SAINT LOUIS UNIVERSITY

SCHOOL OF MEDICINE
DEPARTMENT OF OPHTHALMOLOGY

OPHTHALMOLOGY ROTATION
JULY 2021

WRITTEN REPORT 3:
BACTERIAL CONJUNCTIVITIS

Submitted by:
VALENCERINA, Djan Kurvie R.

Submitted to:
Dr. Joanne Balderas
 BACTERIAL CONJUNCTIVITIS

Bacterial conjunctivitis is an infection of the eye's mucous membrane, the conjunctiva, which
extends from the back surface of the eyelids (palpebral and tarsal conjunctiva), into the fornices,
and onto the globe (bulbar conjunctiva) until it fuses with the cornea at the limbus.

Acute bacterial conjunctivitis

Acute bacterial conjunctivitis. The most common causative bacteria are Staphylococcus aureus
(in children and adults), Streptococcus pneumoniae and Haemophilus influenzas (especially in
children) and others include Streptococcus viridans and pyogenes. Usually, the onset is
relatively acute and the eyelids are frequently stuck together with a mucopurulent exudate upon
waking. By the time of presentation, the infection is usually bilateral. Subconjunctival
haemorrhages may be seen particularly with pneumococcal or haemophilus infections
The conjunctivitis usually responds well to a 7–10-day course of topical antibiotic drops or
ointment (e.g., chloramphenicol). Combined preparations of corticosteroids with antibiotics are
contraindicated.
Hyperacute (gonococcal) conjunctivitis

Hyperacute (gonococcal) conjunctivitis. Gonococcal conjunctivitis is severe, rapidly progressive,

particularly purulent and liable to lead to rapid corneal ulceration because Neisseria
gonorrhoeae are able to penetrate an intact epithelium (unlike the majority of bacteria). Other
signs include swollen eyelids, chemosis and preauricular lymphadenopathy. The conjunctivitis
has an incubation period of up to five days and tends to affect adults usually as a result of
infection from an acute urethritis. The infection can also infect the newborn infant of a mother
with an infection of the birth canal. The organism can be demonstrated as Gram negative
intracellular diplococci in conjunctival scrapings at the onset and in the exudate a little later.
Culture is best achieved using chocolate agar or Thayer-Martin media.
Treatment is with systemic and local antibiotics (penicillin with probenecid, spectinomycin or
tetracycline) together with frequent ocular irrigation. Any accompanying keratitis and uveitis
should be managed with appropriate, intensive treatment. In some cases, gonococcal urethritis
may cause a bacteremia with signs of polyarthritis and tenosynovitis. Sterile conjunctivitis may
also occur, which must be differentiated from Reiter's syndrome. In all cases, sexual partners
should be investigated for gonorrhea.
Chronic bacterial conjunctivitis

Chronic infection is most often due to toxins of Staphylococcus aureus or S. epidermidis

resident in the lid margin. Associated signs include blepharitis, inferior punctate corneal
erosions and marginal keratitis. Other causes include infection with gram-negative bacteria such
as proteus, klebsiella, Escherichia coli and moraxella. Any associated chronic dacryocystitis has
to be treated before an improvement in the conjunctivitis occurs.
Another type of chronic conjunctivitis is meibomitis. This is a chronic conjunctivitis caused by
inflammation of the meibomian oil glands that line the posterior lid margin behind the eyelashes.
These glands malfunction when inflamed, leading to chronic inflammation of the lid margins and
the conjunctiva as well as dry eyes. Meibomitis and blepharitis (inflammation of the eyelid) are
also often associated with the skin disorder acne rosacea.
Trachoma infection of the eyes can also cause chronic conjunctivitis and can lead to chronic
keratoconjunctivitis. Trachoma infection is the most common cause of preventable blindness in
the world. It is uncommon in North America, but patients from Africa, Asia, and the Middle East
with this condition may experience scarring of the ocular surface and eyelids, leading to
decreased vision.