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CONJUNTIVACONJUNTIVA

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RED EYERED EYE

CONJUNCTIVACONJUNCTIVA

  

1.1.Conjunctivitis Conjunctivitis

2.2.Chronic conjunctivitisChronic conjunctivitis

3.3.Ophthalmia neonatorumOphthalmia neonatorum

4.4.Adenoviral conjunctivitisAdenoviral conjunctivitis

5.5.TrachomaTrachoma

6.6.Allergic conjunctivitisAllergic conjunctivitis

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CONJUNCTIVA

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..CONJUNTIVACONJUNTIVAanatomyanatomy

ConjunctivitisConjunctivitisClasificationClasification acuteacute hhyperacuteyperacute chronicchronic

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CONJUNCTIVAL SECRETIONCONJUNCTIVAL SECRETION

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Folliculles, papillae, chemosisFolliculles, papillae, chemosis

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Bacterial conjunctivitisBacterial conjunctivitisClinicClinic:: quikly onset of unilateral conjunctival quikly onset of unilateral conjunctival

hyperemiahyperemia lid edemalid edema mucopurulent dischargemucopurulent discharge second eye becomes involved 1-2 days latersecond eye becomes involved 1-2 days later

1.Bacterial conjunctivitis 1.Bacterial conjunctivitis is characterized by: rapid onset of unilateral conjunctival hyperemia, lid edema is characterized by: rapid onset of unilateral conjunctival hyperemia, lid edema and mucopurulent discharge; second eye becomes involved 1-2 days later. Bacterial conjunctivitis (bc.) and mucopurulent discharge; second eye becomes involved 1-2 days later. Bacterial conjunctivitis (bc.) can be classified into three clinical types: acute, hyperacute and chronic. The most common conjunctival can be classified into three clinical types: acute, hyperacute and chronic. The most common conjunctival pathogens include Staphylococcus, Streptococcus, Haemophilus, Neisseria and Gram negative.pathogens include Staphylococcus, Streptococcus, Haemophilus, Neisseria and Gram negative.

1.a. Acute bc.1.a. Acute bc. begins unilaterally with hyperemia, irritation, tearing and mucopurulent discharge; begins unilaterally with hyperemia, irritation, tearing and mucopurulent discharge; other common ocular manifestations include punctate epithelial keratitis, blepharitis, marginal ulcers.other common ocular manifestations include punctate epithelial keratitis, blepharitis, marginal ulcers.

Treatment: topical antibiotic drops or ointment; the choice of antibiotic is based upon results of Treatment: topical antibiotic drops or ointment; the choice of antibiotic is based upon results of cultures; if the treatment is based upon clinical features, a broad-spectrum antibiotic such gentamicin, cultures; if the treatment is based upon clinical features, a broad-spectrum antibiotic such gentamicin, floroquinolone or trimethoprim-polimixin may be used for 7-10 days.floroquinolone or trimethoprim-polimixin may be used for 7-10 days.

1.b. Hyperacute bc. 1.b. Hyperacute bc. The most common cause is Neisseria gonorrhea. This is an oculo-genital The most common cause is Neisseria gonorrhea. This is an oculo-genital disease seen primarily in neonates, sexually active teenagersdisease seen primarily in neonates, sexually active teenagers and young adults. and young adults.

The clinical course includes profuse, thick, yellow-green purulent discharge, painful hyperemia, The clinical course includes profuse, thick, yellow-green purulent discharge, painful hyperemia, and chemosis. Untreated cases may lead to peripheral corneal ulceration and eventual perforation with and chemosis. Untreated cases may lead to peripheral corneal ulceration and eventual perforation with possible endophthalmitis.possible endophthalmitis.

Treatment: conjunctival scraping and culture on blood and chocolate agar is suggested strongly. Treatment: conjunctival scraping and culture on blood and chocolate agar is suggested strongly. Gonococal conjunctivitis is treated with both topical and systemic antibiotics: ceftriaxone 1 g followed by 2-Gonococal conjunctivitis is treated with both topical and systemic antibiotics: ceftriaxone 1 g followed by 2-3 weeks course of oral tetracycline or erythromycin; topical antibiotics: bacitracine or erythromycin 3 weeks course of oral tetracycline or erythromycin; topical antibiotics: bacitracine or erythromycin ointments every 2 hours. Frequent irrigation of the ocular surface is helpful.ointments every 2 hours. Frequent irrigation of the ocular surface is helpful.

Treatment:Treatment:hygiene hygiene hots compresses,hots compresses, gentle shampoo applied gentle shampoo applied

topical antibiotic drops or ointment (the topical antibiotic drops or ointment (the choice of antibiotic is based upon results of choice of antibiotic is based upon results of cultures) if the treatment is based upon cultures) if the treatment is based upon clinical featuresclinical features AminoglicozidAminoglicozid FloroquinoloneFloroquinolone

corticosteroidscorticosteroids

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Ophthalmia neonatorumOphthalmia neonatorumoral eritromycine syrup 50 mg/kg/day for oral eritromycine syrup 50 mg/kg/day for 14 days;14 days;

treatment of mother and sexual partners treatment of mother and sexual partners with tetracycline or eritromycine 7 days;with tetracycline or eritromycine 7 days;

prevention:prevention: treatment of chlamydial, gonococcal and treatment of chlamydial, gonococcal and

herpetic infections during pregnancyherpetic infections during pregnancy Crede method Crede method

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Ophthalmia neonatorum Ophthalmia neonatorum is defined as any conjunctivitis occurring within the first 4 weeks of life. It is is defined as any conjunctivitis occurring within the first 4 weeks of life. It is caused by bacterial, viral, chlamydial infection or by toxic response to topically applied chemicals.caused by bacterial, viral, chlamydial infection or by toxic response to topically applied chemicals.

a)chemical conjunctivitis a)chemical conjunctivitis results from the instillation of silver nitrate drops used for infection results from the instillation of silver nitrate drops used for infection prophylaxis. prophylaxis.

b)Chlamydial infection b)Chlamydial infection is the most frequent cause of neonatal conjunctivitis in USA. Symptoms is the most frequent cause of neonatal conjunctivitis in USA. Symptoms develops 5-14 days after delivery; initially infants develops a watery discharge and mucopurulent later. develops 5-14 days after delivery; initially infants develops a watery discharge and mucopurulent later. Signs include: lid edema, a papillary conjunctival response and pseudomembranes. The infection is Signs include: lid edema, a papillary conjunctival response and pseudomembranes. The infection is mild and self-limited; however, severe cases may occur and have conjunctival scaring and peripheral mild and self-limited; however, severe cases may occur and have conjunctival scaring and peripheral corneal panus.corneal panus.

Treatment:-oral eritromycine syrup 50 mg/kg/day for 14 days;Treatment:-oral eritromycine syrup 50 mg/kg/day for 14 days;

-treatment of mother and sexual partners with tetracycline or eritromycine 7 days;-treatment of mother and sexual partners with tetracycline or eritromycine 7 days; -prevention: -prevention: treatment of chlamydial, gonococcal and herpetic infections during pregnancy.treatment of chlamydial, gonococcal and herpetic infections during pregnancy.

c)Neisseria infection:c)Neisseria infection: hyperacute conjunctivitis with edema, chemosis and excessive purulent hyperacute conjunctivitis with edema, chemosis and excessive purulent discharge, which begins 24-48 hours after birth. The discharge is so copious that it reaccumulates after discharge, which begins 24-48 hours after birth. The discharge is so copious that it reaccumulates after the eye has been clean. Gram stain is essential to prompt and effective treatment.the eye has been clean. Gram stain is essential to prompt and effective treatment.

Treatment:-systemic penicillin G 100,000ui/kg/day in 4 doses for 7 days or intravenous ceftriaxone 25-Treatment:-systemic penicillin G 100,000ui/kg/day in 4 doses for 7 days or intravenous ceftriaxone 25-50 mg/kg once a day for 7 days;50 mg/kg once a day for 7 days; -topical antibiotics.-topical antibiotics.

d) other bacterial infection d) other bacterial infection bacteria are probably transmitted through the air to the infant. bacteria are probably transmitted through the air to the infant.

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Viral conjunctivitis (v.c.) Viral conjunctivitis (v.c.) is one of the most common causes of visits to the emergency room or doctor’s office.is one of the most common causes of visits to the emergency room or doctor’s office.

2.a.Adenoviruses2.a.Adenoviruses produce: produce:

-pharyngoconjunctival fever -pharyngoconjunctival fever is a condition characterized by combination of pharyngitis, fever and is a condition characterized by combination of pharyngitis, fever and conjunctivitis. The conjunctivitis is follicular with watery discharge, hyperemia and mild chemosis. The cornea may be conjunctivitis. The conjunctivitis is follicular with watery discharge, hyperemia and mild chemosis. The cornea may be involved with fine punctate epitheliopathy and preauricular limfonodes are enlarged in 90% of cases. Treatment is involved with fine punctate epitheliopathy and preauricular limfonodes are enlarged in 90% of cases. Treatment is usually supportive with cold compresses, vasoconstrictive drops; the disease resolve spontaneously within 2 weeks.usually supportive with cold compresses, vasoconstrictive drops; the disease resolve spontaneously within 2 weeks.

--epidemic keratoconjunctivitis epidemic keratoconjunctivitis is a more severe type and lasts for 7-21 days. is a more severe type and lasts for 7-21 days.

Clinical signs:*hyperaemia, chemosis, watery discharge, a mixed papillary and follicular response and Clinical signs:*hyperaemia, chemosis, watery discharge, a mixed papillary and follicular response and ipsilateral preauricular limphadenopathy, subconjunctival hemorrhages and conjunctival membranes;corneal ipsilateral preauricular limphadenopathy, subconjunctival hemorrhages and conjunctival membranes;corneal involvement.involvement.

Treatment:prevention – hand washing, relative isolation of infected individuals, disinfecting of ophthalmic Treatment:prevention – hand washing, relative isolation of infected individuals, disinfecting of ophthalmic instruments;curative :vasoconstrictive eye drops and for corneal involvement topical corticosteroids.instruments;curative :vasoconstrictive eye drops and for corneal involvement topical corticosteroids.

2.b. Acute hemorrhagic conj. 2.b. Acute hemorrhagic conj. are produced by picornaviruses.are produced by picornaviruses.

Signs: severe painful conjunctivitis with chemosis, tearing and subconjunctival hemorrhages; the disease Signs: severe painful conjunctivitis with chemosis, tearing and subconjunctival hemorrhages; the disease resolves within 4-6 days but the hemorrhages clear later; the conjunctivitis tends to occur in epidemics with more than resolves within 4-6 days but the hemorrhages clear later; the conjunctivitis tends to occur in epidemics with more than 50% of the local population affected.50% of the local population affected.

2.c. Herpes simplex conj.2.c. Herpes simplex conj. is nonspecific; typical signs include: ocular irritation, watery discharge, follicular is nonspecific; typical signs include: ocular irritation, watery discharge, follicular conjunctivitis and preauricular limphadenopathy , an epidermal vesicular eruption of the eyelid and lid margins. conjunctivitis and preauricular limphadenopathy , an epidermal vesicular eruption of the eyelid and lid margins. Conjunctivitis resolves spontaneously without treatment; if corneal involvement exist administration of topical antiviral Conjunctivitis resolves spontaneously without treatment; if corneal involvement exist administration of topical antiviral is indicated.is indicated.

2.d. Other causes 2.d. Other causes rubella, rubella, varicela-zoster, Epstein-Barr viruses.rubella, rubella, varicela-zoster, Epstein-Barr viruses.

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Viral conjunctivitisViral conjunctivitisAdenovirusesAdenoviruses pharyngoconjunctival feverpharyngoconjunctival fever epidemic keratoconjunctivitisepidemic keratoconjunctivitis

Acute hemorrhagicAcute hemorrhagic

Herpes simplex, varicela-zosterHerpes simplex, varicela-zoster

Rubella, Epstein-Barr virusesRubella, Epstein-Barr viruses

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. . Viral conjunctivitisViral conjunctivitis..

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.chlamidial conjunctivitis.chlamidial conjunctivitis

TrachomaTrachoma

adult inclusion conjunctivitisadult inclusion conjunctivitis

neonatal conjunctivitisneonatal conjunctivitis

McCallan classificationMcCallan classificationI. I. early lymphoid hyperplasia with follicles early lymphoid hyperplasia with follicles formation on the superior tarsal conjunctiva;formation on the superior tarsal conjunctiva;

IIa. IIa. mature follicles on full superior tarsus;mature follicles on full superior tarsus;

IIb. IIb. florid inflammation with increase in pretarsal florid inflammation with increase in pretarsal and limbal follicular and papillary hypertrophy;and limbal follicular and papillary hypertrophy;

III. III. resolution of the papillary hypertrophy and resolution of the papillary hypertrophy and early conjunctival scaring;early conjunctival scaring;

IV. IV. no active inflammation, replacement of papillae no active inflammation, replacement of papillae and follicles with scars and resolution of panus.and follicles with scars and resolution of panus.

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Chlamidia trahomatisChlamidia trahomatis. Trachoma . Trachoma results from stereotypes A – C, is endemic in areas of close human contact and poor results from stereotypes A – C, is endemic in areas of close human contact and poor hygiene. Trachoma begins as a follicular conjunctivitis of the upper palpebral conjunctiva with hygiene. Trachoma begins as a follicular conjunctivitis of the upper palpebral conjunctiva with associated limbal follicles. Other findings include conjunctival papillary hypertrophy, a superficial associated limbal follicles. Other findings include conjunctival papillary hypertrophy, a superficial corneal panus and a fine epithelial keratitis. The inflammation leads to scaring of the cornea, corneal panus and a fine epithelial keratitis. The inflammation leads to scaring of the cornea, conjunctiva and eyelids.conjunctiva and eyelids.

McCallan classification:McCallan classification:

I. early lymphoid hyperplasia with follicles formation on the superior tarsal conjunctiva;I. early lymphoid hyperplasia with follicles formation on the superior tarsal conjunctiva;

IIa. mature follicles on full superior tarsus;IIa. mature follicles on full superior tarsus;

IIb. florid inflammation with increase in pretarsal and limbal follicular and papillary IIb. florid inflammation with increase in pretarsal and limbal follicular and papillary hypertrophy;hypertrophy;

III. resolution of the papillary hypertrophy and early conjunctival scaring;III. resolution of the papillary hypertrophy and early conjunctival scaring;

IV. no active inflammation, replacement of papillae and follicles with scars and resolution of IV. no active inflammation, replacement of papillae and follicles with scars and resolution of panus.panus.

Complications: conjunctival and eyelids deformities: trichiasis,distichiasis, entropion, ectropion; Complications: conjunctival and eyelids deformities: trichiasis,distichiasis, entropion, ectropion; corneal involvement:scars, vascularization and ulcers (infection, perforation) corneal involvement:scars, vascularization and ulcers (infection, perforation) blindness. blindness.

Treatment:-oral tetracycline (1 g/day) or doxicycline 100 mg/day 3-4 weeks;Treatment:-oral tetracycline (1 g/day) or doxicycline 100 mg/day 3-4 weeks;

-topical tetracycline or eritromycine ointments twice a day for 5 days each month for 6 -topical tetracycline or eritromycine ointments twice a day for 5 days each month for 6 months;-oral azithromicine in endemic areas.months;-oral azithromicine in endemic areas.

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LECTURER DR. RUSU LECTURER DR. RUSU VALERIUVALERIU 1919

Trachoma Trachoma

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Treatment Treatment

oral tetracycline (1 g/day) or doxicycline oral tetracycline (1 g/day) or doxicycline 100 mg/day 3-4 weeks;100 mg/day 3-4 weeks;

topical tetracycline or eritromycine topical tetracycline or eritromycine ointments twice a day for 5 days each ointments twice a day for 5 days each month for 6 months;month for 6 months;

oral azithromicine in endemic areas has oral azithromicine in endemic areas has shown promise to eradicate the disease.shown promise to eradicate the disease.

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ALLERGIC CONJUNCTIVITISALLERGIC CONJUNCTIVITIS

1.Acute atopic conjunctivitis1.Acute atopic conjunctivitis is a Type 1 allergic response mediated by Ig E. The is a Type 1 allergic response mediated by Ig E. The response is stimulated by airborne allergens such as: dust, pollen, spores and animal dander.response is stimulated by airborne allergens such as: dust, pollen, spores and animal dander.

Symptoms are itching, burning. Signs are hyperemia, lid edema, chemosis and watery Symptoms are itching, burning. Signs are hyperemia, lid edema, chemosis and watery discharge. Reaction may be limited to the eye or it may be part of a generalized allergic reaction discharge. Reaction may be limited to the eye or it may be part of a generalized allergic reaction with nasal and respiratory symptoms.with nasal and respiratory symptoms.

Treatment: cold compresses, topical vasoconstrictors topical antihistamines Treatment: cold compresses, topical vasoconstrictors topical antihistamines (levocabastine); also corticosteroids for severe cases.(levocabastine); also corticosteroids for severe cases.

2.Chronic atopic conjunctivitis2.Chronic atopic conjunctivitis same symptoms as in acute condition except less same symptoms as in acute condition except less evidence of the acute inflammation. Conjunctiva exhibits a pale edema with papillary hypertrophy.evidence of the acute inflammation. Conjunctiva exhibits a pale edema with papillary hypertrophy.

33. Giant papillary conjunctivitis . Giant papillary conjunctivitis is a syndrome of inflammation of the upper palpebral is a syndrome of inflammation of the upper palpebral conjunctiva associated with contact lens wear, ocular prosthesis. Patients complains of a mild conjunctiva associated with contact lens wear, ocular prosthesis. Patients complains of a mild itching after removal of the contact lenses; macropapillae and giant papillae cover superior tarsal itching after removal of the contact lenses; macropapillae and giant papillae cover superior tarsal conjunctiva.conjunctiva.

Treatment: stopping lenses wear until the inflammation subsides; the correct Treatment: stopping lenses wear until the inflammation subsides; the correct manipulation of the lens is essential; a short course of topical corticosteroids can lessen the manipulation of the lens is essential; a short course of topical corticosteroids can lessen the symptoms in severe cases.symptoms in severe cases.

  

  

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Alergic cAlergic conjunctivonjunctivitisitisAtopic conjunctivitisAtopic conjunctivitis acuteacute chronicchronic

Allergic dermato-conjunctivitisAllergic dermato-conjunctivitis

Microbioallergic conjunctivitisMicrobioallergic conjunctivitis

Vernal conjunctivitisVernal conjunctivitis

Giant papillary conjunctivitisGiant papillary conjunctivitis

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Symptoms Symptoms itchingitching burningburning

Signs Signs hyperemiahyperemia lid edemalid edema chemosis chemosis watery dischargewatery discharge

generalized allergic reaction generalized allergic reaction nasal nasal respiratory symptoms.respiratory symptoms.

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Treatment Treatment

hygiene hygiene alergen evictionalergen eviction cold compressescold compresses

topical vasoconstrictorstopical vasoconstrictors

topical antihistamines topical antihistamines (levocabastine)(levocabastine)

corticosteroids corticosteroids

topical cyclosporinetopical cyclosporine