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1. DR.PRRAFULLA C.PATIL.
S.C.H.M.C.JALGAON.
MEMBRANOUS CONJUNCTIVITS.

2. DEFINITION:-
 This disease is rare and is characterized by
conjunctivitis with membrane formation on the
conjunctiva.

4. ETIOLOGY:-
 Age :-usually in children from 2-8 years of age.
 General ill health following eruptive fevers and
unhygienic living condition.
 Causative agents:-a) corynebacterium diphtheria
b) Staphylococci.
c) Pneumococci.
d) Streptococcus haemolyticus.

5.  Mode of infection with diphtheria bacillus:-
1) Faucial diphtheriaby contamination.
2) Nasal diphtheria by spread along naso
lacrimal duct.
3) By infection from a carrier.

6. PATHOLOGY:-
Ultimately the membrane sloughs off and healing takes place by granulation tissue.
Along with membrane formation there is coagulative necrosis of conjunctiva
Membrane is tough in consistency,firmly adherent to conjunctiva
This membrane formed on the palpebral conjunctiva,also on bulbar conjunctiva.
This exudate forms a membrane in the same way formed in the throat in faucial diphtheeria
Fibrinous exudate deposited on the surface of conjunctiva and within its substance
Bacillus invading conjuctiva produce inflammation

7. As the bacillus invade corneal epithellium
corneal ulcer may result.
Due to contraction of scar tissue entropion or
trichiasis may result
During healing symbelopheron or
ankyloblephapheron occur

8. SYMPTOMS:-
 Clinical course may be mild or severe
 Oedema of the lids
 Muco-purulent discharge
 Conjunctival congestion
 Moderate pain
 On everting the lid white membrane is senn on
palpebral conjunctiva.

9.  In severe cases clinical course may be in three
stages:-
1) Stage of infiltration:-It lasts for 5-10 days.
Eye beecome red,hot and swollen hard like a
board.
due to stiffness,imposssible to evert the eyelid,
scanty conjunctival discharge
pain is severe.
Stiff greyish yellow membrane on palpebral or
on bulbar
conjunctiva.

10. 2) Stage of suppuration:-
Pain is less.
Lids become soft
Membrane is sloughed off,leavving red ,raw
,granulating
surface.
Discharge is copious.

11. 3) Stage of cicatrization:-
Symbelepharon.
Entropion contraction of fibrous tissue.
Xerosis of conjunctiva due to occlusion of
lacrimal ducts
and conjuctival sac.

12.  Associated of the eye changes there are systemic
signs and symptoms:-
1) Patient is highly toxic and acutely ill
2) Rise of temperatue
3) Albumin may appear in urine.

13. DIAGNOSTIC CRITERIA:-
 1) history of diphtheria or contact with a carrier.
2) signs of acute conjunctivitis
3) tough yellowish white menmbrane on tarsal
conjunctiva.

14. COMPLICATION:-
 Corneal ulcer
 In severe cases whole cornea may slough out
 Symbelepharon
 Entropion
 Trichiasis
 Xerosis

15. TREATMENT :-
 Prophylactic :Isolation of patient
 Curative:- it is advisable to trake conjuctival swab
for culture and smear examination before starting
the treatment.
 Local treatment:-
1) Crystalline penicillin of 10000 units per c.c. of
distilled water to be dropped at frequent interval.
2) Instillation of anti diphtheritic serum
3) Atropine sulphate ointment if cornea is ulcerated.
4) Broad spectrum antibiotic.
5) After membrane slogh off ,soft contact les to
cover the eyeball.

16.  Systemic :-IM injection anti diphtheritic serum
injection crystalline penicillin
500000 units twice daily.