Differential diagnoses - Conjunctivitis and iritis in pictures


How to differentiate between these allergic and infective eye conditions.




Acute iritis

Presentation
  • Painful inflammation of the iris. Uncommon in children Can be acute, chronic or relapsing May be associated with other conditions, such as rheumatoid arthritis, Behcet's disease (BD), malignancy, trauma to the eye and infection

Signs and symptoms may include any or all of the following:
  • Pain in the eye or brow region.
  • Worsened eye pain when exposed to bright light.
  • Reddened eye, especially adjacent to the iris.
  • Small or funny shaped pupil.
  • Blurred vision.
  • Headache.

Management

Attacks typically only involve one eye at a time. Without correct treatment,iritis can cause permanent visual problems. Young and middle-aged people are most commonly affected. There is no cure, but treatment of individual episodes can control inflammation and prevent complications.

  • Usually requires referral to secondary care Treatment is usually with steroid eyedrops and cycloplegic drops ,Dark glasses may be helpful where there is photophobia ,Oral analgesia such as paracetamol, can be helpful Chronic cases may require immuno suppressant medication.


Viral conjunctivitis


Presentation

  • This is a common condition (more common than the bacterial form)Presents with pink rather than red conjunctiva, with dilated blood vessels- Not usually associated with pain, photophobia or visual disturbance- Discharge not usually present, although the eye may water excessively- Often associated with a viral URTI.

Management

  •  viral causes of conjunctivitis generally are self-limited and treated supportively with cool or warm compresses for comfort, topical antihistamines to limit redness and itching, chilled artificial tears for comfort, and topical antibiotics as necessary to prevent bacterial superinfection.



Bacterial conjunctivitis

Presentation

  • Benign condition caused by infection of the conjunctiva Common; occurs at any age May be unilateral or bilateral Conjunctiva become red and inflamed with dilated blood vessels, not usually painful Discharge usually present and tends to be thick.
Management
The following are older topical antibiotics that remain efficacious:
  1. Trimethoprim with polymyxin B.
  2. Azithromycin.
  3. Gentamicin.
  4. Tobramycin.
  5. Neomycin.
  6. Ciprofloxacin.
  7. Ofloxacin.
  8. Gatifloxacin.

  • Usually managed in primary care or by pharmacist Bathing helpful in removing the discharge Topical antibiotic ointment or eyedrops If diagnosis is in doubt, swabs can be helpful.

Allergic conjunctivitis

Presentation

  • Irritation of conjunctiva by an allergen such as pollen. Both eyes usually affected Rapid onset after exposure Eyes are usually itchy, with a red or pink appearance Eyelids may swell and there may be a burning sensation Not usually associated with pain, photophobia or visual disturbance
Management


  • Antihistamine drops can help Patient should avoid allergens and rubbing the eyes Bathing with cold water can helpIn severe cases, steroid eyedrops may be required, mast cell stabilizers, non-steroidal anti-inflammatory drugs (NSAIDs), and corticosteroids.

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