Conjunctivitis is an inflammation or swelling of the conjunctiva. The conjunctiva is the thin transparent layer of tissue that lines the inner surface of the eyelid and covers the white part of the eye. Often called "pink eye".
2. DeďŹnition
The conjunctiva is a thin membrane that
covers the inner surface of the eyelid and
sclera
The conjunctivitis is an inďŹammation of
the conjunctiva, which eye appear red
with or without discharges.
Infectious Non-Infectious
8. ⢠Fluoroquinolones:
⢠2nd generation: CiproďŹoxacin 0.3% drops or ointment, or OďŹoxacin 0.3% drops
⢠3rd generation: LevoďŹoxacin 0.5% drops
⢠4th generation: MoxiďŹoxacin 0.5% drops, GatiďŹoxacin 0.5% drops, or
BesiďŹoxacin 0.6% drops
⢠Aminoglycosides:
⢠Tobramycin 0.3% drops
⢠Gentamicin 0.3% drops
⢠Macrolides:
⢠Erythromycin 0.5% ointment
⢠Azithromycin 1% solution
⢠Other
⢠Bacitracin ointment
⢠Bacitracin/Polymixin B ointment
⢠Neomycin/Polymixin B/Bacitracin
⢠Neomycin/Polymixin B/gramicidin
⢠Polymixin B/Trimethoprim
⢠Sulfacetamide
⢠Chloramphenicol
⢠Fusidic Acid (Common treatment in the UK; not used in the US)
Medical Therapy
9. ⢠Characterized by marked conjunctival hyperaemia and mucopurulent
discharge.
⢠Most common
b. Acute bacterial conjunctivitis
Symptoms
⢠Discomfort & F.B sensation
⢠Mucopurulent discharge
⢠Mild photophobia
⢠Slight blurring of vision
⢠Sticking of lid margins
Signs
⢠Conjunctival congestion
⢠Chemosis
⢠Petechial haemorrhages
⢠Flakes of mucopus
⢠Matting of eyelashes
Clinical Course
⢠Peak in 3-4 days
⢠Cured in 10-15 days
⢠Pass it to chronic catarrhal
10. Treatment
⢠Topical antibiotics: chloramphenicol /
moxiďŹoxacin / tobramycin eye drops
⢠Ointment at night
⢠Anti-inďŹammatory & analgesic drugs
General measures
⢠Irrigation of conjunctivial sac
⢠Dark goggles
⢠No bandage
⢠No steroids
11. c. Chronic bacterial conjunctivitis
Predisposing
Factors
Mode of
Infection
Causative
Organisms
⢠Chronic exposure to
smoke, dust, chemical
irritants
⢠Local irritant as trichiasis,
concretions, FB
⢠Eye-strain due to Ref
error, convergence
insuďŹciency
⢠Alcohol abuse
⢠As continuation of acute
mucopurulent
conjunctivitis
⢠As chronic infection from
chronic dacryocystitis or
chronic URI
⢠As a mild exogenous
infection from direct
contact or air-borne
⢠Staphylococcus aureus-
(most common)
⢠Gram - (Entrobacilli)
12. Symptoms
⢠Burning & grittiness of eyes, specially in
evening
⢠Mild chronic redness
⢠Feeling of heat & dryness on lid margins
⢠DiďŹculty in keeping eyes open
⢠Mild mucoid disharge
⢠On & oďŹ lacrimation
⢠Feeling of sleeping & tiredness in the eyes
Signs
⢠Congestion of posterior conjunctival
vessels
⢠Mild papillary hypertrophy
⢠Surface of conjunctiva look sticky,
congested lid margins
Treatment
⢠Topical antibiotics : chloramphenicol, moxiďŹoxacin / tobramycin eye drops.
⢠Astringent eye drops : zinc boric acid for symptomatic relief
13. ⢠Characterized by Mild chronic conjunctivitis conďŹned to the conjunctiva & lid
margins near the angles.
⢠Etiology: Moraxella AxenďŹeld Bacilli, Rarely staphylococci.
d. Angular bacterial conjunctivitis
Symptoms
⢠Irritation discomfort
⢠H/O collection of dirty white
foamy discharge at the angles
⢠Redness in the angles of the
eye.
Signs
⢠Hyperaemia of bulbar conjunctiva near the
canthi
⢠Hyperaemia of lid margins near the angles
⢠Excoriation of skin around the angles
⢠Presence of foamy mucopurulent
discharge at the angles
Treatment
⢠Oxytetracycline 1 % eye ointment 2-3
times x 10-14 days
14. 2. Viral Conjunctivitis
⢠Usually benign and self-limited, (longer course approximately 2-4 weeks)
⢠Is highly contagious.
⢠Avoid touching their eyes, shaking hands, and sharing towels, among other
activities.
⢠Transmission; accidental inoculation of viral particles from the patient's hands
or by contact with infected upper respiratory droplets, fomites, or contaminated
swimming pools.
⢠Common External Ocular infection.
⢠In 90% cases, Adenovirus is the causative agent.
⢠May be Sporadic, or occur in epidemics.
16. Spread of infection
Facilitated by
⢠Virus can survive on dry surfaces for weeks.
⢠Viral shedding may occur for many days before clinical features are apparent.
Transmission by
⢠Contact with Respiratory or ocular secretions.
⢠Via Contaminated Fomites such as Towels.
⢠Route of transmission is usually Eye-Hands-Eyes.
⢠In Clinical setting,Eye-Instruments-Eye.
17. Presentation
Epidemic Keratoconjunctivitis
⢠Most severe presentation.
⢠Caused by adenoviruses type 8,19 and 37.
⢠Markedly contagious.
⢠incubation period after infection (8 days) & virus shed from the inďŹamed eye for
2-3 weeks.
⢠Keratitis occurs in 80% cases.
Non-speciďŹc acute follicular Conj.
⢠Most common form of acute follicular conjunctivitis
⢠Caused by adenovirus serotypes 1 to 11 & 19
⢠Milder form of acute follicular conjunctivitis.
⢠Unilateral symptoms, Other eye involved 1-2 days later, but less severely.
⢠Patient may have systemic symptoms such as sore throat or common cold.
18. Pharyngoconjunctival fever
⢠Adenoviral infection commonly associated with subtypes 3,4 & 7.
⢠Acute follicular conjunctivitis, associated with pharyngitis.
⢠Fever & pre-auricular lymphadenopathy.
⢠Cornea : superďŹcial punctate keratitis. (30%)
Chronic/relapsing adenoviral conj.
⢠Rare
⢠Gives a clinical picture of chronic non-speciďŹc
⢠Follicles/papillas.
⢠Can persist over years, but eventually self limiting.
19. Clinical features
Symptoms
⢠Watering
⢠Redness
⢠Irritation.
⢠Itching.
⢠Photophobia (When Cornea is involved).
Signs
⢠Eyelids Edema, Ranging from mild to Severe.
⢠Lymphadenopathy Tender Pre-auricular nodes (common).
⢠Conjunctiva Hyperemia, Follicles. May be Papillae (Particularly superior tarsal
conjunctiva).
⢠Severe InďŹammation: may be associated with conjunctiva Hamorrhages,
chemosis, membranes (Rare) and pseudomembranes. Sometimes conjunctiva
Scarring.
⢠Keratitis (Adenoviral): PEK Usually occur in 7-10 days of onset of symptoms.
Resolving in 2 weeks.
⢠Anterior Stromal inďŹltrates/SEI: may persist for months or years.
⢠Anterior uveitis: Usually mild.
20.
21. Herpes simplex Virus
⢠Causes Follicular conjunctivitis particularly in primary disease.
⢠Usually unilateral.
⢠Often Associated skin lesions.
⢠Micro dendrites may be mistaken for punctate epithelial keratitis, But Corneal
sensation is reduced in HSV
Acute hemorrhagic conjunctivitis
⢠Usually occurs in tropical areas.
⢠Caused by Enterovirus and coxsackie virus (Picornavirus family).
⢠Rapid onset, resolves within 1-2 weeks.
22. Treatment
Approach Considerations
Treatment of adenoviral conjunctivitis is supportive.
Symptomatic Treatment
Cold compresses and lubricants, such as artiďŹcial tears, for comfort.
Topical vasoconstrictors and antihistamines.
Antibiotic and Topical Steroid Treatment
23. 3. Allergic Conjunctivitis
InďŹammation of conjunctiva due to allergic or hypersensitive reaction which may
be immediate (humoral ) or delayed (cellular) to speciďŹc antigens
25. ⢠Mild, non speciďŹc IgE mediated Type I hypersensitivity reaction.
Etiology:
⢠Hay fever conjunctivitis: associated with allergic rhinitis.
⢠Allergens: pollens, grass, animal dandruďŹs.
⢠SAC: common, grass pollens
⢠PAC: not common, house dust and mites
1. Simple allergic conjunctivitis
Symptoms
⢠Itching
⢠Redness
⢠Burning sensation
⢠Watery discharge
⢠Mild photophobia
Signs
⢠Hyperemia and chemosis
⢠Mild papillary reaction
⢠Oedema of eyelids
26. Treatment
⢠Elimination of allergens if possible
⢠Cold compresses
⢠Antihistamines oral/ topical (epinistine, fexofenadrine)
⢠Mast cell stabilizers (sodium cromoglycate, lodaximide)
⢠Combination( ketotifen, patalon, azelastine)
⢠Topical corticosteroids
⢠Immunosuppressant's (cyclosporin) for steroid resistant cases
27. ⢠Recurrent, Bilateral, self limiting allergic inďŹammation of the conjunctiva
aďŹecting children and young adults
⢠More common in males.
⢠Allergic disorder in which IgE and cell mediated immune mechanism play an
important role
2. Vernal Keratoconjunctivitis (VKC)
Symptoms
⢠98% bilateral, can be asymmetric
⢠Intense ocular itching, Lacrimation,
Photophobia, blepharospasm, blurred vision, FB
sensation, burning and diďŹculty opening eyes in
the morning.
⢠Thick mucous discharge, Pseudoptosis due to
large papillae.
⢠Giant papillae on the superior Palpebral
conjunctiva are the clinical hallmark.
31. Treatment
⢠Topical antihistamine
⢠Mast cell stabilizers: sodium chromoglycate 2 % drops 4-5 times/day
⢠Topical steroid: Every 4 hrs. for 2 days followed by 3-4 times a day for 2
weeks . â¨
MONITOR IOP TO PREVENT STEROID INDUCED GLAUCOMA
⢠Acetyl cysteine (0.5%)
⢠Systemic :
I. Oral antihistamine : for itching
II.Oral steroid : short course for very severe non responsive case
⢠Treatment of large papilla supratarsal injection of long acting steroid or
surgical removal
⢠General measures: dark goggles, cold compress, change of place from hot
to cold