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.
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3. CLASSIFICATION
(Continued)
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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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
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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.
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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.
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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.
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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.
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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.
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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.
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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 .
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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.
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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.
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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 .
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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.
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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
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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
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