NR569 Differential Diagnosis in Acute Care Final Study Guide
Study online at https://quizlet.com/_dscg88
1. Allergic Conjunc- - Inflammation of the conjunctiva due to allergies is common, occurring in up to
tivitis 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 con-
junctivitis 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 treated
empirically with topical fluoroquinolones such as moxifloxacin or gatifloxixin. If no
, NR569 Differential Diagnosis in Acute Care Final Study Guide
Study online at https://quizlet.com/_dscg88
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 Conjunctivi- - Viral conjunctivitis is the most common cause of infectious conjunctivitis. Red,
tis 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 staff become 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 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
corneal infection, or globe penetration, EMERGENT OPHTHALMOLOGY CONSUL-
TATION IS INDICATED.
, NR569 Differential Diagnosis in Acute Care Final Study Guide
Study online at https://quizlet.com/_dscg88
7. Subconjunctival Subconjunctival hemorrhage is bleeding below the conjunctiva and is charac-
Hemorrhage terized 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, bacterial and oily
secretions initiate an inflammatory response that blocks the gland and causes a
Study online at https://quizlet.com/_dscg88
1. Allergic Conjunc- - Inflammation of the conjunctiva due to allergies is common, occurring in up to
tivitis 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 con-
junctivitis 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 treated
empirically with topical fluoroquinolones such as moxifloxacin or gatifloxixin. If no
, NR569 Differential Diagnosis in Acute Care Final Study Guide
Study online at https://quizlet.com/_dscg88
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 Conjunctivi- - Viral conjunctivitis is the most common cause of infectious conjunctivitis. Red,
tis 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 staff become 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 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
corneal infection, or globe penetration, EMERGENT OPHTHALMOLOGY CONSUL-
TATION IS INDICATED.
, NR569 Differential Diagnosis in Acute Care Final Study Guide
Study online at https://quizlet.com/_dscg88
7. Subconjunctival Subconjunctival hemorrhage is bleeding below the conjunctiva and is charac-
Hemorrhage terized 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, bacterial and oily
secretions initiate an inflammatory response that blocks the gland and causes a
