Case 7
45 year old Male Chief Complaint: Swelling of the Left Eye
Upper Respiratory Tract Infection Tearing of the Left Eye Eye Redness One week Upper Respiratory Tract Infection Tearing of the Left Eye Eye Redness Lid swelling No medication Three days Diplopia Increase swelling of the Left Eye 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
Swelling of the Left Eye Pertinent Data 45 y/o Male 20/20 right eye, 20/200 left eye Swelling of the 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 (5-14 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