CHLAMYDIAL CONJUNCTIVITIS

• BY:

• DR. ZULFIQAR ALI

• ASSISTANT PROFESSOR
• DEPARTMENT OF OPHTHALMOLOGY
• QAMC, BVH, BAHAWALPUR
Chlamydial Conjunctivitis

• PATHOGENESIS
• ADULT INCLUSION CONJUNCTIVITIS
• It is caused by D-K Chlamydia trachomatis
• TRACHOMA
• It is caused by serovars A, B, Ba, and C of Chlamydia trachomatis,

• VECTOR

• Common house fly, but there may be direct transmission from eye or nasal discharge.
• Trachoma is the leading cause of preventable irreversible blindness in the world. It is related to
poverty, overcrowding, and poor hygiene,
• Cell-mediated delayed hypersensitivity (type IV) reaction
CLINICAL FEATURES
SYMPTOMS
• Unilateral /bilateral after few days
• Chronic irritation
• Watering
• Redness
• Decrease Vision
SIGNS
• Mucuprulant Discharge
• Follical formation
• follicular/papillary is common but papillary component is predominant in children under
two years.
• Superior epithelial keratitis and pannus formation .
SIGNS
WHO GRADING OF TRACHOMA

•    TF = trachomatous inflammation (follicular): five or more follicles

(>0.5 mm) on the superior tarsus
   TI = trachomatous inflammation (intense):diffuse involvement of
the tarsal conjunctiva, obscuring 50% or more of the normal deep
tarsal vessels; papillae are present
   TS = trachomatous conjunctival scarring: easily visible fibrous white
tarsal bands
   TT = trachomatous trichiasis: at least one lash touching the globe
   CO = corneal opacity sufficient to blur details of at least part of the
pupillary margin
COMPLICATIONS
1.    EYE LIDS
• Ptosis (Mechanical ptosis due to scaring)
• Cicatricial Entropion
• Trichiasis, distichiasis

2.    CORNEA
• Severe corneal opacification (due to keratinization).
• Herbert pits Superior limbal follicles may resolve to leave a row of shallow depressions
• Pannus formation

3. DRY EYE
• Dry eye caused by destruction of goblet cells and the ductules of the lacrimal gland
• Severe corneal opacification.
INVESTIGATIONS
• are rarely used and the diagnosis is made on clinical grounds.
• But in case of adult inclusion conjunctivitis
• Gimsa Stain shows intracytoplasmic inclusion bodies
• PCR Studies
Management
• The SAFE strategy for trachoma management supported by the WHO and other agencies encompasses
• S- Surgery for trichiasis,
• A-Antibiotics for active disease,
• F-Facial hygiene
• E-Environmental improvement.   
• 1    Antibiotics
• A single dose of azithromycin (20 mg/kg up to 1g) is the treatment of choice.
• Erythromycin 500 mg b.d. for 14 days is an alternative for women of childbearing age.
• Topical 1% tetracycline ointment is less effective than oral treatment; it should be given for 6 weeks.

   2    Facial cleanliness is a critical preventative measure.

   3    Environmental improvement such as access to adequate water and sanitation, as well as control of flies, is
important.

   4    Surgery is aimed at relieving entropion and trichiasis and maintaining complete lid closure with
bilamellar tarsal rotation.
PROPHLEXIS
• Required in endemic areas
• Tetracycline eye ointment 0.1% OD for ten days in a month for six
months in a year or
• Tetracycline eye ointment 0.1% BD for five days in a month for six
months in a year
• Hand and face washing with soap
OPHTHALMIA NEONATORUM

By:

Dr. Zulfiqar Ali

Assistant Professor,
Department of Ophthalmology
QAMC,BVH, Bahawalpur.
OPHTHALMIA NEONATORUM

• DEFINITION
• Neonatal conjunctivitis in the first
month of life
ETIOLOGICAL CLASSIFICATION
• Chemical Conjunctivitis (1% silver nitrate) replacement of silver nitrate with erythromycin ointment in United States
• First 24 hours
• Gonococcal conjunctivitis (Most severe and feard)
• N.Gonococcus (Gonococcal: first week)
• Simple Bacterial Conjunctivitis
• Stephlococcus
• Steptococcus
• Hemophilus
• end of the first week
• Viral Conjunctivitis (HSV-II)
• 1–2 weeks.
• Chalamydial conjunctivitis (Most common)
• Chalamydia trachomatus (1-3 weeks)
CHEMICAL CONJUNCTIVITIS

• CAUSES & TREATMENT:-

• Silver nitrate, antibiotics
• Onset in 24 hours
• And resolves spontaneously in 36 hours
CHLAMYDIA
• 30-40%
SYSTEMIC INVOLVEMENT
• In addition, 10% to 20% of these children develop pneumonia related
to Chlamydia. localized infection in the nasopharynx, middle ear,
vagina, and rectum.
CLINICAL FEATURES
• 40% neonates infected :- watery conjunctivitis becoming purulent, papillary reaction (no follicles in
newborn), +/- pseudomembranes, corneal scarring

• COMPLICATIONS:
• pneumonia, otitis media, rhinitis, GIT infection.

• DIAGNOSIS
• ELISA, Giemsa, culture, direct immunofluorescent antibodies (fastest). PCR
• TREATMENT
• Neonate- 50mg/kg erythromycin in 4 divided doses for 3 weeks, topical tetracycline 1%
• Adults- erythromycin 250mg QID for 3 weeks
• Prophylaxis- Oc tetracycline or Oc erythromycin within 1hr after birth
GONOCOCCAL CONJUNCTIVITIS
CLINICAL FEATURE
75% Bilateal
hyperacute conjunctivitis associated with marked
• Eye lid edema,
• Chemosis
• Purulent discharge,
• Beginning within first week after birth.
• Conjunctival membranes may be present.
• Delay in diagnosis, corneal ulceration may occur and can rapidly progress to perforation.
SYSTEMIC INVOLVMENT
• Septicemia and meningitis are possible systemic involvements.
OCULAR COMPLICATIONS
• Keratitis, Corneal ulceration, Perforation, Endophtahlmitis .
GONOCOCCAL
• DIAGNOSIS
• Gram stain (intracellular diplococci), culture
• Culture on chocolate agar for N gonorrhoeae. (Thayer-Martin media may also be used)
• TREATMENT
• topical treatment is broad spectrum antibiotic and clean the eyes frequently.
• ceftriaxone 125mg stat IMI , 50,000u/kg penicillin in 2 divided doses for 7/7
COMMON BACTERIAL
CONJUNCTIVITIS
• Staphyloccus aureus,
• Strep. epidermidis,
• Streptococcus pneumoniae,
• E. coli,
• Pseudomonas,
• Haemophilus influenzae

• DIAGNOSIS
• By gram and culture.
CLINICAL FEATURES
• Classically, the onset of bacterial conjunctivitis is described as occurring at the end of first week.
• Lid edema,
• chemosis,
• conjunctival injection
• Prulant discharge
• Look for corneal trauma or ulceration or NLD Block

• TREATMENT
• Neosporin ophthalmic covers most
• If Haemophilus:- need systemic ampicillin or cefuroxime as well
HERPES SIMPLEX VIRUS
• Although either herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2) can cause
neonatal conjunctivitis, up to 70% of neonatal herpetic infections have been
attributed to the genital strain, HSV
• Most neonatal HSV-1 infections seem to be related to contact with active
infections ("fever blister" or "cold sores") in the immediate family during the
perinatal period.
• HSV-2 is usually transmitted during passage through the birth canal or by
transplacental mechanisms.
 HERPES SIMPLEX TYPE 2

• Usually type II
• Vesicular blepharitis +/- keratitis.
• DIAGNOSIS
• Immunofluorescence, smears, culture.
• TREATMENT
• Topical / systemic acyclovir
HERPES SIMPLEX TYPE 2

• COMPLCATIONS
• Dendtretic Keratitis
• Vesical on the periobtial skin, blephritis
• Pseudomembrane formation
OPHTHALMIA NEONATORUM
DIFFERENTIAL DIAGNOSIS

The differential diagnosis of neonatal conjunctivitis includes:

• Dacrocysitis
• Congenital glaucoma
• Nasolacrimal duct obstruction
• Preseptal/Orbital cellulitis
• Congenital glaucoma
• Infectious keratitis
 Management of Pterygium
By:

Dr. Zulfiqar Ali

Assistant Professor,
Department of Ophthalmology
QAMC, BVH, Bahawalpur
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 Pterygium
• Defn : An Elastotic Degenerative condition of conjunctiva with a wing like
encroachment of conjunctiva on to the Cornea.

• Pathogenesis –
Environmental causes- UV exposure, dust heat , wind exposure
Heredity
Coroneo Effect -Nasal segment of cornea gets highest UV exposure effect
Limbal Stem cell defect with Fibroblast Activation

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Pterygium - Classification
•On the basis of Development Body Neck
Primary Pterygium
Recurrent Pterygium
Head

•On the basis of Growth

Atrophic Pterygium
• Older pts, thin translucent body with thin vessels
Pogressive Pterygium
• Thick fleshy growth seen in Younger pts
• On the basis of Number ____Single & Double
• On the basis of Latrality____Unilateral & Bilateral
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Pterygium
• Grading of pterygium helps for management
• Depending on Size-
• I Grade 1 2 Gr 3
•
•

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PTERYGIUM- MANAGEMENT
Observation
• Asymptomatic , grade 1 pterygium

Medical Management
• Symptomatic Grade 1 and 2 pterygium
• Eye drops – Tear substitutes, Decongestants

Surgical Management

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 Pterygium -Surgical Management

• Indications-
Symptomatic patients
- recurrent irritation, redness and watering
Visual need
- covering visual axis or threatening visual axis
- causing irregular astigmatism
- Grade 2 and 3 Pterygium
Cosmetic
Recurrent Inflammation
Therapeutic
- suspected associated neoplastic degeneration
- motility restrict

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Pterygium -Surgical Management
Different Procedures have been described
Excision - Bare sclera technique
Excision and direct suturing of cut ends of conjunctiva
Excision of Head +Rotation and burial of body in inferior fornix (Transpostion)
Excision + Conj Auto graft (CAG) - most preferred (Ocular surface transplantation)
Excision + Conjunctivolimbal Auto graft
Excision + MMC
Excision + MMC + Conj Auto graft For recurrent pterygium 30-50%
Excision + AMG
Excision + MMC + AMG

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Pterygium -Surgical Management
• Excision
• Either from medial conjunctival side or from head
• Peeling off pterygium from corneal surface
• Smoothening of Corneal surface with 15 no Blade or diamond Burr
• Conjuntiva sutured with 8-0 Vicryl suture
• Limbal apposition - can be done by 10-0 nylon Monofilament suture
•

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Pterygium -Surgical Management
• Adjuvants – to reduce recurrence
• Mitomycin C- For recurrent pterygia
• Intra op or post op
• Uncommonly used
• Late Scleral necrosis & melt High complications
• Thiotepa – used post op
• Beta radiation with Strontium 90

• Excimer Laser in PTK mode – for corneal smoothening

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 THANK YOU

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12/19/2021