Conjunctivitis
Dr. Mohamed A.
Conjunctivitis
• Definition: Conjunctivitis is an inflammatory
process involving the surface of the eye and
characterized by vascular dilation, cellular
infiltration, and exudation. Two forms of the
disorder are distinguished:
Acute conjunctivitis. Onset is abrupt and initially
unilateral with inflammation of the second eye
within one week. Duration is less than four weeks.
Chronic conjunctivitis. Duration is longer than
three to four weeks.
• Epidemiology: Conjunctivitis is one of the most
frequent eye disorders.
• Etiology: Causes of conjunctivitis may be fall into
two broad categories:
• Infectious
– bacterial
– viral
– parasitic
– mycotic
• Noninfectious
- from a persistent irritation (such as lack of tear
fluid or uncorrected refractive error
- allergic
- toxic (due to irritants such as smoke, dust, etc.)
- as a result of another disorder (such as Stevens–
Johnson syndrome).
Symptoms
• Typical symptoms exhibited by all patients include
reddened eyes and sticky eyelids in the morning
due to increased secretion.
• Any conjunctivitis also causes swelling of the eyelid,
which will appear partially closed (pseudoptosis).
• Foreign-body sensation, a sensation of pressure,
and a burning sensation are usually present,
• Intense itching always suggests an allergic reaction.
• Photophobia and lacrimation (epiphora) may also
be present but can vary considerably.
Follicular conjunctivitis
Papillary conjunctivitis.
Membranous conjunctivitis.
Infectious Conjunctivitis
• The normal conjunctiva contains
microorganisms. Inflammation usually occurs
as a result of infection from direct contact
with pathogens (such as from a finger, towel,
or swimming pool) but also from complicating
factors (such as a compromised immune
system or injury).
Bacterial Conjunctivitis
• Epidemiology: Bacterial conjunctivitis is very
frequently encountered.
• Etiology: Staphylococcus, streptococcus, and
pneumococcus infections are most common in
temperate countries.
• Symptoms: Typical symptoms include severe
reddening, swelling of the conjunctiva, and
purulent discharge that leads to formation of
yellowish crusts.
• Treatment: Bacterial conjunctivitis usually
responds very well to antibiotic treatment.
• A wide range of well tolerated, highly effective
antibiotic agents is available today.
• Preparations that combine an antibiotic and
cortisone can more rapidly alleviate subjective
symptoms when findings are closely
monitored.
Chlamydial Conjunctivitis
• Chlamydia are Gram-negative bacteria
Inclusion Conjunctivitis
Trachoma
Inclusion Conjunctivitis
• Epidemiology: Inclusion conjunctivitis is very
frequent in temperate countries.
• The incidence in western industrialized
countries ranges between 1.7% and 24% of all
sexually active adults depending on the
specific population studied.
• Etiology: Oculogenital infection (Chlamydia
trachomatis serotype D–K) is also caused by
direct contact. In the newborn (see neonatal
conjunctivitis), this occurs at birth through the
cervical secretion.
• In adults, it is primarily transmitted during
sexual intercourse, and rarely from infection in
poorly chlorinated swimming pools.
• Symptoms: The eyes are only moderately red and
slightly sticky from viscous discharge.
• Treatment: In adults, the disorder is treated with
tetracycline or erythromycin eyedrops or ointment
over a period of four to six weeks.
• The oculogenital mode of infection entails a risk of
reinfection. Therefore, patients and sexual
Treatment: In adults, the disorder is treated with
tetracycline or erythromycin eyedrops or ointment
over a period of four to six weeks.
• The oculogenital mode of infection entails a risk of
reinfection. Therefore, patients and sexual
Trachoma
• Trachoma (Chlamydia trachomatis serotype A–
C) is rare in temperate countries.
• In endemic regions (warm climates, poor
standard of living, and poor hygiene), it is
among the most frequent causes of blindness.
• Left untreated, the disorder progresses through
four stages (Fig. 4.14):
Stage I: Hyperplasia of the lymph follicles on
the upper tarsus.
Stage II: Papillary hypertrophy of the upper
tarsus, subepithelial corneal infiltrates, pannus
formation, follicles on the limbus.
Stages III and IV: Increasing scarring and
symptoms of keratoconjunctivitis sicca.
Viral Conjunctivitis
• Epidemiology: The incidence of epidemic
keratoconjunctivitis is high in general, and it is
by far the most frequently encountered viral
conjunctivitis.
• Etiology: This highly contagious conjunctivitis
is usually caused by type 18 or 19 adenovirus
and is spread by direct contact. The incubation
period is eight to ten days.
• Treatment with artificial tears and cool
compresses helps relieve symptoms.
• Cortisone eyedrops should usually be avoided
as they can compromise the immune system
and prolong the clinical symptoms.
• Prophylaxis: This is particularly important.
Because the disease is spread by contact, the
patient should refrain from rubbing his or her
eyes despite a severe itching sensation and
avoid direct contact with other people such as
shaking hands, sharing tools, or using the
same towels or wash cloths, etc.
THANKS
