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ACUTE CONJUNCTIVITISDr. s.veni priya
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CLASSIFICATION Based on onset
Acute. Sub-acute. Chronic.
Based on type of Exudates Serous (Viral, allergic, toxic). Catarrhal (allergic – Ropy or thread like thick mucoid discharge). Mucopurulent. Purulent. Pseudo-Membranous / Membranous.
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CLASSIFICATION (Continued)
Based on Conjunctival ReactionFollicular.Papillary. Granulomatous.
Based on Etiology Infectious (Bacterial, Viral, Chlamydial, Fungal and
parasitic).Non-infectious (Allergic, Irritants).
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RISK FACTORSDisruption of host defense mechanism caused by:
Dry Eye. Exposure due to lid retraction, exophthalmos, lagophthalmos and inadequate blinking. Nutritional deficiencies / Avitaminosis A. Local or Systemic Immune Deficiency:
After topical and systemic immunosuppressive therapy Nasolacrimal duct obstruction and infection. Radiation damage . Trauma. Surgery. Prior Conjunctival inflammation or infection. Systemic Infection. Exogenous inoculation
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TYPES OF ACUTE CONJUNCTIVITIS
Bacterial Conjunctivitis:a. Acute Purulent & Muco Purulentb. Gonococcalc. Membraneous & Pseudo Membraneousd. Angular
Viral – Follicular Conjunctivitis. Chlamydial – Adult & Neonatal Inclusion Conjunctivitis.Ophthalmia Neonatorum Conjunctivitis.
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BACTERIAL CONJUNCTIVITIS Acute Purulent & Muco Purulent Etiology
Contagious Transmitted by discharge Staph.aureus – most common H.aegyptius, N.gonorrhoea.
Clinical Features Hyperaemia Mucous discharge Stickiness of the lids Flakes of mucus & Pus in Fornices and lid margins Haloes Certain clinical features indicates likelihood of certain specific infections.
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BACTERIAL CONJUNCTIVITIS Acute Purulent & Muco Purulent - Continued
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BACTERIAL CONJUNCTIVITIS Acute Purulent & Muco Purulent - Continued
TreatmentTopical fluro quinolone – ciprofloxacin, Ofloxacin,
Moxifloxacin, Gatifloxacin.Bacitracin or ciprofloxacin OintmentOral antibiotics for patients with pharyngitis and
haemophilus infection in children.
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BACTERIAL CONJUNCTIVITIS Gonococcal Etiology
Caused by Neisseria Gonorrhoeae (a bun- shaped Gram-negative intracellular diplococcus).
It is sexually transmitted disease
Clinical FeaturesPre-auricular lymphadenopathy, tenderness and
suppuration.No immunity is conferred by an attack. Associated systemic signs – Urethritis, rise of
temperature and depression.
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BACTERIAL CONJUNCTIVITIS Gonococcal - Continued Complications• Corneal involvement – Gonococcus is capable of
invading the normal cornea through intact cornea. Location of Corneal Ulcer – Central, Marginal Ulcer , all
round. Progressing rapidly depth-wise leading to perforation and complications associated with it.
Other complications of Gonorrhoeal Conjunctivitis– Iritis , Iridocyclitis .
Non Ocular complications – Arthritis, Endocarditis and Septicaemia.
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BACTERIAL CONJUNCTIVITIS Gonococcal - Continued
TreatmentOf Gonococcal Conjunctivitis is started on confirmation
ofintracellular Gram-negative diplococci in conjunctival scrapings in clinically suspected cases.
Aim of therapy is to prevent or limit the corneal involvement and to eliminate systemic source.
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BACTERIAL CONJUNCTIVITIS Gonoccol - Continued
Treatment – Continued Systemic Treatment
Ceftriaxone - 1 gm IM , single dose. Tetracycline In cases where co-existing Chlamydial
Trachomatis infection is suspected and cases with history of allergy to Penicillin / Cephalosporins
Topical Treatment Cleanliness Ciprofloxacin / Ofloxacin/ Gentamicin/ Tobramycin Eye
Drops 2 hrly. Bacitracin Eye Ointment 6 hrly. Cycloplegic (Atropine) – in cases of Corneal involvement .
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BACTERIAL CONJUNCTIVITISMembranous & Pseudo Membranous
EtiologyCaused by C.diphtheriae, Beta haemolytic strettocci, H.aegyptius, Staph.aureus
& E.coliOccurs in children in assosiation with neasels , searlet fever, influenza &
whooting cough.
Clinical FeaturesSwelling of lidsEucopurulant dischargeWhite Membrane on everting lidGreat danger of corneal ulcerations – 6 to 10 days. Increase risk of symbletharon.
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BACTERIAL CONJUNCTIVITISMembranous & Pseudo Membranous - Continued
TreatmentSystemic Treatment
4,000 to 10,000 units of anti diphtheretic serum.Penicillin
Topical Treatment Topical 10,000 units / ml drops made from injectable
preparations.
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BACTERIAL CONJUNCTIVITISAngular
EtiologyCaused by Staphylococci and more typically by
Moraxella Lacunata. Incubation period is usually 4 days . Symptoms - Redness, discomfort, frequent blinking,
sharp pricking pain and mucopurulent discharge.
Clinical FeaturesCongestion limited to intermarginal strip at inner and
outer canthi and neighbouring bulbar conjunctiva. Excoriation of skin at inner and outer palpabral angles .
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BACTERIAL CONJUNCTIVITISAngular - Continued
Complications
Chronic conjunctivitis, Blepheritis, corneal ulcer (marginal or central associated with hypopyon) .
Attack does not confer immunity, and relapses may occur. Swelling of lids.
TreatmentTopical Treatment
Tetracycline eye ointment .Eye drops containing Zinc also beneficial, acts by
inhibiting proteolytic ferment.
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VIRAL CONJUNCTIVITIS TYPES• Acute Follicular Conjunctivitis• Sub Acute or Chronic Follicular Conjunctivitis• Epidemic Keroto Conjunctivitis.• Pharyngo Conjuctival fever.• Heaymorrhagic Conjunctivitis• Acute Herpitic Conjunctivitis• Herps Simplex Conjunctivitis
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VIRAL CONJUNCTIVITIS(Continued)
Clinical Features Serous or watery discharge Conjunctival foillicals. Sub Conjunival haemorrhage Punctate epithelial opacities Preoricular lymph node. Decreased corneal sensation.
Treatment Topical Treatment
Artificial Tears Antibiotic eye drops to prevent secondary infection.
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OPHTHALMIA NEONATORUM Etiology
Neisseria Gonorrhoeae, Streptococcus Pneumoniae, Staphylococcus etc.
Chlamydial Trachomatis, Chalmydial OculogenitalisChemical Conjunctivitis due to Silver Nitrate 1or 2%
(used as Crede’s method) Clinical Features
Purulent bilateral conjuntival dischargeHyper acute blenorrhoeaSwelling of lidsMucopurulent discharge
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OPHTHALMIA NEONATORUM (Continued)
Complications Corneal Ulcer : Oval ulcer, just below the centre of
cornea, rarely oval marginal ulcer, progressive ulcer resulting in – perforation of corneal ulcer, prolapse of uveal tissue, purulent uveitis, prolapse of lens, prolapse of vitreous.
Scarring of cornea, adherent leucoma, anterior staphyloma, anterior capsular cataract, anophthalmitis.
Non development of fixation due to corneal opacity during first 3 weeks.
Nystagmus due to non-development of macular fixation
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OPHTHALMIA NEONATORUM(Continued)
Treatment
Systemic Treatment Ceftriaxone – 25 to 50 mg/kg single dose.Cefatoxine – 100 mg / kg single dose.
Topical Treatment Saline irrigation Topical flouro quinolones.Topical cycloplejia.
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ACUTE CONJUNCTIVITIS
QUESTION & ANSWER SESSION
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