Con Jung Tiva

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    CONJUNGTIVA

    FK. UMJ

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    The conjunctiva

    A transparent mucous membrane that

    lines the inner surfaces of the eyelids and

    the front surface of the eyeball.

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    The conjunctiva is composed of 3

    sections Palpebral conjunctiva

    (covers the posteriorsurface of the eyelids).

    Bulbar conjunctiva

    (coats the anteriorportion of the eyeball).

    Fornix (the transitionportion forming the

    junction between theposterior eyelid andthe eyeball).

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    Conjunctiva

    Conjunctivitis

    Ophthalmia neonatorum

    Subconjunctival hemorrhageDry Eyes (keratoconjunctivitis sicca)

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    Conjunctivitis

    History and symptoms can help determine

    the etiology

    Correct diagnosis has direct implications

    for treatment and possible spread to close

    contacts

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    Conjunctivitis Contd

    History

    Any recent contact with some one with ared eye (within the past 2-3 weeks)?

    How did it start?

    Has it spread from one eye to the other?

    Any tearing or discharge?

    Any changes in vision?

    Does it itch?

    Has the child been rubbing their eyes?

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    Conjunctivitis - Discharge

    Discharge Cause

    Purulent Bacteria

    Clear Viral

    White mucous Allergies

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    Bacterial Conjunctivitis

    Common causes

    Staphylococcus

    Streptococcus

    Hemophilus

    Pneumococcus

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    Pathogenesis

    Staph.epidremidis,staph aureus, strept.

    pneumoniae or H.influenzae transmitted

    by direct contact with infected secretions.

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    Bacterial Conjunctivitis

    Erythema of conjunctiva

    Purulent discharge

    May be monocular (one eye) or binocular(both eyes)

    Hemophilis may cause hemorrhage on the

    conjuctiva and occasionally the lids

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    Bacterial conjunctivitis: note the purulent

    discharge and conjunctival hyperemiaPicture taken from Basic Ophthalmology for Medical Students and Primary Care Residents published by the American Academy of

    Ophthalmology

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    Bacterial Conjunctivitis - treatment

    Broad spectrum topical antibiotics

    Polytrim, Ocuflox, Ciloxan

    Warm compresses

    Children may return to school once

    antibiotic therapy is instituted

    Refer if not markedly improved within 4days

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    Viral Conjunctivitis

    Adenovirus

    May be associated with systemic viral

    infections

    Herpetic

    Picornavirus and enterovirus type 70

    cause a hemorrhagic conjunctivitis

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    Viral Conjunctivitis (non-herpetic)

    HIGHLY CONTAGIOUS

    Usually starts in one eye and progresses

    to the second eye

    Often a history of recent contact with

    another person with a red eye or pink

    eye

    Children must be kept out of school until

    tearing stops (up to two weeks)

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    Viral conjunctivitis - symptoms

    Often bilateral

    Often with diffuse, marked hyperemia

    Watery dischargeChemosis ( swelling of conjunctiva)

    Some itching and foreign body sensation

    Preauricular adenopathyURI, sore throat, fever common

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    Viral conjunctivitis: note the diffuse redness and watery

    discharge

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    Viral conjunctivitis - treatment

    Cold compresses

    Good hygienewash hands, do not share

    wash cloths, pillows, towels etc.

    Topical treatment for symptom relief only

    (will not shorten the course of the disease)

    Patanol, Zaditor, Acular, Artificial tears

    No role for topical antibiotics

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    Viral Conjunctivitis - Herpetic

    Profuse watery discharge

    May have eyelid margin ulcers and

    vesicles

    Corneal involvement may result in

    permanent scarring and visual loss

    Urgent referral to ophthalmologist fortreatment with topical antivirals

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    Typical herpetic corneal lesion stained with rose bengal.

    Note the branching (dendritic) pattern.

    Picture from Section 6 of the Basic and Clinical Science Course published by the Foundation of the American Academy of Ophthalmology

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    Allergic Conjunctivitis

    Associated with hay fever, asthma,

    eczema

    Often bilateral and seasonal

    Milder conjunctival hyperemia

    Chemosis

    Itching (primary symptom)Not contagious, children may return to

    school

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    Allergic conjunctivitis: note the conjunctival

    erythema but no watery discharge

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    Ophthalmia Neonatorum

    Chemical

    Gonococcal

    ChlamydialHerpetic

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    Chemical conjunctivitis

    Onset: first 24 hours

    Cause: silver nitrate (90%)

    Signs & Sxs: bilateral, mild eyelid edema,clear discharge, conjunctival injection

    Treatment: supportive, spontaneous

    resolution in a few days

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    Gonococcal conjunctivitis

    Onset: 48 hours

    Cause: Neisseria gonorrheavia birth

    canal

    Signs & Sxs: severe, purulent discharge,

    chemosis, eyelid edema

    Dx: gram staining is negative.

    Treatment: systemic cefriaxone or Pen G,

    topical erythromycin and irrigation

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    Gonococcal conjunctivitisnote the copious amounts of

    purulent dischargePicture from Section 6 of the Basic and Clinical Science Course published by the Foundation of the American Academy of Ophthalmology

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    Neonatal chlamydial conjungtivitis

    Pathogenesis :

    Chlam trachomatosis serotypes D to K

    acquired from the mother during delivery

    Diagnosis :

    Presentation is 512 days postpartum.

    Signs :

    Mucopurulent discharge associated with

    papillary conjungtivitis.

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    Neonatal Chlamydial conjunctivitis

    Investigations :

    conjungtival and maternal vaginal swabs

    for Gram and Giemsa staining.

    Signs & Sxs: more indolent, eyelidedema, pseudomembrane formation

    Treament:

    - topical tetracyclin and oral erythromycin

    - parents should also be treated.

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    Differential diagnosis

    Bacterial conjungtivitis:

    typically occurs more than 5 days

    postpartum.

    Gonococcal conjungtivitis :

    typically within 2 days postpartum and

    is associated with profuse creamy disch

    Primary herpes conjungtivitis :

    develop 3-15 days postpart ,and watery

    discharge.

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    Herpetic conjunctivitis

    Onset: 12 weeks

    Cause: HSV 2 via birth canal

    Signs & Sxs: serous discharge,conj

    injection and geographic keratitisDx: Gram stain (multinucleated giantcells), Papanicolaou stain, viral cultures

    Treatment: topical antiviraltrifluorothymidine and systemic acyclovir

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    Subconjunctival hemorrhage

    If associated with trauma inspect globe

    carefully to rule out other injuries

    Corneal abrasions (discussed later)

    Open globe (emergency requiring immediate

    referral to ophthalmologist)

    Hyphema (discussed later)

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    Subconjunctival hemorrhage

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    TRACHOMA

    Trachoma is one of the mayor blinding

    diseases of the world.

    It is