Download Acute Hemorrhagic Conjunctivitis

Case 7
• 45 year old
• Male
• Chief Complaint: Swelling of the Left Eye
One week
• Upper Respiratory Tract Infection
• Tearing of the Left Eye
• Eye Redness
• Lid swelling
• No medication
• Diplopia
• Increase swelling of the Left Eye
Three days • High Grade Fever
One day
• Persistence of symptoms
• Blurring of Vision
• Hence CONSULT
P.E.
• Visual acuity- 20/20 right eye, 20/200 left eye
• Swelling of the left eye
• Positive relative afferent pupillary defect left
eye.
• Intraocular pressure 19mm Hg both eyes
• Cornea was clear, No lens opacity
• Fundoscopy: +ROR, clear media, distinct disc
margin, no hemorrhage, no exudates, AV 2:3,
C/D 0.3, both eyes
Pertinent Data
45 y/o Male
Swelling of the Left Eye
20/20 right eye, 20/200 left
eye
(+) RAPD left eye
Tearing of the Left Eye
IOP- 19 mmHg both eyes
Eye Redness
Lid swelling
No medication
DIFFERENTIAL DIAGNOSIS
“Red Eye”
– Viral conjunctivitis
– Allergic conjunctivitis
– Bacterial conjunctivitis
– Drug toxicity
– Episcleritis, Scleritis
– Iritis, Uveitis, Keratitis
Discharge
ETIOLOGY
SEROUS
MUCOID
MUCOPURULENT
PURULENT
Viral
+
-
-
-
Chlamydial
-
+
+
-
Bacterial
-
-
+
+
Allergic
+
+
-
-
Toxic
+
+
+
-
Upper Respiratory Tract Infection
• Viral conjunctivitis
• Chlamydia conjunctivitis
• Gonococcal conjunctivitis
VIRAL CONJUNCTIVITIS
VIRAL CONJUNCTIVITIS
•
•
•
•
•
Pharyngoconjunctival Fever
Epidemic Keratoconjunctivitis
Herpes Simplex Virus Conjunctivitis
Newcastle Disease Conjunctivitis
Acute Hemorrhagic Conjunctivitis
VIRAL CONJUNCTIVITIS
• Pharyngoconjunctival Fever
–
–
–
–
–
–
–
•
•
•
•
Caused by adenovirus type 3 (also 4 and 7)
Fever: 38.3-40 C
Sore throat
Follicular conjunctivitis in one or both eyes
Bilateral or unilateral
Injection and tearing
Preauricular lymphadenopathy (nontender)
Epidemic Keratoconjunctivitis
Herpes Simplex Virus Conjunctivitis
Newcastle Disease Conjunctivitis
Acute Hemorrhagic Conjunctivitis
VIRAL CONJUNCTIVITIS
• Pharyngoconjunctival Fever
• Epidemic Keratoconjunctivitis
–
–
–
–
Caused by adenovirus types 8, 19, 29, 37
Usually bilateral
Injection, moderate pain, and tearing
Photophobia, epithelial keratitis, and round subepithelial opacities (514 days)
– Acute phase: edema of te eyelids, chemosis, and conjunctival
hyperemia
– Pseudomembranes occur
– Lasts 3-4 weeks at most
• Herpes Simplex Virus Conjunctivitis
• Newcastle Disease Conjunctivitis
• Acute Hemorrhagic Conjunctivitis
VIRAL CONJUNCTIVITIS
• Pharyngoconjunctival Fever
• Epidemic Keratoconjunctivitis
• Herpes Simplex Virus Conjunctivitis
–
–
–
–
–
–
–
caused by type 1 (most common) and type 2 (newborn)
Disease of young children
Unilateral injection
Irritation
Mucoid discharge
Pain
Mild photophobia
• Newcastle Disease Conjunctivitis
• Acute Hemorrhagic Conjunctivitis
VIRAL CONJUNCTIVITIS
•
•
•
•
Pharyngoconjunctival Fever
Epidemic Keratoconjunctivitis
Herpes Simplex Virus Conjunctivitis
Newcastle Disease Conjunctivitis
– Burning, itching, pain, redness, tearing, blurring of
vision
– Occurs in small epidemics among poultry workers
• Acute Hemorrhagic Conjunctivitis
VIRAL CONJUNCTIVITIS
•
•
•
•
•
Pharyngoconjunctival Fever
Epidemic Keratoconjunctivitis
Herpes Simplex Virus Conjunctivitis
Newcastle Disease Conjunctivitis
Acute Hemorrhagic Conjunctivitis
– Caused b enterovirus type 70 and coxsackievirus A24
– Short incubation period and course
– Pain, photophobia, foreign body sensation, copious
tearing, redness, lid edema, subconjunctival
hemorrhage
– Preauricular lymphadenopathy