1 / 36

Now that you Established the Cause – How do you Treat?

Now that you Established the Cause – How do you Treat?. Moderate – Topical antibiotics 6 – 8 times daily tapering to QID x 7 to 10 days. Severe – may be at risk of cellulitis and will require topical and oral antibiosis. Topical steroids for concurrent inflammation?

psyche
Télécharger la présentation

Now that you Established the Cause – How do you Treat?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Now that you Established the Cause – How do you Treat? • Moderate – Topical antibiotics 6 – 8 times daily tapering to QID x 7 to 10 days. • Severe – may be at risk of cellulitis and will require topical and oral antibiosis. • Topical steroids for concurrent inflammation? • Clinical Pearl – Avoid Sulfa, Tetracyclines and Chloramphenicol.

  2. Some Choices to Consider: Trimethoprim • wide spectrum but no Pseudomonas coverage • 1 gtt QID • Studies show that it is good for kids @ 2 months. • Available with polymyxin B as Polytrim

  3. The Aminoglycosides: • Bacteriocidal against Psedomonas ans some Gram +’s. • Dosage is QID. • Toxic epitheliopathy especially in more frequent dosings. • Neuromuscular blocking activity especially in Myasthenia patients.

  4. Fluoroquinolones: • Most effective ophthalmic antibiotics. • Good for moderate to severe conjunctivitis. • Dosed 6 to 8 times daily tapering to QID over 5 to 7 days. • Numerous studies but the best one is not well established.

  5. Fluoroquinolones:

  6. Hyperacute Conjunctivitis • Most commonly from Neisseria. • Can be from S. aureus, Strept., H. influenzae, Moraxella, E. coli and Pseudomonas. • Sudden, abundantly purulent conjunctivitis with chemosis and hyperemia. • If not treated properly cellulitis, keratitis, ulceration, dacryadenitis and septicemia.

  7. Hyperacute Conjunctivitis

  8. Hyperacute Conjunctivitis

  9. Treatment of Hyperacute Conjunctivitis • Must be treated aggressively: • Topical antibiotics • Oral antibiotics • Injected antibiotics (Ceftriaxone 1 g IM) • Frequent irrigation with saline • Gonoccal conjunctivitis is often found with concurrent Chlamydial infection.

  10. Chronic Conjunctivitis • Difficult to evalutate because symptoms are so nonspecific. • FB sensation, burning, tearing, sticky eyelids… • Conjunctiva is thickened, diffusely red, papillary or follicles. • Rule out Chlamydia, lid disease, HSV and rosacea. • May need culturing.

  11. Chlamydia • Primary organism is Chlamydia trachomatis Types D - K • Very small, obligate intracellular parasite. • Chlamydial infection is the most common sexually transmitted disease in the U.S. • 75% of women and 50% of men have no urogenital symptoms. • One of the most common causes of chronic conjunctivitis.

  12. Inclusion Conjunctivitis • Sexually active adults with follicular conjunctivitis with mucopurulent discharge. • Usually unilateral with sometimes a small nontender preauricular node. • During the second week epithelial keratitis may develop with marginal or central infiltrates. ** Usually superior cornea.

  13. Inclusion Conjunctivitis • Commonly misdiagnosed with a history of multiple topical antibiotics used. • Diagnosis made by laboratory testing: 1) Conjunctival scraping with Giemsa stain 2) Immunodiagnostic studies 3) PCR

  14. Giemsa Stain 1) Scrape the conjunctiva. 2) Place on slide 3) Fix the slide & stain with Giemsa

  15. Polymerase Chain Reaction (PCR) • High sensitivity and specificity for Inclusion conjunctivitis.

  16. Direct Immunofluorescent Antibody Assay

  17. Management of Inclusion Conjunctivitis: Doxycycline – 100 mg twice daily for 7 days. **Remember to avoid using this in pregnant women and children under 8 y.o. Use instead: Erythromycin 500 mg PO QID x 7 d Azithromycin 1000 mg PO once or Amoxicillin 500 mg PO TID x 7 d

  18. Trachoma • Chlamydia trachomatis Types A - C • A serious world health problem. • In the U.S. there are small pockets found in the southwest in Native Americans.

  19. Trachoma: • Early in the disease it is a chronic follicular conjunctivitis. • Later the reaction appears more papillary • Patients begin to experience photophobia, tearing and a mucopurulent discharge. • Follicles form at the limbus. • Keratitis begins superiorly with infiltrates and ulcerations.

  20. Trachoma: Continued • Conjunctiva scarring replaces the initial inflammatory signs. (Arlt’s Line) • This can lead to trichiasis & entropion which inturn can cause corneal ulceration and scarring. • The limbal follicles involute (Herbit’s pits) which is pathognomonic for trachoma

  21. Trachoma: Arlt’s Line: Herbit’s Pits:

  22. Treatment of Trachoma • Tetracycline – 250 mg QID x 3 weeks. • Erythromycin – 500 mg QID *No changes seen for 3 to 4 months. *Reinfection rates are high. • Azithromycin single dose. • Surgery for the scarring (PK) or for the entropion and trichiasis.

  23. Viral Conjunctivitis

  24. Viral Conjunctivitis • Manifests as a Follicular Conjunctivitis. • A follicular conjunctivitis can be Acute or Chronic. • Follicles are rare on the Bulbar conjunctiva but can sometimes be seen limbally. • An acute follicular conjunctivitis is almost pathognomonic of viral involvement.

  25. Viral Conjunctivitis • Chronic Follicular conjunctivitis can be seen in… 1) Trachoma 2) Some long standing allergies

  26. Viral Conjunctivitis

  27. Viruses of Concern: • Adenovirus • Herpesvirus • Picornavirus • Influenza Virus A • Varicella Zoster Virus

  28. Adenoviruses • A DNA virus with 51 serotypes with about 33 types causing disease. • Virus can replicate lytically • 1 million viruses produced per host cell killed. • Patients feel sick. • Viruses that cause chronic or latent infections tend to reproduce with smaller numbers of viruses being released and therefore patients don’t feel as sick. • Cause an Acute Respiratory Disease (ARD), Pharyngeal Conjunctival Fever (PCF) and Epidemic Keratoconjunctivitis (EKC)

  29. Pharyngeal Conjunctival Fever (PCF) • Caused by Adenovirus type 3 and 7. • Symptoms consist of: Follicular conjunctivitis Sore throat Fever Runny nose Pre-auricular adenopathy • Most commonly seen in children.

  30. Pharyngeal Conjunctival Fever • Acute Follicular conjunctivitis. • Pharyngitis • Fever • Pre-auricular lymphadenopathy (Nontender)

  31. Epidemic Keratoconjunctivitis (EKC) • Caused by Adenovirus type 8, 19 an 37. • After exposure the patient experiences inflammed sticky lids in 4 to 24 days and the keratitis can last 2 to 8 weeks. • 5 to 8% will have concurrent respiratory symptoms as well.

  32. Epidemic Keratoconjunctivitis

  33. Epidemic Keratoconjunctivitis What distinguishes EKC from PCF is… In EKC: 1) Subepithelial infiltrates 2) Tender palpable pre-auricular nodes 3) Can occur in any age group.

  34. EKC Subepithelial Infiltrates (SEI’s)

  35. Epidemic Keratoconjunctivitis • Pain • Photophobia • Watery eyes with blurred Vision • Moderate to severe redness • SEI’s 6) Pseudomembrane 7) Lymphadenopathy

  36. Treatment of Adenoviral Infections • Most cases resolve in about 2 to 3 weeks. • Supportive therapy (cold compresses, lubricants). • Betadine 5% lavage • Steroids may limit the infiltrates and decrease pseudomembrane formation. i gtt every 1 – 2 hours is controversial.

More Related