EENT DISORDERS
OPHTHALMIC DISORDERS
CONJUNCTIVITIS
● Conjunctiva is the transparent mucosal tissue that lines the eye and
inner surface of the eyelids
● Conjunctivitis is a broad term for a group of conditions that result
in swelling, inflammation, or infection of the conjunctiva
● This inflammation can be hyperacute, acute or chronic in presentation
● Conjunctivitis can be bacterial, viral or allergic in nature.
● Commonly referred to as “pink eye”.
Viral Conjunctivitis
● 70% of all infectious cases viral
● 65-90% is caused by adenovirus (common cold)
● Other viral agents: herpes simplex virus (HSV), rubella,
● measles, varicella-zoster (chickenpox/shingles),
● Epstein-Barr (mono) and Molluscum contagiosum (pox virus)
● Lasts 5-14 days
● Contagious as long as they are tearing or at least 1 week
Clinical Presentation/Chief Complaint
● Recent upper respiratory infection (spread through coughing) or
exposure to sick contacts
● Ocular s/s:
○ onset of red eye
○ excessive watery discharge
○ burning/itching
○ Photophobia
○ watering and foreign body sensation
● Classically it begins in one eye then involves the other eye within a few
days
● Patients are usually able to recall the precise moment symptoms began
● Approximately 50% of the patients will have bilateral involvement
NEW Master EENT 2 - Conjunctivitis and Related Disorders Notes
, ● Resolves spontaneously after 1-2 weeks
Viral Conjunctivitis Treatment
VIRAL: self-limiting and resolves after 5-14 days and treatment is supportive
Pharmacological
● No longer recommend antibiotic treatment prophylactically to prevent
a bacterial infection
● Antihistamine/decongestant
drops Non-pharmacological
● Supportive
● Ocular decongestants
● artificial tears
● cool compresses
REFER TO OPHTHALMOLOGIST IF S/S DO NOT RESOLVE AFTER 7- 10 DAYS OR
WITH CORNEAL INVOLVEMENT
Bacterial Conjunctivitis
Acute Conjunctivitis is most common bacterial infection.
•Typically unilateral but frequently spreads to the
opposite eye Common organisms:
● S. aureus
● S. pneumoniae
● H. influenzae
● M. Catarrhalis
● Pseudomonas spp.
● N. gonorrhea
● C. trachomatis
**Note: Treat contact lens wearers with fluoroquinolone to cover
Pseudomonas;
counsel to discontinue contact lens use until infection has cleared; discard
lens case, eye drops, and disposable lenses
Adults: typically Staphylococcus aureus most common
NEW Master EENT 2 - Conjunctivitis and Related Disorders Notes
, Children: typically Haemophilus influenzae and Streptococcus pneumoniae.
Clinical Presentation/Chief Complaint
● Most commonly spread through direct contact with contaminated
fingers
● Can be categorized as hyperacute, acute or chronic based on s/s
○ Hyperacute:
○ (12 to 24 hours) of symptoms with severe purulent discharge is
highly
○ consistent with Neisseria gonorrhoeae in sexually active adults
○ S/S:
■ copious, purulent yellow or green discharge
■ Pain
■ diminished vision loss
■ both eyes are “sticky or glued shut”
■ worse in the morning
○ •Sudden onset and rapid progression
○ Acute: most common form of bacterial conjunctivitis (S. aureus)
■ S/S: persist less than 3-4 weeks
○ Chronic: s/s: that persist for at least four weeks with frequent
relapses
■ Refer to ophthalmologist
Bacterial Conjunctivitis Treatment
Non-gonococcal, non-chlamydial:
•Erythromycin 0.5% ophthalmic ointment – 1 cm ribbon 4-6x/day x 7days
•Polymyxin B/Trimethoprim ophthalmic solution, 1 drop Q3H while awake x
7-10 days
•Bacitracin/Polymyxin B ophthalmic ointment 1 cm ribbon Q 3-4 hours x 7-10
days
• Fluoroquinolones in case of allergy:
● Ofloxacin oph solution 0.3% 1-2 drops Q 2-4 hours while awake
x 2 days, THEN 4x/day x 5 days
● Ciprofloxacin oph solution 0.3% 1-2 drops Q2H while awake x 2
days, THEN 4x/day x 5 days
● Levofloxacin 0.5% oph solution 1-2 drops Q2H while awake x 2
NEW Master EENT 2 - Conjunctivitis and Related Disorders Notes
, days, THEN 4x/day x 5 days
● Moxifloxacin 0.5% oph solution 1 drop Q8H while awake x 7 days
NEW Master EENT 2 - Conjunctivitis and Related Disorders Notes
OPHTHALMIC DISORDERS
CONJUNCTIVITIS
● Conjunctiva is the transparent mucosal tissue that lines the eye and
inner surface of the eyelids
● Conjunctivitis is a broad term for a group of conditions that result
in swelling, inflammation, or infection of the conjunctiva
● This inflammation can be hyperacute, acute or chronic in presentation
● Conjunctivitis can be bacterial, viral or allergic in nature.
● Commonly referred to as “pink eye”.
Viral Conjunctivitis
● 70% of all infectious cases viral
● 65-90% is caused by adenovirus (common cold)
● Other viral agents: herpes simplex virus (HSV), rubella,
● measles, varicella-zoster (chickenpox/shingles),
● Epstein-Barr (mono) and Molluscum contagiosum (pox virus)
● Lasts 5-14 days
● Contagious as long as they are tearing or at least 1 week
Clinical Presentation/Chief Complaint
● Recent upper respiratory infection (spread through coughing) or
exposure to sick contacts
● Ocular s/s:
○ onset of red eye
○ excessive watery discharge
○ burning/itching
○ Photophobia
○ watering and foreign body sensation
● Classically it begins in one eye then involves the other eye within a few
days
● Patients are usually able to recall the precise moment symptoms began
● Approximately 50% of the patients will have bilateral involvement
NEW Master EENT 2 - Conjunctivitis and Related Disorders Notes
, ● Resolves spontaneously after 1-2 weeks
Viral Conjunctivitis Treatment
VIRAL: self-limiting and resolves after 5-14 days and treatment is supportive
Pharmacological
● No longer recommend antibiotic treatment prophylactically to prevent
a bacterial infection
● Antihistamine/decongestant
drops Non-pharmacological
● Supportive
● Ocular decongestants
● artificial tears
● cool compresses
REFER TO OPHTHALMOLOGIST IF S/S DO NOT RESOLVE AFTER 7- 10 DAYS OR
WITH CORNEAL INVOLVEMENT
Bacterial Conjunctivitis
Acute Conjunctivitis is most common bacterial infection.
•Typically unilateral but frequently spreads to the
opposite eye Common organisms:
● S. aureus
● S. pneumoniae
● H. influenzae
● M. Catarrhalis
● Pseudomonas spp.
● N. gonorrhea
● C. trachomatis
**Note: Treat contact lens wearers with fluoroquinolone to cover
Pseudomonas;
counsel to discontinue contact lens use until infection has cleared; discard
lens case, eye drops, and disposable lenses
Adults: typically Staphylococcus aureus most common
NEW Master EENT 2 - Conjunctivitis and Related Disorders Notes
, Children: typically Haemophilus influenzae and Streptococcus pneumoniae.
Clinical Presentation/Chief Complaint
● Most commonly spread through direct contact with contaminated
fingers
● Can be categorized as hyperacute, acute or chronic based on s/s
○ Hyperacute:
○ (12 to 24 hours) of symptoms with severe purulent discharge is
highly
○ consistent with Neisseria gonorrhoeae in sexually active adults
○ S/S:
■ copious, purulent yellow or green discharge
■ Pain
■ diminished vision loss
■ both eyes are “sticky or glued shut”
■ worse in the morning
○ •Sudden onset and rapid progression
○ Acute: most common form of bacterial conjunctivitis (S. aureus)
■ S/S: persist less than 3-4 weeks
○ Chronic: s/s: that persist for at least four weeks with frequent
relapses
■ Refer to ophthalmologist
Bacterial Conjunctivitis Treatment
Non-gonococcal, non-chlamydial:
•Erythromycin 0.5% ophthalmic ointment – 1 cm ribbon 4-6x/day x 7days
•Polymyxin B/Trimethoprim ophthalmic solution, 1 drop Q3H while awake x
7-10 days
•Bacitracin/Polymyxin B ophthalmic ointment 1 cm ribbon Q 3-4 hours x 7-10
days
• Fluoroquinolones in case of allergy:
● Ofloxacin oph solution 0.3% 1-2 drops Q 2-4 hours while awake
x 2 days, THEN 4x/day x 5 days
● Ciprofloxacin oph solution 0.3% 1-2 drops Q2H while awake x 2
days, THEN 4x/day x 5 days
● Levofloxacin 0.5% oph solution 1-2 drops Q2H while awake x 2
NEW Master EENT 2 - Conjunctivitis and Related Disorders Notes
, days, THEN 4x/day x 5 days
● Moxifloxacin 0.5% oph solution 1 drop Q8H while awake x 7 days
NEW Master EENT 2 - Conjunctivitis and Related Disorders Notes
