Chronic conjunctivitis can be caused by infection or allergy. Infectious causes include trachoma caused by Chlamydia trachomatis, which is the leading cause of preventable blindness worldwide. If left untreated, repeated trachoma infections can lead to scarring of the conjunctiva and complications like trichiasis and corneal opacity. Granulomatous conjunctivitis presents with localized conjunctival granulomas and lymphadenopathy in conditions like cat scratch disease or tuberculosis. Non-specific chronic conjunctivitis can be caused by chronic irritation or hypersensitivity reactions.

1. CHRONIC
CONJUNCTIVITIS
DR.A.R.RAJALSKSHMI, M.S.

2.  Revision of previous class
 Submission of assignment

3. OUTLINE - CHRONIC
CONJUNCTIVITIS
 Definition
 Infective causes
 Allergic conjunctivitis
 Steven Johnson syndrome

4. DEFINE
 Duration of more than 4 weeks  chronic
conjunctivitis

5. OUTLINE
 TRACHOMA
 GRANULOMATOUS CONJUNCTIVITIS
 FUNGAL CONJUNCTIVITIS
 NON SPECIFIC CONJUNCTIVITIS

7. TRACHOMA
 The leading cause of preventable blindness in
the world
 15 – 20% world’s blindness
 Caused by chlamydia trachomatis A , B, Ba &
C
 Self limiting disease
 Repeated infections + secondary infection
blindness

8. CHLAMYDIA
CHLAMYDIA
TRACHOMA –
A,B,Ba,C
PARATRACHOMA
– D K
LGV –L1,L2,L3
C.PSITTACOSIS

9. Chlamydia trachomatis
 Bacterium – prokaryotic, obligatory
intracellular organism
 In Conjunctival epithelial cells as colonies –
HALBERSTEADTER – PROWAZEK
INCLUSION BODIES

10. LIFE CYCLE OF TRACHOMA

11. TRACHOMA
REPEATED
CONJUNCTIVITIS
• Does
not
cause
defectiv
e vision
CHRONIC
INFALMMATION
& SCARRING
• Complic
ations
Lid abnormalities
Corneal
complications
• Loss of
vision

12. Trachoma
 RISK FACTORS:
living in crowded & unhygienic
conditions
Transmitted by Fingers , Fomites &
FLIES

13. CLINICAL FEATURES
 ACTIVE STAGE
 CHRONIC STAGE
 COMPLICATIONS
ACTIVE
1st
decade
CHRONIC
2nd
decade
COMPLICATIONS
4th / 5th
decade

14. TRACHOMA
 CONJUNCTIVA
 Congestion, papillae & FOLLICLES
 UPPER TARSUS
 Follicles - > 5 mm in diameter
along the upper border of the upper
tarsus
NEVER ON THE BULBAR
CONJUNCTIVA
 MINUTE STELLATE SCARS
 HISTOPATH – aggregations of lymphocytes with
necrosis & leber cells - follicles

15. UPPER TARSAL FOLLICLES

16. FOLLICLES

17. TRACHOMA - CORNEA
CORNEA:
 Superficial keratitis – upper k – epithelial
erosions with infiltration
 TRACHOMATOUS PANNUS
 corneal ulcers
 LIMBUS – HERBERT FOLLICLES –
HERBERT PITS

18. TRACHOMATOUS PANNUS
 Defn: lymphoid infiltration with vascularisation
of the corneal margin – upper cornea
 2 types :
1. progressive pannus
2. regressive pannus

19. PANNUS
Progressive pannus regressive pannus

20. PANNUS

21. Corneal ulcer
 Usually occur at the advancing edge of the
pannus
 Shallow but more symptomatic

22. Chronic stage
 Cicatrization starts (SCARRING)
 Follicles - stellate scars
 Conjunctival scarring – Arlt line

23. COMPLICATIONS
 LIDS :
entropion, trichiasis, ptosis, tylosis,
madarosis & ankyloblepharon
 CONJUNCTIVA:
dry eyes, concretions, symblepharon
 CORNEA:
opacity, ectasia, xerosis, pannus
 Chronic dacryocystitis , chronic dacryoadenitis

25. video

26. investigations
 mcCoy cell cultures, monoclonal antibody test
& IgA-IPA light microscopy – best combination
 CLINICAL DIAGNOSIS:
any 2 of the signs
1.follicles on the upper tarsus
2.superficial keratitis – upper k
3.pannus – upper k
4.limbal follicles/ Herbert pits
5.stellate scars/Arlt’s line – upper tarsus

27. Maccallan classification
STAGES FEATURES
I IMMATURE FOLLICLES , SPK
IIA MATURE FOLLICLES
IIB PANNUS, LIMBAL FOLLICLES, SUPERFICIAL KERATITIS
III FOLLICLES + SCARRING
IV SCARRING

28. WHO CLASSIFICATION [
FISTO]
STAGES FEATURES TREATMENT
FOLLICLES ≥5 FOLLICLES, >0.5MM IN
UPPER TARSUS
NEEDS TREATMENT
NO SCARRING
INTENSE >50% PALPEBRAL BLOOD
VESSELS NOT SEEN
UREGENT
TREATMENT
COMPLICATIONS +
SCARRING TARSAL CONJ SCARRING WITH
WHITE FIBROUS BANDS
INACTIVE
TRICHIASIS ATLEAST ONE TRICHIATIC LASH CORRECTIVE
SURGERY
OPACITIES K OPACITY COVERING
PUPILLARY REGION

29. WHO CLASSIFICATION [
FISTO]
STAGES FEATURES TREATMENT
FOLLICLES ≥5 FOLLICLES, >0.5MM IN
UPPER TARSUS
NEEDS TREATMENT
NO SCARRING
INTENSE >50% PALPEBRAL BLOOD
VESSELS NOT SEEN
UREGENT
TREATMENT
COMPLICATIONS +
SCARRING TARSAL CONJ SCARRING WITH
WHITE FIBROUS BANDS
INACTIVE
TRICHIASIS ATLEAST ONE TRICHIATIC LASH CORRECTIVE
SURGERY
OPACITIES K OPACITY COVERING
PUPILLARY REGION

30. MANAGEMENT –
PREVENTION
How will you prevent this disease ?
 Manage the risk factors
 Frequent face wash & hand wash
 Prophylactic topical antibiotic therapy -
BLANKET THERAPY:
- In endemic areas
-1% tetracycline e/o 2 times / day –5 days a
month 6 months

31. TREATMENT – ACTIVE
STAGE
 TOPICAL:
 1% tetracycline / erythromycin
e/o
4 times /day 6 weeks
1% tetracycline e/o bed time6 weeks

32. TREATMENT
SYSTEMIC:
 Tetracycline / erythromycin 250mg q.i.d  3-4
wks
 Doxycycline 100 mg b.d  3-4 weeks
 Azithromycin 1 gm single dose

33. COMPLICATIONS
LID ABNORMALITIES
 lid surguries , EPILATION – trichiasis
CORNEAL OPACITY
 keratoplasty , optical iridectomy

34. TREATMENT- “nutshell”
 SAFE STRATEGY
S – surgery for trichiasis & entropion
A – antibiotic (erythromycin)
F – face washing
E – environmental hygiene

35. Management in a community
prevalence of
trachoma in
children 1-10 yrs
treatment Eye health
promotion
TF≥20%
TI≥5%
MASS TOPICAL
IF SEVERE- SYSTEMIC
SANITATION, FLIES
CONTROL, PERSONAL
HYGIENE,AB RX
DURING OUTBREAKS
TF 5-20% MASS TOPICAL
IF SEVERE -
SYSTEMIC
AS ABOVE
TF< 5% INDIVIDUAL TOPICAL
RX
CASE FINDING

36. IMPORTANT POINTS (must
know)
 By chlamydia trachomatis (HP bodies)
 3Fs – fomites , flies, fingers
 upper tarsal follicles  stellate scars, Arlt’s
line
 Trachomatous pannus  corneal opacity
 Lid trichiasis, entropion  corneal opacity
 FISTO
 SAFE STRATEGY

37. QUESTIONS
 TRACHOMA – essay
 Clinical features & complications of trachoma
 WHO classification of trachoma / FISTO
classification
 Management & prevention of trachoma
 SAFE strategy

38. GRANULOMATOUS
CONJUNCTIVITIS
 Rare, Unilateral , localised
conjunctival granuloma
 Associated with
LYMPHADENOPATHY
PARINAUD’S OCULOGLANDULAR
SYNDROME

39. GRANULOMATOUS
CONJUNCTIVITIS
 Pathogens causing systemic disease
 Enter through the conjunctiva
 Granulomatous conjunctivitis

40. CAUSES
 CAT SCRATCH DISEASE
 TULAREMIA
 TB
 SYPHILIS
 INFECTIOUS MONONUCLEOSIS
 FUNGAL
 LGV
 NON INFECTIOUS SARCOID,
LYMPHOMA, LEUKAEMIA

41. PARINAUD’S
OCULOGLANDULAR
SYNDROME

42. CLINICAL FEATURES
 SYSTEMIC: fever, malaise & skin rash
 LOCAL: redness, foreign body sensation
& mucopurulent discharge

43. OPHTHALMIA NODOSA
 Nodular conjunctivitis caused by caterpillar
hair
 Semitranslucent nodules on conjunctiva, k or
iris
 Hair surrounded by giant cells & lymphocytes
 Rx : excision

44. Ophthalmia nodosa

46. FUNGAL CONJUNCTIVITIS
 By aspergillus, candida, nocardia, leptothrix,
sporothrix
Modes of presentation:
 Follicular conjunctivitis with lymphadenopathy
 Ulcerative / pseudomembranous
 Granulomatous actinomycosis,
sporotrichosis, rhinosporidiosis
 Rx : topical miconazole or clotrimazole 1%

47. NON SPECIFIC
CONJUNCTIVITIS
 Continuation of simple conjunctivitis
 Chronic irritation: smoke, dust, heat, alcohol
abuse,etc
 Hypersensitivity to allergen
 Concretion, trichiasis, blepharitis,
dacryocystitis, chronic rhinitis
 Symptoms:
burning & grittiness ^^ in the evening

48. Non specific conjunctivitis
 Signs: lower lid congestion
sticky mucous membrane
Rx:
 Short course of antibiotics
 Eliminate the cause
 Lubricants

49. IMPORTANT QUESTIONS
 TRACHOMA
 TRACHOMA
 TRACHOMA
 Ophthalmia nodosa , Parinaud oculoglandular
syndrome.