CONJUNCTIVITIS

DEFINITION
Conjunctivitis is inflammation of the conjunctiva
It is the most common ocular disease worldwide.
Characterized by a pink appearance (hence the common term
pink eye) because of subconjunctival blood vessel hemorrhages.
Clinical Manifestations
General symptoms include foreign body sensation, scratching or burning sensation, itching, and photophobia.
Conjunctivitis may be unilateral or bilateral, but the infection usually starts in one eye and then spreads to the
other eye by hand contact.
Eye discharge (ie, watery, mucoid, purulent, or mucopurulent),
Presence or absence of lymphadenopathy (ie, enlargement of the preauricular and submandibular lymph
nodes where the eyelids drain)
Assessment and Diagnostic Findings

The four main clinical features important to evaluate are the type
Of discharge
type of conjunctival reaction (ie, follicular or papillary),
Presence of pseudomembranes or true membranes, and
CONT’D
Pseudo-membranes consist of coagulated exudate that adheres to the surface of the inflamed
conjunctiva.
True membranes form when the exudate adheres to the superficial layer of the conjunctiva, and
removal results in bleeding.
Follicles are multiple, slightly elevated lesions encircled by tiny blood vessels; they look like
grains of rice.
CONT’D
Papillae are hyperplastic conjunctival epithelium in numerous
projections that are usually seen as a fine mosaic pattern under
slit lamp examination.
Diagnosis is based on the distinctive characteristics of ocular
signs, acute or chronic presentation, and identification of any
precipitating events.
Positive results of swab smear preparations and cultures confirm
the diagnosis.
Types of Conjunctivitis
Conjunctivitis is classified according to its cause.
The major causes are microbial infection, allergy, and irritating toxic stimuli.
A wide spectrum of exogenous microbes can cause conjunctivitis, including:
bacteria (eg, Chlamydia), viruses, fungus, and parasites.
Conjunctivitis can also result from infection of an existing ocular infection or can be a manifestation of
a systemic disease.
MICROBIAL CONJUNCTIVITIS
Bacterial conjunctivitis can be acute or chronic.
The acute type can develop into a chronic condition.
Signs and symptoms can vary from mild to severe.
Chronic bacterial conjunctivitis is usually seen in patients with lacrimal duct obstruction, chronic dacryocystitis,
and chronic blepharitis.
The most common causative microorganisms are Streptococcus pneumoniae, Haemophilus influenzae, and
Staphylococcus aureus.
Bacterial conjunctivitis
(cont)
Bacterial conjunctivitis manifests with an acute onset of redness,
burning, and discharge.
There is papillary formation, conjunctival irritation, and injection in the fornices.
The exudates are variable but are usually present on waking in the morning.
The eyes may be difficult to open because of adhesions caused by the exudate.
CONT’D
Purulent discharge occurs in severe acute bacterial infections,
whereas mucopurulent discharge appears in mild cases.
In gonococcal conjunctivitis, the symptoms are more acute.
The exudate is profuse and purulent, and there is
lymphadenopathy.
Viral Conjunctivitis
Viral conjunctivitis can also be acute and chronic.
The discharge is watery, and follicles are prominent.
The common causative organisms are adenovirus and herpes simplex virus.
Conjunctivitis caused by adenovirus is highly contagious.
The symptoms include extreme tearing, redness, and foreign body sensation that can involve one or
both eyes.
CONT’D
The condition is usually preceded by symptoms of upper
respiratory infection.
Corneal involvement causes extreme photophobia.
There is lid edema, ptosis, conjunctival hyperemia (ie, dilation
of the conjunctival blood vessels), watery discharge, follicles,
and papillae.
These signs and symptoms vary from mild to severe and may
last for 2 weeks.
Viral conjunctivitis, although self-limited, tends to last longer
than bacterial conjunctivitis.
Epidemic keratoconjunctivitis
(EKC)
Epidemic keratoconjunctivitis (EKC) is most often accompanied by preauricular lymphadenopathy and occasionally
periorbital pain.
There are marked follicular and papillary formations.
EKC can lead to keratopathy.
EKC is a highly contagious viral conjunctivitis that is easily transmitted from one person to another among
household members, school children, and health care workers.
The outbreak of epidemics is seasonal, especially during the summer when people frequent swimming pools.
Chlamydial conjunctivitis
Chlamydial conjunctivitis includes trachoma and inclusion conjunctivitis.
Trachoma is an ancient disease and is the leading cause of preventable blindness in the world.
It is prevalent in areas with hot, dry, and dusty climates and in areas with poor living conditions.
It is spread by direct contact or fomites, and the vectors can be insects such as flies and gnats.
Trachoma conjunctivitis
Trachoma is a bilateral chronic follicular conjunctivitis of childhood that leads to blindness during
adulthood, if left untreated.
The onset in children is usually insidious, but it can be acute or subacute in adults.
The initial symptoms include red inflamed eyes, tearing, photophobia, ocular pain, purulent exudates,
preauricular lymphadenopathy, and lid edema.
At the middle stage of the disease, there is an acute inflammation with papillary hypertrophy and follicular
necrosis, after which trichiasis (turning inward of hair follicles) and entropion begin to develop.
CONT’D
The lashes that are turned in rub against the cornea and, after prolonged irritation, cause
corneal erosion and ulceration.
The late stage of the disease is characterized by scarred conjunctiva, subepithelial keratitis,
abnormal vascularization of the cornea (pannus), and residual scars from the follicles that look
like depressions in the conjunctiva (ie, Herbert’s pits).
Severe corneal ulceration can lead to perforation and blindness.
Inclusion conjunctivitis
Inclusion conjunctivitis affects sexually active young people who have genital chlamydial infection.
Transmission is by oral-genital sex or hand-to-eye transmission.
It has been reported that indirect transmission has been acquired from inadequately chlorinated swimming pools.
The eye lesions usually appear a week after exposure and may be associated with a nonspecific urethritis or
cervicitis.
The discharge is mucopurulent, follicles are present, and there is lymphadenopathy.
ALLERGIC CONJUNCTIVITIS
Immunologic or allergic conjunctivitis is a hypersensitivity reaction as a part of allergic rhinitis (hay
fever), or it can be an independent allergic reaction.
The patient usually has a history of an allergy to pollens and other environmental allergens.
There is extreme itching, epiphora (ie, excessive secretion of tears), injection, and usually severe
photophobia.
The string-like mucoid discharge is usually associated with rubbing the eyes because of severe itching.
Vernal Conjunctivitis
Vernal conjunctivitis is also known as seasonal conjunctivitis
because it appears mostly during warm weather.
There may be large formations of papillae that have a
cobblestone appearance.
It is more common in children and young adults.
Most affected individuals have a history of asthma or eczema.
TOXIC CONJUNCTIVITIS

Chemical conjunctivitis can be the result of medications, chlorine

from swimming pools (more common during the summer),
exposure to toxic fumes among industrial workers, or exposure to
other irritants such as smoke, hair sprays, acids, and alkalis.
Management
The management of conjunctivitis depends on the type.
Most types of mild and viral conjunctivitis are self-limiting, benign conditions that may not require treatment and
laboratory procedures.
For more severe cases, topical antibiotics, eye drops, or ointment are prescribed.
Patients with gonococcal conjunctivitis require urgent antibiotic therapy.
If left untreated, this ocular disease can lead to corneal perforation and blindness.
The systemic complications can include meningitis and generalized septicemia.
Management (cont)

Acute bacterial conjunctivitis is almost always self-limiting.

If left untreated, the disease follows a 2-week course with
resolution of symptoms.
If treated with appropriate antibiotics, it may last for a few days,
with the exception of gonococcal and staphylococcal
conjunctivitis.
Viral conjunctivitis is not responsive to any treatment.
Cold compresses may alleviate some symptoms.
Management (cont)
It is important to remember that viral conjunctivitis,
especially EKC, is highly transmissible.
Patients must be made aware of the contagious nature of the disease, and adequate instructions must be given.
These instructions should include an emphasis on hand-washing and avoiding sharing hand towels, face
cloths, and eye drops.
Tissues should be directly discarded into a trashcan.
Management (cont)
Proper steps must be taken to avoid nosocomial infections.
Frequent hand hygiene, procedures for environmental cleaning, and disinfection of equipment
used for eye examination must be strictly followed at all times.
During outbreaks of conjunctivitis caused by adenovirus,
it is necessary that health care facilities assign specified areas for treating patients with or
suspected of having conjunctivitis caused by adenovirus to prevent spread.
Management (cont)
All forms of tonometry must be avoided unless medically
indicated.
All multidose medications must be discarded at the end of each
day or when contaminated.
Infected employees and others must not be allowed to work or
attend school until symptoms have resolved, which can take 3 to
7 days.
Management (cont)
Patients with allergic conjunctivitis, especially recurrent vernal or seasonal
conjunctivitis, are usually given corticosteroids in ophthalmic preparations.
Depending on the severity of the disease, they may be given oral preparations.
Use of vasoconstrictors, such as topical epinephrine solution, cold compresses, ice
packs, and cool ventilation usually provide comfort by decreasing swelling.
Management (cont)
For trachoma, treatment is usually broad-spectrum antibiotics administered topically and systemically.
Surgical management includes the correction of trichiasis to prevent conjunctival scarring.
Adult inclusion conjunctivitis requires a 1-week course of antibiotics.
Prevention of reinfection is important, and affected individuals and their sexual partners must be advised to seek
assessment and treatment for sexually transmitted disease, if indicated.
For conjunctivitis caused by chemical irritants, the eye must be irrigated immediately and profusely with saline or
sterile water.
MURAKOZE