Eye started Crying II: Conjunctivitis

Welcome back. We’re going to continue reviewing common eye complaints. This time we’ll focus on the conjunctiva.

conjunctiva

Let’s quickly review. The conjunctiva is a thin, clear lining that covers the anterior portion of the eyes and eyelids.

allergy

Both my eyes have been itchy and red. I’m tearing up a lot, and my nose feels stuffy.

Allergic conjunctivitis is irritation of the conjunctiva caused by exposure to an allergen. Allergic conjunctivitis is usually painless, involves both eyes, and does not include any discharge.
Treatment: Supportive – artificial tears, oral antihistamines, antihistamine drops

viralconjunctivitis

My left eye has been red and a little painful. I wake up with a lot of clear discharge. The light makes the pain worse. My kid had the same thing a week ago and wouldn’t stop touching my face.

Viral conjunctivitis is a viral infection of the conjunctiva, usually caused by Adenovirus. Viral conjunctivitis is very common and very communicable. Clinically, it can be difficult to distinguish from bacterial infections. Fortunately upon examination, the type of discharge usually differentiates the two entities. Viral conjunctivitis is characterized by clear, watery discharge while bacterial conjunctivitis is characterized by thick, mucous-like discharge.
Treatment: Supportive – artificial tears, cold compresses, good hygiene practices to avoid spreading.

bacterialconjunctivis

My right eye has been red and painful. I get a lot of thick eye gunk in the morning. It makes it difficult to open my eye.

Bacterial conjunctivitis is a bacterial infection of the conjunctiva. It is usually caused by Staph aureus, Strep pneuma, or H. influenza. As previous stated, bacterial conjunctivitis is usually distinguished from viral conjunctivitis by thick mucous-like discharge.

Treatment: Bacterial conjunctivitis is usually treated with ophthalmic antibiotics. Erythromycin ointment and/or polymyxin + trimethoprim eye drops are usually prescribed. If the patient wears contact lenses, pseudomonas infection should be considered and covered with a fluoroquinolone or aminoglycoside.

Review chart

image-bacterial-viral-allergic-conjunctivitis

subconjhem

I think my eye is bleeding. I just noticed it this morning. I don’t know what happened, but tt doesn’t really bother me.

Subconjunctival hemorrhage is bleeding from a vessel just underneath the conjunctiva. Bleeding does not cross over to the cornea, and vision is preserved. It is usually asymptomatic. It can be preceded by strong sneeze or cough.

Treatment: Reassurance – the blood will be reabsorbed in a week or two.

pterygium

Sup, dude. I’ve had this thing growing on the side of my eye for years, but recently it’s been making it hard for me see. I need help so I can get back to riding waves ASAP. Thanks, bro.

Pterygium is a benign, fibrous tissue growth over the conjunctiva that extends to corneal surface. It is also called surfer’s eyes. It can be caused by repeated irritation by dust, sand, or dirt.

Treatment: Removal if it is affecting vision. Otherwise, no treatment is necessary.

Pinguecula: It has the same pathophysiology; just a different name.

References:
Walker, Richard A., and Srikar Adhikari. “Chapter 236. Eye Emergencies.”Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7e. Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2011. n. pag. AccessMedicine.Web. 2 Sep. 2016.

Remember, what we do in practice may not always be the right answer on the exam. Frustrating, I know, but don’t cry about it.