- 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
- - 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.
- 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.
- 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
- 1. Pharyngoconjunctival Fever :
- - adenovirus types 3,4 and 7
- - transmitted by droplets (respiratory/ ocular secretions)
- - affects children (epidemics) who also develop an URTI
- - 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
- 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
- 1. Symptoms : acute watering, redness, discomfort, photophobia
- 2. Signs : eyelid edema, watery discharge, conj. follicles, subconj hemorrhages, chemosis, pseudomembranes (rarely)
- preauricular lymphadenopathy
- - 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.
- a. Stage 1 : occurs within 7 days of onset.
- punctate epithelial keratitis
- 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
- - 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.
- 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)
- - violent conjunctivitis with subconj hemorrhages, preauricular lymphadenopathy.
- 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
- 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