Conjunctivitis

1. CONJUNCTIVITIS

2. Case three
• A 23 year old student studying in a medical school presented with complaints of right eye
pain, redness, watering and swelling 5 days ago, followed by the same complaints in the left
eye since 3 days. Both the eyes has yellowish discharge and the student had difficulty in
opening the eyes after sleep. A room-mate had the same complaint a week ago and was
using some eye drops. When the patient developed mild grittiness in the eye she used the
drops of her room-mate and the symptoms worsened.

3. • On examination

4. Signs and symptoms of bacterial
conjunctivitis
Symptoms
• Discomfort, foreign body, grittiness, blurring and redness of sudden onset
• Mild photophobia
• Mucopurulent discharge from the eyes.
• Sticking together of lid margins with discharge during sleep.
• Slight blurring of vision due to mucous flakes in front of cornea.
• Coloured halos, may be complained by some patients due to prismatic effect of mucus present on cornea.
Signs
• Flakes of mucopus seen in the fornices, canthi and lid margins is a critical sign.
• Conjunctival congestion, more marked in palpebral conjunctiva, fornices and peripheral part of buIbar
conjunctiva (fiery red eye). Typically less marked in circumcorneal zone.
• Chemosis seen
• Papillae of fine type may be seen.
• Cilia are usually matted together with yellow crusts.
• Eyelids may be slightly oedematous.

5. Case one
• An 11 year-old male reports a 4-day history of irritation and itching, first in the Left eye followed
by the Right eye one day later. Both eyes have also had watering and matting of the eyelids
making it difficult to open the eyes in the morning. There is minimal eye redness but no foreign
body sensation, flashes, floaters, decreased vision or diplopia. No history of using any drops. On
questioning further the mother gives history of cough and running nose a week ago.

6. • He was given topical tobramycin eye drops qid for a week.
• 3 days later the child was brought back to the OPD, with complaints of foreign body
sensation and dimunision of vision in the right eye. He also complained of inability to see
bright light.
• In addition to the findings of the first visit, there were sub epithelial infiltrates in the right
eye and tender pre auricular lymph nodes in the right side. The corneal sensation was
normal.

7. Viral conjunctivitis
Symptoms are –
• Redness of sudden onset associated with watering, usually profuse, with mild mucoid
discharge,
• Ocular discomfort
• Photophobia, usually mild.
Conjunctival signs are:
• Hyperemia is usually marked and prominent.
• Chemosis of conjunctiva is often present.
• Follicles of small to moderate size typically involving the lower fornix and palpebral
conjunctiva form the characteristic feature
• Papillary reaction is seen in many cases.
• Petechial subconjunctival haemorrhages seen in severe adenoviral conjunctivitis
• Pseudomembrane lining the lower fornix and palpebral conjunctiva may be formed in
about 3% patients with severe inflammation.

8. Case two
• The patient is an eight-year-old male who suffers from seasonal allergic rhinitis. He presents
for an eye examination complaining of a four month history of decreased distance visual
acuity. Of note, he has a history of phlyctenulosis superiorly in the right eye during the
previous summer that resolved with lotepredonol 0.5% topical therapy. He is mildly myopic
with a current optical prescription of -1.75 spherical in both eyes (OU). He has a history of
asthma and seasonal allergies throughout his childhood. His allergic rhinitis is treated with
beclomethasone dipropionate nasal spray. He is a well-adjusted child studying in std 2 who
lives at home with his parents. He has had no known exposure to anyone with infectious eye
disease.

9. • Ocular Examination: Moderate photophobia noted during the exam.
• Visual Acuity, with correction (-1.75 sphere, OU): Right eye (OD) – 6/12; Left eye (OS) – 6/12
• Extraocular motility: Full, both eyes (OU)
• Pupils: Normal with no relative afferent pupillary defect (RAPD)
• Confrontation Visual Fields: Full, OU
• Intra-ocular pressure: OD --17 mmHg; OS --18 mmHg
• Slit lamp examination: Limbal papillary reaction superiorly and bulbar conjunctival injection
superiorly, OU . Palbebral papillae are evident on the superior tarsal conjunctiva, OS, other-wise
normal.
• Dilated Fundal Exam: No pallor or edema of disc, OU. Normal macula vessels and periphery,
OU.

10. • The day of presentation, the patient was started on the topical steroid
(loteprednol etabonate 0.5%) QID and the topical antihistamine
(azelastine 0.05%) BID.
• At his 1 week follow-up visit, the limbal and palpebral signs were
resolving. The loteprednol was tapered off.
• At his 6 week follow-up, there was no sign of limbal involvement of
disease and only mild papillae of the tarsal conjunctiva. The patient
was continued on Azelastine until symptoms resolved.
The parents were counselled regarding eye hygiene, avoid rubbing the
eyes frequently, use cold compress, use goggles while stepping out.

11. ALLERGIC
CONJUNCTIVITIS
SIGNS AND SYMPTOMS OF SIMPLE ALLERGIC CONJUNCTIVITIS
Intense itching and burning
Watery ,mucus, stringy discharge
Mild photophobia
Hyperemia and chemosis (swollen juicy appearance)
Mild papillary reaction on palpebral conjunctiva
Oedema of lids

12. REFERENCES:-
COMPREHENSIVE OPTHALMOLOGY-A K KHURANA
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13. THANK YOU