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10. Conjunctivitis.pptx
- 1. CONJUNCTIVITIS By: Qurat-ul-ain Ophthalmic Medical Technologist/ MBA Health & Hospital management
- 2. Acute Conjunctivitis Symptoms: • Red eye (conjunctival hyperemia) • Discharge • Crusting • Foreign body sensation • <4-week duration of symptoms Chronic Conjunctivitis Symptoms: • Red eye (conjunctival hyperemia) • Conjunctival discharge • Eyelids sticking • Foreign body sensation • Duration >4 weeks of symptoms
- 3. ACUTE CONJUNCTIVITIS CLASSIFICATION Acute conjunctivi tis Viral HSV Allergi c Vernal Bacteri al Gonococc al Pediculosi s
- 4. Viral conjunctivit is Etiology: Adenovirus enterovirus Coxsackievirus Adenovirus serotype 11. Viral syndromes: measles, mumps, influenza Symptoms: Itching, burning, tearing, gritty sensation History of recent URTI, or contact with someone with viral conjunctivitis. Starts with one eye and involved fellow eye later on. Signs: Inferior palpebral conjunctival follicles, tender, palpable pre- auricular lymph node. Watery discharge, red & edematous eye-lids, pinpoint sub-conjunctival hemorrhages, punctate keratopathy, epithelial erosion, membrane, microcyst-subepithelial infiltrates (SEI). Treatment: Counsel the patient that it is self-limited & should take care of hygiene. Preservative –free artificial tears or ointment 4 to 8 times/ day for 1 to 3 weeks Cool compresses Anti-histamine drops if itching is severe. Membrane should be peeled off, if present. If SEIs reduce vision or cause photophobia, topical steroids should be initiated.
- 5. HSV Conjunctivit is Etiology: Herpes Simplex Virus Symptoms: Red eye, pain, foreign body sensation, photophobia, tearing, decreased vision, skin vesicular rash, previous episodes history, usually unilateral. Signs: Conjunctival injection, unilateral follicular conjunctivitis, with or without conjunctival dendrites, or geographic ulceration. Palpable pre-auricular node. Treatment: Antiviral-therapy e.g., trifluridine 1% e/d 8 times/ day, ganciclovir 0.05% gel 5 times/ day Oral agents such as acyclovir 400mg 5 times a day. Warm compresses.
- 6. Allergic Conjunctiviti s Symptoms: Itching, watery discharge, history of allergies. Usually bilateral Signs: Chemosis, red Edematous eyelids, conjunctival papillae, periocular hyperpigmentation, No preauricular node. Treatment: Frequent washing of hair & clothes may be helpful. Cool compresses several times/ day. Mild: artificial tears 4 to 8 times/ day. Moderate: use anti-histamine or mast-cell stabilizer drops. Severe: mild topical steroids. Oral anti-histamine in moderate to severe cases can be very helpful.
- 7. Vernal/ Atopic Conjunctivitis Symptoms: Usually bilateral Frequently asymmetric itching with thick, ropy discharge. Seasonal recurrences History of atopy, asthma . Signs: Large conjunctival papillae seen under the upper eyelid or along the limbus. Superior corneal shield ulcer, limbal raised white dots of degenerated eosinophils, superficial punctate keratoplasty. Treatment: As for allergic conjunctivitis prophylactic use of a mast-cell stabilizer for 2 – 3 weeks before the allergy season starts. If a shield is present add topical steroids, topical anti-biotic and cycloplegic agent.
- 8. Bacterial Conjunctivit is Symptoms: Redness, foreign body sensation, discharge, itching Signs: white-yellow discharge of mild to moderate degree. Conjunctival papillae, chemosis, pre-auricular node. Treatment: Topical antibiotic therapy. H. Influenzae should be treated with oral amoxicillin,/ clavulanate
- 9. Gonococca l Conjunctiv itis Signs: Severe purulent discharge, hyperacute onset, conjunctival papillae, chemosis, adenopathy, eyelid swelling Treatment: Dual treatment regimen of ceftriaxone plus azithromycin. Topical fluoroquinolone ointment or fluoroquinolone drop q2h. Saline irrigation Treat for possible chlamydial coinfection.
- 10. Pediculosis (lice, crabs) Conjunctivitis Symptoms: Itching, Mild conjunctival injection. Signs: Adult lice, nits Blood-tinged debris on the eyelids and eye lashes. Follicular conjunctivitis Treatment: Mechanical removal of lice and eggs Bland ophthalmic ointment to the eyelids Anti-lice lotion and shampoo
- 12. Chlamydial inclusion Conjunctivitis Signs: Inferior tarsal or bulbar conjunctival follicles, superior corneal pannus, palpable pre-auricular node, or peripheral SEIs. Stringy, mucous discharge. Treatment: azithromycin, topical erythromycin or tetracycline ointment.
- 13. Trachom a Etiology: C. Trachomatis serotypes A-C Signs: Stage 1: sup. Tarsal follicles, mild sup. SPK, and pannus, preceded by purulent discharge & tender pre-auricular node. Stage 2: florid sup. Tarsal follicular reacted with sup. Corneal SEIs, pannus & limbal follicles. Stage 3: follicles & scarring of sup. Tarsal conjunctiva Stage 4: no follicles, extensive conjunctival scarring. Late complications: severe dry eyes, trichiasis, entropion, keratitis, corneal scarring, sup, fibrovascular pannus, Herbert pits, corneal bacterial superinfection & ulceration. Treatment: Azithromycin Tetracycline, erythromycin or sulfacetamide
- 14. Molluscum Contagiosu m Signs: Dome-shaped, usually multiple, umbilicated shiny nodules on the eyelid or eyelid margin. Follicular conjunctival response from toxic viral products, SPK, immunocompromised patients & more numerous lesions, pediatric atopic dermatitis Treatment: Lesions should be removed by simple excision & curettage or cryosurgery.
- 15. Micro-sporidial kerato- conjunctivitis Signs: Diffuse, coarse, raised punctate keratitis & non-purulent papillary or follicular conjunctivitis. In immuno-compromised patient, corneal stromal keratitis, Treatment: Regimens of antiparasitic and antibiotic agents are recommended. Topical fumagillin, poly hexa- methylene biguanide, oral anti-parasitic medications, antibiotic ointment. Treat any systemic infestation
- 16. RESOURCE: • The wills eye Manual by 7th edition.
- 17. THANK YOU!