Final Exam v1: NR569 / NR 569 (Latest
Update
) Differential Diagnosis in Acute
Care
Practicum | Review Questions and Answers |
Grade A | 100% Correct – Chamberlain
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.
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.
, Final Exam v1: NR569 / NR 569 (Latest
Update
) Differential Diagnosis in Acute
Care
Practicum | Review Questions and Answers |
Grade A | 100% Correct – Chamberlain
- 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.
Toxic Conjunctivitis
- Inflammation of the conjunctiva due to medications, chemicals, or toxins
can cause red, itchy eyes.
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
, Final Exam v1: NR569 / NR 569 (Latest
Update
) Differential Diagnosis in Acute
Care
Practicum | Review Questions and Answers |
Grade A | 100% Correct – Chamberlain
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
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.
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
, Final Exam v1: NR569 / NR 569 (Latest
Update
) Differential Diagnosis in Acute
Care
Practicum | Review Questions and Answers |
Grade A | 100% Correct – Chamberlain
and then re-start with new products. Topical antibiotics: Agents with gram
positive coverage - erythromycin or ciprofloxacin ophthalmic ointment.
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 trimethoprimpolyumyxin 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.
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.
Update
) Differential Diagnosis in Acute
Care
Practicum | Review Questions and Answers |
Grade A | 100% Correct – Chamberlain
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.
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.
, Final Exam v1: NR569 / NR 569 (Latest
Update
) Differential Diagnosis in Acute
Care
Practicum | Review Questions and Answers |
Grade A | 100% Correct – Chamberlain
- 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.
Toxic Conjunctivitis
- Inflammation of the conjunctiva due to medications, chemicals, or toxins
can cause red, itchy eyes.
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
, Final Exam v1: NR569 / NR 569 (Latest
Update
) Differential Diagnosis in Acute
Care
Practicum | Review Questions and Answers |
Grade A | 100% Correct – Chamberlain
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
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.
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
, Final Exam v1: NR569 / NR 569 (Latest
Update
) Differential Diagnosis in Acute
Care
Practicum | Review Questions and Answers |
Grade A | 100% Correct – Chamberlain
and then re-start with new products. Topical antibiotics: Agents with gram
positive coverage - erythromycin or ciprofloxacin ophthalmic ointment.
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 trimethoprimpolyumyxin 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.
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.
