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Conjunctivitis PDF
Conjunctivitis PDF
The conjunctiva is a thin, transparent mucous Table 1. Causes of conjunctivitis, and who is primarily affected
membrane, which lines the inner surface of the
eyelids and covers the sclera (the white part of the Cause of Newborn babies Children Adults
conjunctivitis
eye). The conjunctiva contains glands which produce
secretions that help to keep the eyes moist, and Viral infection Uncommon Usually affects Usually affects
antibodies, which reduce infection. both eyes both eyes
Conjunctivitis means ‘inflammation of the
conjunctiva’, and the commonest cause is infection
by viruses or bacteria. Conjunctivitis can also be due Bacterial May be severe and May affect one or May affect one or
to chemical irritants, traditional eye remedies or infection sight threatening both eyes. May be both eyes. May be
allergy. It is usual for both eyes to be affected in severe and sight severe and sight
infectious cases. The patient notices that the eyes threatening threatening
are red and uncomfortable, and there is discharge Chlamydia Can cause Causes trachoma, Usually affects both
which may make the eyelids stick together in the conjunctivitis of which usually eyes
morning. The vision is usually not affected. On the newborn affects both eyes
examination the eyelids may be slightly swollen,
the eyes are red, and there may be some visible Allergy Uncommon Usually affects Uncommon
discharge. The cornea should be bright, and the both eyes
pupils should be round, regular and react to light.
Conjunctivitis due to infection occurs at all ages, but
some of the less common causes affect particular Chemical Uncommon Can affect one or Can affect one or
age groups (Table 1). There is one form of conjuncti- irritants/ both eyes both eyes
vitis which can be sight threatening – that due to traditional eye
gonococcal infection. remedies
Treatment: This condition does not get Treatment of babies: Clean the eyelids, Trachoma
better on its own, and the treatment and show the mother how to do this. Gently
Trachoma infection principally affects
consists of removing the lid lesion, with a open the eyes, and instill tetracycline eye
children. The child may not complain of
curette or other blunt instrument. ointment, or other antibiotic eye ointment,
symptoms or may have some discomfort
Health education: Mothers and adult showing the mother how to do this. Make
and discharge. On examination, the upper
patients can be shown how to remove the sure she can instill the ointment, give her a
eyelids may be slightly swollen and drooping,
skin lesions. tube of tetracycline (or other antibiotic), and
and the eyes will be slightly red, with some
tell her to put it in both eyes every hour. Tell
discharge. The diagnosis is confirmed by
Herpes simplex blepharo- the mother that this is a very serious
everting the upper eyelid and examining the
infection, and that she and her baby should
conjunctivitis go urgently to an eye department as she
conjunctiva over the tarsal plate. Evert the
lid by i) ask the child to look down; ii) get
Again, this condition is more common in and her baby need an injection of antibiotic.
hold of the lashes of the upper eyelid; iii)
children. The child presents with fluid filled Treatment of adults: Prescribe antibiotic
place a narrow object, such as a matchstick
vesicles on the skin around one eye, and a eye drops or ointment, and tell the patient
2-3 mm above the lid margin, holding it
red, sore eye which may be sensitive to to use the treatment hourly. They should be
parallel to the lid margin; iv) fold the eyelid
light. The treatment is topical antiviral eye told that the infection is serious, and that
upwards, against the matchstick. The eyelid
drops or ointment (e.g. idoxuridine, acyclovir). they should go to an eye department.
will then evert.
Health education: Steroid eye drops Health education: If a newborn baby has
Active infection causes two eye signs:
should never be used as they make the conjunctivitis and Gonococcus is suspected,
trachoma with follicles ‘TF’ (Figure 3), and
infection much worse. the mother should take her baby to an eye
trachoma with intense inflammation ‘TI’
clinic immediately for treatment. She
(Figure 4).
Bacterial
should also should be treated as well as her
husband/partner. Communities should be
ICEH
warned of the potential dangers of traditional
conjunctivitis eye remedies, particularly urine, which may
have come from someone with gonorrhea.
Acute conjunctivitis
Conjunctivitis due to bacteria differs from Chronic bacterial
infection due to viruses, as it is more likely conjunctivitis
to affect only one eye, and the amount of
Bacterial infection of the eyelid margins
discharge and lid swelling is usually greater.
can lead to chronic conjunctivitis. The patient
The patient complains of irritation, a foreign
complains of sore eyelids and sore eyes with
body sensation, and the eyelids are stuck
little discharge. On examination, the eyelid
together in the mornings. Fig 3. Trachoma TF. There are at least five
margins are thickened, slightly inflamed and
Treatment: Broad-spectrum topical follicles (small, whitish spots) on the
crusty. The eyes themselves may look normal
antibiotic such as tetracycline eye ointment. everted eye lid, which are at least 1 mm
or slightly red.
across
Treatment: As the source of the
Conjunctivitis due to conjunctivitis is infection of the eyelids,
ICEH
Gonococcus treatment is aimed at the eyelids and
Certain groups of individuals are at risk of a consists of tetracycline eye ointment applied
very severe form of bacterial conjunctivitis to the lid margins three times a day, after
due to the Gonococcus organism (which cleaning the lid margins to remove the crusts.
causes gonorrhea): i) newborn babies, who
acquire the infection during delivery; ii) Chlamydial conjunctivitis
adults, who acquire the infection during Chlamydia are organisms which have
sexual activity; and iii) individuals of any age some characteristics of viruses and some
who have used urine infected with of bacteria. They can cause conjunctivitis
Gonococcus as a traditional remedy. Taking in three groups of individuals: i) newborn
a history is, therefore, very important. babies, who acquire the infection Fig 4. Trachoma TI. Very active infection
Infection with Gonococcus should be during delivery; ii) children, who develop when at least half of the blood vessels of
suspected in any age group (including trachoma; and iii) young adults, who the conjunctiva on the upper eyelid
babies) if the eyelids are very swollen, if the acquire the infection during sexual activity. cannot be seen because the conjunctiva
discharge is thick and profuse, and if the is so thickened and inflamed
cornea is ulcerated or perforated (Figure 2).
Neonatal chlamydial Treatment: The child should be treated
either with topical tetracycline eye ointment,
Pak Sang Lee
Tissa Senaratne
common, but is only
conjunctivitis rarely sight threatening’
There are two forms: an acute form and
a chronic form.
Chemical
as this makes the condition worse. • Tetracycline eye ointment
• Povidone iodine eye drops
Chronic allergic
conjunctivitis
conjunctivitis (vernal
Many different substances put in the Summary
keratoconjunctivitis) eyes can cause chemical reactions (e.g. Conjunctivitis is common but is only rarely
The cause of vernal keratoconjunctivitis is traditional remedies, reaction to the sight threatening. However, accurate
not known, but it is often associated with preservatives in eye drops). The findings diagnosis and prompt treatment at the
asthma or eczema and is probably due to a are similar to that seen in viral conjunctivitis, primary level is very important as it instills
longstanding allergic reaction. The condition and so the history is important. confidence in the community, and reduces
usually starts between the ages of three and Treatment: The person should be told to the risk that people may first try traditional
25 years, and the patient complains of chronic stop instilling the substance that has remedies, which can, and do, lead
itching, a thick, clear, stringy discharge, light caused the reaction. Tetracycline eye to blindness.