This document describes various eye conditions including: 1) Conjunctivitis which can be caused by allergies, viruses, bacteria, herpes, gonorrhea, and Kawasaki disease. 2) Blepharitis which causes redness and swelling of the eyelid margins. 3) Preseptal and postseptal cellulitis which are infections anterior or posterior to the orbital septum respectively. 4) Other conditions described include chalazion, insect bites, pterygium, allergic shiners, raccoon eyes from basilar skull fractures, and scleral epithelial melanosis. Causes, symptoms, signs, time courses and treatments are provided for

1. Eye conditions

3. Conjunctivitis with a subconjunctival
hemorrhage
• Painless,Benign, Spontaneous resolutio
• Localized rupture of small subconjunctival vessels
• Resolves in 2-3 weeks
• Periorbital trauma
• None Direct trauma
• Spontaneous
• Childbirth
• Increased intrathoracic pressure (from coughing,
vomiting)

5. Allergic conjunctivitis with lid edema and
conjunctival injection
• Seasonal
• Pruritic
• Conjunctival edema (chemosis)
• Usually watery discharge
• Bilateral,Diffuse (involves whole conjunctiva and sclera)
Resolves with allergen removal and/or treatment
• Recurs every season Atopy
• Teary eyes
• Photophobia Usually noneAllergens including pollen,
ragweed, dust, animal dander (usually airborne)

7. Viral Conjunctivitis
• History of exposure
• Ocular discomfort
• Watery discharge
• Tender preauricular node
• Follicular aggregates,Diffuse (involves whole
conjunctiva and sclera) 3-7 days
• Self-limited, Viral syndrome (fever, pharyngitis,
adenopathy)
• Ocular discomfort
• Eyelid swelling, Infectious to others Exposure from
direct contact or from fomites

9. Bacterial Conjunctivitis
• Usually mucopurulent discharge
• Early morning crusty glu eye, Diffuse marked
erythema 7-10 days
• Generally self-limited in infants and older
children Sometimes occurs with otitis media
(usually because of nontypable H. influenzae)
• Ocular discomfort Infectious to others
Exposure from direct contact with other
infected individuals

11. Herpes
Keratoconjunctivitis
• Lid often swollen
• Watery discharge
• Painful
• Unilateral
• Photophobia
• Foreign body sensation
• Periorbital vesicles
• Dendritic pattern with fluorescent stain Diffuse Variable, depends on
treatment
• May be recurrent Mucocutaneous or predominantly periorbital vesicles
• Corneal ulceration
• Systemic involvement
• Sepsis-like picture or seizures in neonates Systemic infection in
neonates
• Infectious to others

14. Gonococcal conjunctivitis
• Profuse purulent discharge
• Lids often swollen
• High risk in neonates usually less than 2 weeks old and sexually
active adolescents Diffuse hyperacute conjunctival injection
Variable, depends on treatment Sepsis-like picture in neonates
• May be associated with disseminated gonococcal disease (arthritis,
rash) or urethral discharge in adolescentsLoss of eye from abscess,
corneal ulceration, and perforation when untreated Infectious to
others Vertical transmission (mothers to baby)
• Sexually active adolescents
• Victims of sexual abuse
• Exposure to (direct contact) infected person

16. Corenal Abrasion
• Intense pain
• Tearing
• (+/-) photophobia Localized Improved in 24-48
hours Facial trauma
• Other eye injury Infection
• Ulceration (contact lens wearers)Direct trauma
• Rubbing eyes
• Foreign body
• Insertion/removal of contact lenses

21. Conjunctivitis with
Kawasaki Disease (KD)
• Nonpurulent
• Nonulcerative
• Bilateral Bulbar conjunctivitis (spares limbus)
1–2 weeks if untreated Signs and symptoms
of acute phase of KD (fever, irritability, rash,
lymphadenopathy, mucous membrane and
extremities changes)
• Transient anterior uveitis or acute iridocyclitis in
83% Coronary artery aneurysms, myocardial
infarction, and/or death when KD is left
untreated Uncertain

23. Blepharitis
• Redness and swelling of eyelid margins
• Scaly, flaky debris on lid margins
• Gritty, burning sensation
• Matting upon awakening Eyelid margins
Chronic/recurrent Rosacea or seborrheic
dermatitis Hordeolum Usually none

25. Preseptal (Periorbital)
Cellulitis
• Infection of space anterior to orbital septum
• Lid warmth, edema, erythema, and tenderness
• More common in children <5 yrs Eyelids, upper
and lower 7–10 days with oral antibiotic
treatment Fever and painOrbital cellulitis
• Bacteremia/sepsis
• Meningitis Minor trauma or insect bite
• Localized lid infections
• Bacteremia because of H. influenza type B

27. Postseptal (Orbital)
Cellulitis
• Infection involving the orbital structures posterior to the orbital septum
• Lid warmth, edema, erythema, and tenderness
• Chemosis
• Proptosis
• Decreased ocular movement
• Periocular pain
• Usually unilateral Eyelids, upper and lower
• Mild, diffuse conjunctival injection 10–14 days with IV+ oral antibiotic treatment Fever
• Associated URI (upper respiratory infection) symptoms
• Decreased visual acuity
• Malaise Blindness
• Brain abscess
• Meningitis
• Death secondary to cavernous sinus thrombosis Minor trauma
• Sinusitis
• Dental abscess
• Preseptal cellulitis

29. • Chemosis

31. • Chlamydia conjunctivitis
• Conjunctivitis is the most common neonatal manifestation of C. Trachomatis
infection.
• -The incubation period is 5-14 days after birth. Presentation before 5 - 14 days is
rare, but has occurred with premature rupture of membranes.
• -Initially the disease presents as watery discharge that becomes purulent.
• -This can (but does not always) progress to marked swelling of eyelids with red and
thickened conjunctiva (chemosis).
• -A pseudomembrane may form over the conjunctiva, which can become friable,
resulting in bloody discharge.
• -A membrane of granulation tissue may form after about two weeks if the
condition is left untreated.
• -Untrested infection may last for months and cause corneal and conjunctival
scarring.
• -N. Gonorrhea conjunctivitis presents earlier and progresses more rapidly, but
must be considered in the differential diagnosis.

33. Chalazion
• Erythematous rubbery nodule
• Painless
• Sometimes, foreign body sensation with blinking
Develops around a Meibomian gland located just
under the conjunctival side of the eyelid Seen in
some patients with blepharitis Blurred vision as
a result of astigmatism secondary to corneal
compression May result from an internal
hordeolum or blepharitis

35. Insect Bite
• Acute
• Nontender, slightly erythematous,
nonpurulent edema of the eyelid
• A central punctate mark may be visible
Unilateral, diffuse swelling of the eyelid
Possible presence of insect bites or stings on
other areasSecondary infection with excessive
scratching Allergic reactions to specific
insects

37. Congenital Dacryocystocele
• 10-12 mm diameter, fluctuant bluish-
appearing mass Nasolacrimal sac region
NoneDacryocystitis
• Respiratory compromise if bilateral and
extending onto the lateral nasal wall
• Cellulitis None

39. Pterygium
• Conjunctival growth Erythema
• Irritation Medially on the ocular surface,
extending horizontally from the nasal conjunctiva
onto the cornea
• Wing or triangular wedged shaped None
Extension onto the cornea may cause irregular
astigmatism and decrease in vision
• Decrease in visual acuity with impingement of the
visual axis Excessive exposure to ultraviolet
light and wind
• Common in tropical regions

41. Allergic
Shiners(allergic rhinitis)
• Bilateral darkening of skin below orbits
• Symptoms and signs of allergic rhinitis Skin below
eyelids Concurrent with symptoms of rhinitis Dennie-
Morgan lines
• Allergic salute
• Deepened nasolabial folds
• Mouth breathingOf rhinitis:
• Epistaxis
• Infection
• Charge in bony structure of face and palate
• Malocclusion Inhaled allergens

43. Raccoon Eyes seen with Basilar Skull
Fracture
• History of trauma
• Bilateral periorbital ecchymoses (Raccoon eyes)
• Bruising behind auricle (Battle's sign)Periorbital
Raccoon eyes resolve with time CSF otorrhea and/or
rhinorrhea Of basilar skull fracture:
• Intracranial infection
• Intracranial air collections
• Cerebral injury/bleed
• Increased intracranial pressure
• Seizures Trauma

46. Scleral Epithelial Melanosis
• Flat, patchy pigmentation of conjunctivae
• Moves with conjuctivae Bilateral, although
not necessarily symmetric
• Limbal areaCongenital Pigmentation of skin
Not risk factor for ocular melanoma More
common in African American, Hispanic, and
Asian children
• May be induced by UV light exposure or
inflammation of conjunctive