Acute purulent conjunctivitis

ACUTE PURULENT CONJUNCTIVITIS (GONORRHOEAL CONJUNCTIVITIS AND OPTHALMIA NEONATORUM)

1. ACUTE PURULENT CONJUNCTIVITIS. DR.PRAFULLA C.PATIL SHRI CHAMUNDAMATA HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL,JALGAON.

2. This is an acute conjunctivitis where the discharge is frankly purulent. It occurs in two forms- 1) In an adults-mainly as gonococcal conjunctivitis.when the causative agent is neisseria gonorrhoeae. 2) In the new born-as ophthalmia neonatorum.

3. Gonorrhoeal conjunctivitis Etiology :- 1) Age- adults with a history of gonorrhoea. 2) Causative agent-gonococcus. 3) But sometimes purulent conjunctivitis may be due to B.subtilis particularly in agricultural areas or by klebs loeffler bacillus and streptococcus haemolyticus.

4. MODE OF INFECTION:- 1) From the genitalia by direct contact. 2) In casse of doctors and nurse by direct contact with the conjunctival discharge 3) Metastatic infection from urethritis.

5. PATHOLOGY (GONORRHOEAL CONJUNCTIVITIS):-

6. CLINICAL PICTURE:- Clinical picture divided into 3 stages:- 1) Stage of infiltration:- - Pain and tenderness of the eyeball. - Conjunctiva appears bright red and velvety. - Discharge is watery or sanious. - Exudation may coagulate on the surface of conjunctiva to form a pseudo-membrane. - lids are tensely swollen. - pre-auricular gland are enlarged.

7. 2) stage of blenorrhoea:- - starts about fifth day. - discharge frankly purulent and abundant and thick,creamy pus drips down the chicks. - onset of this stage,tenseness of lids and conjunctiva subsides.

8. 3) stage of slow healing:- - pain becomes very much lkess - swelling of the lids subsides. - conjunctiva becomes red,thick,velvety. - papillary formation over the tarsal conjunctiva. - bulbar conujnctiva remains hyperaemic. - dsicharge slowly diminishes ,virulent goncocci may be present in discharge.

9. COMPLICATIONS:- Oedma of the corneal epithelium. Ulceration of the cornea. Perforation of the corneal ulcer. Iritis or iridocyclitis with hypopyon.

10. Diagnostic criteria:- Adult male or female. History of gonococcal infection. Marked inflammation of the lid and conjunctiva. Copious frankly purulent discharge showing gram negative intracellular diplococci on smear examination.

11. Treatment:- Prophylactic:- To prevent infection of the other eye and eyes of other members of the family:- a) Dressings to be destroyed. b) Towels and linens used by the patient to be kept separate. c) In case of accidental infection of the eye of a doctors and nurse,silver nitrate 1 % has to be dropped in the eye followed by broad spectrum antibiotic.

12. Curative :- - Normal saline wash to wash out the purulent matter as far as possible. - Frequent drops of penicillin lotion. - Solution of crystalline penicillin in distilled water is prepared in the srenght of 10000 units of penicillin in one cc of distilled water and is dropped in the eye,at first every one minute for half an hour,and then every 5 minute for one hour,and then every 15 minutes,half an hour and one hour,until the discharge stops completely. - Broad spectrum antibiotic ointment applied at bedtime. - If corneal ulcer develop atropine sulphate 1% ointment should be applied at bed time.

13. OPHTHALMIA NEONATORUM:- DEFINITION:- It is bilateral purulent conjunctivitis occuring in the new born within the first three weeks of life.

14. Etiology:- Causative organisms:- 1) Gonococcus. 2) B.coil. 3) Pneumococcus. 4) Staphylococcus aureus. 5) streptococcus haemolyticus. 6) A genital virus present in mother’s birth passage-the condition is then known as inclusion blenorrhoea.

15. Mode of infection:- The eye may be infected in 3 ways- 1) Before birth –extremely rare. 2) During birth,particularly if there is face presentation. 3) After birth-from soiled linen.

16. PATHOLOGY:-

17. A few anatomical peculiarities of the new born should be kept in mind- A) Absence of tears for 3 weeks to 1 month after birth. B) Conjuctival and corneal epithelium are very thin-only two layers in cornea. C) No adenoid layer in the conjunctiva. The pathological process is same as in gonorrhoeal conjunctivitis.papillae formation is marked in the epithelium.In the sub epithelial tissue,lymphoid layer is rapidly formed.

18. CLINICAL PICTURE:- Incubation period for gonococcus is 1-3 days. For other organisms varies from 1 to 2 weeks. In case of virus,the period is 7 to 9 days. Condition is bilateral. Conjunctival discharge ceases within 6 to 8 weeks,leaving very little cicatrical changes. Clinical signs are the same as in adult,but the whole picture is less virulent and more mild.

19. Diagnostic criteria:- a) Purulent conjunctivitis in the new born. b) Conjunctival smear shows gonococcus.

20. COMPLICATIONS:- In untreated cases,complications usually occur.the cornea is most commonly affected- a) Corneal ulcer which may heal leaving an opacity.Due to bilateral corneal opacity,the macula in the retina fails to develop due to obstruction to vision and ultimately nystagmus is developed. b) Corneal ulcer may parforate,causing adherent leucoma. c) Cornea may slough out ,causing anterior staphyloma.

21. PROGNOSIS:- Earlier the treatment better is the prognosis.

22. Treatment:- A) Prophylactic:- a) Thorough antenatal care and examination of the mother for any infection. b) Crede’s method- 1% silver intrate solution is dropped into the eyes of the baby immediately after birth.As a modern method,a solution of crystalline penicillin 10000 units per c.c. of distilled water is dropped .

23. B) Curative:- B efore treatment is started ,it is always wise to take a conjunctival swab for smear examination and culcture.treatment is same as gonococcal conjunctivitis in adults. If the cornea is affected atropine sulphate ointment has to be dropped.