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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