conjuntivits .pptx

7/24/2019 Conjuntivits .pptx

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CONJUNTIVITS


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Background

Common eye disease worldwide

Varies in severity


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Diferentiation o the CommonTypes o Conjunctivitis

ClinicalFindings andCytology

Viral Bacterial

Itching Minimal Minimal

Hyperemia Generalized GeneralizedTearing Profuse Moderate

Eudation Minimal Profuse

Preauricularadenopathy

Common !ncommon

In stainedscrapings andeudates

Monocytes "acteria# PM$s%

&ssociated sore

throat and fever

'ccasionally 'ccasionally


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Important symptom

Hyperemiamost conspicuous clinical sign of acute con(unctivitis)

& *rilliant red suggests *acterial con(unctivitis# and a mil+y appearance

suggests allergic con(unctivitis) Hyperemia without cellular infiltration

suggests irritation from physical causes# such as wind# sun# smo+e# etc

Tearing,epiphora-prominent in con(unctivitis

resulting from the foreign *ody sensation# the *urning or scratching

sensation# or the itching

Eudation

feature of all types of acute con(unctivitisfla+y and amorphous in *acterial con(unctivitis and stringy in allergic

con(unctivitis)

and if the eudate is copious and the lids are firmly stuc+ together# the

con(unctivitis is pro*a*ly *acterial or chlamydial


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Pseudoptosisdrooping of the upper lid secondary to infiltration of M.ller/s muscle)

Papillary hypertrophya nonspecific con(unctival reaction that occurs *ecause the

con(unctiva is *ound down to the underlying tarsus or lim*us *y finefi*rils

Chemosisstrongly suggests acute allergic con(unctivitis *ut may also occur in

acute gonococcal or meningococcal con(unctivitis and especially in

adenoviral con(unctivitis

0olliclesit can *e recognized as a rounded# avascular white or gray

structure) 'n slitlamp eamination# small vessels can *e seen

arising at the *order of the follicle and encircling it


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Pseudomem*ranea coagulum on the surfaceof the epithelium# and when

it is removed# the epithelium remains intact)

1igneous con(unctivitispeculiar form of recurring mem*ranous con(unctivitis

Preauricular lymphadenopathy& grossly visi*le preauricular node is seen in Parinaud/s

oculoglandular syndrome and# rarely# in epidemic

+eratocon(unctivitis) & large or small preauricular node#sometimes slightly tender# occurs in primary herpes

simple con(unctivitis# epidemic +eratocon(unctivitis#

inclusion con(unctivitis# and trachoma


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Conjuntivitis bacteria

Two form are recognise&cute

2 !sually *enign n self limited

Chronic2 !sually secondary to eyelid disease


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Cinical eature

characterized *y a rapid onset of

unilateral con(unctival hyperemia# lid

edema# and mucopurulent discharge

3ischarge varies4usually purulent 5persist


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Hyperacute(purulent bacterialconjuncitivitis

&gent6N gonorrhoeae, Neisseria kochii,and N

meningitidis

presents with the rapid onset of con(unctival

in(ection# eyelid edema# severe# continuous# andcopious purulent discharge# chemosis# and

discomfort or pain)

If there is any delay# there may *e severe

corneal damage or loss of the eye# or thecon(unctiva could *ecome the portal of entry for

either N gonorrhoeaeor N meningitidis,leading

to septicemia or meningitis)


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!cute mucopurulent (catarrhalconjunctivitis

occurs in epidemic form and is called

7pin+eye7 *y most laymen

characterized *y an acute onset of

con(unctival hyperemia and a moderateamount of mucopurulent discharge)


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Chronic bacterial conjunctivitis

red eye with purulent discharge persisting

for longer than a few wee+s

occurs in patients with nasolacrimal duct

o*struction and chronic dacryocystitis#which are usually unilateral) It may also *e

associated with chronic *acterial

*lepharitis or mei*omian gland

dysfunction) Patients with floppy lid

syndrome or ectropion may develop

secondary *acterial con(unctivitis)


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"ab #nding ncomplication Con(unctival scrapings for microscopic

eamination and culture are recommended for

all cases and are mandatory if the disease is

purulent# mem*ranous# or pseudomem*ranous

Chronic marginal *lepharitis often

accompanies staphylococcal con(unctivitis

Con(unctival scarring may follow *oth

pseudomem*ranous and mem*ranouscon(unctivitis# and in rare cases corneal

ulceration and perforation supervene)


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Treatment

8pecific therapy depend on identification of the

micro*iologic agent

In any purulent con(unctivitis in which Gram/s stain shows

gram9negative diplococci suggestive of neisseria# *oth

systemic and topical therapy should *e startedimmediately&ntimicro*ial

2 ointments 6 erythromycin and *acitracin

2 oral 6 tetracycline :;


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$iral conjunctivitis

Viral con(unctivitis# a common affliction#

can *e caused *y a wide variety of

viruses) 8everity ranges from severe#

disa*ling disease to mild# rapidly self9limited infection)


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Adenoviral Conjunctivitis

&denoviral infections occur worldwide and

pro*a*ly represent the most common eternal

ocular infection)

8pectrum consists of adenoviral con(unctivitis6follicular con(unctivitis

pharyngocon(unctival fever

epidemic +eratocon(unctivitis


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a) 0ollicular Con(unctivitis

9 Mildest form of adenoviral con(unctivitis

, serotypes % through %% and %>

9 &cute onset and9 Initially unilateral with possi*le involvement

of the second eye within % wee+)

9 Manifested 6 watery discharge# con(unctival

hyperemia# follicular and papillary

con(unctival# preauricular lymphadenopathy

on the affected side)


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acute watery discharge and follicles


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Pharyngoconjunctival Fever

Caused regularly by adenovirus type 3 and

occasionally *y types = and ?)

Sign and Symtomps:

9 fever of @A)@B=< C# sore throat# and a follicular

con(unctivitis in one or *oth eyes

9 In(ection #tearing #transient superficial epithelial

+eratitis and occasionally some su*epithelial opacities#

preauricular lymphadenopathy ,nontender

Conjunctival scrapings

predominantlymononuclear cells# and no *acteria grow in cultures

No specific treatment self!limited# usually lasting

a*out %< days


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Pharyngoconjunctival Fever

"his ##!year!old man has pharyngoconjunctival fever and the conjunctivitis

was preceded by a viral upper respiratory tract infection$


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Herpetic Conjunctivitis

Infection with a mem*er of the Herpesvirus genus ,e)g)#

herpes simple# varicella9zoster# or Epstein9"arr virus- can

result in acute con(unctivitis)

Herpes zoster is a recurrent Herpesvirus varicellaeinfection)

2 It usually affects middle9aged or older patients# *oth

genders eDually# and shows no seasonal or racial

predilection)

2 0ifty percent of patients with herpes zoster ophthalmicus

,involving the ophthalmic division of the trigeminal nerve-

show involvement of the ocular structures# of which

con(unctivitis is the most common manifestation)


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%erpes simple& conjunctivitis

'nilateral eyelid vesicles Follicular conjunctivitis


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Treatment

Most viral con(unctivitis is related to adenoviral infection

however# no antiviral agent has *een demonstrated to *e

effective in treating these infections)

8upportive therapy includes time honored treatment options6cold compresses# lu*ricants# and ocular decongestants)

In herpetic con(unctivitis we can give topical antivirals to

prevent +eratitis

Prophylais6 This is particularly important) "ecause the

disease is spread *y contact# the patient should refrain fromru**ing his or her eyes despite a severe itching sensation

and avoid direct contact with other people such as sha+ing

hands# sharing tools# or using the same towels or wash

cloths# etc)


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!myloidosis Conjuntivitis

&myloid may *e deposited in the

con(unctiva

Con(unctival amyloidosis is usually

asymptomatic

It is most often found in the inferior

forni *ut can occur anywhere on the

*ul*ar con(unctiva or at the lim*us


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(t presents as a discrete

nontender nonulcerative wa&y

yellow!white firm subconjunctival

mass$


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definite diagnosis is made on the basis

of biopsy$

"he histochemical reactions include

birefringence and dichroism with Congored metachromasia with crystal violet

and fluorescence with thioflavin!"$

"reatment may involve wor)!up for

systemic amyloidosis but local e&cisionof conjunctival masses is not usually

necessary$


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T%&IC '%""IC"!)C%*+*CTI$ITI,

follows chronic eposure of the

con(unctiva to a variety of foreign

su*stances# including molluscum

contagiosum of the lid margin "hey are characteri*ed by elevated

round pearly white wa&y

noninflammatory lesions withumbilicated centers


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Most of it was association with eye

medication# li+e neomycin# gentamicin#

idouridine In contact lens wearers

mar+ed follicular response can also

accompany the use of eye cosmetics

such as mascara and eyeliner


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-olluscum contagiosum lesion on the

lo.er eyelid/


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Treatment

includes cessation of drug use where

possi*le or su*stitution with an

alternative or preservative9free

preparation) The period to resolution of symptoms

and clinical signs may vary from a few

days to a few months

conjuntivits .pptx

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