Conjunctivitis

Definition
• Conjunctivitis: inflammation of the
conjunctiva
Eye Anatomy
 Classification of Conjunctivitis
Viral
• Infectious  Hyperacute
Bacterial  Acute
Chronic

• Noninfectious  Allergic, Toxins/ Chemicals,

Foreign body, Trauma, Neoplasm
 Etiological classification

• 1. Infective conjunctivitis: bacterial, chlamydial,

viral,fungal, rickettsial, spirochaetal, protozoal,
parasitic etc.
• 2. Allergic conjunctivitis.
• 3. Irritative conjunctivitis.
• 4. Keratoconjunctivitis associated with diseases of
skin and mucous membrane.
• 5. Traumatic conjunctivitis.
• 6. Keratoconjunctivitis of unknown etiology.
eg: Trachoma..
Prevalence
 Viral Conjunctivitis
• Most common viral cause is adenovirus (enterovirus,
HSV)

• Occurs in community epidemics (schools,

workplaces, physicians’ offices)

• Usual modes of transmission: contaminated fingers,

medical instruments, swimming pool water
Viral infections of conjunctiva include:

• Adenovirus conjunctivitis
• Herpes simplex keratoconjunctivitis
• Herpes zoster conjunctivitis
• Pox virus conjunctivitis
• Myxovirus conjunctivitis
• Paramyxovirus conjunctivitis
• ARBOR virus (ARthropod-BOrne virus)
conjunctivitis
 Clinical presentations.
• Acute viral conjunctivitis may
present in three clinical forms:
• 1. Acute serous conjunctivitis
• 2. Acute haemorrhagic conjunctivitis
• 3. Acute follicular conjunctivitis
 Symptoms:

include:
unilateral or bilateral
• redness,
• watering,
• mild mucoid discharge,
• mild photophobia
• feeling of discomfort
and foreign body sensation.
• May be part of viral prodrome:
• tender preauricular node
• adenopathy,
• fever,
• pharyngitis,
• cough,
• rhinorrhea
 ACUTE SEROUS CONJUNCTIVITIS

• Etiology. It is typically caused by a mild grade viral

infection which does not give rise to follicular response.
• Clinical features. Acute serous conjunctivitis is
characterised by
- a minimal degree of congestion,
- watery discharge and
- boggy swelling of the conjunctival mucosa.
• Treatment. Usually it is self-limiting and does not
need any treatment.
• But to avoid secondary bacterial infection,
--broad spectrum antibiotic eye drops may be used three
times a day for about 7 days.
ACUTE HAEMORRHAGIC CONJUNCTIVITIS

• It is an acute inflammation of conjunctiva

characterised by
• multiple conjunctival haemorrhages,
• conjunctival hyperaemia and
• mild follicular hyperplasia.
• Symptoms: include
• pain,
• redness,
• watering,
• mild photophobia
• transient blurring of vision and
• Lid swelling.
• Signs:
• conjunctival congestion,
• chemosis,
• multiple haemorrhages in bulbar conjunctiva,
• mild follicular hyperplasia,
• lid oedema and
• pre-auricular lymphadenopathy.
• Corneal involvement may occur in the form of
-fine epithelial keratitis.
 Treatment
• very infectious and poses major potential problems of
cross-infection. Therefore,
• prophylactic measures are very important.
• No specific effective curative treatment is known.
However,
• broad spectrum antibiotic eye drops may be used to
prevent secondary bacterial infections.
• Usually the disease has a self-limiting course of 5-7
days.
 FOLLICULAR CONJUNCTIVITIS
• Types
• 1. Acute follicular conjunctivitis.
• 2. Chronic follicular conjunctivitis.
• 3. Specific type of conjunctivitis with follicle formation
e.g., trachoma
 ACUTE FOLLICULAR CONJUNCTIVITIS

It is an acute catarrhal conjunctivitis associated

with--
• marked follicular hyperplasia--
especially of the lower
fornix and lower palpebral conjunctiva.
 Symptoms
--- similar to acute catarrhal conjunctivitis
include:
• Burning and grittiness in the eyes, especially
in the evening.
• Feeling of heat and dryness on the lid
margins.
• Difficulty in keeping the eyes open.
• Feeling of sleepiness and tiredness in the eyes
• Mild chronic redness in the eyes.
• Mild mucoid discharge especially in the
canthi. Off and on lacrimation.
 Signs
• conjunctival hyperaemia, associated with-
multiple follicles, more prominent in
lower lid than the upper lid
 Treatment
• Primary herpetic infection is usually
selflimiting.
• The topical antiviral drugs control the
infection effectively and prevent recurrences
 BACTERIAL CONJUNCTIVITIS
• Etiology:
- Predisposing factors
- Causative organisms
- Acording to Mode of infection
 Pathology
Vascular response

Cellular response

Conjunctival tissue repsonse

Conjunctival discharge
 CLINICAL TYPES OF BACTERIAL
CONJUNCTIVITIS
1. mucopurulent conjunctivitis.
2. Acute purulent conjunctivitis
3. Acute membranous conjunctivitis
4. Acute pseudomembranous conjunctivitis
5. Chronic bacterial conjunctivitis
6. Chronic angular conjunctivitis
1. MUCOPURULENT CONJUNCTIVITIS
• Common causative bacteria are:
Staphylococcus aureus,
Koch-Weeks bacillus,
Pneumococcus and
Streptococcus.
 Symptoms
• Discomfort and foreign body
• Mild photophobia.
• Mucopurulent discharge from the eyes.
• Sticking together of lid margins
• Slight blurring of vision due to mucous flakes
• may complain of coloured halos.
 Signs
• Conjunctival congestion
• Chemosis
• Petechial haemorrhages
• Flakes of mucopus
• Cilia are usually matted
• Yellow crust
 2. PURULENT CONJUNCTIVITIS
Etiology:
-causative organism
Clinical picture:
1 Stage of infiltraton
2 Stage of blenorrhoea
3 Stage of slow healing
 Stage of infiltraton

• Considerably painful and tender eyeball.

• Bright red velvety chemosed conjunctiva.
• Lids are tense and swollen.
• Discharge is watery or sanguinous.
• Pre-auricular lymph nodes are enlarged.
 Stage of blenorrhoea
• Frankly purulent, copious, thick discharge
trickling down the cheeks.
• Other symptoms are increased but tension in
the lids is decreased
 Complications
• 1. Corneal involvement
• 2. Iridocyclitis
• 3. Systemic complications—
- gonorrhoea arthritis
- endocarditis
- septicaemia
3. MEMBRANOSA CONJUNCTIVITIS
Etiology:
Corynebacterium diphteriae dan Streptococcus
haemolyticus
4. Pseudomembranosa conjungtivitis

coagulasion eksudat fibrinosa

 Treatment
• Topical antibiotics- broad specturm antibiotics
• Irrigation of conjunctival sac
• Anti-inflammatory and analgesic drugs
 OPHTHALMIA NEONATORUM
• Source and mode of infection:
- Before birth infection is very rare through
infected liquor amnii in mothers with ruptured
membrances
- During birth.
- After birth
 Causative agents
• Gonococcal infection
• Other bacterial infections
• Herpes simplex ophthalmia neonatorum
 Symptoms and signs
• 1. Pain and tenderness in the eyeball.
• 2. Conjunctival discharge. It is purulent in
gonococcal ophthalmia neonatorum and
mucoid or mucopurulent in other bacterial
cases and neonatal inclusion conjunctivitis.
• 3. Lids are usually swollen.
• 4. Conjunctiva may show hyperaemia and
chemosis
• 5. Corneal involvement, though rare.
 Treatment
• A. Prophylaxis needs antenatal, natal and
postnatal care.
• Curative treatment:
• Chemical ophthalmia neonatorum is a self-
limiting condition, and does not require any
treatment.
• Topical therapy
- Saline lavage
-Bacitracin eye ointment 4 times/day
• However in cases with proved penicillin
susceptibility, penicillin drops 5000 to 10000
units per ml should be instilled every minute
for half an hour, every five minutes for next
half an hour and then half hourly till the
infection is controlled.
• Systemic therapy:
• Ceftriaxone 75-100 mg/kg/day IV or IM, QID.
• Cefotaxime 100-150 mg/kg/day IV or IM, 12
hourly.
• Ciprofloxacin 10-20 mg/kg/day or Norfloxacin
10 mg/kg/day.