conjunctivitis

CHAPTER-IV

BYJ. jayasutha

lecturer department of pharmacy practice

Srm college of pharmacySRM UNIVERSITY

Conjunctivitis

The most common extraocular disorderEtiology:infection of microorganismphysical injurieschemical injuriesallergic disorderimmunological disordernutritional deficiency

Conjunctivitis Classification

According to the cause: bacterial, chlamydial, viral, fungal, allergic conjunctivitis

According to the course: acute, subacute and chronic

Conjunctivitis Clinical manifestation

Symptoms◦ Foreign body sensation◦ Scratching◦ Burning ◦ Fullness around the eyes◦ Itching and tearing ◦ pain and photophobia

Signs of conjunctivitis

Hyperemia Tearing Exudation Pseudoptosis Papillary hypertrophyChemosis Follicless Pseudomembranes Ligneous conjunctivitisGranulomas Phlyctenules Preauricular lymphadenopathy

Physical sign

Hyperemia

Hyperemia Ciliary flush

Secretion

Bacterial serous, mucous and purulent

Viral watery or serous

Allergic one or xerophthalmiaropy filamentous

Subconjunctival hemorrhage

Physical sign

papillary hyperplasia: palpebral conjunctival

epithelium

follicular formation: accumulation of lymphocyte

beneath the conjunctival epithelium

Physical sign

pseudomembrane or membrane : the exudation rich in fibrin from palpebral conjunctiva .

Pseudomembrane: in baby and children, adenoviral, neonatal inclusion, streptococcal conj.

True membrane: diphtheritic conj.

Conjunctivitis Examination and diagnosis

Clinical examination Cytologic examinationsmear of conjunctival and scaling smear of conjunctiva

Bacteriological examinationbacterial culture and drug sensitive

testVirus isolation and its antigenic detection

Conjunctivitis Principle treatment

Remove pathogenic cause, take local phamacotherapy as major, systemic treatment as supplement if necessary1)instillation of eyedrops2)instillation of ointment3)washing of conjunctival sac4)systemic treatmentPrevention

Hyperacute Bacterial conjunctivitis

Hyperacute purulent conjunctivitis with the strongest infectivity and large destructibilityEtiology: diplococcus gonorrhoeaeadult: auto infectionchildren: touch infectionnewborn: direct infection

Hyperacute Bacterial conjunctivitis

Clinical findings1)incubation period: 10h-2, 3d, acute

onset2)opthalmalgia, photophobia, tearing3)swelling of the eyelids

palpebral and bulbar hyperemia and chemosis

secretion: serous-bloody-purulent-nong lou yan

inflammatory pseudomembrane preauricular lymphadenectasis corneal ulcer and perforation

Hyperacute Bacterial conjunctivitis

Diagnosis:clinical findings lab examination(Gram’ stain, G-

diplococcus)

Treatment:topical and systemic one is the same

important

Preventionbe isolated to avoid infection and

epidemic

Bacterial conjunctivitisAcute catarrhal conjunctivitis

Clinical finding:acute onset(1-3days), both eyetearing, foreign body and burning sensationconjunctival hyperemia, purulent secretion, palpebral swelling, spots of subconjunctival hemorrhage

Ill process: 2 weeks

Bacterial conjunctivitisAcute catarrhal conjunctivitis

Bacterial conjunctivitisChronic catarrhal conjunctivitis

Etiologybacterial infection:acute-chronic or infection of

bacterial with weak toxicity◦ non-infectious

environment factors: dust, chemical smoke or gas and irritating eye drugs◦ complicated from other disorders

Bacterial conjunctivitisChronic catarrhal conjunctivitis

Clinical finding:chronic onset, both eyeitching, foreign body and asthenopia or no symptomsconjunctival hyperemiamucous secretionpapillary and follicle hyperplasia

Treatment: give management according to different causes

Bacterial conjunctivitisChronic catarrhal conjunctivitis

Chlamydial conjunctivitisChlamydin psittaci:Chlamydia trachomatis:antigen:ABCBa DEFGHIJK

trachoma genitourinary system inclusion

conjunctivitis

clinical findingsAcute or subacute stage(1-2mon):photophobia, tearing, foreign body sensation1)palpebral and bulbar conjunctival hyperemia2)ropy secretion3)papillary hyperplasia, follicles formation4)corneal epithelitisbe cured without scar left

clinical findings

Clinical findingsChronic stage: superinfections or concomitant bacterial infections1)Conjunctival hyperemia2)ropy secretion3)papillary hyperplasia, follicles

in upper fornix and palpebral conjunctiva

conjunctival thickening scar white luster like tenden

4)corneal epithelitis trachomatous pannus

Clinical findings

Chronic stage

ClassificationOur country Mac Callan’s

I Early stage of infiltration hyperemia and thickeningearly follicle and corneal panus

I progressive stagepapillae and follicles, upper fornix is blurred,corneal panus

pc

II active stageapillae and follicles, orneal panus

II regressive stagescar,a little active lesion

III precicatricial stage

III complete cicatricial stagescar, no active lesion and infectivity

IV cicatricial stage

Equela and complication

Entropion and trichiasisBlepharopatosisSymblepharon (lower fornix)Parenchymatous xerosis of conjunctivaChronic dacryocystitisCorneal pannus

Diagnosis1)the vessels of upper fornix and palpebral conjunctiva are blurred, congested, papillary hyperplasia or follicle formation or both2)corneal pannus3)scar4)trachomatous inclusion

Diagnosison the basis of the first plus one

of other threeantigenic test

Scar corneal pannus

Treatment

Topical tetracyclin, erythromycin

Systemic sulfadiazinerifampin

Operative: sequelae and complication

Viral conjunctivitisEpidemic keratoconjunctivitis

Acute onset, strong infectivity, may be sporadic or epidemicEtiology: adenovirus, type 8, 19, 29 and 37.

Viral conjunctivitisEpidemic keratoconjunctivitis

Clinical findings:1)incubation period: 5-7 days2)foreign body sensation, itching,

pain, photophopia and tearing3)palpebral edema, conjunctival

hyperemia and chemosis, less andwatery secretion, follicles in palpebraland fornix conjunctiva, preauricularlymphadeectasis and tenderness4)be cured after one week

exacerbate: superfial punctatekeratitis

Viral conjunctivitisEpidemic keratoconjunctivitis

Diagnosis:Acute folliclar cinjunctivitis superfial punctate keratitis preauricular lymphadenectasisneutrophialTreatment: no specific drug1)antiviral:topical(mainly) and systemic-acyclic 2)antibiotic

Viral conjunctivitisEpidemic hemorrhagic conjunctivitis

Fulminant epidemic ocular infectionsEtiology:entero-virus type 70,

picornavirusCoxsackie virus type A 24

Viral conjunctivitisEpidemic hemorrhagic conjunctivitis

Clinical findings:1)incubation period: 24hr2)ill course: self-limited, 10d or

shorter3)ophthalmagia, foreign body

sensation, photophopia and tears4)eyelid and conjunctiva red and

swollen, watery secretion, follicular hyperplasis of palpebral conjunctiva, patchy hemorrhage on bulbar conjunctiva, preauricular lymphadenectasis 5) Transient fine punctate epithelial keratitis

Immunologic conjunctivitis Vernal conjunctivitis (Clinical findings)

Symptom:extreme itchingSign1)palpebral type:papillary hyperplasia in the

upper palpebral conjunctiva that like oval flat cobblestone, eosinophillia in secretion 2)corneal limbal type:collid tubercles at the corneal

limbus3)mixed type:

Vernal conjunctivitis

Vernal conjunctivitisTreatment:1)self-limited, no vision affected2)general treatment:keep away proble sensitinogen3)medical treatment:natrii cromoglycascorticosteroid

Allergic conjunctivitis

Immediated allergic antigen:pollen, contact lens, etc.Delayed one: various drug

Clinical findings:immediate type: dermatitis

of palpebral skin, blepharitis, mild infiltrative conjunctivitis

Allergic conjunctivitis

Lab examination:degenerative epithelial cell, few polynuclear cells and mononuclear cells in secretionTreatment:1)find out and get rid of

sensitinogen2)corticosteroid3)3% boric solution4)anti-allergic agents

Phlyctenular keratoconjunctivitis

Etiology: delayed reaction to protein of microorganism, mostly to mycobecterium tuberculosis and staphylococcus aureusClinical findings: herpetic tubercle may appear on the bulbar conjunctiva or limbus.

PterygiumEtiology: unclear, outdoor workClinical findings:1)hypertrophic bular conjunctiva

and its subconjunctival tissue invade onto the cornea with the shape of tiangle2)composed of head, neck, body.3)progressive, stationary4)differentiated with

pseudopterygiumTreatment: operation

Pingueculae

A degenerative lesion of the bulbar conjunctiva caused by the effect of ultraviolet raysClinical findings:a kind of white–yellow

amorphous subepithelial deposition near to the limbusTreatment: no needed

Pterygium Pingueculae

Conjunctival concretion

Concrement on the palpebral conjunctivaOld or those with chronic conjunctivitisWhite-yellow depositTreatment:no needbe rejected

Primary benign tumors of the conjunctiva

nevi Dermolipoma

Subconjunctival hemorrhage

Caused by vascular rupture beneath the bulbar conjunctiva or by osmotic increase of vascular wallTreatment:1)find out the cause2)good explanation