Dr.veni priya acute conj 10.02.16

Dr.veni priya acute conj 10.02.16

1. ACUTE CONJUNCTIVITIS Dr. s.veni priya 1

2. CLASSIFICATION Based on onset Acute. Sub-acute. Chronic. Based on type of Exudates Serous (Viral, allergic, toxic). Catarrhal (allergic – Ropy or thread like thick mucoid discharge). Mucopurulent. Purulent. Pseudo-Membranous / Membranous. 2 1 2

3. CLASSIFICATION (Continued) Based on Conjunctival Reaction Follicular. Papillary. Granulomatous. Based on Etiology Infectious (Bacterial, Viral, Chlamydial, Fungal and parasitic). Non-infectious (Allergic, Irritants). 3 3 4

4. RISK FACTORS Disruption of host defense mechanism caused by: Dry Eye. Exposure due to lid retraction, exophthalmos, lagophthalmos and inadequate blinking. Nutritional deficiencies / Avitaminosis A. Local or Systemic Immune Deficiency: After topical and systemic immunosuppressive therapy Nasolacrimal duct obstruction and infection. Radiation damage . Trauma. Surgery. Prior Conjunctival inflammation or infection. Systemic Infection. Exogenous inoculation 4 1 2 3 4

5. TYPES OF ACUTE CONJUNCTIVITIS Bacterial Conjunctivitis: Acute Purulent & Muco Purulent Gonococcal Membraneous & Pseudo Membraneous Angular Viral – Follicular Conjunctivitis. Chlamydial – Adult & Neonatal Inclusion Conjunctivitis. Ophthalmia Neonatorum Conjunctivitis. 5 1 2 3 4

6. BACTERIAL CONJUNCTIVITIS Acute Purulent & Muco Purulent Etiology Contagious Transmitted by discharge Staph.aureus – most common H.aegyptius , N.gonorrhoea . Clinical Features Hyperaemia Mucous discharge Stickiness of the lids Flakes of mucus & Pus in Fornices and lid margins Haloes Certain clinical features indicates likelihood of certain specific infections. 6

7. BACTERIAL CONJUNCTIVITIS Acute Purulent & Muco Purulent - Continued 7

8. BACTERIAL CONJUNCTIVITIS Acute Purulent & Muco Purulent - Continued Treatment Topical fluro quinolone – ciprofloxacin, Ofloxacin , Moxifloxacin , Gatifloxacin . Bacitracin or ciprofloxacin Ointment Oral antibiotics for patients with pharyngitis and haemophilus infection in children. 8

9. BACTERIAL CONJUNCTIVITIS Gonococcal Etiology Caused by Neisseria Gonorrhoeae (a bun- shaped Gram-negative intracellular diplococcus ). It is sexually transmitted disease Clinical Features Pre-auricular lymphadenopathy , tenderness and suppuration. No immunity is conferred by an attack. Associated systemic signs – Urethritis , rise of temperature and depression. 9

10. BACTERIAL CONJUNCTIVITIS Gonococcal - Continued Complications Corneal involvement – Gonococcus is capable of invading the normal cornea through intact cornea. Location of Corneal Ulcer – Central, Marginal Ulcer , all round. Progressing rapidly depth-wise leading to perforation and complications associated with it. Other complications of Gonorrhoeal Conjunctivitis– Iritis , Iridocyclitis . Non Ocular complications – Arthritis, Endocarditis and Septicaemia. 10

11. BACTERIAL CONJUNCTIVITIS Gonococcal - Continued Treatment Of Gonococcal Conjunctivitis is started on confirmation ofintracellular Gram-negative diplococci in conjunctival scrapings in clinically suspected cases. Aim of therapy is to prevent or limit the corneal involvement and to eliminate systemic source. 11

12. BACTERIAL CONJUNCTIVITIS Gonoccol - Continued Treatment – Continued Systemic Treatment Ceftriaxone - 1 gm IM , single dose. Tetracycline In cases where co-existing Chlamydial Trachomatis infection is suspected and cases with history of allergy to Penicillin / Cephalosporins Topical Treatment Cleanliness Ciprofloxacin / Ofloxacin/ Gentamicin/ Tobramycin Eye Drops 2 hrly . Bacitracin Eye Ointment 6 hrly . Cycloplegic (Atropine) – in cases of Corneal involvement . 12

13. BACTERIAL CONJUNCTIVITIS Membranous & Pseudo Membranous Etiology Caused by C.diphtheriae, Beta haemolytic strettocci, H.aegyptius, Staph.aureus & E.coli Occurs in children in assosiation with neasels , searlet fever, influenza & whooting cough. Clinical Features Swelling of lids Eucopurulant discharge White Membrane on everting lid Great danger of corneal ulcerations – 6 to 10 days. Increase risk of symbletharon. 13

14. BACTERIAL CONJUNCTIVITIS Membranous & Pseudo Membranous - Continued Treatment Systemic Treatment 4,000 to 10,000 units of anti diphtheretic serum. Penicillin Topical Treatment Topical 10,000 units / ml drops made from injectable preparations. 14

15. BACTERIAL CONJUNCTIVITIS Angular Etiology Caused by Staphylococci and more typically by Moraxella Lacunata . Incubation period is usually 4 days . Symptoms - Redness, discomfort, frequent blinking, sharp pricking pain and mucopurulent discharge. Clinical Features Congestion limited to intermarginal strip at inner and outer canthi and neighbouring bulbar conjunctiva. Excoriation of skin at inner and outer palpabral angles . 15

16. BACTERIAL CONJUNCTIVITIS Angular - Continued Complications Chronic conjunctivitis, Blepheritis , corneal ulcer (marginal or central associated with hypopyon ) . Attack does not confer immunity, and relapses may occur. Swelling of lids. Treatment Topical Treatment Tetracycline eye ointment . Eye drops containing Zinc also beneficial, acts by inhibiting proteolytic ferment. 16

17. VIRAL CONJUNCTIVITIS TYPES Acute Follicular Conjunctivitis Sub Acute or Chronic Follicular Conjunctivitis Epidemic Keroto Conjunctivitis. Pharyngo Conjuctival fever. Heaymorrhagic Conjunctivitis Acute Herpitic Conjunctivitis Herps Simplex Conjunctivitis 17

18. VIRAL CONJUNCTIVITIS (Continued) Clinical Features Serous or watery discharge Conjunctival foillicals. Sub Conjunival haemorrhage Punctate epithelial opacities Preoricular lymph node. Decreased corneal sensation. Treatment Topical Treatment Artificial Tears Antibiotic eye drops to prevent secondary infection. 18

19. OPHTHALMIA NEONATORUM Etiology Neisseria Gonorrhoeae , Streptococcus Pneumoniae , Staphylococcus etc. Chlamydial Trachomatis, Chalmydial Oculogenitalis Chemical Conjunctivitis due to Silver Nitrate 1or 2% (used as Crede’s method) Clinical Features Purulent bilateral conjuntival discharge Hyper acute blenorrhoea Swelling of lids Mucopurulent discharge 19

20. OPHTHALMIA NEONATORUM (Continued) Complications Corneal Ulcer : Oval ulcer, just below the centre of cornea, rarely oval marginal ulcer, progressive ulcer resulting in – perforation of corneal ulcer, prolapse of uveal tissue, purulent uveitis, prolapse of lens, prolapse of vitreous. Scarring of cornea, adherent leucoma , anterior staphyloma , anterior capsular cataract, anophthalmitis . Non development of fixation due to corneal opacity during first 3 weeks. Nystagmus due to non-development of macular fixation 20

21. OPHTHALMIA NEONATORUM (Continued) Treatment Systemic Treatment Ceftriaxone – 25 to 50 mg/kg single dose. Cefatoxine – 100 mg / kg single dose. Topical Treatment Saline irrigation Topical flouro quinolones . Topical cycloplejia . 21

22. ACUTE CONJUNCTIVITIS 22 QUESTION & ANSWER SESSION

23. Thank you 23

24. Thank you 24

25. Thank you 25

26. Thank you 26