BACTERIAL CONJUNCTIVITIS PPT.pptx FOR OPTOMETRISTS

Bacterial conjunctivitis

1. A SEMINAR PRESENTATION ON BACTERIAL CONJUCTIVITIS BY   DR. DANIEL EMEDIONG WALTER AND DR GBEREVBIE JOHN-MATHIAS   SUPERVISED BY CHIEF DR. ANAVHE MARY   13 TH MARCH 2024  

2. INTRODUCTION Conjunctivitis, or pink eye, is an irritation or inflammation of the conjunctiva (the transparent lubricating mucous membrane which covers the white part of the eyeball and lining of the undersurface of the eyelids), caused by allergies or a bacterial or viral infection. Conjunctivitis can be extremely contagious and is spread by contact with eye secretions from someone who is infected.

3. ETIOLOGY Conjunctivitis, which is defined as inflammation of the bulbar and/or palpebral conjunctiva, has many etiologies, including infection from various bacteria, fungi, and viruses, as well as toxic and allergic causes.   Bacterial conjunctivitis most often occurs in otherwise healthy individuals. Risk factors include exposure to infected individuals, fomite, contact lens wear, sinusitis, immunodeficiency states, prior ocular disease, trauma, and exposure to agents of sexually transmitted disease at birth.

4. PREVALENCE A prevalence between 2% and 6% is reported in various parts of Africa. In 2001 it was reported that there was a prevalence rate of 34.7% of MRSA (Methicillin-resistant Staphylococcus aureus) among S. aureus isolates in Ilorin, in the North Central part of Nigeria. The highest rate of bacterial conjunctivitis was found among infants and children (0-10 years). The rate was also higher in males (59.2%) than in females (40.8%). The bacterial etiology often depends on geography and age, but the most common include Staphylococcus, Streptococcus, Corynebacterium, Haemophilus, Pseudomonas, and Moraxella species.

5. BACKGROUND Bacterial conjunctivitis due to gram-positive bacteria such as Staphylococcus aureus or Streptococcus pneumoniae is generally milder than conjunctivitis caused by gram-negative bacteria. Gram-negative conjunctivitis is caused by bacteria such as Pseudomonas, Haemophilus influenzae, Moraxella, C trachomatis, and N gonorrhoeae. Gram-negative conjunctivitis is caused by bacteria such as Pseudomonas, Haemophilus influenzae, Moraxella, C trachomatis, and N gonorrhoeae.

6. PATHOPHYSIOLOGY The surface tissues of the eye and the ocular adnexa are colonized by normal flora such as streptococci, staphylococci, and corynebacteria. Alterations in the host defense, in the bacterial titer, or in the species of bacteria can lead to clinical infection. The primary defense against infection is the epithelial layer covering the conjunctiva. Disruption of this barrier can lead to infection.

7. SIGNS AND SYMPTOMS Symptoms include ; Burning sensation, sensation of grittiness , mild pain or discomfort in the eye. Signs of bacterial conjunctivitis, beyond injected and edematous (inflamed) conjunctiva, include the following.. Papillae on the injected tarsal conjunctiva, also seen in viral conjunctivitis and ocular allergy.

8. SYMPTOMS CONTD…. 2. Discharge: More purulent than in viral conjunctivitis, with more mattering (generally white, green, or yellow mucous discharge) of the eyelid margins and greater associated difficulty prying the eyelids open following sleep; patients may report waking up with their eyes “glued” shut.

9. SYMPTOMS CONTD…. 3. Enlarged preauricular lymph node: Common in viral conjunctivitis and unusual in bacterial conjunctivitis, although found in severe bacterial conjunctivitis caused by N gonorrhoeae.

10. SYMPTOMS CONTD…. 4. Eyelid edema: Often present in bacterial conjunctivitis, but mild in most cases; severe eyelid edema in the presence of copious purulent discharge raises the suspicion of N gonorrhoeae infection.

11. DIAGNOSIS Know the differential diagnosis. Perform an eye examination and, in particular, document that keratitis, iritis, and acute glaucoma have been ruled out. Always document the best corrected visual acuity in each eye. Ascertain the absence of glaucoma on every visit or the inability to safely do so. Always consider Chlamydia or N gonorrhoeae in the differential diagnosis. Be sure to treat systemically and ask for advice from other specialists when needed.

12. DIAGNOSIS CONTD.. Although most routine cases of bacterial conjunctivitis should not require culture confirmation, certain presentations, such as the following, suggest utility to the astute clinician: Neonatal conjunctivitis Hyperacute conjunctivitis suggestive of N gonorrhoeae Extremely elderly patients Immunocompromised patients: HIV infection, chemotherapy, immunosuppressive therapy Recurrent or recalcitrant conjunctivitis Patients who have undergone recent intraocular surgery: pars plana vitrectomy, cataract, glaucoma shunt.  

13. DIAGNOSIS CONTD… Conjunctival scrapings can also be used in the diagnosis of bacterial conjunctivitis; they can be collected with topical anesthetic and gentle use of a platinum spatula or similar blunt metallic object.   Bacterial infections: Neutrophils predominate Viral infections: Lymphocytes predominate Allergic reactions: Eosinophils predominate

14. HISTORY TAKING A medical and detailed ocular history includes questions about the onset and duration of the red eye, the quality and quantity of discharge, presence or absence of pain, photophobia, trauma, blurry vision, foreign body sensation, ocular itch e.t.c An eye evaluation should be performed with particular attention to reductions in best corrected vision in either eye, gross evaluation of lid margins and both bulbar and tarsal conjunctiva any ocular discharge, pupillary reactions, any pain with eye movements, slit lamp biomicroscope evaluation of the cornea IOP, and anterior chamber flare or cell.

15. FACTORS TO CONSIDER WHEN TAKING HISTORY History of systemic illnesses. History of recent exposure to other cases is extremely helpful, especially to children. A medication history is important to document what already has been tried and to rule out medicamentosa A history of allergies to medications. Contact lens wear, especially extended-wear contact lens use. Duration of the disease and previous attempts at therapy should be documented. Compliance to antibiotic use can also help determine whether antibiotic resistant bacteria may be involved. Venereal diseases should be considered in patients at a sexually active age

16. PROGNOSIS The prognosis for complete recovery without sequelae is excellent in bacterial conjunctivitis, as long as the cornea is not involved. Most benign cases are treated with topical antibiotics or self-resolve. Complications are expected to develop only in cases caused by extremely pathogenic bacteria, such as C trachomatis or N gonorrhoeae. Mortality in the setting of bacterial conjunctivitis is related to the failure to recognize and treat the underlying disease. Sepsis and meningitis caused by N gonorrhoeae can be life-threatening. Chlamydial infection in the newborn can lead to pneumonia and/or otitis media.

17. COMPLICATIONS Bacterial conjunctivitis, as long as the cornea is not affected, seldom leads to complications. General concerns include membrane formation, severe post recovery dry eye, and subsequent scarring of the punctum; corneal ulcer when the epithelium is not intact; and symblepharon from severe inflammation .

18. DIFFERENTIAL DIAGNOSIS OF BACTERIAL CONJUCTIVITIS

19. MANAGEMENT The mainstay of treatment for bacterial conjunctivitis is topical (administered as eye drops or ointment) antibiotic therapy. Systemic antibiotics are indicated for gonorrhea and chlamydial infections. Under certain circumstances, topical antibiotics may be considered of limited benefit and, considering the risks of widespread antibiotic resistance, should be withheld while the disease course resolves without treatment.  Steroid use is controversial.

20. TOPICAL ANTIBIOTIC THERAPY For mild and non–vision-threatening bacterial conjunctivitis, older-generation antibiotics should be used. Later-generation antibiotics and the latest fluoroquinolones should be reserved for more serious infections to minimize the risk of developing microbial resistance.  The following are older topical antibiotics that remain efficacious: Trimethoprim with polymyxin B, Azithromycin. Gentamicin, Tobramycin, Neomycin, Ciprofloxacin , Ofloxacin, Gatifloxacin, Erythromycin, Bacitracin.

21. TOPICAL ANTIBIOTIC THERAPY For moderate and severe bacterial conjunctivitis, the latest fluoroquinolones, including moxifloxacin, besifloxacin, and levofloxacin, are generally effective. Rare severe infections may also require patient hospitalization to ensure consistent administration of fortified aminoglycoside-cephalosporin combination therapy, fortified topical vancomycin, or topical fluoroquinolone monotherapy treatment every 15 minutes to hourly.

22. TOPICAL ANTIBIOTIC THERAPY Regardless of the topical antibiotic regimen chosen, start off with a higher frequency of dosing ( e.g , q2h) for the first 1-2 days before decreasing the dosage ( e.g , qid) for the subsequent 5-7 days. Neonatal chlamydial infection is treated with oral erythromycin. Doxycycline is used to treat the mother of a neonate with chlamydial infection as well as her at-risk contacts. Intravenous penicillin G is used for neonatal gonorrhea infections. Third-generation cephalosporins are used in the treatment of adult gonorrhea infections.

23. SYSTEMIC MEDICATIONS Azithromycin ( zithomax , zmax ) Doxycycline. Erythromycin base. Levofloxacin. Cetriazone

24. PREVENTION To prevent bacterial conjunctivitis, patient education should include good hygiene and avoidance of touching the eyes, especially after exposure to potentially infectious sources. Proper contact lens care includes avoidance of contact lens wear while sleeping and proper cleaning and discarding of both lenses and contact lens cases. Patients with bacterial conjunctivitis should be instructed not to touch their eyes and to avoid sharing fomites. They should also be educated regarding their infectious nature to prevent transmission and the importance of finishing their antibiotic regimen. Patients with bacterial conjunctivitis who wear contact lenses should be instructed to discontinue contact lens use and to discard their used contact lenses, open contact lens solutions, used contact lens cases, and used makeup and makeup brushes.