VIRAL CONJUNCTIVITIS (C32889)
Having read the article on page 23-27 (Optician 02.08.13), read the following clinical guidelines for viral conjunctivitis then answer six questions relating to both. Successful completion of these will result in you being sent instruction about a simple interactive exercise
PATIENT PROFILE
There is a spectrum of presentation ranging from very mild to two full-blown syndromes associated with adenovirus strains.
Pharyngoconjunctival fever (PCF) tends to affect children and also causes an upper respiratory tract infection. Keratitis is present in 30 per cent of cases. Epidemic keratoconjunctivitis (EKC) is not normally associated with systemic symptoms, but there is associated keratitis in 80 per cent of cases. Both are highly contagious, so careful hand-washing is recommended after seeing one of these patients.
SYMPTOMS
Acute onset redness, discomfort and photophobia with a watery discharge. 60 per cent of cases are bilateral
DIAGNOSIS
- Lid oedema
- Follicles
- Preauricular adenopthy (swollen glands)
- Patient usually has flu-like symptoms and ‘swollen glands’
- In severe cases pseudomembranes, subconjunctival haemorrhages and chemosis
- Keratitis, which begins after a week or two of the onset. This begins as diffuse punctate staining, then focal white infiltrates, usually sub-epithelial. Severe cases may have stromal infiltrates which are persistent, and mild anterior chamber reaction.
MANAGEMENT
- Check cornea for ulcer/compromise other than SPEE
- Advice on cross contamination
- Reassure on resolution in 7 to 10 days maximum
Refer if;
- Patient feels ill
- Cornea is significantly compromised (look for any early ulceration)
- Condition is persistent (present for over 10 days) or recurrent
If referring, it is always worth phoning ahead to the clinic to where you are sending the patient. They will appreciate this as the condition is usually highly contagious. For the same reason ALWAYS take extreme care to disinfect all surfaces with which you feel the patient has made contact (especially the slit-lamp)
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