Conjunctivitis

Dr. Prasad B. Chinchole
Pharm D
SCOP, Almala

Index
1. Introduction
2. Etiology
3. Clinical presentation
4. Risk Factors
5. Diagnosis
6. Management
@ Dr. Prasad B. Chinchole

Introduction
• Conjunctivitis is an inflammation or infection of the transparent
membrane (conjunctiva) that lines your eyelid and covers the
white part of your eyeball.
• When small blood vessels in the conjunctiva become inflamed,
they're more visible.
• This is what causes the whites of your eyes to appear reddish or
pink.
• Pink eye is commonly caused by a bacterial or viral infection, an
allergic reaction, or — in babies — an incompletely opened tear
duct.

Etiology
Causes of pink eye include:
• Viruses
• Bacteria
• Allergies
• A chemical splash in the eye
• A foreign object in the eye
• In newborns, a blocked tear duct

• Viral causes
– include adenovirus, Herpes simplex.
• Bacterial causes
– include Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae..
• Ophthalmia neonatorum
– is conjunctivitis secondary to gonorrhoea or chlamydia within the first month of life.

Clinical presentation
• 'Red eye' (diffuse conjunctival injection).
• Eye discomfort/burning/gritty sensation (not painful).
• Minimal pruritus.
• Vision is usually normal - although 'smearing', particularly on waking, may be common
• Photophobia mild or absent.
• May be unilateral or bilateral, although usually starts in one eye (not discriminatory of
cause).
• Association with URTI, watery discharge, and pre-auricular lymphadenopathy are
suggestive of viral cause.
• A purulent discharge suggests bacterial cause.
• History of contact with similarly affected person is common.

Risk
• If untreated, this condition can lead to corneal ulcers and blindness.
• Other types of bacterial and viral conjunctivitis are usually treated with
antibiotic eye drops or ointments.
• A warm compress to the eye may also help relieve swelling and irritation
• Blocked tear ducts may cause conjunctivitis.

Transmission
How it spreads
• Several viruses and bacteria can cause conjunctivitis. Both viral and bacterial are
highly contagious. Each of these types of germs can spread from person to person in
different ways.
• They usually spread from an infected person to others through
 Cose personal contact, such as touching or shaking hands
 The air by coughing and sneezing
 Touching an object or surface with germs on it, then touching your eyes before
washing your hands

Types
1. Viruses
2. Bacteria
3. Allergies

Bacterial Conjunctivitis
• Symptoms and signs: red eyes, discharge of pus, pain.
• It is usually bilateral. It may start in one eye and later spread to the other.
• The common organisms are the Staphylococcus aureus, Staphylococcus epidermidis,
Group A Streptococcus and Streptococcus pneumoniae.
• Other organisms are Haemophilus influenzae, Pseudomonas and Escherichia coli.
• Moraxella lacunata causes an angular conjunctivitis with a whitish discharge at the o
uter canthus.
• The spectrum of organisms causing conjunctivitis varies around the world.

• Bacterial infection of the conjunctival sac can be secondary to discharge resulting from
a foreign body, dry eye, trichiasis, or lacrimal mucocele.
• It is necessary to examine the lid margins, evert the upper lid, and look for discharge
from the lacrimal puncta.
• To make a specific diagnosis of the organism involved, a culture should be t
aken.

• In most instances the disease will respond if the secondary causes are treated & a broad
-spectrum antibiotic is used.
• Eye drops are more practical than ointments as vision is not blurred with drops.
• They can be easily and frequently applied.
• However, most primary clinics will have tetracycline eye ointment as their ophthalmic
antibiotic, so this should be used.
• Chloramphenicol & gentamicin are both broad spectrum antibiotics and often available.
• Initially the drops should be instilled every 10 min. until the infection is under control.
• The eye should not be padded.
• Frequent eyelid cleaning is necessary.

Viral Conjunctivitis
• Symptoms and signs: watery discharge, red eye, itch.
• Epidemic kerato-conjunctivitis, often due to type 8 adenovirus, may have a follicular
reaction of the tarsal conjunctiva.
• The pre-auricular lymph nodes may be enlarged.
• Epidemic (acute) haemorrhagic conjunctivitis was first reported in West Africa in the
1960s and is usually caused by enterovirus 70.
• Small sub-conjunctival haemorrhages are characteristic of this highly infective eye in
flammation which often lasts for a only few days.

• Viral conjunctivitis is a self-limiting disease and does not require antibiot
ic treatment unless a secondary bacterial infection occurs.
• Cold compresses will help the discomfort, but usually the patient will ha
ve to let the disease run its course. Antivirals, e.g., acyclovir, are not indi
cated.

Prevention of Conjunctivitis
Prevention of infective conjunctivitis relies primarily on good personal hygiene.
• Bacterial conjunctivitis is uncommon but can be spread by the hands or from upper
respiratory tract infections.
• Gonnoccal infection is transmitted from the genital tract or urine to the eye by hands.
• This is a serious breach of normal hygiene.
• Ophthalmia neonatorum can be prevented by the use of povidone iodine drops,
tetracycline eye ointment or other antiseptics or antibiotics at birth.

• Viral conjunctivitis, in particular adenovirus, can sweep through a community or an i
nstitution such as a school very quickly.
• This is highly infectious & needs to be controlled by the enforcement of strict hygiene
standards – towels, face cloths, hands and applanation tonometers are some examples
of how this can easily be transmitted.
• Prevention of allergic conjunctivitis is not possible unless the patient is able to change
his or her environment or job or identify the allergen causing the allergy and remove
it, e.g., pollen, animal fur.
• Drugs can cause an allergy that is reversed by stopping the drug.
• Atropine, neomycin and eye drop preservatives are particularly common causes of
such drug reactions.

Conjunctivitis

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