Conjunctivitis by Muhammad ibrahim

PowerPoint Presentation

The eyes are the window of the soul1

The eyes are useless when the mind is blind

CONJUNCTIVITISMuhammad IbrahimMPH 2nd Semester2

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LEARNING OUTCOMES3After attending this presentation, the audience will be able to:Differentiate different types of conjunctivitisInterpret signs and symptoms of different types of conjunctivitisDevise management of different types of conjunctivitisDesign prevention plan for conjunctivitis

THE CONJUNCTIVAPalpebral or tarsal conjunctiva

Bulbar or ocular conjunctiva

Fornix conjunctiva

4Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap2, page 17, London, RE&PP Ltd.

Mucus membraneComposed of non-keratinized, stratified squamous epithelium, stratified columnar epithelium, goblet cells, blood vessels, fibrous tissue, and lymphatic channelsAdditional cells present in the conjunctival epithelium include melanocytes, T and B cell lymphocytesThe conjunctival functions include the lubrication, immune surveillance, and prevent entrance of the microbes into the eyes

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CONJUNCTIVITIS5IrritationItchingWatering and dischargeRednessDiscomfortPain and photophobia in keratoconjunctivitis

VasodilatationIncreased secretionsEdemaFolliclesPapillaeKeratinizationMembrane formationScarring (fibrosis)

Typical symptomsTypical signsInfection or inflammation of the conjunctivaMore common in hot climatesSmith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 83, London, RE&PP Ltd.

The signs vary very much according to the type of conjunctivitis . In contrast to papillae, follicles are small, dome-shaped nodules without a prominent central vessel. Accordingly, whereas a papilla clinically appears more red on its surface and more pale at its base, a follicle appears more pale on its surface and more red at its base. Histologically, a lymphoid follicle is situated in the subepithelial region and consists of a germinal center, containing immature, proliferating lymphocytes; and surrounding corona, containing mature lymphocytes and plasma cells. The follicles in follicular conjunctivitis are typically most prominent in the inferior palpebral and forniceal conjunctiva.5

BACTERIAL CONJUNCTIVITIS6The bacteria may invade a normal, healthy conjunctiva to produce a primary bacterial conjunctivitisThe bacteria may invade because the conjunctival defense against infection is weakened, called secondary bacterial conjunctivitisSmith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 86, London, RE&PP Ltd.

The inflammation is acute, sever and usually bilateralPrimary: The disease last for 1-2 weeks then resolves spontaneously, usually without scarringSecondary bacterial conjunctivitis usually persists with chronic recurrent symptoms until the primary cause is treated

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Bacterial conjunctivitis7SIGNS AND SYMPTOMSKey characteristic, mucopurulent dischargeIn severe cases it is like yellow pusIn mild cases the eyelids may be stuck together on wakingThere is always vasodilatation of conjunctivaIn severe cases there may be chemosis of the conjunctiva, edema of eyelids and general malaise

COMMON CAUSATIVE AGENTSStaphylococcus cause acute primary conjunctivitisHaemophilus influenza cause seasonal conjunctivitisGonococcus comes form genital discharges and cause severe conjunctivitisMoraxella lacunata causes mild angular conjunctivitis Other bacteria, pneumococcus, meningococcus, streptococcus etc.

Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 88, London, RE&PP Ltd.

TRACHOMA8Trachoma ( Ancient Greek Rough eye)Leading infectious cause of blindness world wideWHO estimates 2.2 million people visually impaired world wide due to trachomaCaused by one of the chlamydia group organism the chlamydia trachomatis

WHO.Trachoma fact sheet N*382,March 2014


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SymptomsMild itching and irritation of the eyeWateringMucopurrulent discharge from the eyeAs the disease progresses, later trachoma symptoms include:Marked light sensitivity (photophobia) Blurred vision Eye painSignsConjunctiva:Follicular conjunctivitis (tarsal conj, fornices)Limbal folliclesConjunctival scarringHerbert's pits (after resolution of follicles)

TRACHOMA


Cont.10Cornea:Keratitis (corneal ulcer)Corneal opacity (end stage)

Lids:EntropionTrichiasis


TRANSMISSION11

TRACHOMATreatmentTetracycline, topical (2 months) and oral (3 weeks)Oral azithromycin

SAFE StrategySurgery for correction of trichiasisAntibioticsFace cleaningEnvironmental improvement

12WHO.Trachoma fact sheet N*382,March 2014 (GET 2020)

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Viral conjunctivitis13Viruses live in the epithelial cells and often invade the epithelial cells of the corneaViruses live inside the body cells so they are all immune to antibioticsDisease may be so mild that it is impossible to recognize it clinicallyIt may be a severe and disabling conditionTYPICAL SIGN AND SYMPTOMSGritty foreign body sensation and photophobiaWatery and not purulent secretions called serous secretionBlood vessels are dilated and there is hypertrophy of the lymphoid follicles There may be papillary hypertrophy on the upper tarsal conjunctiva


ADENOVIRUS CONJUNCTIVITISMost common viral infection of the conjunctivaThere are many different strains of the virus, all the strains are very contagious Usually bilateral but often affects one eye more severely than otherSuperficial punctate keratitis and psuedomembrane are specific signsThe infection is easily spreads from person to person by direct contact specially in workers examining eyes

14Viral conjunctivitisSmith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 90, London, RE&PP Ltd.

Viral conjunctivitisMEASLESGeneralized viral infection Also invades the conjunctival and corneal epitheliumIt can cause serious corneal ulceration and blindnessMOLLUSCUM CONTAGIOSUMViral wart which appears on the margins of the eyelidsVirus particles are discharged from the wart into the conjunctiva and cause a typical follicular conjunctivitisTreatment is to remove the wart either by excision, cautery or curettage


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Viral conjunctivitis16HERPES SIMPLEX VIRUSWide spread virusCause follicular conjunctivitis, corneal ulcer, multiple vesicles on the face, mouth, or eyelidsSpread by direct contactThe virus remain dormant until years and cause recurrent infectionsAnti viral treatmentDebridement and chemical cauterization techniques are used for corneal epithelial removal


GRANULOMATOUS CONJUNCTIVITISAlso called parinauds syndromeUnilateral with a local inflammatory granuloma in the conjunctivaUsually means the conjunctiva has become by chance the route of entry into the body for some micro organismPossible causes:TuberculosisSyphilisActinomycosis ( fungal disease)Sporotrichosis ( fungal disease)


ALLERGIC CONJUCTIVITISIt can occur in four formsA. Vernal conjunctivitisOriginally called spring catarrhMay occur through out the yearCommon in childrenNot caused by specific allergen Most likely agent is some material in the atmosphere such as pollenBelong to same group of diseases as allergic rhinitis, asthma and eczema atopic diseases


ALLERGIC CONJUCTIVITIS19SYMPTOMS AND SIGNSSevere and persistent itching and irritation in both eyesFeeling string or worms in the eyesSticky white dischargeThickening of conjunctiva with formation of papillaeGiant papillae in the advance stage, spaces between papillae filled with mucusCobblestone appearanceSuperficial punctate keratitisShield ulcer

MANAGEMENTSteroidsAntihistamineCryotheraphyDiathermy and cauteryBeta radiation given with a strontium 90 applicator


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ALLERGIC CONJUCTIVITISB. Hay fever conjunctivitisAcute allergic reaction to pollen in the airUsually associated with acute rhinitisNon of the structural changes like in the vernal conjunctivitisC. Phlyctenular conjunctivitisPhlycten is Greek word for a blisterLocalized hypersensitivity reaction to bacterial proteins in the bloodstream, mostly tubercularPhlycten appears as a raised pinkish nodule surrounded by an area of hyperemiaIt then develops a necrotic grey center surrounded by reactive inflammationD. Allergies to drugs and cosmeticsMedications , chemical preservatives, cosmetics can provoke an allergic reaction Diagnosed by taking careful historyStop the provoking agentTopical steroids will relieve the symptoms20Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 95, London, RE&PP Ltd.

Endogenous conjunctivitisCause of the inflammation may be an inflammation arising from within the body itselfExact mechanism is not known but in most cases it is a type of auto immune diseaseKERATOCONJUNCTIVITIS SICCACommon specially in old peopleOften associated with rheumatoid arthritisThe lacrimal gland and accessory conjunctival glands become inflammed so produce fewer tearsThe eyes are sore and grittySchirmers test21Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 97, London, RE&PP Ltd.

Endogenous conjunctivitisOCULAR PEMPHIGOIDSome times called essential shrinkage of the conjunctivaGradual shrinkage and fibrosis of the conjunctivaSymblepharon in advance casesSTEVEN-JOHNSON SYNDROMEAcute ulceration of the conjunctiva and other mucous membranes like the mouth and vaginaFollowed by severe scarring of the membranesOften caused by sensitivity to drugs, particularly sulphonamidesTopical and systemic steroids in acute stage may help22Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 98, London, RE&PP Ltd.

NEONATAL CONJUCTIVITIS ( OPHTHALMIA NEONATORUM)Conjunctivitis in a newborn child GONOCOCCUS is most serious causeBaby may be infected during delivery if the mother genital tract is infectedCause acute conjunctivitis within the first few days of birthMay cause corneal ulceration, scarring and eventually blindnessCHLAMYDIA, Organism similar to trachomaMay be present in the female genital tractCause conjunctivitis within the first 2 weeks of birthSTAPHYLOCOCCUS and other organism of a non genital origin may also infect the infant conjunctiva23Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 99, London, RE&PP Ltd.

PREVENTION OF CONJUNCTIVITIS24If you have infectious conjunctivitis, you can help limit its spread to other people by following these steps:Wash your hands often with soap and warm waterAvoid touching or rubbing your eyesWash any discharge from around the eyes several times a dayWash hands after applying eye drops or ointment

PREVENTION OF CONJUNCTIVITISDo not use the same eye drop dispenser/bottle for infected and non-infected eyeseven for the same personWash pillowcases, sheets, washcloths, and towels in hot water and detergent; hands should be washed after handling such itemsAvoid sharing articles like towels, blankets, and pillowcasesClean eyeglasses, being careful not to contaminate items (like towels) that might be shared by other peopleDo not share eye makeup, face make-up, make-up brushes, contact lenses and containers, or eyeglassesDo not use swimming pools

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PREVENTION OF CONJUNCTIVITIS26If you are around someone with infectious conjunctivitis, you can reduce your risk of infection by following these steps:Wash your hands often with soap and warm waterWash your hands after contact with an infected person or items he or she usesDo not share items used by an infected person; for example, do not share pillows, washcloths, towels, eye drops, eye or face makeup, and eyeglasses

PREVENTION OF CONJUNCTIVITIS27If you have infectious conjunctivitis, there are steps you can take to avoid re-infection once the infection goes away:Throw away and replace any eye or face makeup you used while infectedThrow away contact lens solutions that you used while your eyes were infectedThrow away disposable contact lenses and cases that were used while your eyes were infectedClean extended wear lenses as directedClean eyeglasses and cases that were used while infected

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Healthcare

Conjunctivitis by Muhammad ibrahim