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Infective Conjunctivitis acute follicular conjunctivitis associated with mucopurulent discharge. sexually active young adults..pptx

acute follicular conjunctivitis associated with mucopurulent discharge. sexually active young adults.

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INFECTIVE CONJUNCTIVITIS
CLASSIFICATION • BASED ON ONSET 1. Acute – resolves less than 4 weeks 2. Subacute 3. Chronic more than 4 weeks duration of infection
CLASSIFICATION • BASED ON TYPE OF EXUDATE 1. SEROUS – Viral , allergic , toxic 2. Catarrhal (Allergic) 3. Purulent (Bacterial) 4. Mucopurulent (bacterial, chlamydial) 5. Membranous (Bacterial) 6. Pseudomembranous (Bacterial)
• BASED ON CONJUNCTIVAL RESPONSE 1. Follicular (Viral, Chlamydial) 2. Papillary (Allergic) 3. Granulomatous (fungal, Parinaud Oculoglandular syndrome, TB, Syphilis, Sarcoidosis , tularaemia, parasitic, foreign body)
FOLLICULAR CONJUNCTIVITIS • ROUND TO OVAL ELEVATIONS , 0.5 TO 1.5MM IN DIA , MORE OFTEN IN SUPERIOR AND INFERIOR TARSAL CONJUNCTIVA • ACUTE – VIRAL (EBV, HERPES), CHLAMYDIAL • CHRONIC - CHRONIC CHLAMYDIAL INFECTION • FOLLICLES ARE LYMPHOID GERMINAL CENTRES WITH AVASCULAR APICES AND FINE VESSELS AT BASE , ALONG WITH REGIONAL LYMPHADENOPATHY
FOLLICULAR CONJUNCTIVITIS
PAPILLARY CONJUNCTIVITIS • NONSPECIFIC DUE TO MULTIPLE ETIOLOGY • FOUND MORE IN UPPER TARSAL CONJUNCTIVA • FINE MOSAIC PATTERN OF DILATED TELANGIECTATIC VESSELS
PAPILLARY CONJUNCTIVITIS
GRANULOMATOUS CONJUNCTIVITIS • PROLIFERATIVE LESIONS THAT REMAIN LOCALISED TO ONE EYE USUALLY 1. TUBERCULOSIS OF CONJ 2. SARCOIDOSIS OF CON 3. SYPHILITIC CONJUNCTIVITIS 4. LEPROTIC CONJUNCTIVITIS 5. OPHTHALMIA NODOSA 6. CONJUNCTIVITIS IN TULARAEMIA
• BASED ON ETIOLOGY 1. INFECTIOUS – Bacterial , viral, Chlamydial, Fungi, Parasitic 2. NON-INFECTIOUS (TOPIC FOR ANOTHER DAY)
INFECTIOUS CONJUNCTIVITIS • BACTERIAL – STAPH AUREUS AND ALBUS, HAEMOPHILUS AEGYPTICUS, H. INFLUENZA, N. GONORRHEA, N. MENGITIDIS , E. COLI, STREPTO. PYOGENES, PROTEUS. S.PNEUMONIAE • VIRAL – HERPES SIMPLEX, ADENO, PICORNA (COXACKIE AND ENTERO 70), MYXOVIRUS (MEASLES), MOLLUSCUM CONTAGIOSUM • CHLAMYDIAL- TRACHOMA (A , B &C) INCLUSION CONJUNCTIVITIS (D-K) LYMPHOGRANULOMA VENEREUM (L1 , L2 AND L3) • FUNGAL (UNCOMMON) – CANDIDA, ASPERGILLUS, NOCARDIA • PARASITIC
INFECTIOUS CONJUNCTIVITIS • COMMONEST • DUE TO DEFEAT OF FOLLOWING PROTECTIVE MECHANISMS : 1. LOW TEMPERATURE (DUE TO EXPOSURE TO AIR) 2. LIDS (PHYSICAL PROTECTION) 3. LYSOSYMES 4. FLUSHING ACTION BY TEARS 5. SECREORY IMMUNOGLOBULINS
ETIOLOGY • PREDISPOSING FACTORS: 1. FLIES 2. DIRTY HABITS 3. HOT DRY CLIMATE 4. POOR SANITATION 5. POOR HYGIENE
COMMON CAUSATIVES • STAPH AUREUS – MCC OF BACTERIAL AND BLEPHAROCONJUNCTIVITIS • STAPH EPIDERMIDIS (INNOCUOUS FLORA OF CONJUNCTIVA) • STREPTO PNEUMONIAE – ASSOC WITH PETECHIAL SUBCONJUNCTIVAL HEMORRHAGE • STREPTO PYOGNENES – PSEUDOMEMBRANOUS • HEMOPHILUS AEGYTPTICUS – MUCOPURULENT , RED EYE • MORAXELLA LACUNATE (ANGULAR CONJUNCTIVITIS) • PSEUDOMONAS PYOCYANEA – INVADES CORNEA • CORYNEBACTERIUM DIPTHERIAE- MEMBRANOUS CONJUNCTIVITIS • NEISSERIA GONORRHEA – OPHTHALMIA NEONATORUM IN CHILDREN PURULENT CONJUNCTIVITIS IN ADULTS • NEISSERIA MENINGITIDIS - MUCOPURULENT
MODE OF SPREAD DIRECT CONTACT VECTOR (FLIES) FOMITES EXOGENOUS LOCAL SORROUNDINGS ENDOGENOUS INFECTED LACRIMAL SAC INFECTED NASOPHARYNX INFECTED LID THROUGH BLOOD (M. COCCI AND G. COCCI) MODE OF SPREAD
PATHOLOGICAL CHANGES • VASCULAR RESPONSE – CONGESTION , CAPILLARY PROLIFERATION, INCREASED VASCULAR PERMEABILITY. • CELLULAR CHANGES – EXUDATION OF PMNL SUBSTANTIA PROPRIA OF CONJUNCTIVA AND CONJUNCTIVAL SAC • CONJUNCTIVAL TISSUE RESPONSE- BECOMES EDEMATOUS , DESQUAMATION OF SUPERFICIAL EPITHELIAL CELLS , PROLIFERATION OF BASAL CELLS • CONJUNCTIVAL DISCHARGE – TEA, FIBRIN , BACTERIA , INFLAMMATORY CELLS, DESQ EPITHELIAL CELLS , AND BLOOD STAINED DUE TO RBC DIAPEDESIS
BACTERIAL CONJUNCTIVAL Assoc with CATARRHAL (MUCOPURULENT) Assoc with PURULENT Assoc with membranous Assoc with pseudomembranous Angular
ACUTE MUCOPURULENT CONJUNCTIVITIS • MOST COMMON • MARKED CONJUNCTIVAL HYPERAEMIA • MUCOPURULENT DISCHARGE FROM EYE • CAUSATIVE ORGANISMS : 1. STAPH. AUREUS 2. H. AEGYPTICUS 3. PNEUMOCOCCUS 4. STREPTOCOCCUS 5. EXANTHEMATA IN MEASLES AND SCARLET FEVER
SYMPTOMS • ENGORGED VESSELS CAUSES DISCOMFORT AND FOREIGN BODY SENSATION • MUCOPURULENT D/C CAUSING STICKING OF LIDS AFTER SLEEP • MILD PHOTOPHOBIA • DUE TO MUCOUS FLAKES – BLURRING OF VISION AND COLORED HALOS DUE TO ITS PRISMATIC EFFECT
SIGNS • FLAKES OF MUCOUS IN FORNICES , CANTHI AND LID MARGINS • MATTED TOGETHER CILIA WITH YELLOW CRUSTS • CONJUNCTIVAL CONGESTION • CHEMOSIS • PETECHIAL HEMORRHAGES IN PNEUMOCOCCUS
CLINICAL COURSE 1. PEAK IN 3-5 DAYS 2. RESOLVES IN MILD CASES OR BECOMES 3. LESS INTENSE AS IN CATARRHAL CONJUNCTIVITIS
COMPLICATIONS • MARGINAL CORNEAL ULCER • SUPERFICIAL KERATITIS • BLEPHARITIS • DACROCYSTITIS
TREATMENT • TOPICAL ANTIBIOTICS : CHLORAMPHENICOL (1%), GENTAMYCIN (0.3%) IF INEFFECTIVE CIPRO (0.3%), OFLOXACIN (0.3%), GATIFLOXACIN (0.3%) • IRRIGATION OF CONJUNCTIVAL SAC : WITH STERILE WARM SALINE ONCE OR TWICE A DAY FREQUENT EYEWASH IS CONTRAINDICATED (WASHES OF LYSOSYMES AND PROTECTIVE PROTEINS ) • DARK GLASS FOR PHOTOPHOBIA • NO BANDAGE (DECREASE IN EXPOSURE  INCREASE IN TEMP  INCREASE IN BACTERIAL GROWTH ) • ANTI INFLAMMATORY AND ANALGESICS •
ACUTE PURULENT CONJUNCTIVITIS • ASSOCIATED WITH BLENORRHEA , HYPER ACUTE CONJUNCTIVITIS • 2 FORMS : 1. ADULT PURULENT CONJUNCTIVITIS 2. OPHTHALMIA NEONATORUM
ADULT PURULENT CONJUNCTIVITIS • ADULTS MAINLY MALES , DIRECT SPREAD FROM GENITALS, CAUSED BY NEISSERIA GONORRHEA , STAPH AUREUS AND PNEUMOCOCCUS (RARE) • CLINICALLY 3 STAGES • STAGE OF INFILTRATION – LASTS FOR 4 TO 5 DAYS, PAINFUL TENDER EYE, BRIGHT RED CHEMOSED CONJUNCTIVA , WATER/SANGINOUS D/C , PREAURICULAR LN + • STAGE OF BLENORRHEA – 5TH DAY TO SEVERAL DAYS , PURULENT D/C DOWN CHEEKS • STAGE OF SLOW HEALING – PAIN AND D/C DECREASES BUT CONJUNCTIVA REMAINS RED VELVETY THICK • CLINICALLY ASSOCIATED WITH URETHRITIS AND ARTHRITIS
COMPLICATIONS • CORNEAL INVOLVEMENT : DUE TO INABILITY TO INVADE NORMAL CORNEA DIFFUSE HAZE ENSUES WITH YELLOW / GREY SPOTS AT CENTER , EDEMA , CENTRAL NECROSIS DUE TO SUCCESSFUL INVASION , ULCERATION AND PERFORATION • IRITIS AND IRIDOCYCLITIS • SYSTEMIC COMPLICATIONS : SEPTICEMIA , ENDOCARDITIS AND ARTHRITIS
TREATMENT • SYSTEMIC THERAPY • NORFLOXACIN 1.2 MG ORALLY QID X 5 DAYS • CEFOXITIM 1 GM IV X 5 DAYS , CEFOTAXIME 500MG IV X5 DAYS, CEFTRIAXONE 1.2 GM IM QID X 5 DAYS • ANY OF ABOVE WITH - ERYTHROMYCIN 250 MG QID FOR X 1 WEEK OR DOXYCYCLINE 100MG ORALLY • TOPICAL ANTIBIOTICS CIPRO, OFLOXACIN , TOBRAMYCIN EYEDROPS EVERY 2 HRS FIRST 2 -3 DAYS F/B 5 TIMES DAILY BACITRACIN OR ERYTHROMYCIN OINTMENT FOR 7 DAYS
• IRRIGATION USING STERILE SALINE – REMOVES INFECTED DEBRIS • TROPICAL ATROPINE (1%) 2 TIMES DAILY IF CORNEAL INVOLVEMENT • SCREEN PARTNER FOR STD
ACUTE MEMBRANOUS CONJUNCTIVITIS • TRUE MEMBRANE FORMATION BLEEDS ON PEELING • CAUSED BY - CORYNEBACTERIUM DIPHTHERIAE BETA – HEMOLYTIC STREPTOCOCCI, N.GONORRHEAE, H.AEGYPTICUS, S.AUREUS, E. COLI, VIRAL INFECTION , THERMAL AND CHEMICAL BURNS
ACUTE MEMBRANOUS CONJUNCTIVITIS
PATHOGENESIS
CLINICAL FEATURES • USUALLY CHILDREN 2-8 YEARS OLD (NOT IMMUNISED)  TOXIC AND FEBRILE 1. STAGE OF INFILTRATION : • SCANTY D/C AND SEVERE PAIN • SWOLLEN AND HARD LIDS , RED SWOLLEN CONJUNCTIVA COVERED WITH GREY YELLOW MEMBRANE WHICH BLEEDS ON REMOVAL • PRE AURICULAR LN + 2. STAGE OF SUPPURATION – • PAIN DECREASES , MEMBRANE SLOUGHS OFF AND LIDS BECOME SOFT • COPIOUS PURULENT D/C 3. STAGE OF CICATRIZATION – • RAW SURFACE COVERED WITH GRANUATION TISSUE AND EPITHELISED • TRICHIASIS , CONJUNCTIVAL XEROSIS
COMPLICATIONS • CORNEAL ULCER • DELAYED – CICATRIZATION  SYMBLEPHARON , TRICHIASIS , ENTROPION, AND CONJUNCTIVAL XEROSIS • DIAGNOSIS BY BACTERIOLOGICAL EXAMINATION
TREATMENT • TOPICAL : 1. PENICILLIN 1:10000 UNIT /ML EVERY 30 MINS 2. ANTI DIPHTHERIC SERUM EVERY 1 HR 3. ATROPINE 1% OINT IF CORNEAL INVOLVEMENT 4. BROAD SPECTRUM ANTIBIOTIC AT BEDTIME • SYSTEMIC : • CRYSTALLINE PENICILLIN 5 LAC UNITS IM BD X 10 DAYS • ANTI – DIPHTHERIC SERUM 50K UNITS IM STAT • TO PREVENT SYMBLEPHARON – APPLY CONTACT SHELL OR SWEEP GLASS ROD WITH OINTMENT • PROPHYLAXIS – ISOLATION OF PATIENT AND IMMUNISATION AGAINST DIPHTHERIA
ACUTE PSEUDOMEMBRANOUS CONJUNCTIVITIS • ETIOLOGY : • BACTERIAL – C. DIPHTHERIAE, STAPH, STREPTO, H. INFLUENZA AND N. GONORRHEA • VIRAL – HERPES SIMPLEX AND ADENO VIRUS • CHEMICAL – ACID , AMMONIA , LIME, COPPER SULPHATE AND SILVER NITRATE • CLINICALLY – ACUTE MUCOPURULENT CONJUNCTIVITIS WITH PSEUDO-MEMBRANE FORMATION • TREATMENT SAME AS MUCOPURULENT CONJUNCTIVITIS
CHRONIC CATARRHAL CONJUNCTIVITIS • ETILOGY : 1. PREDISPOSING FACTORS – CHRONIC EXPOSURE TO DUST, SMOKE, CHEMICAL IRRITANTS 2. LOCAL IRRITANTS SUCH AS TRICHIASIS AND CONCRETIONS , FB 3. ALCOHOL ABUSE • CAUSATIVE AGENTS: 1. STAPH AUREUS 2. GRAM NEG BACILLI – PROTEUS , KLEBSIELLA PNEUMONIAE , E. COLI AND MORAXELLA
SOURCE AND MODE OF INFECTION • AS A SEQUALAE OF UNTREATED ACUTE MUCOPURULENT CONJUNCTIVITIS • AS CHRONIC INFECTION FROM DACROCYSTITIS, ASSOC RHINITIS , URI • AS MILD INFECTION FOR EXOGENOUS DIRECT CONTACT / AIRBORNE
SYMPTOMS AND SIGNS • SYMPTOMS : 1. BURNING AND GRITTINESS OF EYES, SPECIALLY IN EVENING 2. MILD CHRONIC REDNESS 3. DRYNESS AND HEATED FEELING OF EYELIDS 4. MILD MUCOUS D/C 5. SLEEPINESS AND TIREDNESS OF EYES • SIGNS : 1. CONGESTION OF POSTERIOR CONJUNCTIVAL VESSELS 2. MILD PAPILLARY HYPERTROPHY 3. SURFACE OF CONJUNCTIVA LOOKS STICKY WITH CONGESTED LID MARGINS
TREATMENT • ELIMINATION OF PREDISPOSING CAUSE • TOPICAL ANTIBIOTIC : CHLORAMPHENICOL / GENTAMYCIN 3-4 TIMES A WEEK • ASTRINGENT EYE DROPS : ZINC BORIC ACID FOR SYMPTOMATIC RELIEF
ANGULAR CONJUNCTIVITIS (DIPLOBACILLARY) • CHRONIC CONJUNCTIVITIS CONFINED TO THE CONJUNCTIVA AND LID MARGINS NEAR ANGLES • ASSOCIATED WITH MACERATION OF NEARBY SKIN
ETIOLOGY • PREDISPOSING FACTORS : ‘SIMPLE CHRONIC CONJUNCTIVITIS’ • CAUSATIVE AGENTS :MORAXELLA AXENFELD (COMMON) – END TO END PLACED DIPLOBACILLI STAPHYLOCOCCI (RARE) • SOURCE OF INFECTION : NASAL CAVITY • MODE OF INFECTION : NASAL CAVITY TO EYE VIA CONTAMINATED FINGERS/KERCHIEF
PATHOLOGY
SYMPTOMS AND SIGNS • SYMPTOMS : 1. IRRITATION, DISCOMFORT 2. COLLECTION OF FOAMY WHITE D/C AT ANGLES 3. REDNESS AT ANGLE OF EYE • SIGNS: 1. HYPERAEMIA OF BULBAR CONJUNCTIVA NEAR CANTHI 2. HYPERAEMIA OF LID MARGINS NEAR ANGLES 3. EXCORIATION OF SKIN AROUND ANGLES 4. PRESCENCE OF FOAMY MUCOPURULENT D/C AT ANGLES
COMPLICATIONS • BLEPHARITIS • MARGINAL CATARRHAL CORNEAL ULCERATION • TREATMENT: • GOOD PERSONAL HYGIENE AND TREATMENT OF NASAL INFECTION • OXYTETRACYLINE 1% EYE OINTMENT 2-3 TIMES X 10-14 TIMES DAYS • ZINC LOTION AT DAYTIME AND ZINC OXIDE AT BEDTIME
CHLAMYDIAL CONJUNCTIVITIS TYPES OF INFECTIONS BY CHLAMYDIA
CHLAMYDIAL CONJUNCTIVIS
• Keratoconjunctivitis, • Primarily affecting the superficial epithelium of conjunctiva & cornea simultaneously. • mixed follicular & papillary response of conjunctival tissue. • one of the leading causes of preventable blindness in the world. TRACHOMA
SOURCE OF INFECTION: • Conjunctival discharge of affected person • Superimposed bacterial infection increased secretions more spread Etiology CAUSITIVE ORGANISM: • Chlamydia trrachomatis (Psittacosis- lymphogranulomatous group) • 11 serotypes (A to K) MODES OF INFECTION: • Direct spread by air-borne or water-borne modes • Vector transmission by flies • Maternal transfer through contaminated fingers, clothes, bedding etc PREDISPOSING FACTORS: • Age: commonly in infancy & childhood, but age no bar • Sex: more in females • Race: very common in Jews • Climate: dry & dusty weather favors • Socio-economic status: more in poor classes • Environmental: exposure to dust, irritants, smoke, sunlight etc
• Incubation period:  5-21 days, mostly insidious onset • Clinical course: 1. Pure trachoma is mild & symptomless, often neglected 2. If superimposed with bacterial infection, presents with typical bacterial conjunctivitis • Natural History: 3. Development of acute disease in 1st decade of life 4. Continues with slow progression 5. Becomes inactive in 2nd decade 6. Sequelae occurs after 20 years of disease 7. Peak incidence of blindness in 4th or 5th decade CLINICAL PROFILE
• Without secondary bacterial infection: 1. Minimal or asymtomatic 2. Mild FB sensation 3. Occasional lacrimation 4. Stickiness of lids 5. Scanty mucoid discharge • With secondary bact infection: All typical symptoms of acute bacterial conjunctivitis SYMPTOMS
Conjunctival signs: • Congestion of upper tarsal and fornicial conjunctiva • Conjunctival follicles • Papillary hyperplasia • Conjunctival scarring • Concretions Corneal signs: • Superficial keratitis • Herbert follicles • Pannus • Corneal ulcer • Herbert Pits • Corneal opacity SIGNS
CONJUNCTIVAL FOLLICLES: • BOILED SAGO-GRAINS LIKE APPEARANCE 1. UPPER TARSAL CONJUNCTIVA 2. ALSO ON BULBAR CONJUNCTIVA ALSO (PATHOGNOMONIC OF TRACHOMA ) • CENTRAL PART  MONONUCLEAR HISTIOCYTES,+ FEW LYMPHOCYTES AND LARGE MULTINUCLEATED CELLS ( LEBER CELLS). • THE CORTICAL PART  A ZONE OF LYMPHOCYTES SHOWING ACTIVE PROLIFERATION. • BLOOD VESSELS ARE PRESENT IN THE MOST PERIPHERAL PART • SIGNS OF NECROSIS +
CONJUNCTIVAL PAPILLAE: • REDDISH FLAT TOPPED RAISED AREAS • GIVES RED VELVETY APPEARANCE TO TARSAL CONJUNCTIVA • CENTRAL CORE OF NUMEROUS DILATED BLOOD VESSELS SURROUNDED BY LYMPHOCYTES AND COVERED BY HYPERTROPHIC EPITHELIUM
CONJUNCTIVAL PAPILLAE:
CONJUNCTIVAL SCARRING • WHICH MAY BE IRREGULAR, STAR-SHAPED OR LINEAR. • LINEAR SCAR PRESENT IN THE SULCUS SUBTARSALIS } ARLT'S LINE.
Concretions due to accumulation of dead epithelial cells & inspissated mucus in the depressions called glands of Henle.
CONJUNCTIVAL CONCRETIONS • DUE TO ACCUMULATION OF DEAD EPITHELIAL CELLS & INSPISSATED MUCUS IN THE DEPRESSIONS CALLED GLANDS OF HENLE.
CORNEAL SIGNS • Superficial keratitis in the upper part. .
Infiltration of cornea is ahead of vascularization. Vessels extend a short distance beyond the area of infiltration. Pannus formation Infiltration of cornea + vascularization Pannus aggressive Regressive
Corneal ulcer • develop at the advancing edge of pannus.
Corneal opacity • Corneal opacity • in the upper part. • extend down and involve the pupillary area.
Herbert’s follicles  typical follicles present in the limbal area.
Herberts pits  oval or circular brown pitted scars, left after healing of Herbert follicles in the limbal area
McCallan’s Classification: STAGE 1: Incipient Trachoma / stage of infiltration • Hyperemia of conjunctiva & immature follicles STAGE 2: Established Trachoma / stage of florid infiltration • Mature follicles, papillae, progressive pannus STAGE 3: Cicatrising Trachoma / stage of scarring • Obvious scarring of palpebral conjunctiva STAGE 4: Healed Trachoma / stage of sequelae • Disease is cured • Sequelae results in symptoms
DIAGNOSIS • CLINICAL: • GRADING TO BE DONE AS PER WHO CLASSIFICATION • AT LEAST 2 SETS OF SIGNS SHOULD BE PRESENT: 1. CONJUNCTIVAL FOLLICLES AND PAPILLAE 2. PANNUS 3. EPITHELIAL KERATITIS NEAR SUPERIOR LIMBUS 4. SIGNS & SEQUELAE OF CICATRIZATION
LABORATORY • CONJUNCTIVAL CYTOLOGY  POLYMORPHONUCLEAR REACTION WITH PRESENCE OF PLASMA CELLS AND LEBER CELLS IN GEIMSA • DETECTION OF INCLUSION BODIES GIEMSA STAIN, IODINE STAIN OR IF STAINING • ELISA FOR CHLAMYDIAL ANTIGENS • PCR • ISOLATION & SEROTYPING OF ORGANISM
1. Trachoma with follicular hypertrophy • follicles in trachoma upper palpebral conjunctiva and fornix • papillae and pannus+ • Laboratory diagnosis of trachoma helps in differentiation. 2. Acute adenoviral follicular conjunctivitis (epidemic keratoconjunctivitis) • follicles in EKC Lower palpebral conjunctiva and fornix DIFFERENTIAL DIAGNOSIS
3. Trachoma with predominant papillary hypertrophy • pH of tears in trachoma it is acidic, • follicles and pannus+ • Conjunctival cytology and other laboratory tests for trachoma usually help in diagnosis. 4. palpebral form of spring catarrh • Papillae are large in spring catarrh • typical cobble-stone arrangement in spring catarrh. • pH of tears is usually alkaline in spring catarrh • Discharge is ropy in spring catarrh
MANAGEMENT: • Treatment of Active Trachoma: 1. Topical therapy:  1% tetracycline / 1% erythromycin eye ointment 4 times daily for 6 weeks 2. Systemic therapy:  Tetracycline / erythromycin 250mg QID orally for 4 weeks  Or Docycline 100mg BD orally for 4 weeks  Or single dose of Azithromycin orally 3. Combined therapy:  Preferred when severe disease  Or associated genital infection is present.
• MANAGEMENT: 1. Treatment of Sequelae: •Removal of concretions • Epilation / electrolysis of trichasis • Surgical correction of entropion • Lubricating drops for xerosis 2. Prophylaxis: • Hygiene measures • Early treatment of conjunctivitis • Blanket antibiotic therapy in endemic areas: • 1 % tetracycline ointment BD for 5 days in a month for 6 months
MANAGEMENT • SAFE Strategy for Trachoma Blindness: • Surgery to correct eyelid deformity & prevent blindness • Antibiotics for acute infections & community control • Facial Hygiene • Environmental changes
ADULT INCLUSION CONJUNCTIVITIS • ACUTE FOLLICULAR CONJUNCTIVITIS ASSOCIATED WITH MUCOPURULENT DISCHARGE. SEXUALLY ACTIVE YOUNG ADULTS. • ETIOLOGY CAUSED BY  D TO K OF CHLAMYDIA TRACHOMATIS. • SOURCE OF INFECTION  URETHRITIS IN MALES AND CERVICITIS IN FEMALES. • THE TRANSMISSION  CONTAMINATED FINGERS OR MORE  CONTAMINATED WATER OF SWIMMING POOLS (SWIMMING POOL CONJUNCTIVITIS)
Incubation Period: • 4-12 days • Symptoms: • Ocular discomfort, foreign body sensation • Mild photophobia • Mucopurulent discharge from the eyes • Signs: • Conjunctival hyperaemia, marked in fornices. • Acute follicular hypertrophy predominantly of lower palpebral conjunctiva • Superficial keratitis in upper half • Superior micropannus occasionally • Pre-auricular lymphadenopathy
• Treatment: • Topical therapy  Tetracycline 1 % eye ointment QID for 6 weeks • Systemic therapy: 1. • Very important 2. • Tetracycline 250 mg four times a day for 3-4 weeks. 3. • Erythromycin 250 mg four times a day for 3-4 weeks 4. • Doxycycline 100 mg twice a day for 1-2 weeks 200 mg weekly for 3 weeks 5. • Azithromycin 1 gm as a single dose
VIRAL CONJUNCTIVITIS
VIRAL CONJUNCTIVITIS • CLASSIFICATION BASED ON CLINICAL PRESENTATION: 1. ACUTE SEROUS CONJUNCTIVITIS 2. ACUTE HEMORRHAGIC CONJUNCTIVITIS 3. ACUTE FOLLICULAR CONJUNCTIVITIS
ACUTE SEROUS CONJUNCTIVITIS • ETIOLOGY MILD GRADE FEVER INFECTION WHICH DOES NOT GIVE A FOLLICULAR RESPONSE • CLINICAL FEATURES : MINIMAL CONGESTION, WATERY DISCHARGE + BOGGY SWELLING OF CONJUNCTIVA MUCOSA • TREATMENT: SELF LIMITING TO PREVENT SECONDARY BACTERIAL INFECTION , BROAD SPECTRUM ANTIBIOTIC 3 TIMES A DAY FOR A WEEK
ACUTE HEMORRHAGIC CONJUNCTIVITIS • ALSO KNOWN AS APOLLO CONJUNCTIVITIS • MULTIPLE CONJUNCTICAL HEMORRHAGES , CONJUNCTICAL HYPERAEMIA AND MILD FOLLICULAR HYPERPLASIA • ETIOLOGY : PICORNAVIRUS (ENTEROVIRUS TYPE 70 ) TRANSMITTED BY DIRECT HAND TO EYE CONTACT.
CLINICAL PICTURE • INCUBATION PERIOD : 1-2 DAYS • SYMPTOMS : PAIN , REDNESS, WATERING , MILD PHOTOPHOBIA , TRANSIENT BLURRING OF VISION AND LID SWELLING • SIGNS : CONJUNCTIVAL CONGESTION , CHEMOSIS , MULTIPLE HEMORRHAGES IN BULBAR CONJUNCTIVA , MILD FOLLICULAR HYPERPLASIA , LID EDEMA AND PRE AURICULAR LYMPHADENOPATHY CORNEAL INVOLVEMENT : FINE EPITHELIAL KERATITIS
TREATMENT • SELF LIMITING COURSE OF 5-7 DAYS • NO SPECIFIC EFFECTIVE CURATIVE TREATMENT KNOWN . • BROAD SPECTRUM EYEDROPS TO PREVENT SECONDARY BACTERIAL INFECTIONS.
FOLLICULAR CONJUNCTIVITIS
FOLLICULAR CONJUNCTIVITIS • FOLLCLES ARE TINY WHITE TRANSLUCENT WHITE ROUND SWELLINGS 1-2 MM IN DIAMETER THAT RESEMBLE SAGOGRAINS • LOCALISED AGGREGATION OF LYMPHOCYTES IN THE ADENOID LAYER OF CONJUNCTIVA .
TYPES OF FOLLICULAR CONJUNCTIVITIS • ACUTE FOLLICULAR CONJUNCTIVITIS • CHRONIC FOLLICULAR CONJUNCTIVITIS • SPECIFIC TYPE OF CONJUNCTIVITIS WITH FOLLICLE FORMATION EX: TRACHOMA
ACUTE FOLLICULAR CONJUNCTIVITIS • AN ACUTE CATARRHAL CONJUNCTIVITIS • ASSOC WITH MARKED FOLLICULAR HYPERPLASIA ESPECIALLY IN LOWER FORNIX AND LOWER PALPEBRAL CONJUNCTIVA • SYMPTOMS AND SIGNS : 1. REDNESS, WATERING, MILD MUCOID DISCHARGE 2. MILD PHOTOPHOBIA AND FEELING OF DISCOMFORT 3. FOREIGN BODY SENSATION • SIGNS : 1. CONJUNCTIVAL HYPERAEMIA 2. MULTIPLE FOLLICLES FOUND MORE IN LOWER LID THAN UPPER LID
ACUTE FOLLICULAR CONJUNCTIVITIS
ETIOLOGICAL TYPES OF FOLLICULAR CONJUNCTIVITIS • ADULT INCLUSION CONJUNCTIVITIS • EPIDEMIC CONJUNCTIVITIS • PHARYNGOCONJUNCTIVAL FEVER • NEWCASTLE CONJUNCTIVITIS • ACUTE HERPETIC CONJUNCTIVITIS
EPIDEMIC KERATOCONJUNCTIVITIS • ACUTE FOLLICULAR CONJUNCTIVITIS ALONG WITH SUPERFICIAL PUNCTATE KERATITIS • AS EPIDEMIC  EPIDEMIC KERATOCONJUNCTIVITIS • ETIOLOGY 1. ADENOVIRUS TYPE 8 AND 19 2. SPREADS THROUGH CONTACT WITH CONTAMINATED FINGERS SOLUTIONS AND TONOMETER 3. INCUBATION PERIOD IS 8 DAYS AND VIRUS IS SHED FOR 2-3 WEEKS
CLINICAL PICTURE Pre – Auricular Lymphadenopathy seen in all cases
PHARYNGOCONJUNCTIVAL FEVER • ETIOLOGY : ADENOVIRUS SUBTYPE 3 AND 7 • CLINICAL PICTURE : 1. ACUTE FOLLICULAR CONJUNCTIVITIS 2. PHARYNGITIS 3. FEVER AND PREAURICULAR LYMPHADENOPATHY 4. SUPERFICIAL PUNCTATE KERATITIS SEEN IN 30% • TREATMENT : SUPPORTIVE
ACUTE HERPETIC CONJUNCTIVITS • ASSOC WITH PRIMARY HERPETIC INFECTION • MAINLY SEEN IN SMALL CHILDREN AND ADOLESCENTS • ETIOLOGY : 1. HSV TYPE 1 SPREADS BY KISSING OR OTHER CLOSE PERSONAL CONTACTS 2. HSV TYPE 2 (RARE) 3. USUALLY UNILATERAL • INCUBATION PERIOD 3 – 10 DAYS
CLINICAL PICTURE • CAN BE EITHER TYPICA OR ATYPICAL • PREAURICULAR LN + • CORNEAL INVOLVEMENT +
CHRONIC FOLLICULAR CONJUNCTIVITIS • MILD CATARRHAL TYPE WITH FOLLICLES PREDOMINANTLY IN LOWER PALPEBRAL CONJUNCTIVA • ETIOLOGY : 1. INFECTIVE (BENIGN FOLLICULOSIS) 2. TOXIC : DUE TO CELLULAR DEBRIS IN MOLLUSCUM CONTAGIOSUM 3. CHEMICAL : PROLONGED USE OF PILOCARPINE, IDU , ADRENALINE 4. ALLERGIC (LESS COMMON)
OPHTHALMIA NEONATORUM • BILATERAL INFLAMMATION OF CONJUNCTIVA OCCURRING IN AN INFANT (<30 DAYS OLD) • ANY DISCHARGE OR EVEN WATER FROM EYE IN THE FIRST WEEK OF LIFE  OPHTHALMIA NEONATORUM ! AS TEARS ARE NOT FORMED TILL THEN. • SOURCE OF INFECTION: 1. BEFORE BIRTH – INFECTED AMNIOTIC LIQUOR IN RUTPTURED MEMBRANE 2. DURING BIRTH- INFECTED BIRTH CANAL (FACE PRESENTATION , FORCEPS DELIVERY) 3. AFTER BIRTH  DURING FIRST BATH OF NEWBORN FROM SOILED CLOTHES/FINGERS WITH WITH INFECTED LOCHIA
CAUSATIVE ORGANISM • HERPES SIMPLEX OPHTHALMIA NEONATORUM (HSV 2) (INCUBATION PERIOD – 5 -7 DAYS) • CHEMICAL CONJUNCTIVITIS  SILVER NITRATE (IP : 4-6 HRS) • GONOCOCCAL (2-4 DAYS) • OTHER BACTERIAL  STAPH AUREUS , STREPTOCOCCUS HEMOLYTICUS , STREPTOCOCCUS PNEUMONIAE (IP : 4-6 DAYS) • NEONATAL INCLUSION CONJUNCTIVITIS : SEROTYPES D TO K OF CHLAMYDIA TRACHOMATIS (IP : 5-7 DAYS)
CLINICAL PICTURE • SIGNS : 1. PAIN AND TENDER EYEBALL 2. PURULENT CONJUNCTIVAL DISCHARGE (GONOCOCCAL) 3. MUCOID/MUCOPURULENT (OTHER BACT INFECTION) 4. SWOLLEN LIDS 5. CONJUNCTIVAL CHEMOSIS 6. CORNEAL INVOLVEMENT RARELY • COMPLICATIONS : CORNEAL ULCERATION WITH PERFORATION TENDANCY
OPHTHALMIA NEONATORUM
PROPHYLAXIS • ANTENATAL : TREATMENT OF GENITAL INFECTION OF MOTHER • NATAL : DELIVERY UNDER ASEPTIC CONDITIONS AND NEWBORN EYELIDS SHOULD BE WELL CLEANED • POST NATAL : 1% TETRACYCLINE /0.5% ERYTHROMYCIN OINTMENT • 1% SILVER NIRTRATE SOLUTION (CREDE’S METHOD) • SINGLE INJECTION OF CEFTRIAXONE 50 MG/KG IM/IV
TREATMENT 1. GONOCOCCAL : A. TOPICAL – • SALINE LAVAGE • BACITRACIN OINTMENT QID, PENICILLIN DROPS 5K – 10K UNITS PER ML PER MIN FOR 30MINS F/B ONCE IN EVERY 5 MINS FOR 30 MINS F/B EVERY 30 MINS ONCE TILL INFECTION IS CONTROLLED • ATROPINE OINT IF CORNEA IS INVOLVED B. SYSTEMIC – • CEFTRIAXONE 75 - 100 MG/KG/DAY IV/IM QID • CEFOTAXIME 100-150 MG/KG/DAY IV/IM BD • IF GONOCOCCAL : CRYSTALLINE BENZYL PENICILLIN G 50K UNITS FOR FULL TERM BABIES IM BD X 3 DAYS
2. OTHER BACTERIAL INFECTION : • BROAD SPECTRUM ANTIBIOTIC DROPS / OINTMENT X 2 WEEKS • NEONATAL INCLUSION CONJUNCTIVITIS • TOPICAL TETRACYCLINE / ERYTHROMYCIN 125 MG QID X 3 DAYS • HERPES SIMPLEX : TOPICAL ANTIVIRALS
GRANULOMATOUS INFECTIONS
Parinaud's oculoglandular syndrome 1. Unilateral granulomatous conjunctivitis (nodular elevations surrounded by follicles), 2. Preauricular lymphadenopathy, and 3. Fever. 4. Causes  tularaemia, cat-scratch disease, tuberculosis, syphilis and lymphogranuloma venereum
OPHTHALMIA NODOSA (CATERPILLAR HAIR CONJUNCTIVITIS) • GRANULOMATOUS INFLAMMATION OF THE CONJUNCTIVA FORMATION OF A NODULE ON THE BULBAR CONJUNCTIVA IN RESPONSE TO IRRITATION CAUSED BY THE RETAINED HAIR OF CATERPILLAR. • HISTOPATHOLOGICAL EXAMINATION HAIR SURROUNDED BY GIANT CELLS AND LYMPHOCYTES. • TREATMENT  EXCISION BIOPSY OF THE NODULE

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Infective Conjunctivitis acute follicular conjunctivitis associated with mucopurulent discharge. sexually active young adults..pptx

  • 1.
  • 2.
    CLASSIFICATION • BASED ONONSET 1. Acute – resolves less than 4 weeks 2. Subacute 3. Chronic more than 4 weeks duration of infection
  • 3.
    CLASSIFICATION • BASED ONTYPE OF EXUDATE 1. SEROUS – Viral , allergic , toxic 2. Catarrhal (Allergic) 3. Purulent (Bacterial) 4. Mucopurulent (bacterial, chlamydial) 5. Membranous (Bacterial) 6. Pseudomembranous (Bacterial)
  • 4.
    • BASED ONCONJUNCTIVAL RESPONSE 1. Follicular (Viral, Chlamydial) 2. Papillary (Allergic) 3. Granulomatous (fungal, Parinaud Oculoglandular syndrome, TB, Syphilis, Sarcoidosis , tularaemia, parasitic, foreign body)
  • 5.
    FOLLICULAR CONJUNCTIVITIS • ROUNDTO OVAL ELEVATIONS , 0.5 TO 1.5MM IN DIA , MORE OFTEN IN SUPERIOR AND INFERIOR TARSAL CONJUNCTIVA • ACUTE – VIRAL (EBV, HERPES), CHLAMYDIAL • CHRONIC - CHRONIC CHLAMYDIAL INFECTION • FOLLICLES ARE LYMPHOID GERMINAL CENTRES WITH AVASCULAR APICES AND FINE VESSELS AT BASE , ALONG WITH REGIONAL LYMPHADENOPATHY
  • 6.
  • 7.
    PAPILLARY CONJUNCTIVITIS • NONSPECIFICDUE TO MULTIPLE ETIOLOGY • FOUND MORE IN UPPER TARSAL CONJUNCTIVA • FINE MOSAIC PATTERN OF DILATED TELANGIECTATIC VESSELS
  • 8.
  • 9.
    GRANULOMATOUS CONJUNCTIVITIS • PROLIFERATIVELESIONS THAT REMAIN LOCALISED TO ONE EYE USUALLY 1. TUBERCULOSIS OF CONJ 2. SARCOIDOSIS OF CON 3. SYPHILITIC CONJUNCTIVITIS 4. LEPROTIC CONJUNCTIVITIS 5. OPHTHALMIA NODOSA 6. CONJUNCTIVITIS IN TULARAEMIA
  • 10.
    • BASED ONETIOLOGY 1. INFECTIOUS – Bacterial , viral, Chlamydial, Fungi, Parasitic 2. NON-INFECTIOUS (TOPIC FOR ANOTHER DAY)
  • 11.
    INFECTIOUS CONJUNCTIVITIS • BACTERIAL– STAPH AUREUS AND ALBUS, HAEMOPHILUS AEGYPTICUS, H. INFLUENZA, N. GONORRHEA, N. MENGITIDIS , E. COLI, STREPTO. PYOGENES, PROTEUS. S.PNEUMONIAE • VIRAL – HERPES SIMPLEX, ADENO, PICORNA (COXACKIE AND ENTERO 70), MYXOVIRUS (MEASLES), MOLLUSCUM CONTAGIOSUM • CHLAMYDIAL- TRACHOMA (A , B &C) INCLUSION CONJUNCTIVITIS (D-K) LYMPHOGRANULOMA VENEREUM (L1 , L2 AND L3) • FUNGAL (UNCOMMON) – CANDIDA, ASPERGILLUS, NOCARDIA • PARASITIC
  • 12.
    INFECTIOUS CONJUNCTIVITIS • COMMONEST •DUE TO DEFEAT OF FOLLOWING PROTECTIVE MECHANISMS : 1. LOW TEMPERATURE (DUE TO EXPOSURE TO AIR) 2. LIDS (PHYSICAL PROTECTION) 3. LYSOSYMES 4. FLUSHING ACTION BY TEARS 5. SECREORY IMMUNOGLOBULINS
  • 13.
    ETIOLOGY • PREDISPOSING FACTORS: 1.FLIES 2. DIRTY HABITS 3. HOT DRY CLIMATE 4. POOR SANITATION 5. POOR HYGIENE
  • 14.
    COMMON CAUSATIVES • STAPHAUREUS – MCC OF BACTERIAL AND BLEPHAROCONJUNCTIVITIS • STAPH EPIDERMIDIS (INNOCUOUS FLORA OF CONJUNCTIVA) • STREPTO PNEUMONIAE – ASSOC WITH PETECHIAL SUBCONJUNCTIVAL HEMORRHAGE • STREPTO PYOGNENES – PSEUDOMEMBRANOUS • HEMOPHILUS AEGYTPTICUS – MUCOPURULENT , RED EYE • MORAXELLA LACUNATE (ANGULAR CONJUNCTIVITIS) • PSEUDOMONAS PYOCYANEA – INVADES CORNEA • CORYNEBACTERIUM DIPTHERIAE- MEMBRANOUS CONJUNCTIVITIS • NEISSERIA GONORRHEA – OPHTHALMIA NEONATORUM IN CHILDREN PURULENT CONJUNCTIVITIS IN ADULTS • NEISSERIA MENINGITIDIS - MUCOPURULENT
  • 15.
    MODE OF SPREAD DIRECTCONTACT VECTOR (FLIES) FOMITES EXOGENOUS LOCAL SORROUNDINGS ENDOGENOUS INFECTED LACRIMAL SAC INFECTED NASOPHARYNX INFECTED LID THROUGH BLOOD (M. COCCI AND G. COCCI) MODE OF SPREAD
  • 16.
    PATHOLOGICAL CHANGES • VASCULARRESPONSE – CONGESTION , CAPILLARY PROLIFERATION, INCREASED VASCULAR PERMEABILITY. • CELLULAR CHANGES – EXUDATION OF PMNL SUBSTANTIA PROPRIA OF CONJUNCTIVA AND CONJUNCTIVAL SAC • CONJUNCTIVAL TISSUE RESPONSE- BECOMES EDEMATOUS , DESQUAMATION OF SUPERFICIAL EPITHELIAL CELLS , PROLIFERATION OF BASAL CELLS • CONJUNCTIVAL DISCHARGE – TEA, FIBRIN , BACTERIA , INFLAMMATORY CELLS, DESQ EPITHELIAL CELLS , AND BLOOD STAINED DUE TO RBC DIAPEDESIS
  • 17.
    BACTERIAL CONJUNCTIVAL Assoc withCATARRHAL (MUCOPURULENT) Assoc with PURULENT Assoc with membranous Assoc with pseudomembranous Angular
  • 18.
    ACUTE MUCOPURULENT CONJUNCTIVITIS •MOST COMMON • MARKED CONJUNCTIVAL HYPERAEMIA • MUCOPURULENT DISCHARGE FROM EYE • CAUSATIVE ORGANISMS : 1. STAPH. AUREUS 2. H. AEGYPTICUS 3. PNEUMOCOCCUS 4. STREPTOCOCCUS 5. EXANTHEMATA IN MEASLES AND SCARLET FEVER
  • 19.
    SYMPTOMS • ENGORGED VESSELSCAUSES DISCOMFORT AND FOREIGN BODY SENSATION • MUCOPURULENT D/C CAUSING STICKING OF LIDS AFTER SLEEP • MILD PHOTOPHOBIA • DUE TO MUCOUS FLAKES – BLURRING OF VISION AND COLORED HALOS DUE TO ITS PRISMATIC EFFECT
  • 20.
    SIGNS • FLAKES OFMUCOUS IN FORNICES , CANTHI AND LID MARGINS • MATTED TOGETHER CILIA WITH YELLOW CRUSTS • CONJUNCTIVAL CONGESTION • CHEMOSIS • PETECHIAL HEMORRHAGES IN PNEUMOCOCCUS
  • 21.
    CLINICAL COURSE 1. PEAKIN 3-5 DAYS 2. RESOLVES IN MILD CASES OR BECOMES 3. LESS INTENSE AS IN CATARRHAL CONJUNCTIVITIS
  • 22.
    COMPLICATIONS • MARGINAL CORNEALULCER • SUPERFICIAL KERATITIS • BLEPHARITIS • DACROCYSTITIS
  • 23.
    TREATMENT • TOPICAL ANTIBIOTICS: CHLORAMPHENICOL (1%), GENTAMYCIN (0.3%) IF INEFFECTIVE CIPRO (0.3%), OFLOXACIN (0.3%), GATIFLOXACIN (0.3%) • IRRIGATION OF CONJUNCTIVAL SAC : WITH STERILE WARM SALINE ONCE OR TWICE A DAY FREQUENT EYEWASH IS CONTRAINDICATED (WASHES OF LYSOSYMES AND PROTECTIVE PROTEINS ) • DARK GLASS FOR PHOTOPHOBIA • NO BANDAGE (DECREASE IN EXPOSURE  INCREASE IN TEMP  INCREASE IN BACTERIAL GROWTH ) • ANTI INFLAMMATORY AND ANALGESICS •
  • 24.
    ACUTE PURULENT CONJUNCTIVITIS •ASSOCIATED WITH BLENORRHEA , HYPER ACUTE CONJUNCTIVITIS • 2 FORMS : 1. ADULT PURULENT CONJUNCTIVITIS 2. OPHTHALMIA NEONATORUM
  • 25.
    ADULT PURULENT CONJUNCTIVITIS •ADULTS MAINLY MALES , DIRECT SPREAD FROM GENITALS, CAUSED BY NEISSERIA GONORRHEA , STAPH AUREUS AND PNEUMOCOCCUS (RARE) • CLINICALLY 3 STAGES • STAGE OF INFILTRATION – LASTS FOR 4 TO 5 DAYS, PAINFUL TENDER EYE, BRIGHT RED CHEMOSED CONJUNCTIVA , WATER/SANGINOUS D/C , PREAURICULAR LN + • STAGE OF BLENORRHEA – 5TH DAY TO SEVERAL DAYS , PURULENT D/C DOWN CHEEKS • STAGE OF SLOW HEALING – PAIN AND D/C DECREASES BUT CONJUNCTIVA REMAINS RED VELVETY THICK • CLINICALLY ASSOCIATED WITH URETHRITIS AND ARTHRITIS
  • 26.
    COMPLICATIONS • CORNEAL INVOLVEMENT: DUE TO INABILITY TO INVADE NORMAL CORNEA DIFFUSE HAZE ENSUES WITH YELLOW / GREY SPOTS AT CENTER , EDEMA , CENTRAL NECROSIS DUE TO SUCCESSFUL INVASION , ULCERATION AND PERFORATION • IRITIS AND IRIDOCYCLITIS • SYSTEMIC COMPLICATIONS : SEPTICEMIA , ENDOCARDITIS AND ARTHRITIS
  • 27.
    TREATMENT • SYSTEMIC THERAPY •NORFLOXACIN 1.2 MG ORALLY QID X 5 DAYS • CEFOXITIM 1 GM IV X 5 DAYS , CEFOTAXIME 500MG IV X5 DAYS, CEFTRIAXONE 1.2 GM IM QID X 5 DAYS • ANY OF ABOVE WITH - ERYTHROMYCIN 250 MG QID FOR X 1 WEEK OR DOXYCYCLINE 100MG ORALLY • TOPICAL ANTIBIOTICS CIPRO, OFLOXACIN , TOBRAMYCIN EYEDROPS EVERY 2 HRS FIRST 2 -3 DAYS F/B 5 TIMES DAILY BACITRACIN OR ERYTHROMYCIN OINTMENT FOR 7 DAYS
  • 28.
    • IRRIGATION USINGSTERILE SALINE – REMOVES INFECTED DEBRIS • TROPICAL ATROPINE (1%) 2 TIMES DAILY IF CORNEAL INVOLVEMENT • SCREEN PARTNER FOR STD
  • 29.
    ACUTE MEMBRANOUS CONJUNCTIVITIS •TRUE MEMBRANE FORMATION BLEEDS ON PEELING • CAUSED BY - CORYNEBACTERIUM DIPHTHERIAE BETA – HEMOLYTIC STREPTOCOCCI, N.GONORRHEAE, H.AEGYPTICUS, S.AUREUS, E. COLI, VIRAL INFECTION , THERMAL AND CHEMICAL BURNS
  • 30.
  • 31.
  • 32.
    CLINICAL FEATURES • USUALLYCHILDREN 2-8 YEARS OLD (NOT IMMUNISED)  TOXIC AND FEBRILE 1. STAGE OF INFILTRATION : • SCANTY D/C AND SEVERE PAIN • SWOLLEN AND HARD LIDS , RED SWOLLEN CONJUNCTIVA COVERED WITH GREY YELLOW MEMBRANE WHICH BLEEDS ON REMOVAL • PRE AURICULAR LN + 2. STAGE OF SUPPURATION – • PAIN DECREASES , MEMBRANE SLOUGHS OFF AND LIDS BECOME SOFT • COPIOUS PURULENT D/C 3. STAGE OF CICATRIZATION – • RAW SURFACE COVERED WITH GRANUATION TISSUE AND EPITHELISED • TRICHIASIS , CONJUNCTIVAL XEROSIS
  • 33.
    COMPLICATIONS • CORNEAL ULCER •DELAYED – CICATRIZATION  SYMBLEPHARON , TRICHIASIS , ENTROPION, AND CONJUNCTIVAL XEROSIS • DIAGNOSIS BY BACTERIOLOGICAL EXAMINATION
  • 34.
    TREATMENT • TOPICAL : 1.PENICILLIN 1:10000 UNIT /ML EVERY 30 MINS 2. ANTI DIPHTHERIC SERUM EVERY 1 HR 3. ATROPINE 1% OINT IF CORNEAL INVOLVEMENT 4. BROAD SPECTRUM ANTIBIOTIC AT BEDTIME • SYSTEMIC : • CRYSTALLINE PENICILLIN 5 LAC UNITS IM BD X 10 DAYS • ANTI – DIPHTHERIC SERUM 50K UNITS IM STAT • TO PREVENT SYMBLEPHARON – APPLY CONTACT SHELL OR SWEEP GLASS ROD WITH OINTMENT • PROPHYLAXIS – ISOLATION OF PATIENT AND IMMUNISATION AGAINST DIPHTHERIA
  • 35.
    ACUTE PSEUDOMEMBRANOUS CONJUNCTIVITIS •ETIOLOGY : • BACTERIAL – C. DIPHTHERIAE, STAPH, STREPTO, H. INFLUENZA AND N. GONORRHEA • VIRAL – HERPES SIMPLEX AND ADENO VIRUS • CHEMICAL – ACID , AMMONIA , LIME, COPPER SULPHATE AND SILVER NITRATE • CLINICALLY – ACUTE MUCOPURULENT CONJUNCTIVITIS WITH PSEUDO-MEMBRANE FORMATION • TREATMENT SAME AS MUCOPURULENT CONJUNCTIVITIS
  • 36.
    CHRONIC CATARRHAL CONJUNCTIVITIS •ETILOGY : 1. PREDISPOSING FACTORS – CHRONIC EXPOSURE TO DUST, SMOKE, CHEMICAL IRRITANTS 2. LOCAL IRRITANTS SUCH AS TRICHIASIS AND CONCRETIONS , FB 3. ALCOHOL ABUSE • CAUSATIVE AGENTS: 1. STAPH AUREUS 2. GRAM NEG BACILLI – PROTEUS , KLEBSIELLA PNEUMONIAE , E. COLI AND MORAXELLA
  • 37.
    SOURCE AND MODEOF INFECTION • AS A SEQUALAE OF UNTREATED ACUTE MUCOPURULENT CONJUNCTIVITIS • AS CHRONIC INFECTION FROM DACROCYSTITIS, ASSOC RHINITIS , URI • AS MILD INFECTION FOR EXOGENOUS DIRECT CONTACT / AIRBORNE
  • 38.
    SYMPTOMS AND SIGNS •SYMPTOMS : 1. BURNING AND GRITTINESS OF EYES, SPECIALLY IN EVENING 2. MILD CHRONIC REDNESS 3. DRYNESS AND HEATED FEELING OF EYELIDS 4. MILD MUCOUS D/C 5. SLEEPINESS AND TIREDNESS OF EYES • SIGNS : 1. CONGESTION OF POSTERIOR CONJUNCTIVAL VESSELS 2. MILD PAPILLARY HYPERTROPHY 3. SURFACE OF CONJUNCTIVA LOOKS STICKY WITH CONGESTED LID MARGINS
  • 39.
    TREATMENT • ELIMINATION OFPREDISPOSING CAUSE • TOPICAL ANTIBIOTIC : CHLORAMPHENICOL / GENTAMYCIN 3-4 TIMES A WEEK • ASTRINGENT EYE DROPS : ZINC BORIC ACID FOR SYMPTOMATIC RELIEF
  • 40.
    ANGULAR CONJUNCTIVITIS (DIPLOBACILLARY) •CHRONIC CONJUNCTIVITIS CONFINED TO THE CONJUNCTIVA AND LID MARGINS NEAR ANGLES • ASSOCIATED WITH MACERATION OF NEARBY SKIN
  • 41.
    ETIOLOGY • PREDISPOSING FACTORS: ‘SIMPLE CHRONIC CONJUNCTIVITIS’ • CAUSATIVE AGENTS :MORAXELLA AXENFELD (COMMON) – END TO END PLACED DIPLOBACILLI STAPHYLOCOCCI (RARE) • SOURCE OF INFECTION : NASAL CAVITY • MODE OF INFECTION : NASAL CAVITY TO EYE VIA CONTAMINATED FINGERS/KERCHIEF
  • 42.
  • 43.
    SYMPTOMS AND SIGNS •SYMPTOMS : 1. IRRITATION, DISCOMFORT 2. COLLECTION OF FOAMY WHITE D/C AT ANGLES 3. REDNESS AT ANGLE OF EYE • SIGNS: 1. HYPERAEMIA OF BULBAR CONJUNCTIVA NEAR CANTHI 2. HYPERAEMIA OF LID MARGINS NEAR ANGLES 3. EXCORIATION OF SKIN AROUND ANGLES 4. PRESCENCE OF FOAMY MUCOPURULENT D/C AT ANGLES
  • 44.
    COMPLICATIONS • BLEPHARITIS • MARGINALCATARRHAL CORNEAL ULCERATION • TREATMENT: • GOOD PERSONAL HYGIENE AND TREATMENT OF NASAL INFECTION • OXYTETRACYLINE 1% EYE OINTMENT 2-3 TIMES X 10-14 TIMES DAYS • ZINC LOTION AT DAYTIME AND ZINC OXIDE AT BEDTIME
  • 45.
    CHLAMYDIAL CONJUNCTIVITIS TYPES OFINFECTIONS BY CHLAMYDIA
  • 46.
  • 47.
    • Keratoconjunctivitis, • Primarilyaffecting the superficial epithelium of conjunctiva & cornea simultaneously. • mixed follicular & papillary response of conjunctival tissue. • one of the leading causes of preventable blindness in the world. TRACHOMA
  • 48.
    SOURCE OF INFECTION: •Conjunctival discharge of affected person • Superimposed bacterial infection increased secretions more spread Etiology CAUSITIVE ORGANISM: • Chlamydia trrachomatis (Psittacosis- lymphogranulomatous group) • 11 serotypes (A to K) MODES OF INFECTION: • Direct spread by air-borne or water-borne modes • Vector transmission by flies • Maternal transfer through contaminated fingers, clothes, bedding etc PREDISPOSING FACTORS: • Age: commonly in infancy & childhood, but age no bar • Sex: more in females • Race: very common in Jews • Climate: dry & dusty weather favors • Socio-economic status: more in poor classes • Environmental: exposure to dust, irritants, smoke, sunlight etc
  • 49.
    • Incubation period: 5-21 days, mostly insidious onset • Clinical course: 1. Pure trachoma is mild & symptomless, often neglected 2. If superimposed with bacterial infection, presents with typical bacterial conjunctivitis • Natural History: 3. Development of acute disease in 1st decade of life 4. Continues with slow progression 5. Becomes inactive in 2nd decade 6. Sequelae occurs after 20 years of disease 7. Peak incidence of blindness in 4th or 5th decade CLINICAL PROFILE
  • 50.
    • Without secondarybacterial infection: 1. Minimal or asymtomatic 2. Mild FB sensation 3. Occasional lacrimation 4. Stickiness of lids 5. Scanty mucoid discharge • With secondary bact infection: All typical symptoms of acute bacterial conjunctivitis SYMPTOMS
  • 51.
    Conjunctival signs: • Congestionof upper tarsal and fornicial conjunctiva • Conjunctival follicles • Papillary hyperplasia • Conjunctival scarring • Concretions Corneal signs: • Superficial keratitis • Herbert follicles • Pannus • Corneal ulcer • Herbert Pits • Corneal opacity SIGNS
  • 52.
    CONJUNCTIVAL FOLLICLES: • BOILEDSAGO-GRAINS LIKE APPEARANCE 1. UPPER TARSAL CONJUNCTIVA 2. ALSO ON BULBAR CONJUNCTIVA ALSO (PATHOGNOMONIC OF TRACHOMA ) • CENTRAL PART  MONONUCLEAR HISTIOCYTES,+ FEW LYMPHOCYTES AND LARGE MULTINUCLEATED CELLS ( LEBER CELLS). • THE CORTICAL PART  A ZONE OF LYMPHOCYTES SHOWING ACTIVE PROLIFERATION. • BLOOD VESSELS ARE PRESENT IN THE MOST PERIPHERAL PART • SIGNS OF NECROSIS +
  • 55.
    CONJUNCTIVAL PAPILLAE: • REDDISHFLAT TOPPED RAISED AREAS • GIVES RED VELVETY APPEARANCE TO TARSAL CONJUNCTIVA • CENTRAL CORE OF NUMEROUS DILATED BLOOD VESSELS SURROUNDED BY LYMPHOCYTES AND COVERED BY HYPERTROPHIC EPITHELIUM
  • 56.
  • 57.
    CONJUNCTIVAL SCARRING • WHICHMAY BE IRREGULAR, STAR-SHAPED OR LINEAR. • LINEAR SCAR PRESENT IN THE SULCUS SUBTARSALIS } ARLT'S LINE.
  • 59.
    Concretions due to accumulationof dead epithelial cells & inspissated mucus in the depressions called glands of Henle.
  • 60.
    CONJUNCTIVAL CONCRETIONS • DUETO ACCUMULATION OF DEAD EPITHELIAL CELLS & INSPISSATED MUCUS IN THE DEPRESSIONS CALLED GLANDS OF HENLE.
  • 61.
    CORNEAL SIGNS • Superficialkeratitis in the upper part. .
  • 62.
    Infiltration of cornea isahead of vascularization. Vessels extend a short distance beyond the area of infiltration. Pannus formation Infiltration of cornea + vascularization Pannus aggressive Regressive
  • 63.
    Corneal ulcer • developat the advancing edge of pannus.
  • 64.
    Corneal opacity • Cornealopacity • in the upper part. • extend down and involve the pupillary area.
  • 65.
    Herbert’s follicles  typicalfollicles present in the limbal area.
  • 66.
    Herberts pits  ovalor circular brown pitted scars, left after healing of Herbert follicles in the limbal area
  • 67.
    McCallan’s Classification: STAGE 1:Incipient Trachoma / stage of infiltration • Hyperemia of conjunctiva & immature follicles STAGE 2: Established Trachoma / stage of florid infiltration • Mature follicles, papillae, progressive pannus STAGE 3: Cicatrising Trachoma / stage of scarring • Obvious scarring of palpebral conjunctiva STAGE 4: Healed Trachoma / stage of sequelae • Disease is cured • Sequelae results in symptoms
  • 71.
    DIAGNOSIS • CLINICAL: • GRADINGTO BE DONE AS PER WHO CLASSIFICATION • AT LEAST 2 SETS OF SIGNS SHOULD BE PRESENT: 1. CONJUNCTIVAL FOLLICLES AND PAPILLAE 2. PANNUS 3. EPITHELIAL KERATITIS NEAR SUPERIOR LIMBUS 4. SIGNS & SEQUELAE OF CICATRIZATION
  • 72.
    LABORATORY • CONJUNCTIVAL CYTOLOGY POLYMORPHONUCLEAR REACTION WITH PRESENCE OF PLASMA CELLS AND LEBER CELLS IN GEIMSA • DETECTION OF INCLUSION BODIES GIEMSA STAIN, IODINE STAIN OR IF STAINING • ELISA FOR CHLAMYDIAL ANTIGENS • PCR • ISOLATION & SEROTYPING OF ORGANISM
  • 73.
    1. Trachoma withfollicular hypertrophy • follicles in trachoma upper palpebral conjunctiva and fornix • papillae and pannus+ • Laboratory diagnosis of trachoma helps in differentiation. 2. Acute adenoviral follicular conjunctivitis (epidemic keratoconjunctivitis) • follicles in EKC Lower palpebral conjunctiva and fornix DIFFERENTIAL DIAGNOSIS
  • 74.
    3. Trachoma withpredominant papillary hypertrophy • pH of tears in trachoma it is acidic, • follicles and pannus+ • Conjunctival cytology and other laboratory tests for trachoma usually help in diagnosis. 4. palpebral form of spring catarrh • Papillae are large in spring catarrh • typical cobble-stone arrangement in spring catarrh. • pH of tears is usually alkaline in spring catarrh • Discharge is ropy in spring catarrh
  • 75.
    MANAGEMENT: • Treatment ofActive Trachoma: 1. Topical therapy:  1% tetracycline / 1% erythromycin eye ointment 4 times daily for 6 weeks 2. Systemic therapy:  Tetracycline / erythromycin 250mg QID orally for 4 weeks  Or Docycline 100mg BD orally for 4 weeks  Or single dose of Azithromycin orally 3. Combined therapy:  Preferred when severe disease  Or associated genital infection is present.
  • 76.
    • MANAGEMENT: 1. Treatmentof Sequelae: •Removal of concretions • Epilation / electrolysis of trichasis • Surgical correction of entropion • Lubricating drops for xerosis 2. Prophylaxis: • Hygiene measures • Early treatment of conjunctivitis • Blanket antibiotic therapy in endemic areas: • 1 % tetracycline ointment BD for 5 days in a month for 6 months
  • 77.
    MANAGEMENT • SAFE Strategyfor Trachoma Blindness: • Surgery to correct eyelid deformity & prevent blindness • Antibiotics for acute infections & community control • Facial Hygiene • Environmental changes
  • 78.
    ADULT INCLUSION CONJUNCTIVITIS •ACUTE FOLLICULAR CONJUNCTIVITIS ASSOCIATED WITH MUCOPURULENT DISCHARGE. SEXUALLY ACTIVE YOUNG ADULTS. • ETIOLOGY CAUSED BY  D TO K OF CHLAMYDIA TRACHOMATIS. • SOURCE OF INFECTION  URETHRITIS IN MALES AND CERVICITIS IN FEMALES. • THE TRANSMISSION  CONTAMINATED FINGERS OR MORE  CONTAMINATED WATER OF SWIMMING POOLS (SWIMMING POOL CONJUNCTIVITIS)
  • 79.
    Incubation Period: • 4-12days • Symptoms: • Ocular discomfort, foreign body sensation • Mild photophobia • Mucopurulent discharge from the eyes • Signs: • Conjunctival hyperaemia, marked in fornices. • Acute follicular hypertrophy predominantly of lower palpebral conjunctiva • Superficial keratitis in upper half • Superior micropannus occasionally • Pre-auricular lymphadenopathy
  • 80.
    • Treatment: • Topicaltherapy  Tetracycline 1 % eye ointment QID for 6 weeks • Systemic therapy: 1. • Very important 2. • Tetracycline 250 mg four times a day for 3-4 weeks. 3. • Erythromycin 250 mg four times a day for 3-4 weeks 4. • Doxycycline 100 mg twice a day for 1-2 weeks 200 mg weekly for 3 weeks 5. • Azithromycin 1 gm as a single dose
  • 81.
  • 82.
    VIRAL CONJUNCTIVITIS • CLASSIFICATIONBASED ON CLINICAL PRESENTATION: 1. ACUTE SEROUS CONJUNCTIVITIS 2. ACUTE HEMORRHAGIC CONJUNCTIVITIS 3. ACUTE FOLLICULAR CONJUNCTIVITIS
  • 83.
    ACUTE SEROUS CONJUNCTIVITIS •ETIOLOGY MILD GRADE FEVER INFECTION WHICH DOES NOT GIVE A FOLLICULAR RESPONSE • CLINICAL FEATURES : MINIMAL CONGESTION, WATERY DISCHARGE + BOGGY SWELLING OF CONJUNCTIVA MUCOSA • TREATMENT: SELF LIMITING TO PREVENT SECONDARY BACTERIAL INFECTION , BROAD SPECTRUM ANTIBIOTIC 3 TIMES A DAY FOR A WEEK
  • 84.
    ACUTE HEMORRHAGIC CONJUNCTIVITIS •ALSO KNOWN AS APOLLO CONJUNCTIVITIS • MULTIPLE CONJUNCTICAL HEMORRHAGES , CONJUNCTICAL HYPERAEMIA AND MILD FOLLICULAR HYPERPLASIA • ETIOLOGY : PICORNAVIRUS (ENTEROVIRUS TYPE 70 ) TRANSMITTED BY DIRECT HAND TO EYE CONTACT.
  • 85.
    CLINICAL PICTURE • INCUBATIONPERIOD : 1-2 DAYS • SYMPTOMS : PAIN , REDNESS, WATERING , MILD PHOTOPHOBIA , TRANSIENT BLURRING OF VISION AND LID SWELLING • SIGNS : CONJUNCTIVAL CONGESTION , CHEMOSIS , MULTIPLE HEMORRHAGES IN BULBAR CONJUNCTIVA , MILD FOLLICULAR HYPERPLASIA , LID EDEMA AND PRE AURICULAR LYMPHADENOPATHY CORNEAL INVOLVEMENT : FINE EPITHELIAL KERATITIS
  • 86.
    TREATMENT • SELF LIMITINGCOURSE OF 5-7 DAYS • NO SPECIFIC EFFECTIVE CURATIVE TREATMENT KNOWN . • BROAD SPECTRUM EYEDROPS TO PREVENT SECONDARY BACTERIAL INFECTIONS.
  • 87.
  • 88.
    FOLLICULAR CONJUNCTIVITIS • FOLLCLESARE TINY WHITE TRANSLUCENT WHITE ROUND SWELLINGS 1-2 MM IN DIAMETER THAT RESEMBLE SAGOGRAINS • LOCALISED AGGREGATION OF LYMPHOCYTES IN THE ADENOID LAYER OF CONJUNCTIVA .
  • 89.
    TYPES OF FOLLICULARCONJUNCTIVITIS • ACUTE FOLLICULAR CONJUNCTIVITIS • CHRONIC FOLLICULAR CONJUNCTIVITIS • SPECIFIC TYPE OF CONJUNCTIVITIS WITH FOLLICLE FORMATION EX: TRACHOMA
  • 90.
    ACUTE FOLLICULAR CONJUNCTIVITIS •AN ACUTE CATARRHAL CONJUNCTIVITIS • ASSOC WITH MARKED FOLLICULAR HYPERPLASIA ESPECIALLY IN LOWER FORNIX AND LOWER PALPEBRAL CONJUNCTIVA • SYMPTOMS AND SIGNS : 1. REDNESS, WATERING, MILD MUCOID DISCHARGE 2. MILD PHOTOPHOBIA AND FEELING OF DISCOMFORT 3. FOREIGN BODY SENSATION • SIGNS : 1. CONJUNCTIVAL HYPERAEMIA 2. MULTIPLE FOLLICLES FOUND MORE IN LOWER LID THAN UPPER LID
  • 91.
  • 92.
    ETIOLOGICAL TYPES OFFOLLICULAR CONJUNCTIVITIS • ADULT INCLUSION CONJUNCTIVITIS • EPIDEMIC CONJUNCTIVITIS • PHARYNGOCONJUNCTIVAL FEVER • NEWCASTLE CONJUNCTIVITIS • ACUTE HERPETIC CONJUNCTIVITIS
  • 93.
    EPIDEMIC KERATOCONJUNCTIVITIS • ACUTEFOLLICULAR CONJUNCTIVITIS ALONG WITH SUPERFICIAL PUNCTATE KERATITIS • AS EPIDEMIC  EPIDEMIC KERATOCONJUNCTIVITIS • ETIOLOGY 1. ADENOVIRUS TYPE 8 AND 19 2. SPREADS THROUGH CONTACT WITH CONTAMINATED FINGERS SOLUTIONS AND TONOMETER 3. INCUBATION PERIOD IS 8 DAYS AND VIRUS IS SHED FOR 2-3 WEEKS
  • 94.
    CLINICAL PICTURE Pre –Auricular Lymphadenopathy seen in all cases
  • 95.
    PHARYNGOCONJUNCTIVAL FEVER • ETIOLOGY: ADENOVIRUS SUBTYPE 3 AND 7 • CLINICAL PICTURE : 1. ACUTE FOLLICULAR CONJUNCTIVITIS 2. PHARYNGITIS 3. FEVER AND PREAURICULAR LYMPHADENOPATHY 4. SUPERFICIAL PUNCTATE KERATITIS SEEN IN 30% • TREATMENT : SUPPORTIVE
  • 96.
    ACUTE HERPETIC CONJUNCTIVITS •ASSOC WITH PRIMARY HERPETIC INFECTION • MAINLY SEEN IN SMALL CHILDREN AND ADOLESCENTS • ETIOLOGY : 1. HSV TYPE 1 SPREADS BY KISSING OR OTHER CLOSE PERSONAL CONTACTS 2. HSV TYPE 2 (RARE) 3. USUALLY UNILATERAL • INCUBATION PERIOD 3 – 10 DAYS
  • 97.
    CLINICAL PICTURE • CANBE EITHER TYPICA OR ATYPICAL • PREAURICULAR LN + • CORNEAL INVOLVEMENT +
  • 98.
    CHRONIC FOLLICULAR CONJUNCTIVITIS •MILD CATARRHAL TYPE WITH FOLLICLES PREDOMINANTLY IN LOWER PALPEBRAL CONJUNCTIVA • ETIOLOGY : 1. INFECTIVE (BENIGN FOLLICULOSIS) 2. TOXIC : DUE TO CELLULAR DEBRIS IN MOLLUSCUM CONTAGIOSUM 3. CHEMICAL : PROLONGED USE OF PILOCARPINE, IDU , ADRENALINE 4. ALLERGIC (LESS COMMON)
  • 99.
    OPHTHALMIA NEONATORUM • BILATERALINFLAMMATION OF CONJUNCTIVA OCCURRING IN AN INFANT (<30 DAYS OLD) • ANY DISCHARGE OR EVEN WATER FROM EYE IN THE FIRST WEEK OF LIFE  OPHTHALMIA NEONATORUM ! AS TEARS ARE NOT FORMED TILL THEN. • SOURCE OF INFECTION: 1. BEFORE BIRTH – INFECTED AMNIOTIC LIQUOR IN RUTPTURED MEMBRANE 2. DURING BIRTH- INFECTED BIRTH CANAL (FACE PRESENTATION , FORCEPS DELIVERY) 3. AFTER BIRTH  DURING FIRST BATH OF NEWBORN FROM SOILED CLOTHES/FINGERS WITH WITH INFECTED LOCHIA
  • 100.
    CAUSATIVE ORGANISM • HERPESSIMPLEX OPHTHALMIA NEONATORUM (HSV 2) (INCUBATION PERIOD – 5 -7 DAYS) • CHEMICAL CONJUNCTIVITIS  SILVER NITRATE (IP : 4-6 HRS) • GONOCOCCAL (2-4 DAYS) • OTHER BACTERIAL  STAPH AUREUS , STREPTOCOCCUS HEMOLYTICUS , STREPTOCOCCUS PNEUMONIAE (IP : 4-6 DAYS) • NEONATAL INCLUSION CONJUNCTIVITIS : SEROTYPES D TO K OF CHLAMYDIA TRACHOMATIS (IP : 5-7 DAYS)
  • 101.
    CLINICAL PICTURE • SIGNS: 1. PAIN AND TENDER EYEBALL 2. PURULENT CONJUNCTIVAL DISCHARGE (GONOCOCCAL) 3. MUCOID/MUCOPURULENT (OTHER BACT INFECTION) 4. SWOLLEN LIDS 5. CONJUNCTIVAL CHEMOSIS 6. CORNEAL INVOLVEMENT RARELY • COMPLICATIONS : CORNEAL ULCERATION WITH PERFORATION TENDANCY
  • 102.
  • 103.
    PROPHYLAXIS • ANTENATAL :TREATMENT OF GENITAL INFECTION OF MOTHER • NATAL : DELIVERY UNDER ASEPTIC CONDITIONS AND NEWBORN EYELIDS SHOULD BE WELL CLEANED • POST NATAL : 1% TETRACYCLINE /0.5% ERYTHROMYCIN OINTMENT • 1% SILVER NIRTRATE SOLUTION (CREDE’S METHOD) • SINGLE INJECTION OF CEFTRIAXONE 50 MG/KG IM/IV
  • 104.
    TREATMENT 1. GONOCOCCAL : A.TOPICAL – • SALINE LAVAGE • BACITRACIN OINTMENT QID, PENICILLIN DROPS 5K – 10K UNITS PER ML PER MIN FOR 30MINS F/B ONCE IN EVERY 5 MINS FOR 30 MINS F/B EVERY 30 MINS ONCE TILL INFECTION IS CONTROLLED • ATROPINE OINT IF CORNEA IS INVOLVED B. SYSTEMIC – • CEFTRIAXONE 75 - 100 MG/KG/DAY IV/IM QID • CEFOTAXIME 100-150 MG/KG/DAY IV/IM BD • IF GONOCOCCAL : CRYSTALLINE BENZYL PENICILLIN G 50K UNITS FOR FULL TERM BABIES IM BD X 3 DAYS
  • 105.
    2. OTHER BACTERIALINFECTION : • BROAD SPECTRUM ANTIBIOTIC DROPS / OINTMENT X 2 WEEKS • NEONATAL INCLUSION CONJUNCTIVITIS • TOPICAL TETRACYCLINE / ERYTHROMYCIN 125 MG QID X 3 DAYS • HERPES SIMPLEX : TOPICAL ANTIVIRALS
  • 106.
  • 107.
    Parinaud's oculoglandular syndrome 1.Unilateral granulomatous conjunctivitis (nodular elevations surrounded by follicles), 2. Preauricular lymphadenopathy, and 3. Fever. 4. Causes  tularaemia, cat-scratch disease, tuberculosis, syphilis and lymphogranuloma venereum
  • 108.
    OPHTHALMIA NODOSA (CATERPILLAR HAIRCONJUNCTIVITIS) • GRANULOMATOUS INFLAMMATION OF THE CONJUNCTIVA FORMATION OF A NODULE ON THE BULBAR CONJUNCTIVA IN RESPONSE TO IRRITATION CAUSED BY THE RETAINED HAIR OF CATERPILLAR. • HISTOPATHOLOGICAL EXAMINATION HAIR SURROUNDED BY GIANT CELLS AND LYMPHOCYTES. • TREATMENT  EXCISION BIOPSY OF THE NODULE