INFECTIVE CONJUNCTIVITIS

ACUTE BACTERIAL CONJUNCTIVITIS ACUTE VIRAL CONJUNCTIVITIS

MUCOPURULENT CONJUNCTIVITIS PURULENT CONJUNCTIVITIS (adults) ANGULAR CONJUNCTIVITIS MEMBRANOUS CONJUNCTIVITIS ADENOVIRAL CONJUNCTIVITIS

etiology characterized by hyperemia associated with mucopurulent discharge which glues the lids together

acute suppurative inflammation characterized by - copious formation of pus - enlargement of draining LN

usually affects children 2-8 years old

cause -Koch-Week’s bacillus (Haem. Aegypticus) - Pneumococci - Staphylococcus aureus and epidermidis * contagious ( can be transmitted by discharge)

Neisseria gonorrhea * OPHTHALMIA NEONATORUM : Gonococci + Chlamydia + H.Simplex type 2

Morax-Axenfeld diplobacilli

Corynebacterium diphtheria bacilli *contagious!

Adeno virus *easily transmitted by finger to eyes

symptoms

- Discomfort & redness - Mucopurulent discharge - Glues the eyelashes together - Burning sensation - Haloes around the light, are noticed if the discharge crosses the cornea and pupil

Incubation stages : few hours -3 days

Infiltration stages : 2-3 days

- conj. : red, chemotic - lids : markedly edematous - NO discharge - mild fever - pre-auricular LNs : enlarge + tender

Stage of discharge

- lid : swollen - conj : red & chemotic - pus pours out on separating the lids

Chronic stage - conj. : papillary thickening - gonococci are still present - redness only in fornix *may occur on top of trachoma (T2C)

- Outer canthal discharge - Angular conjunctival hyperaemia - Skin excoriation at the canthus

- IP: few hrs-3days

Stage of infiltration (1 week)

- Lids : edematous + difficult to separate - Palp. conj. : true membrane ( grayish + firm adherence to conj + formed of necrotic & granulation tissue) - Pre-auricular LN : enlarged - Fever & tachycardia

Stage of discharge(2-3 weeks) - Lids : softer + can be separated with membrane shedding - Discharge: more profuse + sero-sanguinous and may be purulent

Stage of cicatrisation Fibrosis complications

- Acute red eye - Conjunctival follicles : ↑↑ in LOWER palpebral conj + LOWER fornix - Subconj. hemorrhage (severe cases) - Photophobia - Watery discharge * lab test : intra-cell inclusion bodies (like in Trachoma) by Giemsa

signs - Oedema of the lids (not severe) - Conjunctival hyperemia maximum @ fornices - Mucopus discharge & lashes glues together - Conjunctival peticheal haemorhages & chemosis *↑ common in pneumococcal type

compli-cation

Corneal ulcer may occur if the cornea get abraded during the course of infection ( superficial, often marginal and crescentic)

Corneal ulcer, dt: - Gonococci (can invade intact epith) - Severe conj edema presses on limbal capillaries (impaired corn. nutrition)

(1) Corneal corneal ulceration

dipthteria bacilli can invade healthy intact corneal epith.

compli-cations dt fibrosis

- symblepharon - entropion and/or trichiasis - conjunctival xerosis

compli-cations dt diphtheria toxins

- paralysis of accommodation (ciliary muscle) - squints due to EOM paralysis - iridocylitis.

(2) General: (to the toxins of diphtheria) - toxics myocarditis heart failure

Rx Prophylaxis : - Combat of flies - Care protect the other eye - Bed clothes & boils towels of infected patient Active treatment : Topical broad spectrum Ab (ciprofloxacin, ofloxacin, polymyxin-bacitracin combination)

- Frequent lotion + Ab ED - Locally : gentamycin or bacitracin drops and ointment

- Oxytetracycline ointment - ED containing Zinc ion inhibit bact. proteolytic enzymes

Local treatment: - Antitoxic serum ED (anti-diptheritic serum) - Ab ointment prevent symblepharon - Atropine ointment if there is corneal ulcer General treatment: - Isolation of pt. & bed rest - Penicillin &anti-toxic serum injections

-Self limited - Artificial tears alleviate pain & discomfort -Ab guards against 2ry bacterial infection

- conjunctival inflammation during the 1

st month of life

- dt contamination from maternal

passages during delivery

ALLERGIC CONJUNCTIVITIS

VERNAL KERATO CONJUNCTIVITIS (SPRING CATTARH) GIANT PAPILLARY CONJUNCTIVITIS (GPC) HAY FEVER CONJUNCTIVITIS PHLYCTENULAR KERATO-CONJUNCTIVITIS

- Ig-E mediated - ↑ in children, spring & summer

caused by FB irritating the conjunctiva: - CL wearers - Artificial eye wearers - Protruding end of nylon sutures after intraocular surgery

during hay fever season - ↑ in children - by endogenous allergens

C/P symptoms : ithing + lacrimation + photophobia + ropy discharge (↑ eosinophils) signs : (1) Conjunctival

PALPEBRAL (upper palpebral conjunctiva)

BULBAR/LIMBAL MIXED

papillae (Cobble-stone app) - flat-topped, multiple - dark red, larger than trachoma

- limbal gelatinous nodules - localized limbal injection - Tranta spots

- both palbebral & bulbar type

(2) Corneal - Punctate epithelial erosions (Keratitis vernalis of topgy) - Shield ulcers

- Itching - Chemosis - Hyperemia

(1) Conjunctival - Phlycten + conjunctival injection (2) Corneal - Corneal phlycten @ limbus may ulcerate into marginal ulcer - Fascicular ulcer: Superficial creeping towards the center ± vascularization - Phlyctenular pannus *Infiltration and vascularization. *All round the limbus. *The cellular infiltration does not end in straight line

Rx - Dark glasses + cold compression - Topical V/constrictor & anti histaminic ED (during attack) - Topical steroid (during attack prolonged use complicate to glaucoma/cataract) - Prophylaxis mast cell stabilizer (topical disodium chromoglycate) prevent recurrence - Oral antihistaminic (lid edema & chemosis)

Vasoconstrictor-antihistaminic ED

- CS drop/ointment - Atropine ointment (corneal affection) - Search underlying cause

TRACHOMA

= chronic infection of conjunctiva & cornea characterized by formation of follicles & papillae in tarsal conjunctiva and pannus in upper part of cornea Epidemiology :

- ↑ in children, poor classes with unavailable safe water for household

Mode of infection : 3F = Flies + Fingers + Fomites

Causative agent : Chlamydia Trachomatis A, B & C Clinical pictures:

Conjunctival Trachoma (Mc-Callan’s classification) Corneal trachoma

T1 T2a T2b T3 T4 Pannus: superficial vascularization + cellular infilteration of the upper part of the cornea Trachomatus Ulcers: -Linear -Superficial -Parallel to lower edge of pannus Healing leads to: -Nebula ex-pannus -Corneal opacities

Immature follicles: small, greyish, non expressible

Mature Follicles: large 2mm, yellowish & expressible

papillae: small, rounded tops

follicles & papillae + starting cicatrization (healing)

healed trachoma (no activity)

Complications

Eye lid: Conjunctiva: Cornea: Lacrimal

-Ptosis -Entropion -Trichiasis

-Dryness (Xerosis)

-Xerosis -Opacities

-Dacryoadenitis -Dacryocystitis

Treatment

Eye drops: Sulphacetamide drops Ointments: -Terramycin (tetracycline) ointment -Erythromycin ointment Systemic: -Erythromycin syrup in children -Azithromycin -Tetracycline: in adults

DEGENERATIVE CHANGES IN CONJUNCTIVA

PINGUECULA PTERYGIUM

Triangular raised patch in the bulbar conjunctiva

Triangular fibrovascular subepithelial ingrowth

C/P - apex is away from the cornea - nasal > temporal - yellowish, fat-like

- triangular encroachment of the conjunctiva upon the cornea -Apex over the cornea -Neck over the limbus -Body over the sclera Nasal >temporal Multiple grey cornea opacities may be seen near the limbus

C/o Asymptomatic except if inflamed - Disfigurement - Irritation & tearing - Visual impairment: dt astigmatism encroachment over the pupil - Limitation of movement ± diplopia (esp if recurrent)

Cause exposure to strong sunlight, dust, wind -Chronic irritation -Ultra violet rays

Pathology Hyaline degeneration Subconjunctival tissue proliferate as vascularized granulation tissue to invade cornea

Treatment not required (except cosmetis) - If asymptomatic = No surgery - Surgery (if progressive + symptomatic) = Excision with bare sclera technique *How to prevent recurrent : - Apply mitomycin c - intraoperative - B- irradiation: - Post- operative. - Conjunctival autograft or flape - Amniotic membrane graft