By: Qurat-ul-ain Ophthalmic Medical Technologist/ MBA Health & Hospital management

1. CONJUNCTIVITIS
By: Qurat-ul-ain
Ophthalmic Medical
Technologist/ MBA Health &
Hospital management

2. Acute Conjunctivitis
Symptoms:
• Red eye (conjunctival hyperemia)
• Discharge
• Crusting
• Foreign body sensation
• <4-week duration of symptoms
Chronic Conjunctivitis
Symptoms:
• Red eye (conjunctival hyperemia)
• Conjunctival discharge
• Eyelids sticking
• Foreign body sensation
• Duration >4 weeks of symptoms

3. ACUTE CONJUNCTIVITIS
CLASSIFICATION
Acute
conjunctivi
tis
Viral HSV
Allergi
c
Vernal Bacteri
al
Gonococc
al
Pediculosi
s

4. Viral
conjunctivit
is
Etiology:
Adenovirus
enterovirus
Coxsackievirus
Adenovirus serotype
11.
Viral syndromes:
measles, mumps,
influenza
Symptoms:
Itching, burning, tearing,
gritty sensation
History of recent URTI, or
contact with someone with
viral conjunctivitis.
Starts with one eye and
involved fellow eye later
on.
Signs:
Inferior palpebral
conjunctival follicles,
tender, palpable pre-
auricular lymph node.
Watery discharge, red &
edematous eye-lids,
pinpoint sub-conjunctival
hemorrhages, punctate
keratopathy, epithelial
erosion, membrane,
microcyst-subepithelial
infiltrates (SEI).
Treatment:
Counsel the patient that it is
self-limited & should take
care of hygiene.
Preservative –free artificial
tears or ointment 4 to 8
times/ day for 1 to 3 weeks
Cool compresses
Anti-histamine drops if
itching is severe.
Membrane should be peeled
off, if present.
If SEIs reduce vision or cause
photophobia, topical steroids
should be initiated.

5. HSV
Conjunctivit
is
Etiology:
Herpes Simplex Virus
Symptoms:
Red eye, pain, foreign
body sensation,
photophobia, tearing,
decreased vision, skin
vesicular rash, previous
episodes history, usually
unilateral.
Signs:
Conjunctival injection,
unilateral follicular
conjunctivitis, with or
without conjunctival
dendrites, or geographic
ulceration.
Palpable pre-auricular
node.
Treatment:
Antiviral-therapy
e.g., trifluridine 1%
e/d 8 times/ day,
ganciclovir 0.05% gel
5 times/ day
Oral agents such as
acyclovir 400mg 5
times a day.
Warm compresses.

6. Allergic
Conjunctiviti
s
Symptoms:
Itching, watery
discharge, history of
allergies.
Usually bilateral
Signs:
Chemosis, red
Edematous eyelids,
conjunctival papillae,
periocular
hyperpigmentation,
No preauricular node.
Treatment:
Frequent washing of hair &
clothes may be helpful.
Cool compresses several times/
day.
Mild: artificial tears 4 to 8 times/
day.
Moderate: use anti-histamine or
mast-cell stabilizer drops.
Severe: mild topical steroids.
Oral anti-histamine in moderate
to severe cases can be very
helpful.

7. Vernal/ Atopic
Conjunctivitis
Symptoms:
Usually bilateral
Frequently asymmetric
itching with thick, ropy
discharge.
Seasonal recurrences
History of atopy,
asthma .
Signs:
Large conjunctival papillae seen
under the upper eyelid or along
the limbus.
Superior corneal shield ulcer,
limbal raised white dots of
degenerated eosinophils,
superficial punctate
keratoplasty.
Treatment:
As for allergic conjunctivitis
prophylactic use of a mast-cell
stabilizer for 2 – 3 weeks before
the allergy season starts.
If a shield is present add topical
steroids, topical anti-biotic and
cycloplegic agent.

8. Bacterial
Conjunctivit
is
Symptoms:
Redness, foreign body
sensation, discharge,
itching
Signs:
white-yellow discharge of
mild to moderate degree.
Conjunctival papillae,
chemosis, pre-auricular
node.
Treatment:
Topical antibiotic
therapy.
H. Influenzae should be
treated with oral
amoxicillin,/ clavulanate

9. Gonococca
l
Conjunctiv
itis
Signs:
Severe purulent discharge,
hyperacute onset, conjunctival
papillae, chemosis,
adenopathy, eyelid swelling
Treatment:
Dual treatment regimen of
ceftriaxone plus azithromycin.
Topical fluoroquinolone
ointment or fluoroquinolone
drop q2h.
Saline irrigation
Treat for possible chlamydial
coinfection.

10. Pediculosis (lice,
crabs)
Conjunctivitis
Symptoms:
Itching,
Mild conjunctival
injection.
Signs:
Adult lice, nits
Blood-tinged debris
on the eyelids and eye
lashes.
Follicular conjunctivitis
Treatment:
Mechanical removal of
lice and eggs
Bland ophthalmic
ointment to the eyelids
Anti-lice lotion and
shampoo

11. CHRONIC CONJUNCTIVITIS
CLASSIFICATION
Chronic
Conjunctivitis
Chlamydial Trachoma
Molluscum
Contagiosum
Micro-
sporidial

12. Chlamydial
inclusion
Conjunctivitis
Signs:
Inferior tarsal or bulbar
conjunctival follicles,
superior corneal pannus,
palpable pre-auricular
node, or peripheral SEIs.
Stringy, mucous discharge.
Treatment:
azithromycin, topical
erythromycin or
tetracycline ointment.

13. Trachom
a
Etiology:
C. Trachomatis serotypes
A-C
Signs:
Stage 1: sup. Tarsal follicles, mild sup. SPK, and pannus,
preceded by purulent discharge & tender pre-auricular node.
Stage 2: florid sup. Tarsal follicular reacted with sup. Corneal
SEIs, pannus & limbal follicles.
Stage 3: follicles & scarring of sup. Tarsal conjunctiva
Stage 4: no follicles, extensive conjunctival scarring.
Late complications: severe dry eyes, trichiasis, entropion,
keratitis, corneal scarring, sup, fibrovascular pannus, Herbert
pits, corneal bacterial superinfection & ulceration.
Treatment:
Azithromycin
Tetracycline, erythromycin or sulfacetamide

14. Molluscum
Contagiosu
m
Signs:
Dome-shaped, usually
multiple, umbilicated shiny
nodules on the eyelid or
eyelid margin.
Follicular conjunctival
response from toxic viral
products, SPK,
immunocompromised
patients & more numerous
lesions, pediatric atopic
dermatitis
Treatment:
Lesions should be removed by
simple excision & curettage or
cryosurgery.

15. Micro-sporidial
kerato-
conjunctivitis
Signs:
Diffuse, coarse, raised
punctate keratitis &
non-purulent papillary
or follicular
conjunctivitis. In
immuno-compromised
patient, corneal stromal
keratitis,
Treatment:
Regimens of antiparasitic and
antibiotic agents are
recommended.
Topical fumagillin, poly hexa-
methylene biguanide, oral
anti-parasitic medications,
antibiotic ointment.
Treat any systemic infestation

16. RESOURCE:
• The wills eye Manual by 7th edition.

17. THANK YOU!