This document discusses conjunctivitis and ophthalmia neonatorum. It defines conjunctivitis as inflammation of the conjunctiva lasting less than 4 weeks. Ophthalmia neonatorum is conjunctivitis occurring in the first month of life, and is a major cause of corneal blindness in children. It outlines the causes, clinical features, and treatment of both conditions.

1. DR. A.R.RAJALAKSHMI
ASSO. PROFESSOR
*

2. *
* The anatomy & functions of conjunctiva.
* Enumerate the symptoms & signs of
conjunctival disorders.
*Enumerate the causes of acute conjunctivitis &
its prevention & management .

3. *

4. *

5. *
*Thin mucous membrane lining the surface of
the eye & the eyelids.
*Parts of conjunctiva :
palpebral
bulbar
fornix

6. *
THREE LAYERS
*EPITHELIUM – non keratinised squamous
epithelium
*ADENOID – loose connective tissue with
leucocytes (LYMPHOID LAYER)
*FIBROUS

7. *Tear production ( goblets & accessory lacrimal
glands)
*Oxygen supply to cornea
*Maintain a smooth ocular surface
*Protection of the eye - intact epithelial
barrier, lacrimation, immunologic mechanism
( adenoid layer)

8. *Non pathogenic commensal
Staphylococcus albus, diphtheroids,
Propionibacterium acnes, Neisseria catarrhalis ,
Corynebacterium xerosis

9. *Redness
*Watering
*Discharge  Stickiness
*Irritation / foreign body sensation
*Itching
*Gritty sesnsation
*Fleshy growth
IF PAIN OR DEFCECTIVE VISION IS THERE ,
THEN SUSPECT CORNEAL INVOLVEMENT / SOME
OTHER DISORDER

10. *CONGESTION /HYPEREMIA
*DISCHARGE
*FOLLICLE
*PAPILLAE
*CHEMOSIS

11. *

13. PALPEBRAL
CONGESTION
CIRCUMCORNEAL
CONGESTION
SITE fornix Around the cornea
COLOUR Bright red Dull red
Arrangement Superficial Deep
ADRENALINE TEST Immeditely blanch Do not blanch
CAUSES Acute
conjunctivitis
Keratitis , acute
iridocyclitis

15. TYPE OF DISCHARGE CAUSATIVE FACTOR
Watery Viral conjunctivitis
Foreign body
Mucoid / ROPY discharge Allergic conjunctivitis
Mucopurulent / purulent Bacterial conjunctivitis

16. *Reddish flat topped raised areas
*Gives ‘VELVETTY ‘ apppearance to the
conjunctiva
*Seen in ALLERGIC CONJUNCTIVITIS
*Central core of dilated blood vessels
surrounded by lymphocytes & covered by
hypertrophied epithelium

17. * ‘BOILED SAGO GRAIN ‘ APPEARANCE
*Seen in upper palpebral conjunctiva –
TRACHOMA
*subepithelial aggregation of
lymphocytes,multinucleated giant cells
with necrosis

19. *
*Parts of conjunctiva
*Layers of conjunctiva
*Name two functions of conjunctiva
*Causes of acute red eye
*Difference between the two congestions
* what is papillae
*What is follicle
*Diagnose this pic

21. *Inflammation fo the conjunctiva < 4 weeks of
duration .

22. *
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.
22

23. *
Based on Conjunctival Reaction
* Follicular.
* Papillary.
* Granulomatous.
Based on Etiology
* Infectious (Bacterial, Viral, Chlamydial, Fungal and
parasitic).
* Non-infectious (Allergic, Irritants).
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24. *
*Bacterial conjunctivitis – gonorrheal , angular,
membraneous
*Viral conjunctivitis
*OPHTHALMIA NEONATORUM

25. *
*Definition
*Etiology – risk factors, cause
*Pathogenesis
*Clinical features – symptoms , signs
*Investigations
*Treatment – medical , surgical , complications
*Prevention
*Complications of the disease

26. *
Etiology
* Staph.aureus – most common,
H.aegyptius , N.gonorrhoea
* RISK FACTORS : highly Contagious ,
Transmitted by discharge
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27. *
Clinical Features
Symptoms
* Mostly bilateral
* Acute onset of redness associated
with
* Purulent discharge
* Stickiness of the lid
* Haloes

28. *
SIGNS :
* purulent / muco prulent discharge
*Matted eyelashes with yellow crusts
* palpebral congestion
*Cornea – clear

29. Treatment
* Topical fluro quinolone – ciprofloxacin,
Ofloxacin, Moxifloxacin, Gatifloxacin.
* Bacitracin or ciprofloxacin Ointment.

30. *Frequent face wash & hand wash
*No sharing of hankies, towels & pillows
30

31. *
*Chronic conjunctivitis – if not treated
*Corneal involvement – corneal ulcer
*Iritis

32. Etiology
* Caused by Neisseria Gonorrhoeae.
* Transmitted from genitalia to eye through hands.
Clinical Features
* Severe lid edema
* Copious purulent discharge ( acute blenorrhea)
* Pre-auricular lymphadenopathy, tenderness and
suppuration
* Associated systemic signs – Urethritis, rise of
temperature and depression.
32

34. *
Complications
• Corneal involvement – Gonococcus is capable of
invading the normal cornea through intact epithelium.
* Iritis , Iridocyclitis .
* Non Ocular complications – Arthritis, Endocarditis and
Septicaemia.
34

35. *
Invetigations:
* conjunctival scraping - intracellular Gram-negative
diplococci .
35

36. *
 Treatment - Aim of therapy is to prevent or limit the corneal
involvement and to eliminate systemic source.
Systemic Treatment
* Ceftriaxone - 1 gm IM , single dose.
Topical Treatment
* Cleanliness
* Ciprofloxacin / Ofloxacin/ Gentamicin/ Tobramycin Eye
Drops 2 hrly.
* Bacitracin Eye Ointment 6 hrly.
* Cycloplegic (Atropine) – in cases of Corneal involvement .
36

37. *
Etiology
* Caused by C.diphtheriae, Streptococcus pneumonia
* Occurs in children in assosiation with Measles , scarlet
fever, influenza & whooping cough.
Clinical Features
* Swelling of lids
* mucopurulant discharge
* White Membrane on everting lid
37

40. *
Treatment – ASK IMMUNISATION HISTORY
* 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.
Complications:
* corneal ulcerations
* Increase risk of symblepharon
40

41. Etiology
* Moraxella Lacunata – diplobacillus.
CLINICAL FEATURES
Symptoms - Redness, discomfort
Signs
* Congestion limited to intermarginal strip at inner and
outer canthi.
* Excoriation of skin at inner and outer palpabral angles .
41

43. *
Treatment
* Topical Treatment
* Tetracycline eye ointment .
* Eye drops containing Zinc also beneficial, acts by
inhibiting proteolytic ferment.
43

44. *
TYPES
• Acute Follicular Conjunctivitis
• Sub Acute or Chronic Follicular Conjunctivitis
• Epidemic Keroto Conjunctivitis.
• Pharyngo Conjuctival fever.
• Heaymorrhagic Conjunctivitis
• Acute Herpitic Conjunctivitis
• Herps Simplex Conjunctivitis
44

46. *
Symptoms
* Serous or watery discharge
* Severe irritation with redness
Signs
* Palpebral congestion
* Conjunctival follicles
* Sub Conjunival haemorrhage
* Preauricular lymph node.
* Decreased corneal sensation.
46

47. Treatment
Topical Treatment
* Artificial Tears
* Antibiotic eye drops to prevent
secondary infection
* PREVENTION

48. *
Definition
any discharge from the eye in the first month
of life .
* responsible for corneal blindness in children
48
Genitourinary tract of
mother is infected
Normal delivery through
the infected tract
Child gets infection

49. Causative factor Time of onset
after birth
Treatment
N. Gonorrhoea Within 24-48 hours Ceftriaxone im
injection, topical
antibiotics
Chemical ( silver
nitrate)
“ Wash eyes &
observe
Other bacteria 48-72 hours Topical antibiotics
Herpes simplex 5-7 days Topical acyclovir
eye ointment
Chlamydia
trachomatis
> 1 week Erythromycin eye
ointment

52. *
(Continued)
Complications
* Corneal 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, endophthalmitis.
52

53. PREVENTION:
* ANTENATAL - treat the maternal infection
* INTRANATAL – aseptic precautions
clean the closed closed eyelids
ommediately after delivery
erythromycin eye ointment –
prophylactically

54. *
Conjunctival discharge
*STAINING – Gram, Giemsa
* CULTURE & SENSITIVITY – bacterial, viral,
chlamydia

55. *
Treatment
* Systemic Treatment
* Ceftriaxone – 25 to 50 mg/kg single dose.
* Cefatoxime – 100 mg / kg single dose.
* Topical Treatment
* Saline irrigation
* Topical flouro quinolones.
55

56. * a 10 day old male baby is brought with the
complaints of watering & discharge from both
eyes since birth. It is also associated with
inability to open the eyes.
1. Name four differential diagnosis ( 2 marks)
2. Define (1) Ophthalmia neonatorum . Describe
the various causes(1), clinical features (2) ,
investigations(1) & management of the above
condition(3).

58. *