Conjunctivitis

CONJUNCTIVITIS

• Refers to inflammation of the conjunctiva.
• Also c/d pink eye or madras eye.

ACUTE MUCOPURULENT CONJUNCTIVITIS

• M/C type of bacterial conjunctivitis & is characterized by mucopurulent discharge.
• The most common causative organism is staphylococcus aureus.

Clinically patient presents with:

1. discomfort & foreign body sensation
2. mucopurulent discharge & sticking together of lid margins with discharge during sleep
3. slight blurring of vision & sometimes coloured halos.

Complications include:

1. Marginal corneal ulcer (marginal infiltration)
2. Superficial keratitis
3. Blepharitis
4. Dacryocystitis

OPHTHALMIA NEONATORUM

• Also c/d neonatal conjunctivitis, is the conjunctivitis in the first month of life.
• Infection may be acquired during birth from infected birth canal (most common) or after birth.

The causative agnets are:

1. Common organisms are: Gonococcus, C.trachomatis, Herpes simplex.
2. Other organisms are: staphylococcus aureus, pneumococcus, Streptococcus, Pseudomonas
3. Chemical conjunctivitis: Caused by use of silver nitrate or antibiotic prophylaxis.

Clinical Features

Depend upon the type of ophthalmia neonatorum:

i) Infective ophthalmia neonatorum:

• Pain, tenderness, purulent or mucopurulent discharge, swollen lids, chemosis & conjunctival hyperaemia.

ii) Chemical ophthalmia neonatorum:

• Watery discharge, minimal or no edema or chemosis

Treatment

• Prophylaxis: 0.5% Erythromycin & 1% tetracycline ointnment have replaced 1%  silver nitrate (Crede’s method) for prophylactic use.
• Single injection of ceftriaxone should be given to infant born to mothers with untreated gonococcal infection.

Curative treatment: Depends upon the causative organisms:

a) Gonococcus:

1. Topical: Bacitracin ointment or pencillin drops (sensitive cases)
2. Systemic (for 7 days): Ceftriaxone, cefotaxime ciprofloxacin, Penicillin G (if organism is sensitive)

b) Other bacteria: Bacitracin-neomycin eye ointment, gentamicin

c) HSV: Acyclovir ointment, Systemic acyclovir

d) Chlamydia trachomatis D-K (inclusion conjunctivitis): Erythromycin or chlortetracycline eye ointment; oral erythromycin

ADULT INCLUSION  CONJUCTIVITIS

• Type of follicular conjunctivitis.
• Caused by serotypes D & K of Chlamydia trachomatis in sexually active young adults.
• The primary source of infection is urethritis males & cervicitis in females.
• Transmission may occur either through contaminated fingers or through contaminated water of swimming pools (Swimming pool granuloma).
• The disease runs a benign course & often evolves into the chronic follicular conjunctivitis.

ANGULAR CONJUNCTIVITIS (DIPLOBACILLARY CONJUNCTIVITIS)

• Type of chronic conjunctivitis.
• Characterized by mild grade inflammation confined to conjunctiva & lid margins near the angles.
• Moraxella axenfeld (Moraxella lacunata), a diplobacillus, is the commonest causative organism.
• Less commonly, staphylococcus aureus can also cause angular conjunctivitis.
• Angular conjunctivitis responds to tetracycline ointment.
• Eye drops containing zinc inhibit the proteolytic ferment.

ACUTE MEMBRANOUS CONJUNCTIVITIS

• Characterised by formation of true membrane n the conjunctiva.
• Caused by Corynebacterium diptheriae & occasionally by Streptococcus haemolyticus.
• There is formation of fibrinous membrane, especially on palpebral conjunctiva.
• There is associated coagulative necrosis, resulting in sloughing of membrane.

PSEUDOMEMBRANOUS CONJUNCTIVITIS

• Type of acute conjunctivitis, characterized by formation of pseudomembranous over conjunctiva.
• The membrane is not a true membrane, it is formed due to coagulation of fibrinous exudates.
• Pseudomembrane is loosely attached to conjunctiva & can be easily peeled off leaving behind intact conjunctival epithelium.

Causative  agents are:

1. Bacteria: Corynebacterium diptheriae, Staphylococci, Streptococci, N.gonorrhoea
2. Virus: HSV, Adenovirus
3. Chemical: Acids, ammonia, lime, silver nitrate, copper sulfate

VIRAL CONJUNCTIVITIS

• Most of the viral infections tend to affect the epithelium, both of the conjunctiva & cornea.
• So, the typical viral lesion is a Keratoconjunctivitis.

Causes are:

1. HSV, Adenovirus,Picorna virus (Enterovirus-70, Coxasackie virus A24)
2. Measles (Myxovirus), VZV, Paramyxovirus, Molluscum conjunctivitis

ACUTE HEMORRHAGIC CONJUNCTIVITIS

• Also k/a Apollo disease is mainly caused by two picornaviruses:

1. Enterovirus 70 (most common)
2. Coxsackievirus A24

• Less commonly, Adenovirus type 11 can also cause acute hemorrhagic conjunctivitis.
• The signs of the disease include rapid onset of severe, painful follicular conjunctivitis with chemosis, tearing, lid edema & the development of tiny subconjunctival hemorrhage.

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