INFECTIVE CONJUNCTIVITIS ACUTE BACTERIAL CONJUNCTIVITIS MUCOPURULENT CONJUNCTIVITIS

etiology

ACUTE VIRAL CONJUNCTIVITIS MEMBRANOUS CONJUNCTIVITIS usually affects children 2-8 years old ADENOVIRAL CONJUNCTIVITIS

PURULENT CONJUNCTIVITIS (adults) acute suppurative inflammation characterized by - copious formation of pus - enlargement of draining LN Neisseria gonorrhea

ANGULAR CONJUNCTIVITIS

characterized by hyperemia associated with mucopurulent discharge which glues the lids together -Koch-Weeks bacillus (Haem. Aegypticus) - Pneumococci - Staphylococcus aureus and epidermidis * contagious ( can be transmitted by discharge) - Discomfort & redness - Mucopurulent discharge - Glues the eyelashes together - Burning sensation - Haloes around the light, are noticed if the discharge crosses the cornea and pupil - Oedema of the lids (not severe) - Conjunctival hyperemia maximum @ fornices - Mucopus discharge & lashes glues together - Conjunctival peticheal haemorhages & chemosis * common in pneumococcal type

- conjunctival inflammation during st the 1 month of life - dt contamination from maternal passages during delivery

cause

* OPHTHALMIA NEONATORUM : Gonococci + Chlamydia + H.Simplex type 2 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) Corneal ulcer, dt: - Gonococci (can invade intact epith) - Severe conj edema presses on limbal capillaries (impaired corn. nutrition)

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

Corynebacterium diphtheria bacilli *contagious!

Adeno virus *easily transmitted by finger to eyes - 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

sympto ms

signs

- 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 + serosanguinous and may be purulent Stage of cicatrisation Fibrosis complications (1) Corneal corneal dipthteria bacilli can invade ulceration healthy intact corneal epith. compli- symblepharon cations dt - entropion and/or trichiasis fibrosis - conjunctival xerosis compli- paralysis of accommodation cations dt (ciliary muscle) diphtheria - squints due to EOM paralysis toxins - iridocylitis. (2) General: (to the toxins of diphtheria) - toxics myocarditis heart failure 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

complication

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

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

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

C/P

ALLERGIC CONJUNCTIVITIS GIANT PAPILLARY VERNAL KERATO CONJUNCTIVITIS (SPRING CATTARH) CONJUNCTIVITIS (GPC) - Ig-E mediated caused by FB irritating - in children, spring & summer the conjunctiva: - CL wearers symptoms : ithing + lacrimation + photophobia + ropy discharge ( eosinophils) - Artificial eye wearers signs : - Protruding end of (1) Conjunctival nylon sutures after PALPEBRAL BULBAR/LIMBAL MIXED intraocular surgery (upper palpebral conjunctiva) papillae (Cobble-stone app) - flat-topped, multiple - dark red, larger than trachoma - limbal gelatinous nodules - localized limbal injection - Tranta spots - both palbebral & bulbar type

HAY FEVER CONJUNCTIVITIS during hay fever season - Itching - Chemosis - Hyperemia

PHLYCTENULAR KERATO-CONJUNCTIVITIS - in children - by endogenous allergens (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 - CS drop/ointment - Atropine ointment (corneal affection) - Search underlying cause

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

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

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-Callans classification) T1 T2a T2b Immature Mature Follicles: papillae: follicles: small, large 2mm, small, greyish, non yellowish & rounded expressible expressible tops Corneal trachoma 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

T3 follicles & papillae + starting cicatrization (healing)

T4 healed trachoma (no activity)

Complications Eye lid: -Ptosis -Entropion -Trichiasis Conjunctiva: -Dryness (Xerosis) Cornea: -Xerosis -Opacities Lacrimal -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 Triangular raised patch in the bulbar conjunctiva - apex is away from the cornea - nasal > temporal - yellowish, fat-like PTERYGIUM Triangular fibrovascular subepithelial ingrowth - 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 - Disfigurement - Irritation & tearing - Visual impairment: dt astigmatism encroachment over the pupil - Limitation of movement diplopia (esp if recurrent) -Chronic irritation -Ultra violet rays Subconjunctival tissue proliferate as vascularized granulation tissue to invade cornea - 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

C/P

C/o

Asymptomatic except if inflamed

Cause Pathology Treatment

exposure to strong sunlight, dust, wind Hyaline degeneration not required (except cosmetis)