This document discusses the classification and types of acute conjunctivitis. It is classified based on onset (acute, sub-acute, chronic), type of exudate (serous, catarrhal, mucopurulent, purulent, pseudo-membranous), and etiology (infectious, non-infectious). The types discussed include bacterial (purulent, gonococcal, membranous, angular), viral, chlamydial, and ophthalmia neonatorum. For each type, the etiology, clinical features, complications, and treatment are described. Risk factors like dry eye, nutritional deficiencies, and immune deficiencies that can lead to acute conjunctivitis are also outlined

1. Dr. s.veni priya
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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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7. BACTERIAL CONJUNCTIVITIS
Acute Purulent & Muco Purulent - Continued
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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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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
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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.
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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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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.
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22. ACUTE CONJUNCTIVITIS
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QUESTION & ANSWER SESSION

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