Conjunctiva 3


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Conjunctiva 3

  1. 1. Angular conjunctivitis <ul><li>Aetiology : Moraxella lacunata – Gram negative diplobacillus – produce a proteolytic ferment, which acts by macerating the epithelium. Also can be caused by Staphylococci </li></ul><ul><li>Incubation period – 4 days </li></ul><ul><li>C/F : </li></ul><ul><li>- Reddening of conj limited to intermarginal strip at inner and outer canthi </li></ul><ul><li>- excoriation of skin at inner and outer palpebral angles </li></ul><ul><li>- slight mucopurulent discharge, frequent blinking </li></ul><ul><li>- if untreated condition becomes chronic and causes blepharitis </li></ul><ul><li>- shallow marginal corneal ulcers may rarely develop </li></ul><ul><li>Treatment: tetracycline eye ointment, eyedrops containing zinc inhibit the proteolytic ferment. </li></ul>
  2. 2. Angular conjunctivitis
  3. 3. Viral conjunctivitis <ul><li>Serous / clear watery discharge </li></ul><ul><li>Usually produce follicular reaction </li></ul><ul><li>Systemic viral illnesses like influenza, mumps, measles and chickenpox may be accompanied by a non-specific conjunctivitis. </li></ul>
  4. 4. Follicular conjunctivitis <ul><li>Acute Follicular conjunctivitis : Chlamydial inclusion conjunctivitis, epidemic karatoconjunctivitis, pharyngoconjunctival fever, Newcastle conjunctivitis, hemorrhagic conjunctivitis, primary herpetic conjunctivitis, recurrent herpes simplex conjunctivitis. </li></ul><ul><li>Subacute/ chronic follicular conjunctivitis : generally drug-induced (pilocarpine users), secondary to lid lesions (molluscum contagiosum), trachoma </li></ul>
  5. 5. Adenoviral conjunctivitis <ul><li>Causative viruses : </li></ul><ul><li>1. Pharyngoconjunctival Fever : </li></ul><ul><li>- adenovirus types 3,4 and 7 </li></ul><ul><li>- transmitted by droplets (respiratory/ ocular secretions) </li></ul><ul><li>- affects children (epidemics) who also develop an URTI </li></ul><ul><li>(pharyngitis, fever) </li></ul><ul><li>- keratitis also develops in 30 % but is usually mild </li></ul><ul><li>2. Epidemic Keratoconjunctivitis : </li></ul><ul><li>- adenovirus types 8 and 19. </li></ul><ul><li>- transmitted by hand to eye contact, instruments and solutions </li></ul><ul><li>- does not cause systemic symptoms </li></ul><ul><li>- keratitis develops in 80 % of cases, may be severe </li></ul><ul><li>- markedly contagious, seen in epidemics </li></ul>
  6. 6. Adenoviral conjunctivitis <ul><li>Incubation period : 4 – 10 days </li></ul><ul><li>Following the onset of the conjunctivitis, the virus is shed for about 12 days. </li></ul><ul><li>Diagnosis is based on immunoflourescent tests that detects the adenoviral group antigens and on rising Ig titres in blood </li></ul>
  7. 8. Adenoviral conjunctivitis <ul><li>C/F : </li></ul><ul><li>Conjunctivitis : </li></ul><ul><li>1. Symptoms : acute watering, redness, discomfort, photophobia </li></ul><ul><li>2. Signs : eyelid edema, watery discharge, conj. follicles, subconj hemorrhages, chemosis, pseudomembranes (rarely) </li></ul><ul><li>preauricular lymphadenopathy </li></ul><ul><li>3.Treatment : </li></ul><ul><li>- spontaneous resolution occurs within 2 weeks </li></ul><ul><li>- artificial tears 4 – 6 times/day to relieve the discomfort. </li></ul><ul><li>- antiviral agents are ineffective </li></ul><ul><li>- topical steroids should be avoided unless inflammation is very severe. </li></ul>
  8. 9. Adenoviral conjunctivitis <ul><li>Keratitis </li></ul><ul><li>1. Signs : </li></ul><ul><li>a. Stage 1 : occurs within 7 days of onset. </li></ul><ul><li>punctate epithelial keratitis </li></ul><ul><li>resolves within 2 weeks </li></ul><ul><li>b. Stage 2 : focal, white, subepithelial opacities </li></ul><ul><li>represents immune response to the virus </li></ul><ul><li>c. Stage 3 : anterior stromal infiltrates </li></ul><ul><li>gradually fade over months to years </li></ul><ul><li>2. Treatment : </li></ul><ul><li>- Artificial tears 4 – 6 times/day to relieve discomfort </li></ul><ul><li>- Topical steroids indicated only if visual acuity is diminished by stage 3 lesions. Steroids do not shorten the course of the disease but merely suppress the corneal inflammation. </li></ul>
  9. 10. <ul><li>New castle conjunctivitis : clinically indistinguishable from the conjunctivitis of pharyngoconjunctival fever. </li></ul><ul><li>Newcastle virus is derived from contact with diseased fowls. </li></ul><ul><li>Hemorrhagic conjunctivitis (Apollo conjunctivitis) : </li></ul><ul><li>- picornavirus (coxsackie virus, enterovirus 70) </li></ul><ul><li>- pandemic form </li></ul><ul><li>- violent conjunctivitis with subconj hemorrhages, preauricular lymphadenopathy. </li></ul>
  10. 11. Herpetic conjunctivitis <ul><li>May occur as a primary manifestation of Herpes in children or as recurrent Herpes simplex in adults. </li></ul><ul><li>May be associated with vesicular lesions on the face </li></ul><ul><li>Preauricular adenopathy </li></ul><ul><li>Corneal dendritic lesions may be present </li></ul><ul><li>Reduced corneal sensation. </li></ul><ul><li>Detection of viral antigen in epithelial cells by flourescent antibody technique, rising serum antibody titre, isolating the virus </li></ul><ul><li>Treatment : artificial tears, usually resolves by 1-2 weeks, frequent followups to detect corneal involvement, Acyclovir/Vidarabine 3% ointment for skin/corneal involvement </li></ul>
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