Difference between revisions of "Keratoconjunctivitis"

(Created page with "==Background== Keratoconjunctivitis is concurrent inflammation of both the cornea and conjunctiva. Multiple etiologies: * Atopic keratoconjunctivitis: common in patients wit...")
 
 
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==Background==
 
==Background==
Keratoconjunctivitis is concurrent inflammation of both the cornea and conjunctiva.  
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*Defined as concurrent inflammation of both the cornea and conjunctiva.  
  
Multiple etiologies:
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{{Keratoconjunctivitis Types}}
* Atopic keratoconjunctivitis: common in patients with atopy(ie: eczema, allergies, asthma, rhinitis)
 
* Epidemic keratoconjunctivitis: highly contagious viral(Adenovirus) conjunctivitis, associated with watery discharge
 
* Keratoconjunctivitis photoelectrica(subtype of [[UV Keratitis]])
 
* Keratoconjunctivitis sicca: associated with autoimmune disorders such as Sjogren's Syndrome, Sarcoidosis, Rheumatoid arthritis, and Schleroderma
 
  
 
==Clinical Features==
 
==Clinical Features==
intense itching
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*Intense itching
excessive tearing
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*Excessive tearing
burning sensation
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*Burning sensation
clear mucus discharge
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*Clear mucus discharge
conjunctival erythema/hyperemia   
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*Conjunctival erythema/hyperemia   
blurred vision
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*[[Blurred vision]]
photophobia
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*photophobia
foreign body sensation
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*Foreign body sensation
Thickened, scaly, indurated eyelids are characteristic of Atopic Keratoconjunctivitis  
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*Thickened, scaly, indurated eyelids are characteristic of Atopic Keratoconjunctivitis  
Chronic inflammation may eventually lead to vision loss
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*Chronic inflammation may eventually lead to vision loss
  
==Diagnosis==
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==Differential Diagnosis==
Diagnosis is usually achieved based on clinical history and presentation alone. 
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* [[Viral conjunctivitis]]
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* [[Bacterial conjunctivitis]]
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* [[Allergic conjunctivitis]]
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* [[Acute angle closure glaucoma]]
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* [[Uveitis]]
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* Keratitis (eg: [[herpes keratitis]])
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* [[Corneal abrasion]]
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* [[ocular Trauma|Trauma]]/[[Ocular foreign body]]
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* [[caustic keratoconjunctivitis|Chemical exposure]]
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* [[Dacryocystitis]]
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* [[Reactive arthritis]]
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* [[Cluster headache]]
  
==Management==
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==Evaluation==
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* Generally a clinical diagnosis
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* Fluorescein test followed by [[Tonopen|tonometry]]:
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** Fluorescein test if concerned for abrasions, corneal damage, foreign body, globe rupture
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** Tonometry of both eyes if concerned for acute angle closure glaucoma, uveitis, hyphema, recent history of trauma to eye
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==Management and Disposition==
 
Based on likely etiology and severity:
 
Based on likely etiology and severity:
  
 
Severity:
 
Severity:
* Mild: basic eye care(resist itching, cold compress, artificial tears), antihistamines, mast cell stabilizers
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* Mild: basic eye care(resist itching, cold compress, artificial tears), [[antihistamines]], mast cell stabilizers
 
* Moderate/Severe: should be referred to Ophthalmologist  
 
* Moderate/Severe: should be referred to Ophthalmologist  
  
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* Keratoconjunctivitis photoelectrica: eye rest and proper eye protection
 
* Keratoconjunctivitis photoelectrica: eye rest and proper eye protection
 
* Keratoconjunctivitis sicca: chronic management should be determined by Ophthalmologist
 
* Keratoconjunctivitis sicca: chronic management should be determined by Ophthalmologist
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==See Also==
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*[[Caustic keratoconjunctivitis]]
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==References==
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Hamrah, MD et.al. Atopic keratoconjunctivitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com
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Munoz, MD et.al. Diagnosis, treatment, and prevention of adenovirus infection. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com
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Tintinalli JE, Stapczynski JS, Ma OJ, Cline D, Meckler GD, Yealy DM. Tintinallis emergency medicine: a comprehensive study guide. New York: McGraw-Hill Education; 2016.
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[[Category:Ophthalmology]]

Latest revision as of 17:11, 5 October 2019

Background

  • Defined as concurrent inflammation of both the cornea and conjunctiva.

Keratoconjunctivitis Types

Clinical Features

  • Intense itching
  • Excessive tearing
  • Burning sensation
  • Clear mucus discharge
  • Conjunctival erythema/hyperemia
  • Blurred vision
  • photophobia
  • Foreign body sensation
  • Thickened, scaly, indurated eyelids are characteristic of Atopic Keratoconjunctivitis
  • Chronic inflammation may eventually lead to vision loss

Differential Diagnosis

Evaluation

  • Generally a clinical diagnosis
  • Fluorescein test followed by tonometry:
    • Fluorescein test if concerned for abrasions, corneal damage, foreign body, globe rupture
    • Tonometry of both eyes if concerned for acute angle closure glaucoma, uveitis, hyphema, recent history of trauma to eye

Management and Disposition

Based on likely etiology and severity:

Severity:

  • Mild: basic eye care(resist itching, cold compress, artificial tears), antihistamines, mast cell stabilizers
  • Moderate/Severe: should be referred to Ophthalmologist

Etiology:

  • Atopic keratoconjunctivitis: chronic management should be determined by Ophthalmologist
  • Epidemic keratoconjunctivitis: usually self-resolving
  • Keratoconjunctivitis photoelectrica: eye rest and proper eye protection
  • Keratoconjunctivitis sicca: chronic management should be determined by Ophthalmologist

See Also

References

Hamrah, MD et.al. Atopic keratoconjunctivitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com

Munoz, MD et.al. Diagnosis, treatment, and prevention of adenovirus infection. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com

Tintinalli JE, Stapczynski JS, Ma OJ, Cline D, Meckler GD, Yealy DM. Tintinallis emergency medicine: a comprehensive study guide. New York: McGraw-Hill Education; 2016.