Conjunctivitis

CONJUNCTIVITIS

Definition:

Conjunctival hyperaemia associated with discharge which may be water, mucoid, mucopurulent or purulent.

A. Infective Conjunctivitis 1. Bacterial Conjunctivitis -Acute bacterial conjunctivitis -Hyperacute bacterial conjunctivitis -Chronic bacterial conjunctivitis -Angular bacterial conjunctivitis

Types of Conjunctivitis

Acute bacterial conjunctivitis

Predisposing factors:- Flies Poor hygienic conditions Hot dry climate Poor sanitation

Etiology

Causative organisms:- Staph. aureus Koch-Weeks Bacillus (H. influenzae) Pneumococcus Streptococcus Moraxella N. gonorrhoea

Mode of infection:- Exogenous infections: directly,

vectortransmission, material transfer. Local spread: infected lacrimal sac, lids

and nasopharynx. Endogenous infections: blood

Symptoms: Discomfort and foreign body sensation, Mild photophobia, Hyperaemia and Mucopurulent discharge, Sticking together of lid margins, Slight blurring of vision, Coloured halos

Signs: Flakes of mucopus seen at fornices, canthi

and lid margins, Conjunctival congestion, Chemosis, Papillae of fine type seen, Oedematous eyelids, Petechial hemorrhages, Matted cilia with yellow crusts

Superficial punctate epitheliopathy, Marginal corneal ulceration, Superficial keratitis, Blepharitis, Dacryocystitis

Complications

Hyperacute bacterial conjunctivitis

Etiology: Neisseria species, most commonly N. gonorrhoeae

Presentation: copious, purulent discharge with rapidly progressive symptoms (12-24 hrs) pain which is moderate to severe,lid swelling, and tender and enlarged preauricular LNs.

Chronic bacterial conjunctivitis

Symptoms-• Burning and grittiness in eyes• Mild chronic redness• Feeling of heat and dryness in lid margins• Mild mucoid discharge Signs- Congestion of post. Conunctival

vessels, mild papillary hypertrophy of palpebral conjunctiva and congested lid margins

Angular bacterial conjunctivitis

Mild inflammation near angles and maceration of surrounding skin

Causative organism- Moraxella axenfeld SOI- Usually nasal cavity Symptoms- Irritation in angles, h/o collection

of dirty white foamy discharge at angles, redness at angles

Signs- hyperaemia of bulbar conjunctiva near canthi and of lid margins, excoriation of skin around angles and foamy mucopurulent discharge.

2. Chlamydial Conjunctivitis - Trachoma - Adult inclusion conjunctivitis - Neonatal chlamydial conjunctivitis

Trachoma

Ocular infections caused by chlamydia

WHO classificationF- T.inflammation FollicularI- T.inflammation IntenseS- T.ScarringT- T.TrichiasisO- Corneal Opacity

Conjunctival signs• Congestion of upper tarsal and forniceal

conjunctiva• Conjuntival follicles• Papillary hyperplasia• Conjunctival scarring• Concretions

Corneal signs• Superficial keratitis• Herbert follicles• Pannus• Corneal ulcers• Herbert pits• Corneal opacity

Follicles

Herbert’s pits

Pannus

Scarring

Sub conjunctival fibrosis leads to lid distorsion and causes eyelashes to rub on cornea.

If left untreated leads to corneal opacity.

Trichiasis

Corneal opacity

Adult inclusion conjunctivitis

C/f: follicular and papillary hypertrophy, superficial keratitis with ocassional pannus

Preauricular lymphadenopathy usually found

Neonatal chlamydial conjunctivitis

3. Viral Conjunctivitis - Adenovirus conjunctivitis >Epidemic keratoconjunctivitis >Pharyngoconjunctival fever - Enterovirus conjunctivitis - Molluscum contagiosum conjunctivitis - Herpes simplex conjunctivitis

Common in all age groups. Most common cause : Adenovirus Others- Herpes simplex keratoconjunctivitis Pox virus conjunctivitis Myxovirus conjunctivitis Paramyxovirus conjunctivitis Arbovirus conjunctivitis Mostly , epithelium is affected (both of

cornea & conjunctiva) so, typical viral lesion is Keratocunjunctivitis

Acute Haemorrhagic Conjunctivitis

Acute Follicular Conjunctivitis

Clinical Presentations

Acute catarrhal conjunctivitis.

Associated with marked follicular hyperplasia especially of lower fornix & lower palpebral conjunctiva.

Acute follicular

Acute inflammation of conjunctiva characterized by :

a) Multiple Conjunctival Haemorrhages

b) Conjunctival Hyperaemia

c) Mild Follicular Hyperplasia.

Acute hemorrhagic

Epidemic keratoconjunctivitis

Pharyngoconjunctival fever

Enterovirus conjunctivitis

Molluscum contagiosum conjunctivitis

Herpes Simplex Conjunctivitis

4. Opthalmia Neonatorum

Risk factorsoPrematurityoMaternal infections harboured in birth canaloExposure to infectious organism (eg- N.

gonorrheae, S. aureus, S. pneumoniae, C. trachomatis)

oOccular trauma during delivery.oPoor prenatal careoPoor hygienic delivery conditionsoSilver nitrate exposure

Causes

Bilateral inflammation of conjunctiva in an infant less than 30 days old

Signs and Symptoms-• Pain and tendernedd in eyeball• Conjunctival discharge• Swollen lids• Hyperemia and chemosis

Causative agent Incubation period

Chemical 4-6 hours

Gonococcal 2-4 days

Other Bacterial 4-5 days

Neonatal Inclusion conjunctivitis 5-14 days

Herpes simplex 5-7 days

5. Granulomatous Conjunctivitis

Proliferative lesions Usually localised to one eye Regional lymphadenitis Common granulomatous conjunctival

inflammations- TB of conjunctiva, sarcoidosis of conjunctiva, syphilitic conjunctivitis, leprotic conjunctivitis, opthalmia nodosa

Granulomatous conjunctivitis

B. Allergic Conjunctivitis 1. Simplex Allergic Conjunctivitis - Rhinoconjunctivitis - Seasonal Allergic Conjunctivitis - Perennial Allergic Conjunctivitis

Most commonly seasonal allergic rhinoconjunctivitis, also called hay fever rhinoconjunctivitis

IgE mediated hypersensitivity reaction precipitated by small airborne allergens local mast cell degranulation release of chemical mediators (histamine, eosinophil chemotactic factors, PAF, etc)

Presentation: bilateral, pruritis, redness, watery discharge, rhinorrhea/congestion

Patients often have h/o atopy, seasonal allergy or specific allergy

2. Vernal keratoconjunctivitis

3. Atopic Keratoconjunctivitis

4. Giant Papillary Conjunctivitis

5. Phlyctenular Conjunctivitis

6. Contact dermatoconjunctivitis

C. Cicatricial conjunctivitis 1. Ocular mucous membrane pemphigoid 2. Stevens Johnson Syndrome 3. Toxic Epidermal Necrolysis 4. Secondary Cicatricial Conjunctivitis

Ocular Mucous Membrane Pemphigoid

Stevens Johnson Syndrome

Toxic Epidermal Necrolysis

Secondary Cicatricial Conjunctivitis

D. Toxic Conjunctivitis 1. Secondary to Molluscum Contagiosum 2. Chemical Toxic Conjunctivitis

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