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.
- 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.**
, Final Exam v1: NR569 / NR 569 (Latest Update
) Differential Diagnosis in Acute Care
Practicum | Review Questions and Answers |
Grade A | 100% Correct – Chamberlain
- 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 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.
, Final Exam v1: NR569 / NR 569 (Latest Update
) Differential Diagnosis in Acute Care
Practicum | Review Questions and Answers |
Grade A | 100% Correct – Chamberlain
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 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.
, Final Exam v1: NR569 / NR 569 (Latest Update
) Differential Diagnosis in Acute Care
Practicum | Review Questions and Answers |
Grade A | 100% Correct – Chamberlain
- 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 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
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.
- TREAT - Treatment for subconjunctival hemorrhage is supportive care. Assess INR level if
patient is on warfarin.
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.
) 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.
- 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.**
, Final Exam v1: NR569 / NR 569 (Latest Update
) Differential Diagnosis in Acute Care
Practicum | Review Questions and Answers |
Grade A | 100% Correct – Chamberlain
- 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 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.
, Final Exam v1: NR569 / NR 569 (Latest Update
) Differential Diagnosis in Acute Care
Practicum | Review Questions and Answers |
Grade A | 100% Correct – Chamberlain
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 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.
, Final Exam v1: NR569 / NR 569 (Latest Update
) Differential Diagnosis in Acute Care
Practicum | Review Questions and Answers |
Grade A | 100% Correct – Chamberlain
- 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 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
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.
- TREAT - Treatment for subconjunctival hemorrhage is supportive care. Assess INR level if
patient is on warfarin.
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.
