Conjunctivitis

Definition
Conjunctivitis: inflammation of the
conjunctiva

Eye Anatomy

Classification of
Conjunctivitis
Viral
Infectious
Bacterial

Hyperacute
Acute

Chronic

Noninfectious Allergic, Toxins/

Chemicals, Foreign body, Trauma,
Neoplasm

Etiological classification
1. Infective conjunctivitis: bacterial, chlamydial,
viral,fungal, rickettsial, spirochaetal, protozoal,
parasitic etc.
2. Allergic conjunctivitis.
3. Irritative conjunctivitis.
4. Keratoconjunctivitis associated with diseases of
skin and mucous membrane.
5. Traumatic conjunctivitis.
6. Keratoconjunctivitis of unknown etiology.
eg: Trachoma..

Prevalence

Viral Conjunctivitis
Most common viral cause is adenovirus
(enterovirus, HSV)
Occurs in community epidemics (schools,
workplaces, physicians offices)
Usual modes of transmission:
contaminated fingers, medical
instruments, swimming pool water

Viral infections of conjunctiva include:

Adenovirus conjunctivitis
Herpes simplex keratoconjunctivitis
Herpes zoster conjunctivitis
Pox virus conjunctivitis
Myxovirus conjunctivitis
Paramyxovirus conjunctivitis
ARBOR virus (ARthropod-BOrne
virus) conjunctivitis

Clinical presentations.
Acute viral conjunctivitis may
present in three clinical forms:
1. Acute serous conjunctivitis
2. Acute haemorrhagic conjunctivitis
3. Acute follicular conjunctivitis

Symptoms:
include:
unilateral or bilateral
redness,
watering,
mild mucoid discharge,
mild photophobia
feeling of discomfort
and foreign body sensation.

May be part of viral prodrome:

tender preauricular node
adenopathy,
fever,
pharyngitis,
cough,
rhinorrhea

ACUTE SEROUS CONJUNCTIVITIS

Etiology. It is typically caused by a mild
grade viral infection which does not give
rise to follicular response.

 Clinical features. Acute serous

conjunctivitis is
characterised by
- a minimal degree of congestion,
- watery discharge and
- boggy swelling of the conjunctival mucosa.

 Treatment. Usually it is self-limiting

and does not
need any treatment.
But to avoid secondary bacterial infection,
--broad spectrum antibiotic eye drops may be
used three times a day for about 7 days.

ACUTE HAEMORRHAGIC CONJUNCTIVITIS

It is an acute inflammation of conjunctiva
characterised by
multiple conjunctival haemorrhages,
conjunctival hyperaemia and
mild follicular hyperplasia.

Symptoms: include
pain,
redness,
watering,
mild photophobia
transient blurring of vision and
Lid swelling.

Signs:
conjunctival congestion,
chemosis,
multiple haemorrhages in bulbar
conjunctiva,
mild follicular hyperplasia,
lid oedema and
pre-auricular lymphadenopathy.

 Corneal involvement may occur in the form

of
-fine epithelial keratitis.

Treatment
very infectious and poses major potential
problems of cross-infection. Therefore,
prophylactic measures are very important.
No specific effective curative treatment is
known. However,
broad spectrum antibiotic eye drops may be
used to prevent secondary bacterial infections.
Usually the disease has a self-limiting course of
5-7 days.

FOLLICULAR
CONJUNCTIVITIS

Types
1. Acute follicular conjunctivitis.
2. Chronic follicular conjunctivitis.
3. Specific type of conjunctivitis with follicle
formation e.g., trachoma

ACUTE FOLLICULAR CONJUNCTIVITIS

It is an acute catarrhal conjunctivitis

associated with- marked follicular hyperplasia-especially of the lower
fornix and lower palpebral
conjunctiva.

Symptoms
--- similar to acute catarrhal conjunctivitis
include:
Burning and grittiness in the eyes,
especially in the evening.
Feeling of heat and dryness on the lid
margins.
Difficulty in keeping the eyes open.
Feeling of sleepiness and tiredness in
the eyes

 Mild chronic redness in the eyes.

Mild mucoid discharge especially in
the canthi. Off and on lacrimation.

Signs
conjunctival hyperaemia, associated
withmultiple follicles, more
prominent in lower lid than the upper
lid

Treatment
Primary herpetic infection is
usually selflimiting.
The topical antiviral drugs control the
infection effectively and prevent
recurrences

BACTERIAL
CONJUNCTIVITIS

Etiology:
Predisposing factors
Causative organisms
Acording to Mode of infection

Pathology
Vascular response
Cellular response
Conjunctival tissue
repsonse
Conjunctival
discharge

CLINICAL TYPES OF BACTERIAL

CONJUNCTIVITIS

1. mucopurulent conjunctivitis.
2. Acute purulent conjunctivitis
3. Acute membranous
conjunctivitis
4. Acute pseudomembranous
conjunctivitis
5. Chronic bacterial conjunctivitis
6. Chronic angular conjunctivitis

1. MUCOPURULENT
CONJUNCTIVITIS
Common causative bacteria are:
Staphylococcus
aureus,
Koch-Weeks bacillus,
Pneumococcus and
Streptococcus.

Symptoms
Discomfort and foreign body
Mild photophobia.
Mucopurulent discharge from the
eyes.
Sticking together of lid margins
Slight blurring of vision due to
mucous flakes
may complain of coloured halos.

Signs

Conjunctival congestion
Chemosis
Petechial haemorrhages
Flakes of mucopus
Cilia are usually matted
Yellow crust

2. PURULENT CONJUNCTIVITIS
Etiology:
-causative organism
Clinical picture:
1 Stage of infiltraton
2 Stage of blenorrhoea
3 Stage of slow healing

Stage of infiltraton
Considerably painful and tender
eyeball.
Bright red velvety chemosed
conjunctiva.
Lids are tense and swollen.
Discharge is watery or sanguinous.
Pre-auricular lymph nodes are
enlarged.

Stage of blenorrhoea
Frankly purulent, copious, thick
discharge trickling down the cheeks.
Other symptoms are increased but
tension in the lids is decreased

Complications
1. Corneal involvement
2. Iridocyclitis
3. Systemic complications
- gonorrhoea arthritis
- endocarditis
- septicaemia

3. MEMBRANOSA
CONJUNCTIVITIS

Etiology:
Corynebacterium
diphteriaedanStreptococcus
haemolyticus

4. Pseudomembranosa
conjungtivitis
coagulasion eksudat fibrinosa

Treatment
Topical antibiotics- broad specturm
antibiotics
Irrigation of conjunctival sac
Anti-inflammatory and analgesic
drugs

OPHTHALMIA
NEONATORUM
Source and mode of infection:
- Before birth infection is very rare
through infected liquor amnii in
mothers with ruptured membrances
- During birth.
- After birth

Causative agents
Gonococcal infection
Other bacterial infections
Herpes simplex ophthalmia
neonatorum

Symptoms and signs

1. Pain and tenderness in the eyeball.
2. Conjunctival discharge. It is purulent in
gonococcal ophthalmia neonatorum and
mucoid or mucopurulent in other bacterial
cases and neonatal inclusion conjunctivitis.
3. Lids are usually swollen.
4. Conjunctiva may show hyperaemia and
chemosis
5. Corneal involvement, though rare.

Treatment
A. Prophylaxis needs antenatal,
natal and postnatal care.
Curative treatment:
Chemical ophthalmia neonatorum is
a self-limiting condition, and does not
require any treatment.

 Topical therapy
- Saline lavage
-Bacitracin eye ointment 4 times/day
However in cases with proved penicillin
susceptibility, penicillin drops 5000 to
10000 units per ml should be instilled
every minute for half an hour, every five
minutes for next half an hour and then
half hourly till the infection is controlled.

 Systemic therapy:
Ceftriaxone 75-100 mg/kg/day IV or
IM, QID.
Cefotaxime 100-150 mg/kg/day IV or
IM, 12 hourly.
Ciprofloxacin 10-20 mg/kg/day or
Norfloxacin 10 mg/kg/day.