ACUTE PURULENT CONJUNCTIVITIS (GONORRHOEAL CONJUNCTIVITIS AND OPTHALMIA NEONATORUM)

1. ACUTE PURULENT
CONJUNCTIVITIS.
DR.PRAFULLA C.PATIL
SHRI CHAMUNDAMATA HOMOEOPATHIC MEDICAL
COLLEGE AND HOSPITAL,JALGAON.

2.  This is an acute conjunctivitis where the discharge is frankly
purulent. It occurs in two forms-
 1) In an adults-mainly as gonococcal conjunctivitis.when the
causative agent is neisseria gonorrhoeae.
 2) In the new born-as ophthalmia neonatorum.

3. GONORRHOEAL CONJUNCTIVITIS
 Etiology :-
1) Age- adults with a history of gonorrhoea.
2) Causative agent-gonococcus.
3) But sometimes purulent conjunctivitis may be due to
B.subtilis particularly in agricultural areas or by klebs loeffler
bacillus and streptococcus haemolyticus.

4.  MODE OF INFECTION:-
1) From the genitalia by direct contact.
2) In casse of doctors and nurse by direct contact
with the conjunctival discharge
3) Metastatic infection from urethritis.

5. PATHOLOGY (GONORRHOEAL
CONJUNCTIVITIS):-
AS A RESULT ,THE ORGANISM PENETRATE INTO THE DEEPER LAYERS
AND EVEN MAY REACH THE SUBEPITHELIAL TISSUES.
SUPERFICIAL EPITHELIAL CELLS BEGIN TO DEGENERATE.
THESE CLUSTER INCREASE IN NUMBER IN NEXT 2-3 DAYS.
CLUSER FORMATION ON THE SURFACE OF CONJUNCTIVAL EPITHELIAL
CELL AND SET IN A SEVERE INFALMMATORY REACTION.
INCUBATION PERIOD MAY VARY FROM FEW HOURS TO 3 DAYS

6. FINAL HEALING OCCURS WITHOUT ANY SCARRING.
NUMEROUS PAPILLAE MAY BE FORMED DUE TO THE OVERGROWTH OF THE EPITHELIUM.
GONOCOCCI INVADES THE NORMAL CORNEAL EPITHELIUM CAUSING DEVELOPMENT OF CORNEAL
ULCER
PROCESS OF PHAGOCYTOSIS CONTINUES UNTIL THE INFECTION IS ELIMINATED.
REGENERATE THE EPITHELIAL CELL,WHICH PHAGOCYTOSE THE ORGANISMS.
ODEMA AND SWELLING OF THE SUBCONJUNCTIVAL TISSUES.
SUPERFICIAL CELLS ARE THEN SHED OFF UP TO THE BASAL LAYER.

7. CLINICAL PICTURE:-
 Clinical picture divided into 3 stages:-
1) Stage of infiltration:-
- Pain and tenderness of the eyeball.
- Conjunctiva appears bright red and velvety.
- Discharge is watery or sanious.
- Exudation may coagulate on the surface of
conjunctiva to form a pseudo-membrane.
- lids are tensely swollen.
- pre-auricular gland are enlarged.

8.  2) stage of blenorrhoea:-
- starts about fifth day.
- discharge frankly purulent and
abundant and thick,creamy pus drips
down the chicks.
- onset of this stage,tenseness of lids and
conjunctiva subsides.

9.  3) stage of slow healing:-
- pain becomes very much lkess
- swelling of the lids subsides.
- conjunctiva becomes red,thick,velvety.
- papillary formation over the tarsal
conjunctiva.
- bulbar conujnctiva remains
hyperaemic.
- dsicharge slowly diminishes ,virulent
goncocci may be present in discharge.

10. COMPLICATIONS:-
 Oedma of the corneal epithelium.
 Ulceration of the cornea.
 Perforation of the corneal ulcer.
 Iritis or iridocyclitis with hypopyon.

11. DIAGNOSTIC CRITERIA:-
 Adult male or female.
 History of gonococcal infection.
 Marked inflammation of the lid and conjunctiva.
 Copious frankly purulent discharge showing gram negative
intracellular diplococci on smear examination.

12. TREATMENT:-
 Prophylactic:-
To prevent infection of the other eye and eyes of other
members of the family:-
a) Dressings to be destroyed.
b) Towels and linens used by the patient to
be kept separate.
c) In case of accidental infection of the eye of
a doctors and nurse,silver nitrate 1 % has
to be dropped in the eye followed by broad
spectrum antibiotic.

13.  Curative :-
- Normal saline wash to wash out the purulent matter as
far as possible.
- Frequent drops of penicillin lotion.
- Solution of crystalline penicillin in distilled water is
prepared in the srenght of 10000 units of penicillin in one cc of
distilled water and is dropped in the eye,at first every one
minute for half an hour,and then every 5 minute for one
hour,and then every 15 minutes,half an hour and one
hour,until the discharge stops completely.
- Broad spectrum antibiotic ointment applied at bedtime.
- If corneal ulcer develop atropine sulphate 1% ointment
should be applied at bed time.

14. OPHTHALMIA NEONATORUM:-
 DEFINITION:-
It is bilateral purulent conjunctivitis occuring in
the new born within the first three weeks of life.

15. ETIOLOGY:-
 Causative organisms:-
1) Gonococcus.
2) B.coil.
3) Pneumococcus.
4) Staphylococcus aureus.
5) streptococcus haemolyticus.
6) A genital virus present in mother’s birth passage-the
condition is then known as inclusion blenorrhoea.

16. MODE OF INFECTION:-
 The eye may be infected in 3 ways-
 1) Before birth –extremely rare.
 2) During birth,particularly if there is face presentation.
 3) After birth-from soiled linen.

17. PATHOLOGY:-

18.  A few anatomical peculiarities of the new born should be kept
in mind-
 A) Absence of tears for 3 weeks to 1 month after birth.
 B) Conjuctival and corneal epithelium are very thin-only two
layers in cornea.
 C) No adenoid layer in the conjunctiva.
The pathological process is same as in gonorrhoeal
conjunctivitis.papillae formation is marked in the epithelium.In
the sub epithelial tissue,lymphoid layer is rapidly formed.

19. CLINICAL PICTURE:-
 Incubation period for gonococcus is 1-3 days.
 For other organisms varies from 1 to 2 weeks.
 In case of virus,the period is 7 to 9 days.
 Condition is bilateral.
 Conjunctival discharge ceases within 6 to 8 weeks,leaving
very little cicatrical changes.
 Clinical signs are the same as in adult,but the whole picture is
less virulent and more mild.

20. DIAGNOSTIC CRITERIA:-
 a) Purulent conjunctivitis in the new born.
 b) Conjunctival smear shows gonococcus.

21. COMPLICATIONS:-
 In untreated cases,complications usually occur.the cornea is
most commonly affected-
a) Corneal ulcer which may heal leaving an opacity.Due to
bilateral corneal opacity,the macula in the retina fails to
develop due to obstruction to vision and ultimately nystagmus
is developed.
b) Corneal ulcer may parforate,causing adherent leucoma.
c) Cornea may slough out ,causing anterior staphyloma.

22. PROGNOSIS:-
 Earlier the treatment better is the prognosis.

23. TREATMENT:-
 A) Prophylactic:-
a) Thorough antenatal care and examination of the mother
for any infection.
b) Crede’s method-
1% silver intrate solution is dropped into the eyes of the
baby immediately after birth.As a modern method,a solution of
crystalline penicillin 10000 units per c.c. of distilled water is
dropped .

24.  B) Curative:-
Before treatment is started ,it is always wise to take a
conjunctival swab for smear examination and
culcture.treatment is same as gonococcal conjunctivitis in
adults.
If the cornea is affected atropine sulphate ointment has to be
dropped.