NR569 Differential Diagnosis in Acute Care Final
Study Guide Exam final update Questions and
Answers |With 100% Verified Solutions | Updated &
Verified | 2025
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.**
- 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. 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.
- 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.
Study Guide Exam final update Questions and
Answers |With 100% Verified Solutions | Updated &
Verified | 2025
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.**
- 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. 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.
- 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.
