BACTERIAL CONJUNCTIVITIS

INFLAMMATIONS OF CONJUNCTIVA

• Infective conjunctivitis
– Bacterial
– Chlamydial
– Viral
• Allergic conjunctivitis
• Granulomatous conjunctivitis
 ETIOLOGY
A/Predisposing factors
• Flies
• poor hygienic conditions
• hot dry climate
• poor sanitation and dirty habits
 ETIOLOGY
B/ Causative organisms
• Staphylococcus aureus+++
• Staphylococcus epidermidis: innocuous flora of lid and
conjunctiva
• Streptococcus pneumoniae (pneumococcus): produce
acute conjunctivitis, self-limiting course 9-10 days
• Streptococcus pyogenes (haemolyticus): virulent, produce
pseudomembranous conjunctivitis
• Haemophilus influenzae (aegyptius, Koch- Weeks bacillus):
cause epidemic of mucopurulent conjunctivitis “red eye”
• Moraxella lacunate (Moraxella Axenfeld bacillus)
 ETIOLOGY
B/ Causative organisms
• Pseudomonas pyocyanea: virulent organism, readily invade
cornea
• Neisseria gonorrhoeae
– produces acute purulent conjunctivitis in adults and ophthalmia
neonatorum in new born
– Can invade intact corneal epithelium
• Neisseria meningitidis (meningococcus): produce
mucopurulent discharge
• Corynebacterium diphtheriae: cause membranous
conjunctivitis
 ETIOLOGY
C/ Mode of infection
• Exogenous infections:
– Directly through close contact, as air-borne infection or as water-
borne infections
– through vector transmission (e.g., flies)
– through material transfer such as infected fingers of doctors,
nurses, common towels, handkerchiefs, and infected tonometers
• Local spread: from neighbouring structures such as infected
lacrimal sac, lids, and nasopharynx
• Endogenous infections: occur very rarely through blood e.g.,
gonococcal and meningococcal infections.
 PATHOLOGY CHANGES OF BACTERIAL
CONJUNCTIVITIS
• Vascular response
– congestion and increased permeability of the conjunctival vessels
– associated with proliferation of capillaries
• Cellular response: exudation of leukocytes + other
inflammatory cells -> substantia propria of conjunctiva &
conjunctival sac
• Conjunctival tissue response
– Conjunctiva becomes oedematous
– superficial epithelial cells degenerate, become loose +
desquamate
• Conjunctival discharge: consist of tears, mucus,
inflammatory cells, desquamated epithelial cells, fibrin and
bacteria
 CLINICAL TYPES OF BACTERIAL
CONJUNCTIVITIS
• Acute catarrhal or mucopurulent
conjunctivitis.
• Acute purulent conjunctivitis
• Acute membranous conjunctivitis
• Acute pseudomembranous conjunctivitis
• Chronic bacterial conjunctivitis
• Chronic angular conjunctivitis
 A/ ACUTE MUCOPURULENT
CONJUNCTIVITIS
• characterised by marked conjunctival
hyperaemia and mucopurulent discharge from
the eye
Common causative bacteria are:
Staphylococcus aureus, Koch-Weeks bacillus,
Pneumococcus and Streptococcus
 A/ ACUTE MUCOPURULENT
CONJUNCTIVITIS
Symptoms
– Discomfort and foreign body sensation due to engorgement
of vessels.
– Mild photophobia, i.e., difficulty to tolerate light.
– Mucopurulent discharge
– Sticking together of lid margins with discharge during sleep.
– Slight blurring of vision due to mucous flakes in front of
cornea.
– Sometimes patient may complain of coloured halos due to
prismatic effect of mucus present on cornea.
A/ ACUTE MUCOPURULENT
CONJUNCTIVITIS

Signs
– Conjuctival congestion: +++palpebral conjunctiva,
fornices and peripheral part of bulbar conjunctiva
– Chemosis
– Petechial haemorrhages( pneumococcus)
– Flakes of mucopus
– Cilia are usually matted together with yellow
crusts.
A/ ACUTE MUCOPURULENT
CONJUNCTIVITIS
clinical course
– reaches its height in three to four days
– If untreated, in mild cases: (i)infection may be
overcome and the condition is cured in 10-15 days,
(ii)pass to less intense form, the ‘chronic catarrhal
conjunctivitis’.
Complications:
– marginal corneal ulcer
– superficial keratitis
– blepharitis or dacryocystitis
A/ ACUTE MUCOPURULENT
CONJUNCTIVITIS
differential diagnosis
– From other causes of acute red eye
– From other types of conjunctivitis
 A/ ACUTE MUCOPURULENT
CONJUNCTIVITIS
treatment
– Topical antibiotic:
• chloramphenicol (1%), gentamycin (0.3%) or framycetin eye
drops 3-4
• Not response: ciprofloxacin (0.3%), ofloxacin (0.3%) or
gatifloxacin (0.3%) hourly in day and ointment used at night
– Irrigation of conjunctival sac
– Dark goggles
– No steroid should be apply
– NSAIDS drugs
 B/ ACUTE PURULENT CONJUNCTIVITIS
OF ADULTS
Etiology
– Gonococcus+++
– (Rare) Staphylococcus aureus or Pneumococcus
– Gonococcal infection directly spreads from
genitals to eye
 B/ ACUTE PURULENT CONJUNCTIVITIS
OF ADULTS
Clinical picture: 3 stages
• Stage of infiltraton: 4-5 days
– Considerably painful and tender eyeball.
– Bright red velvety chemosed conjunctiva.
– Lids are tense and swollen.
– Discharge is watery or sanguinous.
– Pre-auricular lymph nodes are enlarged.
 B/ ACUTE PURULENT CONJUNCTIVITIS
OF ADULTS
Clinical picture: 3 stages
• Stage of blenorrhoea: starts at about fifth day,
lasts for several days
– Frankly purulent, copious, thick discharge
– trickling down the cheeks
– Other symptoms are increased but tension in the
lids is decreased.
 B/ ACUTE PURULENT CONJUNCTIVITIS
OF ADULTS
Clinical picture: 3 stages
• Stage of slow healing
– decrease in pain and swelling
– Conjunctiva remains red, thickened and velvety.
– Discharge diminishes slowly and in the end
resolution is complete.
 B/ ACUTE PURULENT CONJUNCTIVITIS
OF ADULTS
Complications
– Corneal involvement: diffuse haze and oedema,
central necrosis, corneal ulceration or even
perforation
– Iridocyclitis
– Systemic complications(rare): gonorrhoea
arthritis, endocarditis and septicaemia
 B/ ACUTE PURULENT CONJUNCTIVITIS
OF ADULTS
Treatment
• Systemic therapy
– Norfloxacin 1.2 gm orally qid for 5 days
–

Cefoxitim 1.0 gm or cefotaxime 500 mg. IV qid

– or ceftriaxone 1.0 gm IM qid, all for 5 days; or
– Spectinomycin 2.0 gm IM for 3 days.
• Topical antibiotic: ofloxacin, ciprofloxacin or tobramycin eye drops or
bacitracin or erythromycin eye ointment
• Irrigation of the eye with sterile saline
• Other general measure
• Topical atropine 1%
• Patient and the sexual partner should be referred for evaluation of
other sexually transmitted disease
C/ ACUTE MEMBRANOUS CONJUNCTIVITIS

Etiology
• Corynebacterium diphtheriae
• Occasionally, Streptococcus haemolyticus
C/ ACUTE MEMBRANOUS CONJUNCTIVITIS

Pathology
• Corynebacterium diphtheriae produces a violent
inflammation of the conjunctiva, associated with
deposition of fibrinous exudate on the surface as well as
in the substance of the conjunctiva resulting in formation
of a membrane.
• Usually membrane is formed in the palpebral conjunctiva.
• There is associated coagulative necrosis, resulting in
sloughing of membrane.
• Ultimately healing takes place by granulation tissue.
C/ ACUTE MEMBRANOUS CONJUNCTIVITIS

Clinical picture: 3 stages

• Stage of suppuration
– Pain decreases and the lids become soft
– Membrane is sloughed off leaving a raw surface
– There is copious outpouring of purulent discharge
C/ ACUTE MEMBRANOUS CONJUNCTIVITIS

Clinical picture: 3 stages

• Stage of cicatrisation
– Raw surface covered with granulation tissue is
epithelised
– Healing occurs by cicatrisation, which may cause
trichiasis and conjunctival xerosis.
C/ ACUTE MEMBRANOUS CONJUNCTIVITIS

Complications
– Corneal ulceration
– Delayed complications due to cicatrization include
symblepharon, trichiasis, entropion and
conjunctival xerosis
C/ ACUTE MEMBRANOUS CONJUNCTIVITIS

Diagnosis
– typical clinical features
– confirmed by bacteriological examination
 C/ ACUTE MEMBRANOUS CONJUNCTIVITIS

Treatment
Topical therapy
• Penicillin eye drops (1:10000 units per ml): every half
hourly
• Antidiphtheric serum (ADS): every one hour.
• Atropine sulfate 1%
• Broad spectrum antibiotic ointment: at bed time.
Systemic therapy
• Crystalline penicillin 5 lac units, IM, twice a day for 10 days
• Antidiphtheric serum (ADS) (50 thousand units), IM
 C/ ACUTE MEMBRANOUS CONJUNCTIVITIS

Prophylaxis
• Isolation of patient will prevent family
members from being infected.
• Proper immunization against diphtheria is
very effective and provides protection to the
community.
D/ PSEUDOMEMBRANOUS CONJUNCTIVITIS

Etiology
• Bacterial infection: Corynebacterium
diphtheriae of low virulence, staphylococci,
streptococci, H. influenzae and N. gonorrhoea
• Viral infections: herpes simplex and adenoviral
epidemic keratoconjunctivitis
• Chemical irritants: acids, ammonia, lime, silver
nitrate and copper sulfate
D/ PSEUDOMEMBRANOUS CONJUNCTIVITIS

Pathology
• The above agents produce inflammation of
conjunctiva associated with pouring of
fibrinous exudate on its surface which
coagulates and leads to formation of a
pseudomembrane.
D/ PSEUDOMEMBRANOUS CONJUNCTIVITIS

Clinical picture
• Acute mucopurulent conjunctivitis, like
features associated with.
• Pseudomembrane formation which is thin
yellowish-white membrane seen in the
fornices and on the palpebral conjunctiva
** Pseudomembrane can be peeled off
easily and does not bleed.
D/ PSEUDOMEMBRANOUS CONJUNCTIVITIS

Treatment
It is similar to that of mucopurulent
conjunctivitis.