Dr.veni priya acute conj 10.02.16

1. Dr. s.veni priya
1

2. CLASSIFICATION
Based on onset
 Acute.
 Sub-acute.
 Chronic.
Based on type of Exudates
 Serous (Viral, allergic, toxic).
 Catarrhal (allergic – Ropy or thread like thick mucoid
discharge).
 Mucopurulent.
 Purulent.
 Pseudo-Membranous / Membranous.
2
1
2

3. CLASSIFICATION
(Continued)
Based on Conjunctival Reaction
 Follicular.
 Papillary.
 Granulomatous.
Based on Etiology
 Infectious (Bacterial, Viral, Chlamydial, Fungal and
parasitic).
 Non-infectious (Allergic, Irritants).
3
3
4

4. RISK FACTORS
Disruption of host defense mechanism caused by:
Dry Eye.
Exposure due to lid retraction, exophthalmos, lagophthalmos
and inadequate blinking.
Nutritional deficiencies / Avitaminosis A.
Local or Systemic Immune Deficiency:
 After topical and systemic immunosuppressive therapy
 Nasolacrimal duct obstruction and infection.
 Radiation damage .
 Trauma.
 Surgery.
 Prior Conjunctival inflammation or infection.
 Systemic Infection.
 Exogenous inoculation
4
1
2
3
4

5. TYPES OF ACUTE CONJUNCTIVITIS
Bacterial Conjunctivitis:
a. Acute Purulent & Muco Purulent
b. Gonococcal
c. Membraneous & Pseudo Membraneous
d. Angular
Viral – Follicular Conjunctivitis.
Chlamydial – Adult & Neonatal Inclusion Conjunctivitis.
Ophthalmia Neonatorum Conjunctivitis.
5
1
2
3
4

6. BACTERIAL CONJUNCTIVITIS
Acute Purulent & Muco Purulent
 Etiology
 Contagious
 Transmitted by discharge
 Staph.aureus – most common
 H.aegyptius, N.gonorrhoea.
 Clinical Features
 Hyperaemia
 Mucous discharge
 Stickiness of the lids
 Flakes of mucus & Pus in Fornices and lid margins
 Haloes
 Certain clinical features indicates likelihood of certain specific
infections.
6

7. BACTERIAL CONJUNCTIVITIS
Acute Purulent & Muco Purulent - Continued
7

8. BACTERIAL CONJUNCTIVITIS
Acute Purulent & Muco Purulent - Continued
 Treatment
 Topical fluro quinolone – ciprofloxacin, Ofloxacin,
Moxifloxacin, Gatifloxacin.
 Bacitracin or ciprofloxacin Ointment
 Oral antibiotics for patients with pharyngitis and
haemophilus infection in children.
8

9. BACTERIAL CONJUNCTIVITIS
Gonococcal
 Etiology
 Caused by Neisseria Gonorrhoeae (a bun- shaped
Gram-negative intracellular diplococcus).
 It is sexually transmitted disease
 Clinical Features
 Pre-auricular lymphadenopathy, tenderness and
suppuration.
 No immunity is conferred by an attack.
 Associated systemic signs – Urethritis, rise of
temperature and depression.
9

10. BACTERIAL CONJUNCTIVITIS
Gonococcal - Continued
 Complications
• Corneal involvement – Gonococcus is capable of
invading the normal cornea through intact cornea.
 Location of Corneal Ulcer – Central, Marginal Ulcer , all
round. Progressing rapidly depth-wise leading to
perforation and complications associated with it.
 Other complications of Gonorrhoeal Conjunctivitis–
Iritis , Iridocyclitis .
 Non Ocular complications – Arthritis, Endocarditis and
Septicaemia.
10

11. BACTERIAL CONJUNCTIVITIS
Gonococcal - Continued
 Treatment
 Of Gonococcal Conjunctivitis is started on confirmation
ofintracellular Gram-negative diplococci in conjunctival
scrapings in clinically suspected cases.
 Aim of therapy is to prevent or limit the corneal
involvement and to eliminate systemic source.
11

12. BACTERIAL CONJUNCTIVITIS
Gonoccol - Continued
 Treatment – Continued
 Systemic Treatment
 Ceftriaxone - 1 gm IM , single dose.
 Tetracycline In cases where co-existing Chlamydial
Trachomatis infection is suspected and cases with history of
allergy to Penicillin / Cephalosporins
 Topical Treatment
 Cleanliness
 Ciprofloxacin / Ofloxacin/ Gentamicin/ Tobramycin Eye
Drops 2 hrly.
 Bacitracin Eye Ointment 6 hrly.
 Cycloplegic (Atropine) – in cases of Corneal involvement .
12

13. BACTERIAL CONJUNCTIVITIS
Membranous & Pseudo Membranous
 Etiology
 Caused by C.diphtheriae, Beta haemolytic strettocci,
H.aegyptius, Staph.aureus & E.coli
 Occurs in children in assosiation with neasels , searlet
fever, influenza & whooting cough.
 Clinical Features
 Swelling of lids
 Eucopurulant discharge
 White Membrane on everting lid
 Great danger of corneal ulcerations – 6 to 10 days.
 Increase risk of symbletharon.
13

14. BACTERIAL CONJUNCTIVITIS
Membranous & Pseudo Membranous - Continued
 Treatment
 Systemic Treatment
 4,000 to 10,000 units of anti diphtheretic serum.
 Penicillin
 Topical Treatment
 Topical 10,000 units / ml drops made from injectable
preparations.
14

15. BACTERIAL CONJUNCTIVITIS
Angular
 Etiology
 Caused by Staphylococci and more typically by
Moraxella Lacunata.
 Incubation period is usually 4 days .
 Symptoms - Redness, discomfort, frequent blinking,
sharp pricking pain and mucopurulent discharge.
 Clinical Features
 Congestion limited to intermarginal strip at inner and
outer canthi and neighbouring bulbar conjunctiva.
Excoriation of skin at inner and outer palpabral angles .
15

16. BACTERIAL CONJUNCTIVITIS
Angular - Continued
 Complications
 Chronic conjunctivitis, Blepheritis, corneal ulcer
(marginal or central associated with hypopyon) .
 Attack does not confer immunity, and relapses may
occur. Swelling of lids.
 Treatment
 Topical Treatment
 Tetracycline eye ointment .
 Eye drops containing Zinc also beneficial, acts by
inhibiting proteolytic ferment.
16

17. VIRAL CONJUNCTIVITIS
 TYPES
• Acute Follicular Conjunctivitis
• Sub Acute or Chronic Follicular Conjunctivitis
• Epidemic Keroto Conjunctivitis.
• Pharyngo Conjuctival fever.
• Heaymorrhagic Conjunctivitis
• Acute Herpitic Conjunctivitis
• Herps Simplex Conjunctivitis
17

18. VIRAL CONJUNCTIVITIS
(Continued)
 Clinical Features
 Serous or watery discharge
 Conjunctival foillicals.
 Sub Conjunival haemorrhage
 Punctate epithelial opacities
 Preoricular lymph node.
 Decreased corneal sensation.
 Treatment
 Topical Treatment
 Artificial Tears
 Antibiotic eye drops to prevent secondary infection.
18

19. OPHTHALMIA NEONATORUM
 Etiology
 Neisseria Gonorrhoeae, Streptococcus Pneumoniae,
Staphylococcus etc.
 Chlamydial Trachomatis, Chalmydial Oculogenitalis
 Chemical Conjunctivitis due to Silver Nitrate 1or 2%
(used as Crede’s method)
 Clinical Features
 Purulent bilateral conjuntival discharge
 Hyper acute blenorrhoea
 Swelling of lids
 Mucopurulent discharge
19

20. OPHTHALMIA NEONATORUM
(Continued)
 Complications
 Corneal Ulcer : Oval ulcer, just below the centre of
cornea, rarely oval marginal ulcer, progressive ulcer
resulting in – perforation of corneal ulcer, prolapse of
uveal tissue, purulent uveitis, prolapse of lens, prolapse
of vitreous.
 Scarring of cornea, adherent leucoma, anterior
staphyloma, anterior capsular cataract, anophthalmitis.
 Non development of fixation due to corneal opacity
during first 3 weeks.
 Nystagmus due to non-development of macular fixation
20

21. OPHTHALMIA NEONATORUM
(Continued)
 Treatment
 Systemic Treatment
 Ceftriaxone – 25 to 50 mg/kg single dose.
 Cefatoxine – 100 mg / kg single dose.
 Topical Treatment
 Saline irrigation
 Topical flouro quinolones.
 Topical cycloplejia.
21

22. ACUTE CONJUNCTIVITIS
22
QUESTION & ANSWER SESSION

23. Thank you
23

24. Thank you
24

25. Thank you
25

26. Thank you
26