conjunctivitis
• Acute conjunctivitis: The onset is sudden and previously unilateral, the inflammation of the second eye occurs within 1 week. Its duration is less than 4 weeks.
• Chronic conjunctivitis: Duration is longer than 3-4 weeks.
Bacterial conjunctivitis
Acute bacterial conjunctivitis
Vasodilation, mucopurulent secretion, is the adhesion of the eyelids to each other.
The most common agents are Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis
Hyperacute bacterial conjunctivitis (acute purulent conjunctivitis)
Hyperacute bacterial conjunctivitis
The causative agent is Neisseria gonorrhoeae. Gram (-) diplococci are seen in the sample.
It is the most serious cause of ophthalmia neonatorum (neonatal conjunctivitis).
If untreated, it causes serious corneal complications (corneal perforation).
Instillation of povidone-iodine 2.5%, erythromycin 0.5% or tetracycline 1% drop/pomade is beneficial prophylactic.
Silver nitrate (AgNO3) 1% solution is still used in some hyperendemic regions.
In the presence of maternal infection, benzylpenicillin or ceftriaxone should be used.
Chronic bacterial conjunctivitis
The most common causative agent is Staphylococcus aureus.
Staphylococcal species cause more blepharitis. It causes crusting on the eyelashes.
Neonatal conjunctivitis (Ophthalmia neonatorum)
Chemical conjunctivitis (AgNO3) ---------------------------------------- ► Within hours
gonococcal conjunctivitis--------------------------------------------------- ► Days 2-4
Other bacteria (Staf., strep., Haemophilus, Pseudomonas) ------------► 4-5. days
Viral (HSV Type 1- 2) ------------------------------------------------------ ► 5-7. days
Chlamydia -------------------------------------------------------------------- ► 5-14. days
Chlamydial Conjunctivitis
a) Inclusion conjunctivitis of the newborn
It is the most common type of neonatal conjunctivitis.
The causative agent is C. trachomatis D-K strains.
It may be associated with systemic infections such as otitis, rhinitis, pneumonia.
Development of lymphoid-adenoid layer starts in the 4-6 weeks. Follicle structure is not seen
Diagnosis can be made by intracytoplasmic inclusion bodies.
Topical erythromycin or tetracycline and oral erythromycin (2 weeks) are used for treatment.
b) Adult inclusion conjunctivitis
The causative agent is C. trachomatis D-K strains.
It causes hyperemic eye, preauricular lymph node and follicular conjunctivitis.
Genital contamination can also pass through swimming pools and cosmetics.
Topical erythomycin or tetracycline and systemic azithromycin 1 g (single dose or repeated after 1 week) or doxycycline 100 mg (2 times a day for 10 days) are used in treatment.
c) Trachoma
The causative agent is Chlamydia trachomatis A, B, Ba, C strains.
Trachoma is the most common cause of preventable irreversible anterior segment blindness in the world. The most common cause of corneal blindness in developed countries is herpetic keratitis.
It is a bilateral chronic mixed follicular and papillary keratoconjunctivitis.
Irrigation, photophobia, edema, pain, chemosis in the bulbar conjunctiva, papillary hypertrophy, tarsal and limbal follicles, pannus, diffuse punctate (spotted) keratitis in the cornea are seen.
There are epithelial keratitis, infiltrates and fibrovascular (pannus) changes in the cornea.
Herbert's pits are seen in the limbus due to bacterial infiltration and destruction.
Chronic linear cicatricial lines (Arlt lines) are seen in the lid conjunctiva.
Topical tetracycline and systemic antibiotics are used in the treatment. In systemic treatment, azithromycin 1 g single dose or erythromycin 500 mg can be used for 4 days or doxycycline 100 mg twice a day for 10 days.
