Keratoconjunctivitis: Difference between revisions

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==Clinical Features==
==Clinical Features==
*intense itching
*Intense itching
*excessive tearing
*Excessive tearing
*burning sensation
*Burning sensation
*clear mucus discharge
*Clear mucus discharge
*conjunctival erythema/hyperemia   
*Conjunctival erythema/hyperemia   
*blurred vision
*[[Blurred vision]]
*photophobia
*photophobia
*foreign body sensation
*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: HSV)
* Keratitis (eg: [[herpes keratitis]])
* Corneal abrasian
* [[Corneal abrasion]]
* Trauma/Foreign body
* [[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 abrasians, corneal damage, foreign body, globe rupture
** 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

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.