Download conjunctiva - UMF IASI 2015

CONJUNTIVA
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RED EYE
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CONJUNCTIVA
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Conjunctivitis
Chronic conjunctivitis
CONJUNCTIVA
Ophthalmia neonatorum
Adenoviral conjunctivitis
Trachoma
Allergic conjunctivitis
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.CONJUNTIVA
anatomy
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Conjunctivitis
Clasification
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acute
hyperacute
chronic
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CONJUNCTIVAL SECRETION
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Folliculles, papillae, chemosis
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Bacterial conjunctivitis
Clinic:
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quikly onset of unilateral conjunctival
hyperemia
lid edema
mucopurulent discharge
second eye becomes involved 1-2 days later
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1.Bacterial conjunctivitis is characterized by: rapid onset of unilateral conjunctival
hyperemia, lid edema and mucopurulent discharge; second eye becomes involved 12 days later. Bacterial conjunctivitis (bc.) can be classified into three clinical types:
acute, hyperacute and chronic. The most common conjunctival pathogens include
Staphylococcus, Streptococcus, Haemophilus, Neisseria and Gram negative.
1.a. Acute bc. begins unilaterally with hyperemia, irritation, tearing and
mucopurulent discharge; other common ocular manifestations include punctate
epithelial keratitis, blepharitis, marginal ulcers.
Treatment: topical antibiotic drops or ointment; the choice of antibiotic is based
upon results of cultures; if the treatment is based upon clinical features, a broadspectrum antibiotic such gentamicin, floroquinolone or trimethoprim-polimixin may be
used for 7-10 days.
1.b. Hyperacute bc. The most common cause is Neisseria gonorrhea. This is
an oculo-genital disease seen primarily in neonates, sexually active teenagers and
young adults.
The clinical course includes profuse, thick, yellow-green purulent discharge,
painful hyperemia, and chemosis. Untreated cases may lead to peripheral corneal
ulceration and eventual perforation with possible endophthalmitis.
Treatment: conjunctival scraping and culture on blood and chocolate agar is
suggested strongly. Gonococal conjunctivitis is treated with both topical and systemic
antibiotics: ceftriaxone 1 g followed by 2-3 weeks course of oral tetracycline or
erythromycin; topical antibiotics: bacitracine or erythromycin ointments every 2 hours.
Frequent irrigation of the ocular surface is helpful.
Treatment:
hygiene
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hots compresses,
gentle shampoo applied
topical antibiotic drops or ointment (the
choice of antibiotic is based upon
results of cultures) if the treatment is
based upon clinical features
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Aminoglicozid
Floroquinolone
corticosteroids
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Ophthalmia neonatorum
oral eritromycine syrup 50 mg/kg/day for
14 days;
treatment of mother and sexual partners
with tetracycline or eritromycine 7 days;
prevention:
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treatment of chlamydial, gonococcal and
herpetic infections during pregnancy
Crede method
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Ophthalmia neonatorum is defined as any conjunctivitis occurring within the first 4
weeks of life. It is caused by bacterial, viral, chlamydial infection or by toxic response
to topically applied chemicals.
a)chemical conjunctivitis results from the instillation of silver nitrate drops used
for infection prophylaxis.
b)Chlamydial infection is the most frequent cause of neonatal conjunctivitis in
USA. Symptoms develops 5-14 days after delivery; initially infants develops a watery
discharge and mucopurulent later. Signs include: lid edema, a papillary conjunctival
response and pseudomembranes. The infection is mild and self-limited; however,
severe cases may occur and have conjunctival scaring and peripheral corneal panus.
Treatment:-oral eritromycine syrup 50 mg/kg/day for 14 days;
-treatment of mother and sexual partners with tetracycline or eritromycine 7
days; -prevention: treatment of chlamydial, gonococcal and herpetic infections during
pregnancy.
c)Neisseria infection: hyperacute conjunctivitis with edema, chemosis and
excessive purulent discharge, which begins 24-48 hours after birth. The discharge is
so copious that it reaccumulates after the eye has been clean. Gram stain is
essential to prompt and effective treatment.
Treatment:-systemic penicillin G 100,000ui/kg/day in 4 doses for 7 days or
intravenous ceftriaxone 25-50 mg/kg once a day for 7 days; -topical antibiotics.
d) other bacterial infection bacteria are probably transmitted through the air to
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the infant.
Viral conjunctivitis (v.c.) is one of the most common causes of visits to the emergency room
or doctor’s office.
2.a.Adenoviruses produce:
-pharyngoconjunctival fever is a condition characterized by combination of pharyngitis,
fever and conjunctivitis. The conjunctivitis is follicular with watery discharge, hyperemia and
mild chemosis. The cornea may be involved with fine punctate epitheliopathy and preauricular
limfonodes are enlarged in 90% of cases. Treatment is usually supportive with cold
compresses, vasoconstrictive drops; the disease resolve spontaneously within 2 weeks.
-epidemic keratoconjunctivitis is a more severe type and lasts for 7-21 days.
Clinical signs:*hyperaemia, chemosis, watery discharge, a mixed papillary and follicular
response and ipsilateral preauricular limphadenopathy, subconjunctival hemorrhages and
conjunctival membranes;corneal involvement.
Treatment:prevention – hand washing, relative isolation of infected individuals,
disinfecting of ophthalmic instruments;curative :vasoconstrictive eye drops and for corneal
involvement topical corticosteroids.
2.b. Acute hemorrhagic conj. are produced by picornaviruses.
Signs: severe painful conjunctivitis with chemosis, tearing and subconjunctival
hemorrhages; the disease resolves within 4-6 days but the hemorrhages clear later; the
conjunctivitis tends to occur in epidemics with more than 50% of the local population affected.
2.c. Herpes simplex conj. is nonspecific; typical signs include: ocular irritation, watery
discharge, follicular conjunctivitis and preauricular limphadenopathy , an epidermal vesicular
eruption of the eyelid and lid margins. Conjunctivitis resolves spontaneously without treatment;
if corneal involvement exist administration of topical antiviral is indicated.
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2.d. Other causes rubella, rubella, varicela-zoster, Epstein-Barr viruses.
Viral conjunctivitis
Adenoviruses
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pharyngoconjunctival fever
epidemic keratoconjunctivitis
Acute hemorrhagic
Herpes simplex, varicela-zoster
Rubella, Epstein-Barr viruses
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. Viral
conjunctivitis
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.chlamidial conjunctivitis
Trachoma
adult inclusion conjunctivitis
neonatal conjunctivitis
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McCallan classification
I. early lymphoid hyperplasia with follicles
formation on the superior tarsal conjunctiva;
IIa. mature follicles on full superior tarsus;
IIb. florid inflammation with increase in
pretarsal and limbal follicular and papillary
hypertrophy;
III. resolution of the papillary hypertrophy and
early conjunctival scaring;
IV. no active inflammation, replacement of
papillae and follicles with scars and
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Chlamidia trahomatis
. Trachoma results from stereotypes A – C, is endemic in areas of close human
contact and poor hygiene. Trachoma begins as a follicular conjunctivitis of the upper
palpebral conjunctiva with associated limbal follicles. Other findings include
conjunctival papillary hypertrophy, a superficial corneal panus and a fine epithelial
keratitis. The inflammation leads to scaring of the cornea, conjunctiva and eyelids.
McCallan classification:
I. early lymphoid hyperplasia with follicles formation on the superior tarsal
conjunctiva;
IIa. mature follicles on full superior tarsus;
IIb. florid inflammation with increase in pretarsal and limbal follicular and
papillary hypertrophy;
III. resolution of the papillary hypertrophy and early conjunctival scaring;
IV. no active inflammation, replacement of papillae and follicles with scars and
resolution of panus.
Complications: conjunctival and eyelids deformities: trichiasis,distichiasis, entropion,
ectropion; corneal involvement:scars, vascularization and ulcers (infection,
perforation)  blindness.
Treatment:-oral tetracycline (1 g/day) or doxicycline 100 mg/day 3-4 weeks;
-topical tetracycline or eritromycine ointments twice a day for 5 days each
month for 6 months;-oral azithromicine in endemic areas.
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Trachoma
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LECTURER DR. RUSU
VALERIU
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Treatment
oral tetracycline (1 g/day) or doxicycline
100 mg/day 3-4 weeks;
topical tetracycline or eritromycine
ointments twice a day for 5 days each
month for 6 months;
oral azithromicine in endemic areas has
shown promise to eradicate the disease.
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ALLERGIC CONJUNCTIVITIS
1.Acute atopic conjunctivitis is a Type 1 allergic response mediated
by Ig E. The response is stimulated by airborne allergens such as: dust,
pollen, spores and animal dander.
Symptoms are itching, burning. Signs are hyperemia, lid edema,
chemosis and watery discharge. Reaction may be limited to the eye or it
may be part of a generalized allergic reaction with nasal and respiratory
symptoms.
Treatment: cold compresses, topical vasoconstrictors topical
antihistamines (levocabastine); also corticosteroids for severe cases.
2.Chronic atopic conjunctivitis same symptoms as in acute
condition except less evidence of the acute inflammation. Conjunctiva
exhibits a pale edema with papillary hypertrophy.
3. Giant papillary conjunctivitis is a syndrome of inflammation of the
upper palpebral conjunctiva associated with contact lens wear, ocular
prosthesis. Patients complains of a mild itching after removal of the contact
lenses; macropapillae and giant papillae cover superior tarsal conjunctiva.
Treatment: stopping lenses wear until the inflammation subsides; the
correct manipulation of the lens is essential; a short course of topical
corticosteroids can lessen the symptoms in severe cases.
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Alergic conjunctivitis
Atopic conjunctivitis
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acute
chronic
Allergic dermato-conjunctivitis
Microbioallergic conjunctivitis
Vernal conjunctivitis
Giant papillary conjunctivitis
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Symptoms
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itching
burning
Signs
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hyperemia
lid edema
chemosis
watery discharge
generalized allergic reaction
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nasal
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respiratory symptoms.
Treatment
hygiene
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alergen eviction
cold compresses
topical vasoconstrictors
topical antihistamines
(levocabastine)
corticosteroids
topical cyclosporine
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