diseases of the conjunctiva

1. Diseases Of Conjuctiva
Amal Sasikumar

2. ACUTE MEMBRANOUS
CONJUNCTIVITIS
TRUE MEMBRANE FORMATION BLEEDS ON PEELING
Membranous conjunctivitis can lead to
symblepharon, ankyloblepharon, and
entropion with trichiasis.

3. Etiology
1. Chemical irritants
A. Acids, such as acetic or lactic
B. Alkalis, such as ammonia or lime
C. Metallic salts, such as silver nitrate or copper sulfate
2. Corynebacterium diphtheriae
3. Ligneous conjunctivitis-chronic, cause unknown
4. Pneumococcus
5. Streptococcus
6. Uncommon-actinomyces, glandular fever, measles,
Neisseria catarrhalis, variola, Pseudomonas aeruginosa,
herpes simplex, Leptothrix, and epidemic keratoconjunctivitis.

4. Pathogenesis
Corynebacterium diphtheriae
Deposition of fibrinous exudate on the
surface as well as in the substance of the
conjunctiva
Inflamation of a membrane in palpebral
conjunctiva
Coagulative necrosis
Sloughing of membrane
Healing takes place by granulation tissue.

5. Usually in children 2-8 years (not immunized) ,toxic & febrile
Stage of infiltration:
Scanty discharge and severe pain
Swollen and hard lids, red swollen conjunctiva covered with grey
yellow membrane
On removal, membrane bleeds , pre auricular LN
Stage of suppuration:
Pain decreases, membrane sloughs off lids are soft
Copious purulent discharge
Stage of cicatrization:
Raw surface covered with granulation tissue & epithelized ,
trichiasis, conjunctival xerosis
Clinical Feautures

6. Early complications : Corneal ulcer
Delayed complications:
Cicatrization , symblepharon, trichiasis, entropion &
conjunctival xerosis.
Complications

7. By bacteriological examination
Diagnosis

8. Topical:
Penicillin eye drops 1:10000 unit/ml every 30 min
Anti-diphtheric serum every 1 hour
Atropine 1% ointment (if corneal involvement)
Broad spectrum antibiotic ointment at bedtime
Systemic:
Crystalline penicillin 5 lac units IM BD x 10 days
Anti-diphtheric serum 50,000 units IM stat
Prevention of symblepharon:
Treatment
Once the membrane is sloughed off, the healing of raw surfaces will result in
symblepharon, which should be prevented by applying contact shell or
sweeping the fornices with a glass rod smeared with ointment.

9. Prophylaxis
1. Isolation of patient
2. Proper immunization against diphtheria

10. PSEUDOMEMBRANOUS
CONJUNCTIVITIS
It is a type of acute conjunctivitis, characterised by formation of a
pseudomembrane (which can be easily peeled off leaving behind intact
conjunctival epithelium) on the conjunctiva.
Pseudomembrane can be peeled off easily and does not bleed.

11. Etiology
It may be caused by following varied factors:
1. Bacterial infection.
Common causative organisms are Corynebacterium diphtheriae of
low virulence, staphylococci, streptococci, H. influenzae and N.gonorrhoea.
2. Viral infections
herpes simplex and adenoviral epidemic keratoconjunctivitis may also
be sometimes associated with pseudomembrane formation.
3. Chemical irritants such as acids, ammonia, lime, silver nitrate and
copper sulfate are also known to cause formation of such membrane.

12. Pathogenesis
The etiological agents produce inflammation of conjunctiva associated
with pouring of fibrinous exudate on its surface which coagulates and
leads to formation of a pseudomembrane.

13. Clinical Feautures
Pseudomembranous conjunctivitis is characterized by:
Acute mucopurulent conjunctivitis, like features associated with.
Pseudomembrane formation which is thin yellowish-white membrane seen
in the fornices and on the palpebral conjunctiva .
Pseudomembrane can be peeled off easily and does not bleed.

14. Treatment
Topical :
Penicillin eye drops 1:10000 unit/ml every 30 min
Anti-diphtheric serum every 1 hour
Atropine 1% ointment (if corneal involvement)
Broad spectrum antibiotic ointment at bedtime
Systemic:
Crystalline penicillin 5 lac units IM BD x 10 days

15. Thank You……
Yesterday, I never believed I’d do
what I did today……….