تشخيص الحالة المرضية الأولى

 

مرحبا بكم جميعا 

شكرا لكل اللي حاول و شارك في تشخيص الحالة المرضية الأولى .

هذا التشخيص الصحيح مع العلاج للحالة المرضية الأولى .

Diagnosis

Acute conjunctivitis of both eyes

Discussion

Differential Diagnosis:

The above presentation is consistent with viral conjunctivitis. Other possible diagnoses include allergic conjunctivitis (usually with pruritus), atopic conjunctivitis (usually with a history of eczema), bacterial conjunctivitis (usually with purulent discharge and severe redness), medication toxicity (ex. patient on chronic drops), exposure toxicity (ex. exposed to fire fumes or other toxic fumes/chemicals) and pediculosis (eyelash lice infestation with chronic follicular conjunctivitis).

Definition:

Viral conjunctivitis is an inflammatory response to infection of the conjunctival tissues surrounding the globe and lids by a virus. The most common cause of viral conjunctivitis is adenovirus. Other causes include coxsackie virus, enterovirus, molluscum contagiosum and systemic viral syndromes such as measles, mumps, influenza and rhinovirus. Viral conjunctivitis most commonly affects patients with upper respiratory infection symptoms or with a history of sick contacts. It usually starts in one eye and develops in the other eye a few days later. Herpetic conjunctivitis has distinct findings but in its mildest form can mimic typical viral conjunctivitis.

Examination:

Ocular findings include conjunctival hyperemia, chemosis and hemorrhages, follicular conjunctival reaction, epiphora, preauricular adenopathy, corneal subepithelial infiltrates, edematous eyelids, conjunctival membranes or pseudomembranes and/or corneal epithelial defects. Visual acuity is minimally affected in viral conjunctivitis. Diagnosis of viral conjunctivitis is usually based on history and exam findings. Fluorescein can help detect corneal epithelial defects. Cultures (to detect bacterial conjunctivitis) should be performed in cases of severe purulent discharge, chronic signs and symptoms or severe corneal findings.

Treatment:

Treatment of viral conjunctivitis is supportive with artificial tears and cool compresses. Topical antibiotics are not needed unless a bacterial etiology is suspected. Corticosteroid drops are usually avoided but can be helpful in the convalescent period in the most severe cases (evidence of membranes/pseudomembranes). Topical anesthetics should not be used as these can impede healing. Patients that use contact lenses should avoid lens wear until signs and symptoms have resolved. Prognosis of viral conjunctivitis is very good as most patients will have spontaneous resolution in two weeks.
Membranes/pseudomembranes may cause permanent conjunctival scarring and chronic subepithelial corneal infiltrates in the visual axis that can impair vision. Reassessment by an eye care provider would be important in this case. Hand washing and other disinfectant techniques (changing pillowcases and towels) are important to prevent transmission.