hi its me bijendra yadav from nepal i am describe about conjunctivitis

1. CONJUNCTIVITIS

2. Defination
• Conjunctivitis: inflammation of the
conjunctiva
• Conjunctiva: thin, translucent, elastic tissue
layer with bulbar and palpebral portions
• Bulbar: lines the outer surface of the globe
to the limbus (junction of sclera and cornea)
• Palpebral: covers the inside of the eyelids

3. Classification of Conjunctivitis
Viral
• Infectious  Hyperacute
Bacterial  Acute
Chronic
• Noninfectious  Allergic, Toxins/
Chemicals, Foreign body, Trauma,
Neoplasm

4. Viral Conjunctivitis
• Most common viral cause is adenovirus
(enterovirus, HSV)
• Occurs in community epidemics (schools,
workplaces, physicians’ offices)
• Usual modes of transmission: contaminated
fingers, medical instruments, swimming pool
water

5. Viral Conjunctivitis
• Presentation: unilateral or
bilateral, acutely red eye,
watery or mucoserous
discharge, chemosis,
tender preauricular
node, burning/
sanding/gritty feeling in
eye(s), rarely photophobia
• May be part of viral
prodrome, fever,
pharyngitis, cough,
rhinorrhea

6. Acute Bacterial Conjunctivitis
• Common causes in neonates: Chlamydia
trachomatis, Neisseria gonorrhoeae
• In children: Haemophilus influenzae (80%),
Streptococcus pneumoniae (20%), and
Moraxella catarrhalis. Concurrent OM seen
in 25%.
• In adults: Staphylococcus aureus

7. Acute Bacterial Conjunctivitis
• Presentation: Unilateral or
bilateral, red eye,
mucopurulent or purulent
discharge continuously
throughout the day,
burning, irritation, mild
chemosis
• Neonates: symptoms
appear 5-14d after birth
(inclusion conjunctivitis
of the newborn)
• Highly contagious: spread
by direct contact or by
contaminated objects

8. Hyperacute Bacterial
Conjunctivitis
• Etiology: Neisseria species,
most commonly N. gonorrhoeae
• Presentation: profuse, purulent discharge with rapidly
progressive symptoms of marked conjunctival injection,
irritation, tenderness to palpation, chemosis, lid swelling,
and tender preauricular adenopathy
• Ophthalmia neonatorum: gonococcal ocular infection
with bilateral discharge 3-5d after birth from vaginal
transmission
• Sexually active teens: transmitted from genitalia to hands
to eyes, commonly see concurrent urethritis
• Sight-threatening

9. Chronic Bacterial Conjunctivitis
• Most common etiology: Staphylococcus species
• More common in adults and patients with acne
rosacea or facial seborrhea
• Presentation varies: redness, itching, burning,
foreign-body sensation, flaky debris, blepharitis
(common), eyelash loss
• Concurrently see styes and chalazia of the lid
margin from chronic inflammation of the
meibomian glands

10. Allergic Conjunctivitis
•
allergic rhinoconjunctivitis,
also called hay fever
rhinoconjunctivitis
• IgE mediated
hypersensitivity reaction
precipitated by small
airborne allergens local
mast cell degranulation
 release of chemical
mediators (histamine,
eosinophil chemotactic
factors, PAF, etc.)
Most commonly seasonal • Presentation: bilateral,
pruritis, redness,
watery discharge,
rhinorrhea/congestion
• Patients often have h/o
atopy, seasonal allergy
or specific allergy

11. Diagnosis ofConjunctivitis
• Clinical diagnosis of exclusion
• Morning crusting of eye
unreliable for determining
etiology
• If focal pathology (hordeolum, cancerous lesion or
blepharitis), conjunctivitis is reactive rather than
primary
• If redness is localized rather than diffuse, consider
foreign body, pterygium or episcleritis

12. “Pink Eye” Differential

13. Treatment
• Viral, allergic, and nonspecific
conjunctivitis are self-limited
• Bacterial conjunctivitis is also likely to be
self-limited but abx treatment shortens the
course, reduces person-to-person spread,
and lowers the risk of sight-threatening
complications

14. Treatment ofViral Conjunctivitis
• Topical antibiotics not necessary because
secondary bacterial infection is uncommon
• Reassurance that the sxs may get worse for 3-5d
before getting better and persist for 2-3 weeks
• Some relief from cold compresses and topical
antihistamines/decongestants
• Do not use topical corticosteroids due to risk of
sight-threatening complications (scarring, corneal
melting, perforation), especially if etiology is
herpes simplex virus or bacterial keratitis

15. Treatment ofAcute Bacterial
Conjunctivitis
• Topical broad-spectrum antibiotics: erythromycin
ointment, bacitracin-polymyxin B ointment (Polysporin),
trimethropim-polymyxin B (Polytrim), sulfa drops
Most H. flu and S. pneumoniae resistant to macrolides•
• Sulfa drops (Bleph-10): less effective and rare side effect
of Stevens-Johnson syndrome
• Rx: 1/2” ointment inside lower lid or 1-2 drops QID for 5-
7 days (response seen typically within 1-2d)
• Inclusion Conjunctivitis of the Newborn: treat with 2 week
course of erythromycin (50mg/kg/d po divided QID) or
sulfisoxazole (150mg/kg/d po divided QID), topical
unnecessary with systemic

16. Treatment of Hyperacute
Bacterial Conjunctivitis
Immediate ophthalmic referral
Systemic and topical antibiotics and saline irrigation
•
•
• Systemic antibiotic of choice due to penicillin-resistant N.
gonorrhoeae is single-dose Ceftriaxone (25-50mg/kg IV or
IM, not to exceed 125mg) or single-dose Cefotaxime
(100mg/kg IV or IM) in neonates
• If venereal disease present in teens, also treat with single-
dose of azithromycin (1g) because over 30% of these
patients will have concurrent chlamydial disease
• AAP and CDC recommendations for prevention of
ophthalmia neonatorum: silver nitrate 1% aqueous solution
(side effect of chemical conjunctivitis), erythromycin 0.5%
ophthalmic ointment, tetracycline 1% ophthalmic ointment

17. Treatment ofAllergic
Conjunctivitis
• Self-limited
• Allergen avoidance, cold compresses,
topical antihistamines/vasoconstrictors (do
not use for greater than 2 weeks), artificial
tears, topical NSAIDS (low efficacy)
• Prophylaxis: oral antihistamines (onset of
action=days), mast cell stabilizers (onset of
action=5-14d)

18. When to Referto
Ophthalmology
• Neonates
• Hyperacute Purulent Conjunctivitis
• Chronic Conjunctivitis
• Sxs of pain, blurred vision, and
photophobia
• Reactive conjunctivitis vs. primary