Professional Documents
Culture Documents
CONJUNCTIVITIS
DR. AMANDEEP
GUPTA
M.S (SCHOLAR) NETRA
ROGA
CONJUNCTIVITIS
The conjunctiva is a thin membrane that covers the inner
surface of the eyelid and the white part of the
eyeball(sclera).
Inflammation of the conjunctiva is called conjunctivitis,
which makes the white of the eye appear red.
Parts of
Conjunctiva
Glands of conjunctiva
Prevalence
General measures:
Irrigation of conjunctivial sac
Dark goggles
No bandage
No steroids
Hyperacute bacterial conjunctivitis
Causative agents
•Gonococcus, staph.
aureus,pneumococuss
Symptoms
•Pain
•Purulent discharge
•Swelling of eyelids
signs
•Tenderness
•Purulent, copius thick discharge
•Bright red velvety chemosed conjunctiva
•Pre-auricular LN enlarged
•Tense and swollen lids
Treatment
•Systemic therapy
•Topical antibiotics therapy (moxifloxacin,ciprofloxacin or tobram
•Bacitracin ointment QID
•Add cycloplegics (if corneal involvement is there)
General measures:
Frequent irrigation of eyes
Treatment of partner
Chronic bacterial conjunctivitis
ETIOLOGY:
•Predisposing factors:
Chronic exposure to smoke, dust, chemical
irritants
Local irritant as trichiasis, concretions, FB
Eye-strain due to Ref error,convergence
insufficiency
Alcohol abuse
Causative agents:
•Staph aureus commonly, gram-ve entrobaccilli
Source & mode of infections:
SIGNS:
•Congestion of posterior conjunctival vessels
•Mild papillary hypertrophy
•Surface of conjunctiva look sticky, congested
lid margins
TREATMENT:
Etiology:
•Moraxella Axenfield Bacilli
•Rarely staphylococci
PATHOLOGY:
•Production of proteolytic enzyme
•Causes maceration of epithelium
SYMPTOMS:
•Irritation discomfort
•H/O collection of dirty white foamy discharge
at the angles
•Redness in the angles of the eye
SIGNS:
•Hyperaemia of bulbar conjunctiva near the
canthi
•Hyperaemia of lid margins near the angles
•Excoriation of skin around the angles
•Presence of foamy mucopurulent discharge at
the angles
TREATMENT:
ETIOLOGY:
•PROPHYLAXIS:
Antenatal:
Treatment of genital infections of mother
Natal:
Delivery under aseptic conditions
Newborns eyelids should be well cleaned
Postnatal:
1% tetracycline / 0.5% erythromycin ointment
1 % silver nitrate solution (Crede’s method)
Single injection of Ceftriaxone 50mg/kg IM/IV
CURATIVE TREATMENT
Chlamydial conjunctivitis
MODES OF INFECTION:
•With follicular
hypertrophy:
Adenoviral
conjunctivitis
•With papillary
hypertrophy
Vernal Conjunctivitis
MANAGEMENT:
Treatment of Active Trachoma
•Topical therapy:
1% tetracycline / 1% erythromycin eye ointment 4 times
daily for 6 weeks
•Systemic therapy:
Tetracycline / erythromycin 250mg QID orally for 4 weeks
Or Doxycycline 100mg BD orally for 4 weeks
Or single dose of Azithromycin orally
•Combined therapy:
Preferred when severe disease
Or associated genital infection is present
Safe Strategy for Trachoma
Blindness:
•Surgery to correct eyelid deformity & prevent blindness
•Antibiotics for acute infections & community control
•Facial Hygiene
•Environmental changes
ADULT INCLUSION CONJUNCTIVITIS
•acute follicular conjunctivitis associated with
mucopurulent discharge
ETIOLOGY:
•Chlamydia trachomatis Serotype D to K
•Primary source urethritis & cervicitis
•Transmission through contact through fingers
Or by contaminated water of swimming pool
Incubation Period:
•4-12 days
Symptoms:
•Ocular discomfort, foreign body sensation
•Mild photophobia
•Mucopurulent discharge from the eyes
Signs:
•Conjunctival hyperaemia, marked in fornices.
•Acute follicular hypertrophy predominantly of lower
palpebral conjunctiva
•Superficial keratitis in upper half
•Superior micropannus occasionally
•Pre-auricular lymphadenopathy
Treatment:
•Topical therapy:
Tetracycline 1 % eye ointment QID for 6 weeks
•Systemic therapy:
Tetracycline 250 mg four times a day for 3-4
weeks.
Erythromycin 250 mg four times a day for 3-4
weeks
Doxycycline 100 mg twice a day for 1-2 weeks
200 mg weekly for 3 weeks
Azithromycin 1 gm as a single dose
Viral conjunctivitis
–Adenoviral conjunctivitis
–Herpes Simplex kerato conjunctivitis
–Herpes Zoster conjunctivitis
–Pox virus conjunctivitis
–Myxovirus conjunctivitis
–Paramyxovirus conjunctivitis
–ARBOR virus conjunctivitis
Clinical presentations:
Two clinical forms:
Adenoviral conjunctivitis
•Epidemic keratoconjunctivitis(EKC)
•Nonspecific acute follicular conjunctivitis
•Pharyngoconjunctival fever (PCF)
•Chronic relapsing adenoviral conjunctivitis
Epidemic keratoconjunctivitis:
Symptoms:
•Redness associated with watering
•Mild mucoid discharge
•Ocular discomfort & f.b sensation
•Photophobia
Signs:
•Swollen eyelids
•Conjunctival signs:
Chemosis conjunctiva
Follicles (small to moderate size)
Petechial subconjunctival
haemorrhages
Pseudomembrane lining
Corneal involvement:
•superior punctate keratitis (typical feature of ekc)
Pre-auricular lymphadenopathy :
•Associated in all cases of ekc
Treatment :
supportive therapy:
Cold compresses & sunglasses
Decongestant & lubricant tear drops
Pharyngoconjunctival fever:
•Treatment : supportive
Newcastle conjunctivitis:
•Rare
•Caused by Newcastle virus
•Contact with diseased owls
•Affects poultry workers
•Similar to pharyngoconjunctival fever.
Acute herpetic conjunctivitis:
•Always accompanies with primary herpetic infection
•HSV type 1 commonly
•Clinically:
Usually unilateral, incubation within 3-10 days
Typical Form: Follicular conjunctivitis with other
herpetic lesions
Atypical Form: Follicular conjunctivitis without
other herpetic lesions
Corneal involvement & preauricular
lymphadenopathy
ETIOLOGY:
•Picornavirus
•Disease very contagious, direct hand-to-eye
contact
Clinical features:
•Incubation period: 1-2 days
Symptoms:
•Pain, redness, watering, mild photophobia
•Transient blurring of vision, lid edema
Signs:
•conjunctival congestion & chemosis
•multiple haemorrhages in bulbar conjunctiva
•mild follicular hyperplasia, lid oedema
•pre-auricular lymphadenopathy
•Fine corneal keratitis
Treatment:
Etiology:
Signs:
•Hypreremia & chemosis
•Mild papillary reaction
•Lid edema may be present
Diagnosis:
•Typical signs & symptoms
•Normal conjunctival flora
•Abundant eosinophils in discharge
Treatment:
ETIOLOGY:
•Hypersensitivity to some exogenous allergen
•IgE mediated atopic mechanisms
Predisposing factors:
•4-20 years, common in males
•More in summer
•Prevalent in tropics, non-existent in cold climate
Symptoms:
•Marked burning and itching, usually intoreble
•Mild photophobia, lacrimation
•“Ropy Discharge”
•Heaviness of eyelids
Signs:
Palpabrel form:
•Upper tarsal conjunctiva
•Presence of hard, flat topped, papillae arranged in 'cobble-stone'
'pavement stone', fashion
•Giant papillae in severe cases
•White ropy conjunctival discharge
Bulbar form:
•Dusky red triangular congestion of bulbar conjunctiva in palpebra
•Gelatinous thickened accumulation of tissue around the limbus
•Presence of discrete whitish raised dots along the limbus (Tranta
Mixed:
•Combined features of both forms
5 types of lesions can be seen:
1)Punctate epithelial keratitis:
•Involves upper cornea, mostly in palpabrel form
•Lesions always stain with rose bengal
2)Ulcerative vernal keratitis:
•Shallow transverse ulcer in upper part of cornea due to epithelial m
3)Vernal corneal plaques:
4)Due to coating of areas of epithelial macroerosions with coating o
exudates
•Subepithelial scarring:
•In a form of a ring scar
5)Pseudogerontoxon:
Classical cupid bow outline
Clinical course:
•Disease is self-limiting
•Usually goes off spontaneously in 5-10 years
Differential diagnosis:
•Trachoma with predominantly papillary hypertrophy
Treatment:
•Local therapy
•Systemic therapy
•Treatment of large papillae
•General measures
•Desensitization
•Treatment of vernal keratopathy
Treatment:
Local therapy
•Topical steroids:
Effective in all forms
Use should be minimal and for short-duration
Frequent instillation to tapering within few
days
Flouromethalone, dexamethasone,
loteprednol
•Mast cell stabilizers:
Sodium cromoglycate, azelastine, ketotifen
•Topical antihistaminic eye drops
•Acetyl cysteine (0.5%) eye drops
•Topical cyclosporine eye drops
Treatment:
Systemic therapy
•Oral histaminics
•Oral steroids in severe cases for short duration
Treatment of large papillae:
•Supratarsal injection of long acting steroid
•Cryo application
•Surgical excision for extra-ordinary large papillae
Treatment:
General measures:
•Dark goggles
•Cold compress & ice packs
•Change of environment (working environment also)
Desensitization
•Not much awarding results
Treatment of vernal keratopathy:
•PEK : steroid instillation should be increased
•Large vernal plaque: surgical lamellar keratectomy
•Severe shield ulcer: debridement, superficial keratectomy, amniotic membrane
ATOPIC KERATOCONJUNCTIVITIS
•Adult equivalent of vernal keratoconjunctivitis
•Often associated with atopic dermatitis
•Mostly young male adults
Symptoms:
Lid margins:
•chronically inflamed
•rounded posterior borders
Tarsal conjunctiva:
•milky appearance
•very fine papillae, hyperaemia and scarring with shrink
Cornea:
•punctate epithelial keratitis
•more severe in lower half
•corneal vascularization, thinning and plaque
Clinical course:
•Protracted course
•Tends to become inactive by 5th decade
Treatment:
•Often frustrating
•Treat lid disease effectively
•Mast cell stabilizers, steroids, tear supplements may be
GIANT PAPILLARY CONJUNCTIVITIS
•Conjunctival inflammation with very large sized papillae
Etiology:
•Localized allergic response
•Contact lens, prosthetic shell
•Suture irritation
Symptoms:
•Itching, stringy discharge
•Reduced wearing time of contact lens or prosthetic shel
Signs:
•Papillary hypertrophy upper tarsal conjunctiva with hype
Treatment:
Signs:
Simple:
•Most common
•Typical pinkish-white nodule at limbus surrounded by h
mostly solitary.
Necrotizing:
•Very large phlycten with necrosis & ulceration
•Leads to severe pustular conjunctivitis
Miliary:
•Multiple phlyctens, may be arranged like a ring around
Phlyctenular Keratitis:
Ulcerative:
•Sacrofulous ulcer: shallow marginal ulcer
•Fascicular ulcer: has prominent parallel
leash of vessels
•Miliary ulcer: multiple ulcers scattered all
over
Diffuse Infiltrative:
•Central infiltration of cornea
•Characteristic rich vascularization all around limbus
•Usually self-limiting, disappears in 8-10 days
D/D:
•Episcleritis, scleritis, FB granuloma
Treatment:
Local therapy:
•Topical steroid eye drops and ointment
•Topical antibiotic eye drops & ointment
•Atropine eye ointment when cornea involved
Systemic therapy:
•Diagnosis & management of TB
•Septic foci like caries, folliculitis, tonsillitis, adenoiditis to
adequately treated
•Parasitic infestations to be ruled out & treated if present
General measures:
•Improve hygiene & supplement high-protein diet
Bibliography