NR569 Differential Diagnosis In Acute Care Final Study Guide With
Correct Answers
1. Allergic
-Inflammation of the conjunctiva due to allergies is common, occurring
Conjunc- tivitis
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 con- junctivitis 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
Con- Bacterial conjunctivitis is the second most common cause of infectious
junctivitis con- junctivitis, 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 unilat- eral (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
,NR569 Differential Diagnosis In Acute Care Final Study Guide With
Correct Answers
treated empirically with
topical fluoroquinolones
such as moxifloxacin or
gatifloxixin. If no
,NR569 Differential Diagnosis In Acute Care Final Study Guide With
Correct Answers
improvement within 48 hours, cultures should be repeated and
ophthalmology should be consulted.
3. Toxic Conjunctivi- - Inflammation of the conjunctiva due to medications, chemicals, or
toxins can
tis cause red, itchy eyes.
4. Viral -Viral conjunctivitis is the most common cause of infectious
Conjunctivi- tis 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.
-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 statt become infected, they will have to be
ott for 7 days after symptoms start in SECOND eye.
, NR569 Differential Diagnosis In Acute Care Final Study Guide With
Correct Answers
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. Dis- continue 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
Correct Answers
1. Allergic
-Inflammation of the conjunctiva due to allergies is common, occurring
Conjunc- tivitis
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 con- junctivitis 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
Con- Bacterial conjunctivitis is the second most common cause of infectious
junctivitis con- junctivitis, 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 unilat- eral (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
,NR569 Differential Diagnosis In Acute Care Final Study Guide With
Correct Answers
treated empirically with
topical fluoroquinolones
such as moxifloxacin or
gatifloxixin. If no
,NR569 Differential Diagnosis In Acute Care Final Study Guide With
Correct Answers
improvement within 48 hours, cultures should be repeated and
ophthalmology should be consulted.
3. Toxic Conjunctivi- - Inflammation of the conjunctiva due to medications, chemicals, or
toxins can
tis cause red, itchy eyes.
4. Viral -Viral conjunctivitis is the most common cause of infectious
Conjunctivi- tis 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.
-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 statt become infected, they will have to be
ott for 7 days after symptoms start in SECOND eye.
, NR569 Differential Diagnosis In Acute Care Final Study Guide With
Correct Answers
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. Dis- continue 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
