Conjunctivitis

Dr. Irfan Shafiq

Conjunctiva
Conjunctivitis
Conjunctival reaction
 FOLLICULAR REACTION
 Follicles are sunbepithelial foci of
hyperplastic lyumphoid tissue within the
stroma most prominent in the fornices
 Causes
 Viral infection

 Chlamydial infections

 Hypersensitivity to topical medication

 PAPILLARY REACTION
 It is characterized by hyperplastic
conjunctival epithelium thrown into
numerous folds of projections, with central
vessels and frequently seen in the upper
palpebral conjuntiva
 Causes
 Chronic blepharitis

 Allergic

 Bacterial conjunctivitis
Bacterial Conjunctivitis

Simple / Mucoprulent bacterial

conjunctivitis
 Staph.aureus and epidermidis, Strep
pneumonia, Haemophilus influenzae
 CLINICAL FEATURES
 Symptoms
 Acute redness, grittiness, burning,
discharge (on waking, the eyelids are
frequently stuck together as a result
of the accumulation of exudates)
 Signs
 Eyelids are crusted

(mucoprulent discharge),
discharge is initially watery
but within a day or so it
becomes mucoprulent.
Simple bacterial conjunctivitis
 Treatment
 Even without treatment, simple conjunctivitis usually resolves within
14 days.
 Antibiotic drops e.g chloramphenicol or ciprofloxacin
 Antibiotic ointments used at night e.g chloramphenicol or
ciprofloxacin

Prulent conjunctivitis
is hyperacute bacterial conjunctivitis,
characterized by prulent discharge. It is
caused by neisseria gonorrhoeae, which is
capable of invading the intact corneal
epithelium.

CLINICAL FEATURES
Symptoms: Acute purulent discharge, pain,
redness
Sings: Eyelids are oedematous and tender,
profuse purulent discharge,conjunctival
hyperaemia, chemosis,
pseudomembraneformation,
lymphadenopathy, keratitis (initially
marginal ulceration then peripheral ring
ulcer), central ulceration (may lead to
perforation and endophthalmitis).
INVESTIGATION: Gram’s staining, culture and sensitivity.

TREATMENT
Patient should be hospitalized
Conjunctival smear taken for staining, culture and sensitivity
Systemic cefotaxime
Topical gentamicin
VIRAL
CONJUNCTIVITIS
Adenovirus (DNA virus)
Herpes simplex virus
Varicella zoster virus
ADENOVIRAL
KERATIOCONJUNCTIVITIS
CLINICAL FEATURES:
 Symptoms; watering, redness,
photophobia
 Signs; eyelid oedema, watery discharge,

conjunctival follicles,subconjunctival
haemorrhages, chemosis, punctate
epithelial keratitis, subepithelial opacities
(develop beneath epithelial lesions),
stromal infiltrates, lymphadenopathy
TREATMENT (antiviral agents are
ineffective
 Symptomatic (spontaneous resolution
usually occurs in 1-2 weeks)
 Topical steroids (for keratitis)

 Topical antibiotics (to reduce risk of

secondary bacterial infection)

CHLAMYDIAL CONJUNCTIVITIS
 ADULT CHLAMYDIAL
CONJUNCTIVITIS
 CLINICAL FEATURES
 Symptoms; are similar to
mucopurulent conjunctivitis.
 Signs; mucopurulent discharge,
conjunctival follicles (predominantly
in lower conjunctiva), upper
peripheral corneal infiltrates,
preauricular lymphadenopathy,
superior pannus.
 TREATMENT
 Topical antibiotics: tetracycline or
erythmycin eye ointment,
 Systemic antibiotics: azithromycin (1 g
in a single dose), erythromycin,
doxycycline.
 NEONATAL CHLAMYDIAL CONJUNCTIVITIS
 CLINICAL FEATURES
 Mucopurulent discharge, papillae (no follicular response due to delayed development
of palpebral tissue), conjunctival scarring, superior corneal pannus.
TREATMENT
Topical tetracycline
Oral erythromycin
ALLERGIC CONJUNCTIVITIS
ACUTE ALLERGIC
CONJUNCTIVITIS: is acute
allergic (type-1 hypersentivity reaction)
conjunctival inflammation.

CLINICAL FEATURES
 Symptoms; redness, watering, itching
 Signs; lid oedema, conjunctival
chemosis(hallmark), papillae

TREATMENT
Topical mast cell stabilizer
Topical antihistamine
 
VERNAL KERATOCNJUNCTIVITS
(VKC) / VERNAL OR SPRING
CATARRH
CLINICAL FEATURES
 Symptoms: ocular itching, lacrimation,
photophbia, foreign body sensation,
burning, thick mucus discharge, ptosis.
 Signs: (depend upon the type)

 The three main clinical types:

 Palpebral VKC (in chronological order)
upper tarsal conjunctival papillae formation,
papillae enlarge and have a flat-topped
polygonal appearance resemble
cobblestones. In severe cases giving rise to
giant papillae.
 Limbal VKC limbal conjunctival papillae

formation around the limbus with discrete

white superficial spots (Trantas dots)
predominantly composed of eosinophils.
 Mixed VKC shows the features of both

palpebral and limbal VKC.

TREATMENT
NonSurgical:
 Mast cell stabilizers e.g sodium cromoglycate, lodoxamide (suoerior to sodium cromoglycate)
 Antihistamines e.g emedastine

 Combined action mast cell stabilizer/antihistamine e.g ketotifen, olopatadine

 Topical NSAID e.g ketorolac

 Topical steroids are indicated for severe cases and keratopathy such as fluorometholone,

dexamethasone or prednisolone. Their prolonged use is avoid because of their complicatiosn

e.g. cataract and glaucoma.
 Topical acetylcysteine is mucolytic agent, for treatment of plaque formation.

 Topical cyclosporin

 Superatarsal steroid injection of betamethasone or dexamethason or triamcinolone

 Oral antihistamine or immunosuppressive agents

Surgical:
Debridement, superficial keratectomy
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