This document provides an overview of conjunctivitis, including: - The anatomy and histology of the conjunctiva. - The signs and symptoms of conjunctivitis. - Bacterial conjunctivitis (BC), its etiology, clinical presentations, laboratory findings, differential diagnosis, complications, treatment, and typical course. - Details are given on diagnosing and treating different types of BC, from hyperacute to chronic forms.

1. ‌
BY:
Intern Maryam Shamal Ghalib
Dept. of Ophthalmology
Shah Amanullah Ghazi Hospital

2. WHAT TO EXPECT?
O Conjunctival Anatomy
O Conjunctival histology
O Conjunctivitis
O Common signs and symptoms of conjunctivitis
O Bacterial conjunctivitis
O Etiology
O Clinic of BC (types)
O Lab Findings
O DDX
O Complications
O Treatment
O Course and prognosis

3. CONJUNCTIVAL ANATOMY
O Thin and transparent mucus membrane
O Types (Bulbar, palpebral)
O Limbus
O Semilunar fold (in inner canthus)
O Nerve: less pain fibers
O Artery: ant. Cilliary and palpebral Arteries
O Vein: multiple
O Lymph: superficial and deep

5. CONJUNCTIVAL HISTOLOGY
O Conjunctival Epithelium: stratified columnar, 2-5 layers,
superficial and deep
O Limbus, caruncle, mucocutaneous Junction: stratified
squamous epithelium
O Superficial: Round , oval secreting goblet cells
O Deep: Stains and pigment layer
O Conjunctival stroma
O Adenoid (superficial): lymph tissue and follicle like
structures
O Fibrous (deep): connective tissue , attached to tarsal plate
O Accessory Lacrimal Glands
O Kraus: more in upper fornix and less in lower fornix
O Wolfring: superior Margin of upper tarsus

7. CONJUNCTIVITIS
O It is defined as the inflammation of
conjunctiva.

8. COMMON S&S OF
CONJUNCTIVITIS
O Hyperemia
O Tearing
O Exudation
O Pseudoptosis
O Papillary hypertrophy
O Chemosis
O Follicles
O Pseudomembranes
and membranes
O Ligneous
conjunctivitis
O Granulomas
O Phlyctenules
O Preauricular LAP

10. ETIOLOGY OF BC
O Nisseria gonorrhea (Hyper Acute)
O N. Meningitis (Hyper Acute)
O Pnuemococcus (Acute)
O H. Aegyptius(Acute)
O H. influenza, (Sub Acute)
O Staph.A (Sub Acute)
O Moraxella Lacunata (Sub Acute)

11. CLINIC
O Hyper Acute (Purulent)
BC:
O Profuse purulent
exhudate
O Mainly in children
O Severe cases: corneal
damage or loss of eye
or port of entry for
bacteria to cause
meningitis or
septicemia

12. CLINIC
O Acute (Mucopurulent)
BC:
O Endemic form
O Acute onset
O Hyperemia
O Mildly mucopurulent
discharge
O +/- subconjunctival
hemorrhage

13. CLINIC
O Sub-Acute BC:
O Mainly by H.Influenza
O Thin, watery exhudate
O Chronic BC:
O Nasolacrimal duct
obstruction
O Chronic Dactryocystitis
O Chronic blepheritis
O Mebomiam gland
dysfunction

14. LABORATORY FINDINGS
O Conjunctival scraping
O Gemsa / Gram
stain
O Polymorphonuclear
neutrophils
O Culture
O Antibiogram
Histopathology in an acute case of
gonococcal infection using Gram-stain
technique

15. DIFFERENTIAL DIAGNOSIS
O Acute viral conjunctivitis
O Blepharitis
O Allergic conjuncitivitis
O Toxic and chemical conjunctivitis
O Anterior uveitis, episcleritis, scleritis

18. COMPLICATIONS
O Chronic marginal blepheritis
O Conjunctival scarring
O Membranous and pseudomembranous
conjunctivitis
O Corneal ulceration
O Corneal perforation
O Toxic Iritis

19. TREATMENT
O Specific therapy after antibiogram
O Broad spectrum AB agent (e.g.
polymyxintrimethoprim)
O Nisseria (systemic and topical)
O If no corneal involvement (single dose
ceftriaxone)
O Corneal involvement (5-day 1-2g ceftriaxone)
O Purulent/mucopurulent: saline irrigation of sac

20. Course & Prognosis
O Acute BC: self-limited (10-14days)
O Chlamydial : blephroconjunctivitis & chronic
phase
O Septicemia and meningitis

21. References
O Vaughan and Ashbury’s GENERAL
OPHTHALMOLOGY, 18th edition, 2011, page
83 to 88
O http://eyewiki.aao.org/Bacterial_Conjunctivi
tis
O Pictures from google