NR569 Differential Diagnosis in Acute Care Final Study Guide
Study online at https://quizlet.com/_dscg88
1. Allergic Con- - Inflammation of the conjunctiva due to allergies is com-
junctivitis mon, 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) , gen-
eralized 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 Con- Bacterial conjunctivitis is the second most common cause
junctivitis of infectious conjunctivitis, Red, itchy eyes are associated
with this condition, as is purulent or mucopurulent dis-
charge 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
, NR569 Differential Diagnosis in Acute Care Final Study Guide
Study online at https://quizlet.com/_dscg88
disease may be treated empirically with topical fluoro-
quinolones such as moxifloxacin or gatifloxixin. If no im-
provement within 48 hours, cultures should be repeated
and ophthalmology should be consulted.
3. Toxic Conjunc- - Inflammation of the conjunctiva due to medications,
tivitis chemicals, or toxins can cause red, itchy eyes.
4. Viral Conjunc- - Viral conjunctivitis is the most common cause of infec-
tivitis tious conjunctivitis. Red, itchy eyes are associated with
this condition, as is a watery discharge.
**65-90 % of viral conjunctivitis are caused by aden-
oviruses, 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 staff be-
come infected, they will have to be off for 7 days after
symptoms start in SECOND eye.
, NR569 Differential Diagnosis in Acute Care Final Study Guide
Study online at https://quizlet.com/_dscg88
5. Blepharitis - Blepharitis, or inflammation of the eyelids, is character-
ized 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 antibi-
otics. 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 Abra- - Corneal abrasion is characterized by an alteration in
sion the epithelial layer of the cornea due to trauma, foreign
bodies, or chemical exposure. This condition is character-
ized 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. Con-
sider topical ophthalmic antibiotics appropriate for the
etiology of the abrasion (i.e., organic material, finger
cat scratch), such as erythromycin ointment or trimetho-
prim-polyumyxin B. Consider pseudomonas with contact
lens, mascara, organic material as a foreign body etiolo-
gy: treat with topical fluoroquinolone. If evidence of bac-
, NR569 Differential Diagnosis in Acute Care Final Study Guide
Study online at https://quizlet.com/_dscg88
terial keratitis, corneal opacification, or corneal infection,
or globe penetration, EMERGENT OPHTHALMOLOGY
CONSULTATION IS INDICATED.
7. Subconjunctival Subconjunctival hemorrhage is bleeding below the con-
Hemorrhage junctiva 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, 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 ophthalmology is appropriate.
9. Chalazion 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,
Study online at https://quizlet.com/_dscg88
1. Allergic Con- - Inflammation of the conjunctiva due to allergies is com-
junctivitis mon, 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) , gen-
eralized 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 Con- Bacterial conjunctivitis is the second most common cause
junctivitis of infectious conjunctivitis, Red, itchy eyes are associated
with this condition, as is purulent or mucopurulent dis-
charge 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
, NR569 Differential Diagnosis in Acute Care Final Study Guide
Study online at https://quizlet.com/_dscg88
disease may be treated empirically with topical fluoro-
quinolones such as moxifloxacin or gatifloxixin. If no im-
provement within 48 hours, cultures should be repeated
and ophthalmology should be consulted.
3. Toxic Conjunc- - Inflammation of the conjunctiva due to medications,
tivitis chemicals, or toxins can cause red, itchy eyes.
4. Viral Conjunc- - Viral conjunctivitis is the most common cause of infec-
tivitis tious conjunctivitis. Red, itchy eyes are associated with
this condition, as is a watery discharge.
**65-90 % of viral conjunctivitis are caused by aden-
oviruses, 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 staff be-
come infected, they will have to be off for 7 days after
symptoms start in SECOND eye.
, NR569 Differential Diagnosis in Acute Care Final Study Guide
Study online at https://quizlet.com/_dscg88
5. Blepharitis - Blepharitis, or inflammation of the eyelids, is character-
ized 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 antibi-
otics. 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 Abra- - Corneal abrasion is characterized by an alteration in
sion the epithelial layer of the cornea due to trauma, foreign
bodies, or chemical exposure. This condition is character-
ized 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. Con-
sider topical ophthalmic antibiotics appropriate for the
etiology of the abrasion (i.e., organic material, finger
cat scratch), such as erythromycin ointment or trimetho-
prim-polyumyxin B. Consider pseudomonas with contact
lens, mascara, organic material as a foreign body etiolo-
gy: treat with topical fluoroquinolone. If evidence of bac-
, NR569 Differential Diagnosis in Acute Care Final Study Guide
Study online at https://quizlet.com/_dscg88
terial keratitis, corneal opacification, or corneal infection,
or globe penetration, EMERGENT OPHTHALMOLOGY
CONSULTATION IS INDICATED.
7. Subconjunctival Subconjunctival hemorrhage is bleeding below the con-
Hemorrhage junctiva 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, 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 ophthalmology is appropriate.
9. Chalazion 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,
