Keratoconjunctivitis: Difference between revisions

Latest revision as of 18:10, 26 September 2020

Background

Defined as concurrent inflammation of both the cornea and conjunctiva.

Keratoconjunctivitis Types

Atopic keratoconjunctivitis
- Common in patients with atopy (ie: eczema, allergies, asthma, rhinitis)
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

Atopic keratoconjunctivitis.

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

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.

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-Keratoconjunctivitis is concurrent inflammation of both the cornea and conjunctiva.
+*Defined as concurrent inflammation of both the cornea and conjunctiva.
-Multiple etiologies:
+{{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==
-intense itching
+[[File:PMC3640929 1824-7288-39-18-5.png|thumb|Atopic keratoconjunctivitis.]]
-excessive tearing
+*Intense itching
-burning sensation
+*Excessive tearing
-clear mucus discharge
+*Burning sensation
-conjunctival erythema/hyperemia
+*Clear mucus discharge
-blurred vision
+*Conjunctival erythema/hyperemia
-photophobia
+*[[Blurred vision]]
-foreign body sensation
+*photophobia
-Thickened, scaly, indurated eyelids are characteristic of Atopic Keratoconjunctivitis
+*Foreign body sensation
-Chronic inflammation may eventually lead to vision loss
+*Thickened, scaly, indurated eyelids are characteristic of Atopic Keratoconjunctivitis
+*Chronic inflammation may eventually lead to vision loss
-==Diagnosis==
+==Differential Diagnosis==
-Diagnosis is usually achieved based on clinical history and presentation alone.
+* [[Viral conjunctivitis]]
+* [[Bacterial conjunctivitis]]
+* [[Allergic conjunctivitis]]
+* [[Acute angle closure glaucoma]]
+* [[Uveitis]]
+* Keratitis (eg: [[herpes keratitis]])
+* [[Corneal abrasion]]
+* [[ocular Trauma|Trauma]]/[[Ocular foreign body]]
+* [[caustic keratoconjunctivitis|Chemical exposure]]
+* [[Dacryocystitis]]
+* [[Reactive arthritis]]
+* [[Cluster headache]]
-==Management==
+==Evaluation==
-Based on likely etiology and severity:
+* Generally a clinical diagnosis
+* Fluorescein test followed by [[Tonopen|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
-Severity:
+==Management and Disposition==
-* Mild: basic eye care(resist itching, cold compress, artificial tears), antihistamines, mast cell stabilizers
+''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:
+===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==
+*[[Caustic keratoconjunctivitis]]
+==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.
+[[Category:Ophthalmology]]