Conjunctivitis
Inflammation of the conjunctiva is classically
defined as conjunctival hyperemia
(conjunctivitis) associated with discharge
which may be watery, mucoid, mucopurulent
or purulent.
Classification of conjunctivitis
Etiological
Clinical
Etiological Classification
Infective Conj.
• Bacterial
• Chlamydial
• Viral
• Fungal
• Parasitic
Etiological Classification
Allergic Conj.
Irritative Conj.
Kerato Conj.
Traumatic Conj.
Unknown itiology
BACTERIAL CONJUCTIVITIS
ETIOLOGY
*PREDISPOSING FACTOR
Bacterial conj., poor hygienic condition,
hot dry climate, poor sanitation,
dirty habits
CAUSATIVE ORGANISM
Staphylococcus aureus
Staphylococcus epidermidis
Streptococcus pneumoniae
Streptococcus pyogens
Haemophilus influenza
Cornibacterium diptheriae
Neisseria gonorrhoea etc..
MODE OF INFECTION
1. Exogenous infection
2. Local spread
3. Endogenous infections
PATHOLOGY
Pathological changes of bacterial conj
consists of:
1. Vascular response:
It is characterized by congestion and
increased permeability of
conjunctival vessels associated with
proliferation of capillaries.
Cellular Response
It is in the form of exudation of
polymorph nuclear cells and other
inflamatory cells into the substantia
propria of conjunctiva as well as in the
conjunctival sac.
CONJUNCTIVAL TISSUE
RESPONSE:
Oedematous ,sup. Epi.cells degenerate
Become loose
CONJUNCTIVAL DISCHARGE
Tears,inflammatory cells, fibrin &
bacteria. If inflam.is severe discharge
– blood stained.
Clinical Types Bacterial conj.
Acute Catarrhal or mucopurulent conj.
Acute purulent conj.
Acute membranous conj.
Acute pseudo membranous conj.
Chronic Bacterial conj.
Chronic angular conj.
Acute mucopurulent conj.
Symptoms
Discomfort / F.B.sensation
Mild photophobia
Mucopurulent discharge
Sticking
Blurred of vision
colored halos
Acute mucopurulent conj.
Signs
Conj. Congestion
Chemosis
Petechial haemorrhages
Flakes of mucopus
cilia – matted – yellow crusts.
Acute mucopurulent conj.
Duration -3-4 days
Untreated – 10-15 days – chronic
catarrhal conj.
Complications – Marginal corneal
ulcer, superficial keratitis,
blephritis,DCT.
Management
Topical antibiotics – cult. & sensitivity
Irrigation of conj. Sac- sterile warm saline
Dark goggles –prevent photophobia
No bandage
No steroids
Anti inflammatory, analgesic drugs
Acute Purulent conj.
Adult purulent conj.
Ophthalmia neonatorum in newborn
Adult - purulent conj.
Etiology – causative organism –
gonococcus, staphylococcus aureus,
pnemococcus
Adult - purulent conj.
Clinical picture
Stage of infiltration -4-5 days
painful, tender eyeball
Bright red velvety chemosed conj.
Discharge – watery
Pre auricular lymph nodes - enlarged
Adult - purulent conj.
Stage of Blenorrhea
starts at 5th day, lasts for several days
frankly purulent , copious, thick
discharge trickling down – cheeks
tenderness is less
Adult - purulent conj.
Stage of slow healing
pain –decreased
swelling – lids – subsides
redness, thickened conj., velvety conj.
discharge less
resolution
Adult - purulent conj.
Complications -corneal
ulcers,prforation
Iridocyclitis- rare
Systemic – arthritis,endocarditis ,
septicaemia
Management
Systemic medicine
Topical antibiotics
Irrigation
Atropine eye drop
Acute Membranous conj.
Etiology
Cornebacterium diphtheriae
Strepto coccus
Acute Membranous conj.
Stage of infiltration
scanty discharge & severe pain
lids swollen
conj. Red, covered with thick grey
yellow membrane. The membrane –
tough , firmly adherent, bleeds on
removing
Acute Membranous conj.
Stage of suppuration – pain
decreases lid becomes soft, sloughed
off membrane
Stage of cicatrisation- raw surface –
granulation., trichiasis,conj. xerosis
Acute Membranous conj.
Corneal ulceration
Trichiasis, entropion , conj. Xerosis
MANAGEMENT
Topical antibiotic eye drop
Systemic treatment
