Difference between revisions of "Keratoconjunctivitis"
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==Background== | ==Background== | ||
*Defined as concurrent inflammation of both the cornea and conjunctiva. | *Defined as concurrent inflammation of both the cornea and conjunctiva. | ||
| − | + | ||
| − | + | {{Keratoconjunctivitis Types}} | |
| − | |||
| − | |||
| − | |||
==Clinical Features== | ==Clinical Features== | ||
| − | * | + | *Intense itching |
| − | * | + | *Excessive tearing |
| − | * | + | *Burning sensation |
| − | * | + | *Clear mucus discharge |
| − | * | + | *Conjunctival erythema/hyperemia |
| − | * | + | *[[Blurred vision]] |
*photophobia | *photophobia | ||
| − | * | + | *Foreign body sensation |
*Thickened, scaly, indurated eyelids are characteristic of Atopic Keratoconjunctivitis | *Thickened, scaly, indurated eyelids are characteristic of Atopic Keratoconjunctivitis | ||
*Chronic inflammation may eventually lead to vision loss | *Chronic inflammation may eventually lead to vision loss | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| − | * Viral conjunctivitis | + | * [[Viral conjunctivitis]] |
| − | * Bacterial conjunctivitis | + | * [[Bacterial conjunctivitis]] |
| − | * Allergic conjunctivitis | + | * [[Allergic conjunctivitis]] |
| − | * Acute angle closure glaucoma | + | * [[Acute angle closure glaucoma]] |
| − | * Uveitis | + | * [[Uveitis]] |
| − | * Keratitis(eg: | + | * Keratitis (eg: [[herpes keratitis]]) |
| − | * Corneal | + | * [[Corneal abrasion]] |
| − | * Trauma/ | + | * [[ocular Trauma|Trauma]]/[[Ocular foreign body]] |
| − | * Chemical exposure | + | * [[caustic keratoconjunctivitis|Chemical exposure]] |
| − | * Dacryocystitis | + | * [[Dacryocystitis]] |
| − | * Reactive arthritis | + | * [[Reactive arthritis]] |
| − | * Cluster headache | + | * [[Cluster headache]] |
==Evaluation== | ==Evaluation== | ||
* Generally a clinical diagnosis | * Generally a clinical diagnosis | ||
| − | * Fluorescein test followed by tonometry: | + | * Fluorescein test followed by [[Tonopen|tonometry]]: |
| − | ** Fluorescein test if concerned for | + | ** 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 | ** Tonometry of both eyes if concerned for acute angle closure glaucoma, uveitis, hyphema, recent history of trauma to eye | ||
| Line 43: | Line 40: | ||
Severity: | Severity: | ||
| − | * Mild: basic eye care(resist itching, cold compress, artificial tears), antihistamines, mast cell stabilizers | + | * 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 | ||
Revision as of 17:11, 5 October 2019
Contents
Background
- Defined as concurrent inflammation of both the cornea and conjunctiva.
Keratoconjunctivitis Types
- Atopic keratoconjunctivitis
- Caustic keratoconjunctivitis
- Secondary to chemical orbital exposure
- Epidemic keratoconjunctivitis
- Highly contagious viral (adenovirus) conjunctivitis, associated with watery discharge
- Ultraviolet keratitis
- Secondary to UV light exposure
- Keratoconjunctivitis sicca
- Associated with autoimmune disorders such as Sjögren syndrome, sarcoidosis, rheumatoid arthritis, and scleroderma
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
- Viral conjunctivitis
- Bacterial conjunctivitis
- Allergic conjunctivitis
- Acute angle closure glaucoma
- Uveitis
- Keratitis (eg: herpes keratitis)
- Corneal abrasion
- Trauma/Ocular foreign body
- Chemical exposure
- Dacryocystitis
- Reactive arthritis
- Cluster headache
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.