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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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