Dr.A.R.Rajalakshmi, 02.2.17 intro, acute conj - i
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Transcript of Dr.A.R.Rajalakshmi, 02.2.17 intro, acute conj - i
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DR. A.R.RAJALAKSHMIASSO. PROFESSOR
*ACUTE CONJUNCTIVITIS
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*AIM
* The anatomy & functions of conjunctiva.* Enumerate the symptoms & signs of
conjunctival disorders.*Enumerate the causes of acute
conjunctivitis & its prevention & management .
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*ANATOMY – CONJUNCTIVA
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*CONJUNCTIVA
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*ANATOMY
*Thin mucous membrane lining the surface of the eye & the eyelids.*Parts of conjunctiva : palpebral bulbar fornix
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* CONJUNCTIVA - histology
THREE LAYERS *EPITHELIUM – non keratinised squamous
epithelium*ADENOID – loose connective tissue with
leucocytes (LYMPHOID LAYER)*FIBROUS
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Conjunctiva – Functions
*Tear production ( goblets & accessory lacrimal glands)*Oxygen supply to cornea*Maintain a smooth ocular surface*Protection of the eye - intact epithelial
barrier, lacrimation, immunologic mechanism ( adenoid layer)
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Conjunctiva – normal flora
*Non pathogenic commensal Staphylococcus albus, diphtheroids, Propionibacterium acnes, Neisseria catarrhalis , Corynebacterium xerosis
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SYMPTOMS
*Redness*Watering *Discharge Stickiness *Irritation / foreign body sensation *Itching *Gritty sesnsation*Fleshy growth
IF PAIN OR DEFCECTIVE VISION IS THERE , THEN SUSPECT CORNEAL INVOLVEMENT / SOME OTHER DISORDER
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SIGNS OF CONJUNCTIVAL
DISORDER
*CONGESTION /HYPEREMIA *DISCHARGE *FOLLICLE *PAPILLAE *CHEMOSIS
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*RED EYE
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Congestion
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RED EYE
PALPEBRAL CONGESTION
CIRCUMCORNEALCONGESTION
SITE fornix Around the cornea
COLOUR Bright red Dull redArrangement Superficial DeepADRENALINE TEST
Immeditely blanch
Do not blanch
CAUSES Acute conjunctivitis
Keratitis , acute iridocyclitis
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OCULAR DISCHARGE
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OCULAR DISCHARGE
TYPE OF DISCHARGE CAUSATIVE FACTOR
Watery Viral conjunctivitis Foreign body
Mucoid / ROPY discharge Allergic conjunctivitis
Mucopurulent / purulent Bacterial conjunctivitis
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PAPILLAE
*Reddish flat topped raised areas*Gives ‘VELVETTY ‘ apppearance to the
conjunctiva *Seen in ALLERGIC CONJUNCTIVITIS *Central core of dilated blood vessels
surrounded by lymphocytes & covered by hypertrophied epithelium
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FOLLICLE
* ‘BOILED SAGO GRAIN ‘ APPEARANCE*Seen in upper palpebral conjunctiva –
TRACHOMA*subepithelial aggregation of lymphocytes,multinucleated giant cells with necrosis
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CHEMOSIS
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*ANATOMY
*Parts of conjunctiva *Layers of conjunctiva *Name two functions of conjunctiva*Causes of acute red eye *Difference between the two congestions* what is papillae *What is follicle *Diagnose this pic
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CONJUNCTIVITIS
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ACUTE CONJUNCTIVITIS
*Inflammation fo the conjunctiva < 4 weeks of duration .
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* 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.
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*CLASSIFICATION (Continued)
Based on Conjunctival Reaction* Follicular.* Papillary. * Granulomatous.
Based on Etiology* Infectious (Bacterial, Viral, Chlamydial, Fungal and
parasitic).* Non-infectious (Allergic, Irritants).
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*TOPICS
*Bacterial conjunctivitis – gonorrheal , angular, membraneous *Viral conjunctivitis *OPHTHALMIA NEONATORUM
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*READING PATTERN of ANY
DISEASE
*Definition *Etiology – risk factors, cause*Pathogenesis *Clinical features – symptoms , signs *Investigations *Treatment – medical , surgical , complications *Prevention *Complications of the disease
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* BACTERIAL CONJUNCTIVITIS Acute Purulent & Muco Purulent
Etiology* Staph.aureus – most common,
H.aegyptius , N.gonorrhoea* RISK FACTORS : highly Contagious , Transmitted by discharge
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*BACTERIAL CONJUNCTIVITIS
Clinical FeaturesSymptoms * Mostly bilateral * Acute onset of redness associated
with * Purulent discharge* Stickiness of the lid* Haloes
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*BACTERIAL CONJUNCTIVITIS
SIGNS :* purulent / muco prulent discharge *Matted eyelashes with yellow crusts * palpebral congestion *Cornea – clear
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Treatment* Topical fluro quinolone – ciprofloxacin,
Ofloxacin, Moxifloxacin, Gatifloxacin.* Bacitracin or ciprofloxacin Ointment.
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PREVENTION
*Frequent face wash & hand wash *No sharing of hankies, towels & pillows
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*COMPLICATIONS
*Chronic conjunctivitis – if not treated *Corneal involvement – corneal ulcer *Iritis
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GONORRHOEAL CONJUNCTIVITIS
Etiology* Caused by Neisseria Gonorrhoeae. * Transmitted from genitalia to eye through hands.
Clinical Features* Severe lid edema * Copious purulent discharge ( acute blenorrhea)* Pre-auricular lymphadenopathy, tenderness and
suppuration * Associated systemic signs – Urethritis, rise of
temperature and depression.
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*BACTERIAL CONJUNCTIVITIS Gonococcal - ContinuedComplications
• Corneal involvement – Gonococcus is capable of invading the normal cornea through intact epithelium.
* Iritis , Iridocyclitis .
* Non Ocular complications – Arthritis, Endocarditis and Septicaemia.
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*BACTERIAL CONJUNCTIVITIS Gonococcal - Continued
Invetigations:* conjunctival scraping - intracellular Gram-negative
diplococci .
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*BACTERIAL CONJUNCTIVITIS Gonoccol - Continued
Treatment - Aim of therapy is to prevent or limit the corneal involvement and to eliminate systemic source. Systemic Treatment * Ceftriaxone - 1 gm IM , single dose.
Topical Treatment * Cleanliness * Ciprofloxacin / Ofloxacin/ Gentamicin/ Tobramycin Eye
Drops 2 hrly.* Bacitracin Eye Ointment 6 hrly.* Cycloplegic (Atropine) – in cases of Corneal involvement .
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*BACTERIAL CONJUNCTIVITISMembranous & Pseudo Membranous
Etiology* Caused by C.diphtheriae, Streptococcus pneumonia* Occurs in children in assosiation with Measles , scarlet fever,
influenza & whooping cough.
Clinical Features* Swelling of lids* mucopurulant discharge * White Membrane on everting lid
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* MEMBRANOUS CONJUNCTIVITIS
Treatment – ASK IMMUNISATION HISTORY* 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.
Complications:* corneal ulcerations * Increase risk of symblepharon
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ANGULAR CONJUNCTIVITIS
Etiology* Moraxella Lacunata – diplobacillus.
CLINICAL FEATURESSymptoms - Redness, discomfortSigns * Congestion limited to intermarginal strip at inner and
outer canthi. * Excoriation of skin at inner and outer palpabral angles .
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*BACTERIAL CONJUNCTIVITISAngular - Continued
Treatment* Topical Treatment * Tetracycline eye ointment .* Eye drops containing Zinc also beneficial, acts by
inhibiting proteolytic ferment.
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*VIRAL CONJUNCTIVITISTYPES• Acute Follicular Conjunctivitis• Sub Acute or Chronic Follicular Conjunctivitis• Epidemic Keroto Conjunctivitis.• Pharyngo Conjuctival fever.• Heaymorrhagic Conjunctivitis• Acute Herpitic Conjunctivitis• Herps Simplex Conjunctivitis
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*VIRAL CONJUNCTIVITIS(Continued)
Symptoms * Serous or watery discharge * Severe irritation with rednessSigns * Palpebral congestion * Conjunctival follicles * Sub Conjunival haemorrhage * Preauricular lymph node.* Decreased corneal sensation.
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TreatmentTopical Treatment * Artificial Tears* Antibiotic eye drops to prevent
secondary infection* PREVENTION
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*OPHTHALMIA NEONATORUMDefinition any discharge from the eye in the first month of life .* responsible for corneal blindness in children
Genitourinary tract of mother is infected
Normal delivery through the infected tract
Child gets infection
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Causative factor
Time of onset after birth
Treatment
N. Gonorrhoea Within 24-48 hours
Ceftriaxone im injection, topical antibiotics
Chemical ( silver nitrate)
“ Wash eyes & observe
Other bacteria 48-72 hours Topical antibiotics
Herpes simplex 5-7 days Topical acyclovir eye ointment
Chlamydia trachomatis
> 1 week Erythromycin eye ointment
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*OPHTHALMIA NEONATORUM (Continued)
Complications* Corneal 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, endophthalmitis.
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PREVENTION:* ANTENATAL - treat the maternal
infection* INTRANATAL – aseptic precautions clean the closed closed eyelids ommediately after delivery erythromycin eye ointment – prophylactically
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*INVESTIGATIONS
Conjunctival discharge *STAINING – Gram, Giemsa * CULTURE & SENSITIVITY – bacterial, viral,
chlamydia
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* OPHTHALMIA NEONATORUM(Continued)
Treatment
* Systemic Treatment * Ceftriaxone – 25 to 50 mg/kg single dose.* Cefatoxime – 100 mg / kg single dose.
* Topical Treatment * Saline irrigation * Topical flouro quinolones.
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ASSIGNMENT
* a 10 day old male baby is brought with the complaints of watering & discharge from both eyes since birth. It is also associated with inability to open the eyes.
1. Name four differential diagnosis ( 2 marks)
2. Define (1) Ophthalmia neonatorum . Describe the various causes(1), clinical features (2) , investigations(1) & management of the above condition(3).
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*ANATOMY