Keratoconjunctivitis: Difference between revisions
No edit summary |
|||
| (10 intermediate revisions by 3 users not shown) | |||
| Line 1: | Line 1: | ||
==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== | ||
* | [[File:PMC3640929 1824-7288-39-18-5.png|thumb|Atopic keratoconjunctivitis.]] | ||
* | *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]] | |||
* [[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]] | |||
==Evaluation== | ==Evaluation== | ||
*Generally clinical | * 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 | |||
==Management== | ==Management and Disposition== | ||
Based on likely etiology and severity: | ''Based on likely etiology and severity:'' | ||
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 | ||
Etiology | ===Etiology=== | ||
* Atopic keratoconjunctivitis: chronic management should be determined by Ophthalmologist | * Atopic keratoconjunctivitis: chronic management should be determined by Ophthalmologist | ||
* Epidemic keratoconjunctivitis: usually self-resolving | * Epidemic keratoconjunctivitis: usually self-resolving | ||
* Keratoconjunctivitis photoelectrica: eye rest and proper eye protection | * Keratoconjunctivitis photoelectrica: eye rest and proper eye protection | ||
* Keratoconjunctivitis sicca: chronic management should be determined by Ophthalmologist | * Keratoconjunctivitis sicca: chronic management should be determined by Ophthalmologist | ||
==See Also== | ==See Also== | ||
*[[Caustic keratoconjunctivitis]] | |||
==References== | ==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]] | [[Category:Ophthalmology]] | ||
Latest revision as of 18:10, 26 September 2020
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.