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