Membranous conjunctivits

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1. DR.PRRAFULLA C.PATIL. S.C.H.M.C.JALGAON. MEMBRANOUS CONJUNCTIVITS.

2. DEFINITION:- This disease is rare and is characterized by conjunctivitis with membrane formation on the conjunctiva.

3. ETIOLOGY:- Age :-usually in children from 2-8 years of age. General ill health following eruptive fevers and unhygienic living condition. Causative agents:-a) corynebacterium diphtheria b) Staphylococci. c) P neumococci. d) Streptococcus haemolyticus.

4. Mode of infection with diphtheria bacillus:- 1) F aucial diphtheriaby contamination. 2) Nasal diphtheria by spread along naso lacrimal duct. 3) By infection from a carrier.

5. PATHOLOGY:-

6. SYMPTOMS:- Clinical course may be mild or severe Oedema of the lids Muco -purulent discharge Conjunctival congestion Moderate pain On everting the lid white membrane is senn on palpebral conjunctiva.

7. In severe cases clinical course may be in three stages:- 1) Stage of infiltration:- It lasts for 5-10 days. Eye beecome red,hot and swollen hard like a board. due to stiffness,imposssible to evert the eyelid, scanty conjunctival discharge pain is severe. Stiff greyish yellow membrane on palpebral or on bulbar conjunctiva.

8. 2) S tage of suppuration:- Pain is less. Lids become soft Membrane is sloughed off,leavving red ,raw ,granulating surface. Discharge is copious.

9. 3) Stage of cicatrization :- Symbelepharon . E ntropion contraction of fibrous tissue. Xerosis of conjunctiva due to occlusion of lacrimal ducts and conjuctival sac.

10. Associated of the eye changes there are systemic signs and symptoms:- 1) Patient is highly toxic and acutely ill 2) Rise of temperatue 3) Albumin may appear in urine.

11. DIAGNOSTIC CRITERIA:- 1) history of diphtheria or contact with a carrier. 2) signs of acute conjunctivitis\ 3) tough yellowish white menmbrane on tarsal conjunctiva.

12. COMPLICATION:- Corneal ulcer In severe cases whole cornea may slough out Symbelepharon Entropion Trichiasis Xerosis

13. TREATMENT :- Prophylactic :Isolation of patient Curative:- it is advisable to trake conjuctival swab for culture and smear examination before starting the treatment. Local treatment:- 1) Crystalline penicillin of 10000 units per c.c. of distilled water to be dropped at frequent interval. 2) Instillation of anti diphtheritic serum 3) Atropine sulphate ointment if cornea is ulcerated. 4) Broad spectrum antibiotic. 5) After membrane slogh off ,soft contact les to cover the eyeball.

14. Systemic :-IM injection anti diphtheritic serum injection crystalline penicillin 500000 units twice daily.