toxins can cause red, itchy eyes.
4. Viral Conjunctivitis: - Viral conjunctivitis is the most common cause of
infectious conjunctivitis. Red, itchy eyes are associated with this condition, as
is a watery discharge.
**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.
,NR569 Differential Diagnosis In Acute Care Final Study
Guide Questions With 100% Correct Answers
- 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 etiology. **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 infection.** If hospital staff become infected, they will have to be
off for 7 days after symptoms start in SECOND eye.
5. Blepharitis: - 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 shampoo 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.
, 6. Corneal Abrasion: - Corneal abrasion is characterized by an alteration in the
epithelial layer of the cornea due to trauma, foreign bodies, or chemical
exposure. This 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 contact 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 trimethoprim-polyumyxin B.
Consider pseudomonas with contact lens, mascara, organic material as a
foreign body etiology: treat with topical fluoroquinolone. If evidence of
bacterial keratitis, corneal opacification, or corneal infection, or globe
penetration, EMERGENT OPHTHALMOLOGY CONSULTATION IS INDICATED.
7. Subconjunctival Hemorrhage: Subconjunctival hemorrhage is bleeding
below 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.8. Uveitis: 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,
