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DR. A.R.RAJALAKSHMIASSO. PROFESSOR
*ACUTE CONJUNCTIVITIS
*AIM
* The anatomy & functions of conjunctiva.* Enumerate the symptoms & signs of
conjunctival disorders.*Enumerate the causes of acute
conjunctivitis & its prevention & management .
*ANATOMY – CONJUNCTIVA
*CONJUNCTIVA
*ANATOMY
*Thin mucous membrane lining the surface of the eye & the eyelids.*Parts of conjunctiva : palpebral bulbar fornix
* CONJUNCTIVA - histology
THREE LAYERS *EPITHELIUM – non keratinised squamous
epithelium*ADENOID – loose connective tissue with
leucocytes (LYMPHOID LAYER)*FIBROUS
Conjunctiva – Functions
*Tear production ( goblets & accessory lacrimal glands)*Oxygen supply to cornea*Maintain a smooth ocular surface*Protection of the eye - intact epithelial
barrier, lacrimation, immunologic mechanism ( adenoid layer)
Conjunctiva – normal flora
*Non pathogenic commensal Staphylococcus albus, diphtheroids, Propionibacterium acnes, Neisseria catarrhalis , Corynebacterium xerosis
SYMPTOMS
*Redness*Watering *Discharge Stickiness *Irritation / foreign body sensation *Itching *Gritty sesnsation*Fleshy growth
IF PAIN OR DEFCECTIVE VISION IS THERE , THEN SUSPECT CORNEAL INVOLVEMENT / SOME OTHER DISORDER
SIGNS OF CONJUNCTIVAL
DISORDER
*CONGESTION /HYPEREMIA *DISCHARGE *FOLLICLE *PAPILLAE *CHEMOSIS
*RED EYE
Congestion
RED EYE
PALPEBRAL CONGESTION
CIRCUMCORNEALCONGESTION
SITE fornix Around the cornea
COLOUR Bright red Dull redArrangement Superficial DeepADRENALINE TEST
Immeditely blanch
Do not blanch
CAUSES Acute conjunctivitis
Keratitis , acute iridocyclitis
OCULAR DISCHARGE
OCULAR DISCHARGE
TYPE OF DISCHARGE CAUSATIVE FACTOR
Watery Viral conjunctivitis Foreign body
Mucoid / ROPY discharge Allergic conjunctivitis
Mucopurulent / purulent Bacterial conjunctivitis
PAPILLAE
*Reddish flat topped raised areas*Gives ‘VELVETTY ‘ apppearance to the
conjunctiva *Seen in ALLERGIC CONJUNCTIVITIS *Central core of dilated blood vessels
surrounded by lymphocytes & covered by hypertrophied epithelium
FOLLICLE
* ‘BOILED SAGO GRAIN ‘ APPEARANCE*Seen in upper palpebral conjunctiva –
TRACHOMA*subepithelial aggregation of lymphocytes,multinucleated giant cells with necrosis
CHEMOSIS
*ANATOMY
*Parts of conjunctiva *Layers of conjunctiva *Name two functions of conjunctiva*Causes of acute red eye *Difference between the two congestions* what is papillae *What is follicle *Diagnose this pic
CONJUNCTIVITIS
ACUTE CONJUNCTIVITIS
*Inflammation fo the conjunctiva < 4 weeks of duration .
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* 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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*CLASSIFICATION (Continued)
Based on Conjunctival Reaction* Follicular.* Papillary. * Granulomatous.
Based on Etiology* Infectious (Bacterial, Viral, Chlamydial, Fungal and
parasitic).* Non-infectious (Allergic, Irritants).
*TOPICS
*Bacterial conjunctivitis – gonorrheal , angular, membraneous *Viral conjunctivitis *OPHTHALMIA NEONATORUM
*READING PATTERN of ANY
DISEASE
*Definition *Etiology – risk factors, cause*Pathogenesis *Clinical features – symptoms , signs *Investigations *Treatment – medical , surgical , complications *Prevention *Complications of the disease
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* BACTERIAL CONJUNCTIVITIS Acute Purulent & Muco Purulent
Etiology* Staph.aureus – most common,
H.aegyptius , N.gonorrhoea* RISK FACTORS : highly Contagious , Transmitted by discharge
*BACTERIAL CONJUNCTIVITIS
Clinical FeaturesSymptoms * Mostly bilateral * Acute onset of redness associated
with * Purulent discharge* Stickiness of the lid* Haloes
*BACTERIAL CONJUNCTIVITIS
SIGNS :* purulent / muco prulent discharge *Matted eyelashes with yellow crusts * palpebral congestion *Cornea – clear
Treatment* Topical fluro quinolone – ciprofloxacin,
Ofloxacin, Moxifloxacin, Gatifloxacin.* Bacitracin or ciprofloxacin Ointment.
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PREVENTION
*Frequent face wash & hand wash *No sharing of hankies, towels & pillows
*COMPLICATIONS
*Chronic conjunctivitis – if not treated *Corneal involvement – corneal ulcer *Iritis
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GONORRHOEAL CONJUNCTIVITIS
Etiology* Caused by Neisseria Gonorrhoeae. * Transmitted from genitalia to eye through hands.
Clinical Features* Severe lid edema * Copious purulent discharge ( acute blenorrhea)* Pre-auricular lymphadenopathy, tenderness and
suppuration * Associated systemic signs – Urethritis, rise of
temperature and depression.
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*BACTERIAL CONJUNCTIVITIS Gonococcal - ContinuedComplications
• Corneal involvement – Gonococcus is capable of invading the normal cornea through intact epithelium.
* Iritis , Iridocyclitis .
* Non Ocular complications – Arthritis, Endocarditis and Septicaemia.
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*BACTERIAL CONJUNCTIVITIS Gonococcal - Continued
Invetigations:* conjunctival scraping - intracellular Gram-negative
diplococci .
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*BACTERIAL CONJUNCTIVITIS Gonoccol - Continued
Treatment - Aim of therapy is to prevent or limit the corneal involvement and to eliminate systemic source. Systemic Treatment * Ceftriaxone - 1 gm IM , single dose.
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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*BACTERIAL CONJUNCTIVITISMembranous & Pseudo Membranous
Etiology* Caused by C.diphtheriae, Streptococcus pneumonia* Occurs in children in assosiation with Measles , scarlet fever,
influenza & whooping cough.
Clinical Features* Swelling of lids* mucopurulant discharge * White Membrane on everting lid
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* MEMBRANOUS CONJUNCTIVITIS
Treatment – ASK IMMUNISATION HISTORY* 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.
Complications:* corneal ulcerations * Increase risk of symblepharon
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ANGULAR CONJUNCTIVITIS
Etiology* Moraxella Lacunata – diplobacillus.
CLINICAL FEATURESSymptoms - Redness, discomfortSigns * Congestion limited to intermarginal strip at inner and
outer canthi. * Excoriation of skin at inner and outer palpabral angles .
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*BACTERIAL CONJUNCTIVITISAngular - Continued
Treatment* Topical Treatment * Tetracycline eye ointment .* Eye drops containing Zinc also beneficial, acts by
inhibiting proteolytic ferment.
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*VIRAL CONJUNCTIVITISTYPES• 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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*VIRAL CONJUNCTIVITIS(Continued)
Symptoms * Serous or watery discharge * Severe irritation with rednessSigns * Palpebral congestion * Conjunctival follicles * Sub Conjunival haemorrhage * Preauricular lymph node.* Decreased corneal sensation.
TreatmentTopical Treatment * Artificial Tears* Antibiotic eye drops to prevent
secondary infection* PREVENTION
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*OPHTHALMIA NEONATORUMDefinition any discharge from the eye in the first month of life .* responsible for corneal blindness in children
Genitourinary tract of mother is infected
Normal delivery through the infected tract
Child gets infection
Causative factor
Time of onset after birth
Treatment
N. Gonorrhoea Within 24-48 hours
Ceftriaxone im injection, topical antibiotics
Chemical ( silver nitrate)
“ Wash eyes & observe
Other bacteria 48-72 hours Topical antibiotics
Herpes simplex 5-7 days Topical acyclovir eye ointment
Chlamydia trachomatis
> 1 week Erythromycin eye ointment
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*OPHTHALMIA NEONATORUM (Continued)
Complications* Corneal 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, endophthalmitis.
PREVENTION:* ANTENATAL - treat the maternal
infection* INTRANATAL – aseptic precautions clean the closed closed eyelids ommediately after delivery erythromycin eye ointment – prophylactically
*INVESTIGATIONS
Conjunctival discharge *STAINING – Gram, Giemsa * CULTURE & SENSITIVITY – bacterial, viral,
chlamydia
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* OPHTHALMIA NEONATORUM(Continued)
Treatment
* Systemic Treatment * Ceftriaxone – 25 to 50 mg/kg single dose.* Cefatoxime – 100 mg / kg single dose.
* Topical Treatment * Saline irrigation * Topical flouro quinolones.
ASSIGNMENT
* a 10 day old male baby is brought with the complaints of watering & discharge from both eyes since birth. It is also associated with inability to open the eyes.
1. Name four differential diagnosis ( 2 marks)
2. Define (1) Ophthalmia neonatorum . Describe the various causes(1), clinical features (2) , investigations(1) & management of the above condition(3).
*ANATOMY