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Conjunctivitis

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Conjunctivitis

  1. 1. conjunctivitis DNYANESHWAR B. POTFODE OPHTHALMIC OFFICER
  2. 2. Anatomy of conjunctiva • The conjunctiva is a translucent mucous membrane which lines the posterior surface of the eyelids and anterior aspect of eyeball. • It stretches from the lid margin to the limbus, and encloses a complex space called conjunctival sac.
  3. 3. Parts of conjunctiva • 1. Palpebral conjunctiva • i. Marginal conjunctiva • ii. Tarsal conjunctiva • iii. Orbital part • 2. Bulbar conjunctiva • 3. Conjunctival fornix.
  4. 4. Parts of conjunctiva and conjunctival glands.
  5. 5. INFLAMMATIONS OF CONJUNCTIVA • Inflammation of the conjunctiva (conjunctivitis) is classically defined as conjunctival hyperemia associated with a discharge which may be watery, mucoid, mucopurulent or purulent.
  6. 6. conjunctivitis
  7. 7. conjunctivitis
  8. 8. Etiological classification 1. Infective conjunctivitis: bacterial, chlamydial, viral, fungal, rickettsial, spirochaetal, protozoal, parasitic etc. 2. Allergic conjunctivitis. 3. Irritative conjunctivitis. 4. Keratoconjunctivitis associated with diseases of skin and mucous membrane. 5. Traumatic conjunctivitis. 6. Keratoconjunctivitis of unknown etiology
  9. 9. Clinical classification • 1. Acute catarrhal or mucopurulent conjunctivitis. • 2. Acute purulent conjunctivitis • 3. Serous conjunctivitis • 4. Chronic simple conjunctivitis • 5. Angular conjunctivitis • 6. Membranous conjunctivitis • 7. Pseudomembranous conjunctivitis • 8. Papillary conjunctivitis • 9. Follicular conjunctivitis • 10. Ophthalmia neonatorum • 11. Granulomatous conjunctivitis • 12. Ulcerative conjunctivitis • 13. Cicatrising conjunctivitis
  10. 10. INFECTIVE CONJUNCTIVITIS • Infective conjunctivitis, i.e., inflammation of the conjunctiva caused by microorganisms is the commonest variety • Low temperature due to exposure to air, • Physical protection by lids, • Flushing action of tears, • Antibacterial activity of lysozymes • Humoral protection by the tear immunoglobulins
  11. 11. BACTERIAL CONJUNCTIVITIS • There has occurred a relative decrease in the incidence of bacterial conjunctivitis in general and those caused by gonococcus and corynebacterium diphtheriae in particular.
  12. 12. Etiology • A. Predisposing factors • B. Causative organisms • C. Mode of infection
  13. 13. Predisposing factors • Bacterial conjunctivitis, especially epidemic forms, are flies, poor hygienic conditions, hot dry climate, poor sanitation and dirty habits. These factors help the infection to establish, as the disease is highly contagious
  14. 14. Causative organisms • It may be caused by a wide range of organisms • Staphylococcus aureus • Staphylococcus epidermidis • Streptococcus pneumoniae • Streptococcus pyogenes • Haemophilus influenzae • Moraxella lacunate • Pseudomonas pyocyanea • Neisseria gonorrhoeae • Neisseria meningitidis
  15. 15. Mode of infection • 1. Exogenous infections • 2. Local spread • 3. Endogenous infections
  16. 16. 1. Exogenous infections (i) Directly through close contact, as air-borne infections or as water-borne infections; (ii) Through vector transmission (e.g., flies); or (iii) Through material transfer such as infected fingers of doctors, nurses, common towels, handkerchiefs, and infected tonometers
  17. 17. 2. Local spread • It occur from neighbouring structures such as infected lacrimal sac, lids, and nasopharynx. • In addition to these, a change in the character of relatively innocuous organisms present in the conjunctival sac itself may cause infections.
  18. 18. 3. Endogenous infections • It occur very rarely through blood e.g., gonococcal and meningococcal infections.
  19. 19. Pathology • Pathological changes of bacterial conjunctivitis consist of : • 1. Vascular response • 2. Cellular response • 3. Conjunctival tissue repsonse • 4. Conjunctival discharge.
  20. 20. 1. Vascular response • It is characterised by congestion and increased permeability of the conjunctival vessels associated with proliferation of capillaries.
  21. 21. 2. Cellular response • It is in the form of exudation of polymorphonuclear cells and other inflammatory cells into the substantia propria of conjunctiva as well as in the conjunctival sac.
  22. 22. 3. Conjunctival tissue repsonse • Conjunctiva becomes oedematous. The superficial epithelial cells degenerate, become loose and even desquamate. • There occurs proliferation of basal layers of conjunctival epithelium and increase in the number of mucin secreting goblet cells.
  23. 23. 4. Conjunctival discharge. • It consists of tears, mucus, inflammatory cells, desquamated epithelial cells, fibrin and bacteria. • If the inflammation is very severe, diapedesis of red blood cells may occur and discharge may become blood stained • The changes are thus more marked in purulent conjunctivitis than mucopurulent conjunctivitis.
  24. 24. Acute mucopurulent conjunctivitis.
  25. 25. Symptoms • Discomfort and foreign body sensation due to engorgement of vessels. • Mild photophobia, i.e., difficulty to tolerate light. • 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. • Sometimes patient may complain of coloured halos due to prismatic effect of mucus present on cornea. • Flakes of mucopus are seen in the fornices, canthi and lid margins. • Cilia are usually matted together with yellow crusts
  26. 26. Acute mucopurulent conjunctivitis
  27. 27. Complications. • Occasionally the disease may be complicated by marginal corneal ulcer, superficial keratitis, blepharitis or dacryocystitis
  28. 28. Treatment • 1. Topical antibiotics • 2. Irrigation of conjunctival sac • 3. Dark goggle • 4. No bandage • 5. No steroids • 6. Anti-inflammatory and analgesic drugs
  29. 29. ACUTE PURULENT CONJUNCTIVITIS • Acute purulent conjunctivitis also known as acute blenorrhea or hyperacute conjunctivitis is characterised by a violent inflammatory response. It occurs in two forms: • (1) Adult purulent conjunctivitis. • (2) Ophthalmia neonatorum in newborn.
  30. 30. OPHTHALMIA NEONATORUM • Ophthalmia neonatorum is the name given to bilateral inflammation of the conjunctiva occurring in infant, less than 30 days old. • It is preventable disease usually occurring as result of carelessness at the time of birth. • any discharge or even watering from eyes in first week of life should suspicion of ophthalmia neonatorum, as tears are not formed till then.
  31. 31. Etiology • Source and mode of infection • Causative agents
  32. 32. OPHTHALMIA NEONATORUM
  33. 33. Source and mode of infection • 1. Before birth infection is very rare through infected liquor amnii in mothers with ruptured membrances. • 2. During birth. It is the most common mode of infection from the infected birth canal especially when the child is born with face presentation or with forceps. • 3. After birth. Infection may occur during first bath of newborn or from soiled clothes or fingers.
  34. 34. Causative agents • 1. Chemical conjunctivitis • 2. Gonococcal infection • 3. Other bacterial infections • 4. Neonatal inclusion conjunctivitis • 5. Herpes simplex ophthalmia neonatorum
  35. 35. Symptoms and signs • 1. Pain and tenderness • 2. Conjunctival discharge. • 3. Lids are usually swollen. • 4. Conjunctiva may show hyperaemia and chemosis • 5. Corneal involvement, though rare, may occur in the form of superficial punctate keratitis especially in herpes simplex ophthalmia neonatorum
  36. 36. Complications • Untreated cases, especially of gonococcal ophthalmia neonatorum, may develop corneal ulceration, which may perforate rapidly resulting in corneal opacification or staphyloma formation.
  37. 37. Treatment 1. Antenatal measures include thorough care of mother and treatment of genital infections when suspected. 2. Natal measures are of utmost importance, as mostly infection occurs during childbirth. • Deliveries should be conducted under hygienic conditions taking all aseptic measures. 3. Postnatal measures include : Use 1 percent tetracycline ointment or 0.5 percent erythromycin ointment or 1 percent silver nitrate solution into the eyes of the babies immediately after birth.
  38. 38. B. Curative treatment. • 1. Chemical ophthalmia neonatorum • 2. Gonococcal ophthalmia neonatorum • i. Topical therapy • ii. Systemic therapy
  39. 39. ACUTE MEMBRANOUS CONJUNCTIVITIS • It is an acute inflammation of the conjunctiva, characterized by formation of a true membrane on the conjunctiva. • Now-a-days it is of very-very rare occurrence, because of markedly decreased incidence of diphtheria. It is because of the fact that immunization against diptheria is very effective.
  40. 40. PSEUDOMEMBRANOUS CONJUNCTIVITIS • It is a type of acute conjunctivitis, characterised by formation of a pseudomembrane (which can be easily peeled off leaving behind intact conjunctival epithelium) on the conjunctiva.
  41. 41. CHRONIC CATARRHAL CONJUNCTIVITIS • ‘Chronic catarrhal conjunctivitis’ also known as ‘simple chronic conjunctivitis’ is characterized by mild catarrhal inflammation of the conjunctiva
  42. 42. ANGULAR CONJUNCTIVITIS • It is a type of chronic conjunctivitis characterised by mild grade inflammation confined to the conjunctiva and lid margins near the angles (hence the name) associated with maceration of the surrounding skin.
  43. 43. Angular conjunctivitis.
  44. 44. CHLAMYDIAL CONJUNCTIVITIS • Chlamydia lie midway between bacteria and viruses, sharing some of the properties of both.
  45. 45. FOLLICULAR CONJUNCTIVITIS • It is the inflammation of conjunctiva, characterised by formation of follicles, conjunctival hyperaemia and discharge from the eyes. • Follicles are formed due to localised aggregation of lymphocytes in the adenoid layer of conjunctiva. • Follicles appear as tiny, greyish white translucent, rounded swellings, 1-2 mm in diameter.
  46. 46. ACUTE HAEMORRHAGIC CONJUNCTIVITIS • It is an acute inflammation of conjunctiva characterised by multiple conjunctival haemorrhages, conjunctival hyperaemia and mild follicular hyperplasia.
  47. 47. ALLERGIC CONJUNCTIVITIS • It is the inflammation of conjunctiva due to allergic or hypersensitivity reactions which may be immediate (humoral) or delayed (cellular). The conjunctiva is ten times more sensitive than the skin to allergens.
  48. 48. ALLERGIC CONJUNCTIVITIS
  49. 49. Types • 1. Simple allergic conjunctivitis • Hay fever conjunctivitis • Seasonal allergic conjunctivitis (SAC) • Perennial allergic conjunctivitis (PAC) • 2. Vernal keratoconjunctivitis (VKC) • 3. Atopic keratoconjunctivitis (AKC) • 4. Giant papillary conjunctivitis (GPC) • 5. Phlyctenular keratoconjunctivitis (PKC) • 6. Contact dermoconjunctivitis (CDC)
  50. 50. SIMPLE ALLERGIC CONJUNCTIVITIS • It is a mild, non-specific allergic conjunctivitis characterized by itching, hyperaemia and mild papillary response. Basically, it is an acute or subacute urticarial reaction.
  51. 51. Clinical picture Symptoms- include intense itching and burning sensation in the eyes associated with watery discharge and mild photophobia. Signs. (a) Hyperaemia and chemosis which give a swollen juicy appearance to the conjunctiva. (b) Conjunctiva may also show mild papillary reaction. (c) Oedema of lids.
  52. 52. Treatment 1. Elimination of allergens if possible. 2. Local palliative measures which provide • i. Vasoconstrictors like adrenaline, ephedrine, and naphazoline. • ii. Sodium cromoglycate drops are very effective in preventing recurrent atopic cases. • iii. Steroid eye drops should be avoided. However, these may be prescribed for short duration in severe and non-responsive patients. 3. Systemic antihistaminic drugs are useful in acute cases with marked itching.
  53. 53. GIANT PAPILLARY CONJUNCTIVITIS (GPC) • It is the inflammation of conjunctiva with formation of very large sized papillae
  54. 54. GIANT PAPILLARY CONJUNCTIVITIS (GPC)
  55. 55. Subconjunctival haemorrhage

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