This document discusses various types of conjunctivitis including bacterial conjunctivitis. It describes acute bacterial conjunctivitis as being caused by bacteria like Staphylococcus aureus and presenting with symptoms of discomfort, redness, and mucopurulent discharge. Hyperacute bacterial conjunctivitis includes adult purulent conjunctivitis caused by Neisseria gonorrhoeae presenting with severe pain, swelling, and copious purulent discharge, as well as ophthalmia neonatorum which can be caused by gonorrhea, staphylococcus, or chlamydia in infants. Chronic bacterial conjunctivitis is also discussed as being caused by staphylococcus or gram-negative bacteria

1. BACTERIAL
CONJUNCTIVITIS
DR.PRAKRITI YAGNAM.K

2. Inflammations of conjunctiva : ( conjunctivitis )
-Conjunctival hyperemia + discharge ( watery,mucoid,purulent
mucopurulent )
Types :
1. Infective
2. Allergic
3. Cicatricial
4. Toxic

3. Infective
Bacterial
Chlamydial Viral Granulo Ophthalmia
matous
neonatorum
- Parinaud glandular
syndrome
Bacterial :
1. Acute
2. Hyper acute
3. Chronic
4. Angular

4. Chlamydial :
1. Trachoma
2. Adult inclusion conjunctivitis
3. Neonatal conjunctivitis
Viral : Epidemic keratoconjunctivitis
1. Adenovirus conjunctivitis Pharyngoconjunctival fever
2. Enterovirus conjunctivitis
3. Molluscum contagiosum
4. Herpes simplex

5. Allergic
Simple
VKC Atopic Giant Phlyctenular Contact
papillary dermato
( drop )
Simple allergic :
1. Hay fever ( rhino conjunctivitis )
2. Seasonal
3. Perennial

6. Cicatricial conjunctivitis :
1. Ocular mucous membrane pemphigoid
2. Stevens Johnson syndrome
3. Toxic epidermal necrolysis
4. Secondary Cicatricial conjunctivitis

7. Natural protective mechanism of conjunctiva :
1. Low temp. due to exposure to air
2. Lid protection
3. Tears flushing action
4. Antibacterial activity of lysozymes
5. Humoral action by tear Igs
When microorganisms invade inspite of these barriers it causes
infective conjunctivitis

8. Acute bacterial conjunctivitis :
Cause : Staph aureus , Koch weeks bacillus ,pneumococcus ,
streptococcus
- Caused by marked Conjunctival hyperemia and mucopuru
lent discharge
- Also called acute mucopurulent conjunctivitis
- Generally accompanied by measles or scarlet fever
Clinical features :
Symptoms : - Discomfort , foreign body sensation , grittiness,
Blurring of vision and redness
- Mild photophobia
- Sticking together of lid margins
- Colored haloes and slight blurring of vision

9. Signs :
- Flakes of mucopus in fornices ,canthi and lid margins – critical sign
- Conjunctival congestion more marked in palpebral part , fornices and
peripheral part of bulbar conjunctiva – fiery red eye
- Congestion typically less in circumcorneal zone
- Chemosis
- Papillae
- Petechial haemorrhages – pneumococcus
- Cilia matted with yellow crusts
- Eyelids edematous

10. Clinical course :
Usually bilateral
Reaches height in 3-4 days
untreated
Cured in 10-15 days Chronic catarrhal conj.

11. Complications :
- Superficial punctate epitheliopathy
- Marginal corneal ulceration
- Superficial keratitis
- Blepharitis
- Dacryocystitis
Differential diagnosis :
Red eye – Acute iridocyclitis , acute congestive glaucoma
Other conjunctivitis

12. Treatment :
1. Topical antibiotics – Broad spectrum
- E/D Chloramphenicol / gentamycin /
tobramycin – 3 to 4 times per day
No response – Ciprofloxacin / oflox /moxiflox / gatifloxacin
E/O at night
2. Frequent eye wash
3. Dark goggles
4.Anti inflammatory and analgesic drugs
NO BANDAGE OR STEROID DROPS

17. Hyper acute bacterial conjunctivitis :
- Acute purulent conjunctivitis or acute blenorrhea
- Two forms
1. Adult purulent conjunctivitis
2. Ophthalmia neonatorum
Adult purulent conjunctivitis :
- Gonococcal conjunctivitis
- Male predominance
- Direct spread from genitals to eye

18. Clinical features :
- Onset hyper acute ( 12- 24 hrs )
Symptoms :
- Pain moderate to severe
- Purulent discharge copious
- Marked swelling of eyelids
Signs :
- Eyelids tense and swollen
- Tenderness marked
- Discharge thick and trickling down the cheeks
- Marked Chemosis,congestion and papillae on conjunctiva –
Red velvety appearance
- Psuedomembrane may be seen

19. - Preauricular lymph nodes enlarged and tender
- Associated with urethritis and arthritis
Complications :
- Gonococcus crosses corneal epithelium so can cause
- Corneal haze , edema, necrosis , ulceration or perforation
- Iridocyclitis
- Systemic like Gonorrhea arthritis , endocarditis , septicemia
Treatment :
- Systemic more important
- Third generation cephalosporin – Cefoxitim 1gm/
Cefotaxime 500mg/
Ceftriaxone 1gm IM QID 5 days

20. - Norfloxacin 1.2 gms QID oral for 5 days
- Spectinomycin 2 gms IM 3 days
- All followed by Doxy 100 mg BD / Erythro 250-500mg QID orally for
one week
Topical antibiotics :
- Oflox / ciprofllox / tobramycin E/D
- Bacitracin / erythromycin E/O every 2 hrs for first 2-3 days and 5
times for one week
- Frequent irrigation of eye
- Topical atropine 1% OD or BD if cornea is involved
- Sexual partner should also be treated and both evaluated for other
sexually transmitted disease

22. Ophthalmia neonatorum :
- Bilateral inflammation of conjunctiva in infant less than 30 days
- PREVENTABLE
- Any discharge or watering in first week – suspicious
Etiology :
- Before birth – Infected liquor amnii with ruptured membranes
- During birth – Most common
Infected birth canal with face presentation or forceps
- After birth – during first bath or soiled clothes or infected lochia
Causative organisms :
- Chemical – Silver nitrate or prophylactic antibiotics
- Gonococcal

23. - Staph aureus , strep hemolyticus , pneumonia
- Neonatal inclusion conjunctivitis – Chlamydia D-K
- Herpes simplex 2 virus
Clinical features :
Incubation period depends on etiology
Chemical – 6 hours
Gonococcal – 4 days
other bacterial - 5 days
Neonatal inclusion conjunctivitis – 21 days
herpes simplex – 15 days
Symptoms and signs :
-Pain and tenderness
- Discharge purulent in Gonococcal , others mucoid or mucopurulent

24. - Lids swollen , eyelids and periocular vesicles in HSV
- Conjunctiva – Chemosis and congestion , papillary response
- Corneal involvement in HSV as SPK
Complications :
- Untreated cause corneal ulceration , perforation or staphyloma
Treatment :
Prophylaxis - Antenatal and natal asepsis
- Post natal – Povidine iodine 2.5%
- 1% tetracycline or 0.5% erythromycin E/O immediately after birth
- Single IM/IV inj. Of Ceftriaxone 50mg/kg for babies born to mothers
with untreated Gonococcal infection
- CREDES method not followed now

25. Causative treatment :
- Chemical is self limiting
- Gonococcal – Systemic and topical
- Systemic includes – Ceftriaxone 75-100mg/kg/day IV or IM QID
Cefotaxime 100-150mg/kg/day IV or IM,BD
Ciprofloxacin 10-20 mg/kg/day
Norfloxacin 10mg/kg/day
If susceptible to penicillin Crystalline benzyl penicillin G
50,000 units to full term
20,000 units to LBW or premature babies IM BD 3 days
- Topical –Bacitracin E/O 4 times
- If penicillin susceptible 5000 to 10000 units per ml
- If cornea involved atropine applied

26. - Other bacterial infections treated with broad spectrum antibiotics E/D
and bacitracin – neomycin E/O for 2 weeks
- Neonatal inclusion conjunctivitis – Topical tetracycline 1% or
erythromycin 0.5% E/O QID for 3 weeks and systemic erythromycin
125 mg orally QID for 3 weeks
- HSV self limiting – topical antivirals may be given

28. Chronic bacterial conjunctivitis :
- Chronic catarrhal or simple chronic conjunctivitis
Predisposing factors :
- Chronic exposure to dust,smoke,chemical irritants
- Local causes like Trichiasis,concretions,FB
- Eye strain due to refractive errors
- Abuse of alcohol, insomnia and metabolic disorders
Source and mode of infection :
- As continuation of acute mucopurulent conj.
- Associated with chronic dacryocystitis, chronic rhinitis. Chronic upper
respiratory catarrh
Causative organisms:
- Staph aureus
- Gram negative like proteus , klebsiella , E. coli , Moraxella lacunata

29. Symptoms :
- Burning and grittiness esp. in evenings
- Mild chronic redness feeling of heat and dryness on lid margins
- Difficulty in keeping eyes open
- Mild mucoid discharge esp. in canthi
- Watering on and off
- Feeling of sleepiness and tiredness
Signs :
- Grossly normal
- Congestion of posterior conj. Vessels
- Mild papillary hypertrophy
- Sticky look of conj.
- Lid margins may be congested

31. Treatment :
- Topical antibiotics – Chloramphenicol,Tobra or gentamycin
- Astringent E/D zinc-boric acid for symptomatic relief
Angular bacterial conjunctivitis :
- Type of chronic confined to angles of conj. And lid margins
associated with maceration of surrounding skin
Etiology :
- Predisposing factors
- Causative organism Moraxella axenfield (diplobacillary conj.)
- Source – nasal cavity

32. Pathology :
MA bacillus
proteolytic enzyme
Maceration of epithelium
vascular and cellular response
chronic inflammation and skin eczema

33. Symptoms :
- Irritation , burning sensation , discomfort feeling
- Dirty white foamy discharge at angles
- Redness in angles of eyes
Signs :
- Hyperemia of bulbar conj. At angles
- Hyperemia of lid margins at angles
- Excoriation of skin at angles
- Foamy mucopurulent discharge at angles
Complications :
- Blepharitis
- Shallow marginal catarrhal corneal ulceration

34. Treatment :
- Oxytetracycline 1% E/O 2-3 times for 9-14 days
- Zinc lotion in day time and zinc oxide E/O night time inhibits
proteolytic enzyme

36. THANK YOU !!!