Download Take up one idea

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Take up one idea
Make that one idea your life
- think of it,
- dream of it,
- live on that idea.
Let the brain, muscles, nerves, every part of
your body, be full of that idea, and just leave
every other idea alone.
This is the way to success
- Swami Vivekananda
Compassion Oct - Dec, 2016
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Conjunctivitis
Clinical
The conjunctiva is a mucous membrane which
lines the upper and lower eyelids and extends
over the sclera to the corneal margin.
It provides mucous to lubricate the
surface, which is secreted by the goblet cells.
The conjunctiva is composed of 3 sections
• Palpebral conjunctiva: It is a loose
connective tissue which covers the
posterior surface of the eyelids.
• Bulbar conjunctiva: It coats the posterior
portion of the eyeball and it reflects back
upon itself to form the inner layer of the
eyelid.
• Fornix: The transition portion, forming the
junction between the posterior eyelid and
the eyeball.
Conjunctivitis
Conjunctivitis, also known as pink eye, is
inflammation of the outermost layer of the
white part of the eye and the inner surface of
the eyelid.
Clinical presentation
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Pain in the eye
Itching
Reduction in visual acuity
Dry periocular and periorbital skin
Conjunctival hyperemia
Conjunctival edema, papillae, follicles
Preauricular adenopathy - enlargement of
the preauricular lymph node located 1 cm
in front of the external ear
Bacterial Conjunctivitis
Symptoms
• Ocular irritation
• Conjunctival redness
• Mucopurulent discharge that is worse in
the morning
Treatment
• Scraping and culturing of the palpebral
conjunctiva can assist with the diagnosis
• Lid margin scrubs and warm compresses
• Treatment with the appropriate topical
antibiotic drops or ointment .
a. Topical Gentamicin and Tobramycin
for gram-negative organisms
b. Topical ciprofloxacin or ofloxacin for a
wide-spectrum of infecting agents.
Neonatal Conjunctivitis (ophthalmia
neonatorum)
• Any conjunctivitis occurring with in the
first 4 weeks after birth is classified as
neonatal conjunctivitis.
Goblet cells - cells found throughout the conjunctival epithelium; Periocular - surrounding the eyeball but within the orbit;
Periorbital - surrounding or lining the orbit of the eye ; Hyperemia - excess of blood; Papillae -white bumps;
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Causative organisms
• Before birth - very rare
• During birth - face presentation is the
most common
• After birth - from soiled linen
• Adenoviral infections are among the most
common viral ocular infections
• Punctate keratopathy - corneal
inflammation characterized by scattered,
fine, corneal epithelial loss or damage
• Superficial ulcerations - disruption of
the epithelial layer of the cornea due
to Herpes Simplex or Herpes Zoster
infections.
Clinical picture
Treatment
• Gonococcus (most common)
• Chlamydia
Mode of Infection
• watering
• redness
• discharge
Treatment
1) Prophylaxis
• Proper antenatal care of mother. Any
vaginal discharge should be treated
methodically.
• Crede’s prophylaxis: 1% silver nitrate is
instilled into the baby’s eyes immediately
after birth.
• Erythromycin or Tetracycline ointment is
applied to the conjunctival surface within
1 hour after the baby is born - the chance
of developing chlamydial conjunctivitis is
almost zero.
2) Curative
• Swab taken for culture and sensitivity
• Gonococcal - Ciprofloxacin hourly for
3 - 5 days
• Chlamydial - 1% Tetracycline 2 times/day
Viral Conjunctivitis
• Has an acute onset, is unilateral and lasts
for approximately one week.
• Burning and absence of itching.
• Extremely contagious
• Treatment of non specific viral
conjunctivitis is largely supportive and
requires no drug therapy.
• Topical vasoconstrictors may provide
symptomatic relief and decrease
conjunctival injection.
• If the corneal epithelium becomes
compromised and there is a risk for
secondary infection, prophylactic
antibiotics may be given.
Allergic Conjunctivitis
• Allergic conjunctivitis is caused by the
direct exposure of the conjunctiva to
environmental allergens
Causes
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Pollen grains
Certain topical drugs e.g.. Neomycin
Contact with pet animals
Dust, cosmetics, chemicals
Symptoms
• Itching
• Tearing
• Burning
Treatment
• Removal of allergen
• Antihistamine tablets & drops
Follicles - round collections of lymphocytes - subtypes of white blood cell; Mucopurulent -composed of mucus and pus;
Prophylaxis - treatment given or action taken to prevent disease; Vasoconstrictors - causes the blood vessels to constrict
Compassion Oct - Dec, 2016
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• Topical 2% Sodium Chromoglycolate to
prevent recurrence
• Corticosteroid drops in severe cases
Vernal Keratoconjunctivitis
Definition
Hypersensitivity reaction of conjunctiva to
exogenous allergens
• Age 6-20 yrs, usually males
• Seasonal variation - Prevalent in summer
• Exciting factors - Dust, dry heat, pollens
Symptoms
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Intense itching
Discharge
Photophobia
Burning
Foreign body sensation
Signs
• Cobble stone appearance due to papillary • Hypertrophy in the palpaberal
conjunctiva
• Multiple small nodules around the limbus
• Superficial white spots scattered around
the limbus.
Treatment
• Cold compresses
• Disodium chromoglycolate 4 times / day
reduces itching
• Topical steroids like dexamethasone 4
times daily and tapering dose depending
on the severity.
Long term use of steroids can cause cataract
and glaucoma.
Atopic Keratoconjunctivitis
• Atopic keratoconjunctivitis (AKC) is the
result of a condition called "atopy".
• Atopy is a genetic condition where the
immune system produces higher than
normal antibodies in response to a given
allergen.
• Symptoms may worsen in the winter.
• With AKC, the conjunctiva lining the
eyelids is usually red and swollen.
• The lower eyelid is affected more than the
upper eyelid.
• If left untreated, AKC can progress to
ulceration, scarring, cataract, keratoconus,
and corneal vascularization.
Symptoms
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Sensitivity to light
Itching
Burning
Tearing
Red and hardened eyelids
Treatment
• Cold compresses and saline irrigation to
lower the elevated tear pH
• In more severe cases, there is potential for
damage to the eye caused by scratching
and rubbing. Wear cotton gloves at night
to prevent unintentional damage to the
ocular surface.
• Astringent drops, e.g. zinc sulphate, to
relieve symptoms.
• Topical steroids such as prednisolone eye
drops are frequently used.
• Antithistamines are only partially
effective.
• Mast cell stabilizers such as Cromolyn
Sodium 4% and Lodoxamide 0.1% are
effective, if used continuously for many
months.
• Mucous membrane graft to the upper lid
tarsal conjunctiva can be useful.
Injection - dilation of the conjunctival vessels; Compromised - inability to resist infection; Antihistamine - medications to treat
allergies; Recurrence - occur again or repeatedly; Corticosteroid - class of steroid hormones; Hypertrophy - increase in size