Bacterial conjunctivitis Ophthalmology

Acute and Hyperacute bacterial conjunctivitis
Ophthalmology

1. BACTERIAL
CONJUNCTIVITIS
Dhanushree G
6th term
SSIMS Davangere

2. CONJUNCTIVA ??
❏Translucent mucous membrane
❏Lines posterior surface of eyelids and anterior surface of
eyeball

4. Microscopy of conjunctiva

6. LYMPHATICS
NERVE SUPPLY

7. CONJUNCTIVITIS
➢Inflammation of conjunctiva

Conjunctival
hyperaemia
Discharge
Watery
Mucoid
Mucopurulent
Purulent

8. TYPES OF CONJUNCTIVITIS
CONJUNCTIVITIS
TOXICCICATRACIAL
ALLERGIC
INFECTIVE
BACTERIAL
VIRAL
OPHTHALMIA
NEONATORUM
GRANULOMATOUS
SIMPLE
VERNAL (VKC)
ATOPIC (ATC)
GIANT PAPILLARY
PHLYCTENULAR
DROP CONJUNCTIVITIS
OMMP
SJS
TeN

9. BACTERIAL CONJUNCTIVITIS
●Most common type in developing countries.
●Sporadic/epidemic

SPORADIC EPIDEMIC
Normal
commensals
Monsoon

10. ETIOLOGY
❖Predisposing factors
❖Causative organisms
❖Mode of infection

11. PRE-DISPOSING FACTORS
➔Flies
➔Poor hygienic conditions
➔Poor sanitation
➔Hot dry climate
➔Dirty habits

12. CAUSATIVE ORGANISMS
●Staphylococcus (aureus,epidermidis)
●Streptococcus (pneumoniae,pyogenes)
●Haemophilus influenzae
●Moraxella lacunata
●Pseudomonas pyocyanea
●Neisseria (gonorrhoeae,meningitidis)
●Corynebacterium diphtheriae

13. MODE OF INFECTION

EXOGENOUS LOCAL ENDOGENOUS
●Direct spread
●Vector
●Material
transfer
●From
neighbouring
structures
●Rarely
through Blood

14. PATHOLOPHYSIOLOGY

15. PATHOLOGICAL CHANGES
❖Vascular response
❖Cellular response
❖Conjunctival tissue response
❖Conjunctival discharge

16. TYPES OF BACTERIAL CONJUNCTIVITIS
1.Acute bacterial conjunctivitis
2.Hyperacute bacterial conjunctivitis
3.Chronic bacterial conjunctivitis
4.Angular bacterial conjunctivitis

17. 1.ACUTE BACTERIAL CONJUNCTIVITIS
★Conjunctival hyperaemia
★Mucopurulent discharge
★a/k/a Acute mucopurulent
conjunctivitis

18. COMMON CAUSATIVE BACTERIA
●Staph. Aureus
●Koch-Weeks bacillus
●Pneumococcus
●Streptococcus

19. CLINICAL FEATURES
SYMPTOMS :
●Discomfort
●Grittiness

20. Blurry vision
Redness

21. Mild photophobia
Mucopurulent discharge

22. Sticky eyelids with
discharge
Coloured halos

23. SIGNS
Mucopus flakes Fiery Red eye
Chemosis

24. Eyelid edema
Petechial hemorrhage
Papillae

25. CLINICAL COURSE
Acute Bacterial Conjunctivitis
3-4 days ---
(reach peak)
Cured
(10-15
days)
Chronic
catarrhal
conjunctivitis
Untreated

26. COMPLICATIONS
★Superficial punctate epitheliopathy
★Marginal corneal ulceration
★Superficial keratitis
★Blepharitis
★Dacrocystitis
Corneal ulcer
Blepharitis Dacrocystitis

27. DIFFERENTIAL DIAGNOSIS
RED EYE CONJUNCTIVITIS
●Acute congestive
glaucoma
●Acute anterior uveitis
●SCH
●Viral
●Allergic
●Chlamydial

28. TREATMENT
1)TOPICAL ANTIBIOTICS
➔Chloramphenicol (1%)
➔Gentamycin (0.3%)
➔Framycetin (0.3%)
◆eye drops 3-4 hourly/day
◆ointment at night
➔If not effective : ciprofloxacin, ofloxacin,moxifloxacin

29. 2) Conjunctival sac irrigation
❏With sterile warm saline once or
twice a day
❏Frequent eye wash is
contraindicated
It will wash off the lysozymes and
protective proteins.

30. 3) Dark goggles
To prevent photophobia


4) Anti-inflammatory and analgesic drugs :
--Ibuprofen / paracetamol given orally for 2-3 days

31. ➢No Bandage :
○Exposure to air
○lowers the temp and decreases
the growth of bacteria
○Discharge escape

➢No steroids :
○Aggrevates the infection
○Causes corneal ulcers

32. PREVENTIVE MEASURES

Hand washing
Avoid sharing
towels/kerchief

33. 2. HYPERACUTE BACTERIAL CONJUNCTIVITIS
❖Also called Acute purulent conjunctivitis or Acute
Blenorrhoea.
❖Occurs in two forms :
➢Adult purulent conjunctivitis
➢Ophthalmia neonatorum in newborn

34. ADULT PURULENT CONJUNCTIVITIS
ETIOLOGY :
●Adults - predominantly males
●Gonococcal infection ( may be associated with
urethritis or arthritis)

ONSET : Hyperacute (12-24 hrs)

35. SYMPTOMS
➔Pain
➔Purulent discharge
➔Eyelid swelling
➔Mild photophobia
➔Sticky eyelids
➔Slight blurring of vision

36. CLINICAL PICTURE : 3 STAGES
1.Stage of infiltration
2.Stage of Blenorrhoea
3.Stage of slow healing

37. COMPLICATIONS
★Corneal ulceration ; edema ; necrosis ; perforation
★Iridocyclitis
★Systemic complications : gonorrhoea arthritis ,
endocarditis, septicaemia. (rare)

38. TREATMENT
1.Systemic therapy :
a.Third gen. Cephalosporins - 5 days
b.Quinolones - Norfloxacin 1.2g orally - 5 days
c.Spectinomycin 2.0g IM - 3 days
2.Topical antibiotics :
a.Eye drops - ofloxacin,ciprofloxacin
b.Ointment - erythromycin

39. 3. Irrigation of eyes : with sterile saline frequently
4. Topical Atropine : 1% eye drops - once or twice if cornea
affected.

NOTE --
-Sexual partner should also be treated with systemic antibiotics.
-Both pt. and partner are evaluated for other STDs

40. THANK
YOU :)