Keratoconjunctivitis: Difference between revisions
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==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 | ||
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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
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.