Академический Документы
Профессиональный Документы
Культура Документы
arcade and h d a of
ascending a e the
branches l s Con
continue in the m . junc
bulbar i tiva
conjunctiva as c Ne The conjunctiva
the posterior rve is practically
conjunctival v Su never free from
artery and e ppl
organisms. The
supply the i
y
eyes of infants
whole of the of
n harbor a
the
bulbar . number of
Co
conjunctiva Lymphatics of bacterial
nju
excepting a zone conjunctiva lie nct species
4 mm wide superficially as iva including S.
around the well as deep aureus , S.
limbus. The The sensory
and form an epidermidis,
terminal nerve supply of
irregular Streptococci and
branches of the the conjunctiva
network. E. coli. With
posterior is derived from
Lymphatics of increasing age,
conjunctival the trigeminal
the palpebral gram-negative
artery nervefrom the
conjunctiva join bacteria invade
anastomose infratrochlear
the the conjunctiva.
freely with the branch of
lymphatics of Propionibacteriu
anterior nasociliary
lids. The lymph m acnes and
conjunctival nerve,
vessels from the Coryne-
artery forming a supratrochlear
lateral side bacterium xerosis
pericorneal and supraorbital
drain into the can be isolated
plexus. branches from
preauricular from the healthy
The conjunctival veins the frontal
lymph conjunctiva.
drain either in the post- nerve, the
nodes and A relatively
tarsal venous lacrimal nerve
those from the low temperature
plexus of the lid and the
medial side into infraorbital of the conjunc-
or in the the nerve. The tiva due to
superior s ciliary nerves constant
o u supply the evaporation of
r b limbal tears, mecha-
m conjunctiva. The
i a
n sympathetic
n nerves come
f d from the
e i sympathetic
r b plexus along the
i u branches of the
o l ophthalmic
r a artery.
r
o
Bac
p n teria
h o l
t Flor
Diseases of the Conjunctiva 4
Diseases of the Conjunctiva 5
The cornea
X2Corneal appears
xerosis cloudy and
soft. The
manifests
sloughing of
into two
the necrotic
forms:
stroma
precorneal
leaves a
xerosis
large ulcer
wherein
which may
there occurs perforate
loss of (Fig. 5).
corneal
F luster and
i decreased
g
. corneal
sensiti- vity
3 and true
: corneal
xerosis in
B
i
which
t cornea lacks
o luster and its
t
surface
s becomes
pebbly.
s Sometimes
p
o keratinized
t plaques may
be formed on
the cornea.
X3A, X3B
Corneal
ulceration/ker
atomalacia is
a late
manifestation
of
xerophthalmi
a in which
less than one-
third of the
Fi corneal
g.
4: stroma melts
Bi away due to
tot colliquative
s
sp necrosis
ot (X3A). In
wi Keratomalaci
th
ke a (X3B) more
ra than one-
tin third of the
iz
ati cornea is
on involved.
Diseases of the Conjunctiva 11
Diseases of the Conjunctiva 12
Children < 12 months 100000 IU 1st day, 2nd day and repeat 2-4 weeks later
Children 12 months or older 200000 IU 1st day, 2nd day and repeat 2-4 weeks later
Women with Child-bearing age 10000 IU Daily for 2 weeks or
NB or Bitots spot 25000 IU Weekly for 4 weeks
Women with 200000 IU 1st day, 2nd day and repeat 2-4 weaks later
corneal lesions
NB: Night-blindness
3. A pigmentati formation conjunctiva.
characteris on. Local of
tic application black
symmetric of soot spots in
al (Kajal) or the
semilunar mascara conjunctiv
accumulati (often used a owing to
on of by females) oxidation
brown or leads to of
gray black adrenaline
pigments pigmentati to melanin.
in the on of
conjunctiv INFLAM
sclera MATION
a.
and/or OF THE
6. Iatrogenic
bulbar CONJUN
brownish
conjunctiv CTIVA
staining of
a is found (CONJUN
the
in CTIVITIS)
conjunc-
ochronosis tiva is Conjunctivitis is
wherein an known as the most
incomplete argyrosis. It common eye
metabolis was disease
m of common worldwide. It is
tyrosine due to usually of two
(alkaptonu prolonged types:
ria) and application 1. Infectious
phenylalan of silver and
ine occurs. salts 2.
4. The for the Noninfectious.
conjunctiva manageme The
becomes nt of noninfectiou
red in trachoma s
subconjunc in the past conjunctiviti
- tival and s may
hemorrhag resulted in further
e and later impregnati be subdivided
leaves a on of into:
brown reduced a. Allergic
pigmentar metallic b. Toxic
y spot. silver in c. Traumatic
5. Benign the elastic d. Secondary,
melanoma tissue of and
of the the
e. Idiopathic.
conjunctiv conjunctiv
a and a. Infectious
precancero 7. Long-term Conjunctivitis
us topical
melanosis A wide variety
use of
of the adrenaline of etiological
conjunctiv in agents, bacteria,
a impart glaucoma virus and fungi,
brown- patients can cause
black may cause infection in the
There is no be associated c such as measles
uniform with rickettsial t and scarlet
criterion for the or viral i fever.
classification of conjunctivitis. v
i Clinical features
infective To facilitate
t Acute
conjunctivitis. description, acute i mucopurulent
Depending on conjunctivitis s conjunc- tivitis
the onset it may may further be
Acute catarrhal may manifest
be divided into classified as
conjunctivitis is either in a mild
two broad acute catarrhal
an acute infec- or a severe form.
clinical or muco-
tive type of The former
categories: acute purulent,
conjunctivitis gives minimum
and chronic. purulent,
characterized symptoms, but
The etiology of membranous
by hyperemia of the presence of
infective conjunctivitis and hemorrhagic.
the bulbar hyperemia of
has
conjunctiva and conjunctiva and
shown a A
c papi- llary tags of mucus at
remarkable
u hypertrophy of the canthi help
change in the
t the palpebral in the diagnosis.
recent past.
e conjunctiva Quite
During
associated with erroneously, it is
preantibiotic C mucopurulent called cold in the
era, bacterial a discharge. The eyes.
conjunctivitis t condition is
dominated. But a
commonly seen
after the middle r
r in children.
of the twentieth
h However, it may
century, 75%
a affect any age
cases of
l group. It has a
conjunctivitis
short
were found to
o incubation
be nonbacterial r period (24-48
in origin in a M hours).
survey u
conducted in c Etiology The
London. Viruses o disease is
were p caused by
responsible for u Staphylococcus
35% of r aureus
u (coagulase-
conjunctivitis. In
l positive), Koch-
the East,
e Weeks bacillus,
outbreaks of n
bacterial Pneumococcus
t
conjunctivitis and
still occur C Streptococcus. It
during each o may also occur
premonsoon n in association
period which j with acute
may or may not u infective
n eruptive fevers
The severe may cause Ideally, the
form reaches its superficial selection of an
peak in 3 to 4 corneal erosions, antibiotic or
days. Heaviness while pneumo- chemotherapeuti
or discomfort in coccal c agent for the
the eye, glueing conjunctivitis control of
of the eyelashes shows petechial infection should
of the upper and hemor- rhages be done after
lower lids, on the bulbar sensitivity test.
particularly after
conjunctiva. However, it is
the night sleep,
Treatment The not possible in
photophobia
treatment of practice.
and colored Fig. 6:
mucopurulent Therefore, one of
halos are the Acute
con- junctivitis
mucopurule the broad-
common nt
symptoms. The is essentially conjunctivitis spectrum
conjunctiva based on two antibiotics like
becomes fiery principles: ciprofloxacin
red with marked frequent 0.3%, ofloxacin
papillary hyper- irrigation of the 0.3%,
trophy of the conjunctival cul- gatifloxacin
palpebral de-sac to remove 0.3%,
conjunctiva (Fig. the discharge moxifloxacin
6) and and control of 0.5% or
congestion of the infection. chloramphenico
vessels towards The infected eye l 0.5% is
the fornices. The commonly used.
is washed 4 to 5
lids are slightly An antibiotic
times a day with
edematous. The ointment
normal saline
mucopurulent (ciprofloxacin,
warmed at room
discharge is gatifloxacin,
temperature.
found in the tetracycline or
The irrigation
fornices and on oxytetracycline)
the margin of not only
removes the is applied at bed
the lids matting
mucus but time to prevent
the lashes. The
dilutes the the lids from
accumulation of
toxins and sticking together.
mucus over the
increases the Dark glasses
cornea results in
flow of may be worn to
colored halos
due to the antibodies. minimize
prismatic effect. photophobia, but
the eye should
Complications
never be
The condition
bandaged as this
is benign but if
promotes the
untreated
growth of
passes into a
organisms and
chronic phase.
enhances the
Staphylococcal
accumulation of
mucopurulent
discharge.
conjunctivitis
Considering the the 20th century ( Staphylococcus
contagious nature of and caused O aureus,
the untold miseries p Streptococcus
disease, by its blinding h pneumoniae,
t Staphylococcus
prophylactic sequelae. It
h
measures must occurs in two
a
be taken to forms: l
check its spread 1. Purulent m
in the family conjunctivitis of i
and community. newborn a
(ophthal-
A m N
c i e
u a o
t n
e n a
e t
P o o
u r
n
r u
a
u m
t )
l
o
e Ophthalmia
r
n neonatorum is a
t u
m bilateral
) conjunc- tivitis
C
, of newborn,
o
characterized
n
j a by copious
u n purulent
n d discharge,
c 2. marked
t Pur chemosis of the
i ule conjunctiva and
v nt swelling of the
i lids.
con
t
jun Etiology The
i
s ctiv disease is
itis contacted
Acute purulent of during birth
conjunctivitis is ad from the
also known as ult. mothers
acute blenorrhea infected
and is marked Purul genitourinary
by a profuse ent tract or from
purulent Conj infected linen
discharge. The uncti and fingers. A
vitis
disease was number of orga-
of
rampant in the nisms, viz.
New
Middle East in born Neisseria
the early part of gonorrhoeae,
hemolyticus and E.coli are established causative
pathogens. Gonococcal ophthalmia
neonatorum is a serious and violent condition,
while Chlamydia and adenoviruses cause mild
purulent conjunc- tivitis.
Causes of neonatal conjunctivitis can be
separated on the basis of duration of onset of
disease. The chemical conjunctivitis starts within
a few hours after the application of silver nitrate
drops (used for prophylaxis of ophthalmia
neonatorum), gonococcal and meningococcal
con- junctivitis 3 days after exposure and
neonatal inclusion conjunctivitis and herpes
Fig. 7: Acute purulent conjunctivitis
simplex conjunctivitis 5 or more days after
exposure (Table 2).
crater-like pit. The lids are swollen and brawny.
Clinical features Ophthalmia neonatorum
The flakes of thick purulent discharge are seen
usually manifests in the first week after birth.
over the conjunctiva and the lid margin. Both
Initially, a watery secretion is noticed from the
gram and Giemsa stains of the conjunctival
babys eye (normally tears are not secreted in
scrapings help to identify N. gonorrhea, C.
the first six weeks of life, therefore, any secretion
trachomatis and other causative organisms.
from the eye should be considered abnormal). It
The disease has a short incubation period (1-3
soon becomes mucopurulent and ultimately
days). If untreated, the acute phase lasts for 10-
purulent. Both eyes are almost always involved.
15 days and then the discharge diminishes
The infant is irritable and his conjunctiva
and swelling gradually subsides.
intensely inflamed, chemotic and red (Fig. 7).
The chemosis is so marked that the bulbar Complications In gonococcal ophthalmia neo-
conjunctiva bulges through the lids and cornea natorum, the corneal complication is a rule. The
appears to be situated at the bottom of a
Silver nitrate (Credes prophylaxis) Within few hours Slight watery or mucus Negative culture
Gonococcal conjunctivitis 2-4 days Copious purulent discharge Intracellular gram-negative
diplococci, culture positive
on blood agar
Nongonococcal bacterial 4-5 days Mucopurulent Gram-positive or gram-
(S. aureus, Streptococcus negative organisms in smear
pneumoniae) and positive culture
Chlamydia (TR-IC infection) 5-14 days Mucopurulent, Cytoplasmic
occasionally purulent inclusion bodies, negative
culture
Herpes simplex infection 5-7 days Watery Multinucleated giant cells,
cytoplasmic inclusion bodies
and negative culture
organism is thoroughly intensive infection can be
capable of cleaned with a antibiotic controlled by
invading the piece of sterile therapy. Earlier topical erythro-
intact corneal gauze. the standard mycin or
epithelium; the Prophylactic regimen was tetracycline.
corneal medication instillation of Systemic
ulceration either by penicillin drops, erythromycin
develops over adopting Credes in a 12.5 mg per/kg
an area just method or other concentration of oral or IV for 14
below the center regimen should 5000 to 10000 days is
of the pupil be carried out. unit/ ml, every recommended to
corres- ponding In Credes minute for half control mixed
to the lower lid method a drop an hour, every infection. Great
margin. The of 1% silver five minutes for care is needed to
nitrate is another half an examine and
ulcer is prone to
instilled in each hour and then treat the eye if
perforation. A
eye of the infant half- hourly the cornea is
mild to severe
soon after birth. instillations till involved.
degree of
The procedure the infection is Topical atropine
iridocyclitis
may cause a controlled. eye ointment
accompanies the
mild chemical Owing to must be used
ulcer. The
conjunc- tivitis increasing but the eye must
perforation of
which is self- prevalence of not be
ulcer gives
limiting. Topical resistance to bandaged.
many blinding penicillin,
sequelae, such instillation of a
combination of topical therapy Acute
as, leukoma with Purulent
adherence, bacitracin and
tetracycline, Conjunc
partial or total polymyxin B
gentamicin, tivitis of
anterior may also be
bacitracin and Adults
staphyloma, used. Povidone-
fluoroquinolone Acute purulent
nystagmus and iodine 5% is
is conjunctivitis of
phthisis bulbi. commonly used
recommended. adults is often
as a prophylactic
Treatment Topical unilateral and
eye drop that
Ophthalmia ciprofloxacin associated with
does not cause
neonatorum is a 0.3% drops urethritis and
any toxic
preven- table hourly and arthritis.
reaction.
disease. The cephtriaxone 25
The infants Etiology The
prenatal to 50 mg/kg IV
with disease is
diagnosis and or IM single
ophthalmia venereal in
treatment of dose or
neonatorum origin and the
cephotaxime 25
birth canal require prompt infection is
mg/kg IM or IV
infection should treatment. The transmitted
12 hourly are
be carried out eye must be from genitals to
found to be very
adequately. irrigated with the eye. Males
effective.
Aseptic warm saline at are
Chlamydial
measures must least four times predominantly
be taken at the a day. Neisseria affected. The
time of delivery. gonorrhoeae disease has a
Soon after birth, infection is short incubation
the lids of the usually period. It is
infant be controlled by commonly due
to N. gonorrhoeae perforation of
but other the corneal
organisms ulcer. The
responsible for patient is febrile
ophthalmia and has
neonatorum can enlarged and
also cause the painful
disease. preauricular
Clinical features lymph nodes.
Gritty sensation, In gonococcal
photophobia, conjunctivitis,
blurring of urethritis is
vision, pain in almost an
the eye and mild invariable
consti- tutional accompaniment
disturbances are . Arthritis,
common endocarditis
symptoms of the and septicemia
disease. The may also be
patient is found.
generally in Treatment The
agony and does basic principle
not allow ocular of treatment of
examination acute purulent
easily. There conjunctivitis of
occurs brawny adults is to
edema of the
protect the
upper lid. The
unaffected eye
eyelashes are
and a prompt
matted with
control of
organized thick
discharge. The
conjunctiva is
markedly
edema- tous and
velvety in
appearance.
Complications
The cornea
becomes hazy
with central
gray area of
necrosis.
Marginal ulcers
usually develop
due to retention
of pus in the
ballooned
conjunctiva.
Iridocyclitis may
ensue even
before
infection in the eral s
affected one. sym
The other eye pto w
can be protected ms. e
by using an eye The l
shield. treatment of l
However, the gonococcal
most effective conjunctiviti a
method is to s s
institute without
prophylactic septicemia in e
treatment in the adults is a c
healthy eye. single dose of o F
Repeated i
ceftriaxone 1g n g
irrigation IM. However, o .
and patients with m
intensive keratoconjuncti i 8
:
therapy vitis or c
with disseminated a M
ciprofloxacin gonococcal l e
(0.3%) eye drop infection should . m
b
2 hourly and be treated with r
erythromycin Acu a
ceftriaxone 1 g
1% eye te n
IV o
ointment often Me
or IM 12 hourly u
bring mbr s
for at least 3 ano
improvement in days. Patients us c
the clinical allergic Con o
picture. to penicillin junc n
j
Gonococcus should be tiviti u
may be present treated with s n
in the spectinomycin c
Acute t
conjunctiva for a 2 g IM as a one i
inflammation of
long period, time dose or 12 v
the conjunctiva i
hence, the hourly in associated with t
therapy should divided i
the formation of
be continued for doses. Oral s
a membrane or
two to ciprofloxacin pseudo-
three weeks. and norfloxacin membrane on
Atropine is are also the palpebral
applied if the e conjunctiva (Fig.
cornea and f 8) characterizes
the uvea are f acute
involved. e membranous
Analgesics are c conjunctivitis.
helpful in t
ame i
lior v
atin e
g
the a
gen
Etiology The deposited on the diagnosis can
membranous surface of the be 3
conjunctivitis is epithelium, made only after
more or less while in a true the s
synonymous membrane the bacteriological t
with epithelial layers examination. a
diphtheritic undergo g
Clinical features
conjunc- tivitis coagulative e
Mucopurulent
since necrosis. The s
discharge, mild
Corynebacterium removal of a .
degree of
diphtheriae pseudo-
swelling of the Stage of
causes membrane
conjunctiva and infiltration: The
membrane leaves an intact
lids, a white conjunctiva is
formation. epithelium,
pseudomembr markedly
However, while a raw
ane on the chemosed and
Streptococcus bleeding surface
palpebral infiltrated with
hemo- is left behind
conjunctiva and semisolid
lyticus, following the
regional exudates
Streptococcus removal of a
lymphadenopat
pneumoniae, true membrane.
hy may be seen
Neisseria Membranous
in the mild
gonorrhoeae, conjunctivitis usually
variety of
Staphylococcus occurs in
conjunctivitis.
aureus, H. children
In severe
aegyptius, E. coli, between 2 and 8
cases, the patient
adenoviruses years of age,
is toxic and
and herpes who are
acutely ill. Pain
simplex virus not immunized.
is often severe.
can also The disease may
The lids are
produce appear either in
swollen, red and
membranous a mild or a
tense making
conjunctivitis. severe form.
their eversion
Ery- Membranous
difficult.
thema conjunc-
The course of
multiforme and tivitis of
membranous
alkali burn may diphtheritic
conjunctivitis can
also lead to origin is often
b
membrane severe. It is,
e
formation. however,
The membrane may be sometimes seen
d
false (pseudo) or true, that mild cases
i
it appears as a of
v
result of membranous
i
coagulative conjunctivitis
d
response to may be
e
infectious or diphtheritic
d
toxic agents. In and severe
pseudomembra nondiphtheritic,
i
ne a coagulum especially
n
consisting of strepto-
t
fibrin, mucus coccal.Therefore
o
and pus is , a confirmed
which impair The 12 hourly. Herpe
ocular motility cicatrization of Diphtheritic s
and threaten the conjunctiva may antitoxins given Simpl
corneal lead to xerosis locally ex
transparency. An and systemically Virus
and entropion.
extensive true are effective Conju
membrane is Treatment when nctivit
found to cover Proper administered is
the entire immunization w Acute
palpebral in infancy and i conjunctivitis
conjunctiva; it is quick isolation t may also be
seldom found of the infected h caused by herpes
on the bulbar patient are the simplex virus
conjunctiva. The usual preventive a (HSV) type 1
regional lymph measures. To n and 2. Herpes
nodes are start with, every t simplex virus
usually enlarged case of i type 1 causes an
and may membranous b acute unilateral
undergo conjunctivitis i blepharo-
suppuration. The must be treated o conjunctivitis
membrane may as diphtherial t with vesicular
also be seen unless proved i lesions on the
covering the otherwise by lids, intense
c
throat or nasal bacterio- logical papillary
.
mucosa in examination. hypertrophy of
Use of
diphtheritic Immediate local
contact shell the conjunctiva
conjunctivitis. and general
may prevent and classical
treatment with dendritic lesion
Stage of symble-
penicillin is on the cornea.
suppuration: The pharon
instituted. Anti-
acute phase formation. Some There occurs
diphtheritic
lasts for 6 to cases may need marked
serum (ADS) enlargement of
10 days during plastic
and penicillin
which cornea surgery with the preauricular
drops (10000 lymph glands.
may ulcerate. amniotic
unit per ml) are The virus can
Gradually, the membrane
instilled hourly also produce a
transplantation.
necrosed into the
For the follicular
conjunctiva conjunctival sac.
management conjunctivitis.
sloughs out and Atropine
of Herpes
appears red and sulphate (1%)
nondiphtheri simplex virus
succulent. should be type 2
tic con-
applied if conjunctivitis is
Stage of junctivitis,
cornea is
cicatrization: treatment with essentially a
involved.
Adhesions topical and venereal
Intramuscular infection
(symblepharon) systemic
injections of acquired by
usually develop antibiotic
antidiphtheritic direct
between the raw (depending on
serum (10000
areas on the the sensitivity of contamination
unit) and
the organism) is of eye from birth
palpebral and crystalline
energetically canal. Primary
the bulbar penicillin (5 lacs HSV
instituted.
conjunctiva. unit) are given
conjunctivitis is j
a self-limiting u E
disease. Topical n p
antiviral therapy c i
with acyclovir t d
3% eye ointment i e
v m
controls the
a i
infection.
l c
A
F K
c
e e
ut
v r
e
e a
A
r t
d
o
e Pharyngoconju c
n nctival fever o
o primarily n
vi affects children j
ru
and appears in u
s
epidemic form. n
C
It is due to c
o
adenovirus t
nj
serotypes 3, 4 i
u
and 7. Acute v
n
follicular i
cti
t
vit conjunctivitis,
i
is pharyngitis,
s
fever and
Adenoviruses
preauricular As is evident by
are known to
lymphadenopat the name, the
produce acute
hy are the keratoconjunctivi
follicular
characteristic tis occurs in
conjunctivitis as
signs. Systemic widespread
seen in
signs mimic epidemics that
pharyngo-
influenza. mostly spreads
conjunctival
Punctate through infected
fever (PCF) and
keratitis may be ophthalmic
epidemic kerato-
the only corneal instruments
conjunctivitis
sign of the especially
(EKC).
disease. tonometers.
The conjunctivitis is self-
P
h limiting and there is
a no specific
r treatment but
y topical
n antibiotics
g should be used
o to control
c secondary
o bacterial
n infection.
Etiology develop within u
n
Epidemic two weeks time c
keratoconjunctiv due to immune t
itis is caused by response to the i
v
adenovirus adenovirus. i
serotypes 3, 7, 8 Later, discrete t
anterior i
and 19. The
s
definitive stromal
diagnosis is infiltrates
made after covering the
recovering the pupillary area
virus from eye (Fig. 9) may
and growing it appear which F
in cell culture. may persist for i
months or g
Clinical features .
years causing
EKC is
visual
characterized by 9
disturbances. :
photo- phobia,
acute follicular Prophylaxis In C
or membranous order to o
conjunc- tivitis, prevent the r
n
subepithelial spread of e
infiltrates in the epidemic, a
cornea, scanty cleaning and l
discharge and sterilization of
all instruments i
preauricular
n
lymphadeno- that touch the f
pathy. patients eye i
must be done. l
Pseudomembr t
ane on the r
Treatment The
palpebral a
treatment of t
conjunctiva
EKC is e
develops s
nonspecific and
predominantly.
symptomatic.
Petechial i
Broad-spectrum n
hemorrhages on
antibiotics are
bulbar
often used to e
conjunctiva and p
prevent
sub- i
secondary
conjunctival d
hemorrhages infections. e
m
can occur. Topical corti- i
Diffuse c
punctate
k
epithelial e
keratitis is r
the a
t
earliest corneal o
lesion. Stromal c
corneal o
n
infiltrates j
costeroids are gic tarsal
recommended Con conjunctiva
in patients with junc and
conjunctival tiviti preauricular
s
membrane or
photophobia. An epidemic of
acute
N hemorrhagic
e conjunctivitis
w occurred at the
c time when
a Apollo
s spacecraft was
t launched,
l hence, it is also
e known as
Apollo
C conjunctivitis.
o Fig. 10: Acute
n Etiology The hemorr
j etiological hagic
conjunc
u agents of tivitis
n acute showin
c hemorrhagic g
hemorr
t conjunctivitis hages
i are identified as in the
v coxsackie virus bulbar
conjunc
i and enterovirus tiva
t 70 belonging to
i picornavirus
s group. The
Newcastle disease affects
conjunctivitis all age groups
is a rare but is mostly
disorder seen in young
occurring in patients. It is
small epidemics contagious and
among poultry its transmission
workers and is appears to be by
caused by hand-to-eye
Newcastle virus. contact.
The Clinical features
conjunctivitis is A sudden onset
indistinguishable of mixed papil-
from pharyngo- lary and
conjunctival follicular
fever. hyperplasia,
petechial and
Acu coalesced
te hemorrhages in
He the bulbar (Fig.
mor 10) and the
rha
lymphadenopath n Simple chronic patients.
y are the c conjunctivitis
Clinical features
hallmarks of the t is marked by
i The patient
disease. Edema congestion of the
v often complains
of the eyelids posterior
i of burning and
and chemosis of conjunctival
t heaviness of the
the conjunc- tiva vessels and
i eyes and feels
are marked. The papillary
s difficulty in
disease may hypertrophy of
cause transient keeping the eyes
Chronic the palpebral
blurring of open. The
conjunctivitis conjunctiva
vision. symptoms are
may occur as a associated with
usually
Complications legacy from an burning or
exaggerated
Ocular inadequately grittiness in the
during evening
complications treated acute eye.
hours. Presence
except punctate conjunctivitis or
Etiology The of concretion,
keratopathy are as simple
condition results trichiasis,
seldom seen. chronic
from foreign body or
Neurological conjunctivitis or
continuation of
sequel specific granulo-
an acute
(radiculomyelitis matous
conjunctivitis
) is noticed in a conjunctivitis.
in absence of
few cases.
an adequate
S
Treatment Acute treatment.
i
hemorrhagic m Errors of
conjunctivitis p refraction, nasal
has no curative l or upper
treatment, it has e respiratory tract
a self-limiting catarrh,
course. Broad- C pollution from
spectrum h smoke and dust,
antibiotics r abuse of alcohol,
should be used o insomnia and
to prevent n metabolic
secondary i disorders more
bacterial c often than not
infection and predis- pose to
cross- infection. C simple chronic
o conjunctivitis.
C n
Occasio- nally,
h j
chronic
r u
n dacryocystitis,
o
c rhinitis or
n
t blepharitis may
i
i be associated
c
v with it.
C i Staphylococcus
o t aureus is usually
n i cultured from
j s conjunctival cul-
u de-sac of these
dacryocystitis i canthi
The
causes unilateral s associated with
inflammatory
chronic conjunc- blepharitis.
Intense itching, reaction of the
tivitis. White Shallow
conjunctival conjunctiva to
scanty discharge marginal corneal
congestion noxious agents
is deposited on ulcers may
towards the usually
the canthi due to occasionally be
inner and outer manifests in two
vicarious found.
canthi, forms an
activity of the
excoriation of Treatment The acute
meibomian
the skin of lid diplobacillary generalized
glands.
margins at the conjunctivitis papillary
Treatment The angle and scanty responds quickly hyperplasia
treatment of mucopurulent to the (vascularization
chronic discharge application of with epithelial
conjunctivitis characterize tetracycline or hyperplasia) and
includes angular oxytetracycline
elimination of conjunctivitis. ointment (1%) 2
predisposing to 3 times a day.
Etiology The
and cau- sative Topical eye
condition is
factors. A drops
caused by
course of containing zinc
Morax- Axenfeld
topical (0.125-
gram-negative
antibiotics 0.25%) are also
diplobacilli
usually controls effective as they
(Moraxella
the infection but inhibit the
lacunata),
symptoms may proteolytic
arranged end-
persist. ferment.
to-end in pairs.
Astringent
The organism F
drops provide
liberates a o
symptomatic
proteolytic l
relief.
enzyme which l
macerates the i
A
epithelium of c
n
the lid margin. u
g
Staphylococci can l
u
also cause such a
l
a condition. r
a
r Clinical features C
Itching, o
C burning, n
o discomfort, j
n
frequent blinking u
j
and slight n
u
mucopurulent c
n
discharge are t
c
common i
t
symptoms. There v
i
occurs redness of i
v
t
i the conjunctiva
i
t towards the
s
a localized follicles, mental factors u
aggregation of papillary favoring the e
lymphocytes hypertrophy of transmission.
(follicles) in the the palpebral In t
subepithelial conjunctiva, trachoma o
adenoid layer. neovascularizati endemic zones,
It is not on and it is almost g
infrequent to infiltration of always r
observe both the the cornea contacted in o
reactions (pannus) and, infancy; eye-to- s
occurring in late stages, eye transmission s
concurrently in conjunctival can
the diseased cicatrization. It be considered as c
conjunctiva. The is one of the a rule. In i
follicles in the oldest and most sporadic cases, c
conjunctiva may widespread genitals a
be found in diseases may be the t
acute affecting more source of r
conjunctivitis, than one-fifth of infection. i
chronic the population Overcrowding, c
conjunctivitis, as of the world. It abundant fly i
a result of is still an population, a
allergic or toxic important insanitary l
response to the cause of visual conditions,
drugs such as impairment paucity of s
topical atropine and blindness. water and poor e
and pilocarpine, The distribution personal q
and in benign of the disease in hygiene u
folliculosis of the world is contribute to e
unknown heterogeneous. the l
etiology. It is highly dissemination a
prevalent in and persistence
e
T North Africa, of the infection.
.
r Middle-East and Trachoma
a certain regions seldom occurs
c of South-East in pure
h Asia. No race is form in endemic
o immune to this zones where
m disease. secondary
a It is bacterial
increasingly or viral
The word
realised that infections
trachoma is
trachoma in superimpose.
derived from a
its The latter helps
Greek word
natural course in transmission
meaning rough.
has a low by increasing
Trachoma is a
contagiousness the conjunctival
specific type of
but secretion and
contagious
becomes adds to the
keratoconjunct
endemic only severity of the
ivitis of chronic
when there disease
evolution
exists environ- d
characterized by
Etiology forms colonies the epithelium
Trachoma is in the and lymphoid
caused by a conjunctival
large-sized epithelial cells
atypical virus called
belonging to the Halberstaedter-
psittacosis- Prowazek
lympho- inclusion bodies
granuloma- (Fig. 11). A few
trachoma (PLT) healthy
group epithelial cells
Chlamydia are attacked by
trachomatis. small elementary
Microimmunoflu bodies which F
i
orescence test is take g
the serologic intracellular .
standard for extranuclear
Chlamydia. As 1
position. They 1
many as 14 swell to form ill- :
serotypes of defined initial
Chlamydia are bodies. On
T
r
recognized and staining, the a
designated by initial bodies c
h
the letters A, B, take violet stain. o
Ba, C, D, Da, E, They rapidly m
a
F, G, H, I, Ia, J divide into
and K. The small, multiple i
agents isolated elementary n
from the bodies
c
l
patients of embedded in a u
trachoma and carbohydrate
s
i
inclusion matrix to form o
conjunctivitis are n
the inclusion
indistinguishable
body, and b
, hence, two are
displace the o
jointly known as d
nucleus of the
TRIC agent (TR i
cell. The cell e
for trachoma and
swells up and s
IC for inclusion
ultimately bursts
conjunctivitis).
to set free the
The life cycle of
elementary
the agent can be
bodies which
studied in the
may attack other
scrapings from
cells.
the conjunctiva.
Pathology The
Life cycle of
TRIC agent
chlamydia
induces
trachomatis
papillary
Chlamydia hyperplasia of
trachomatis
Fig. 12: Histopathology of trachomatous follicles Fig. 13: Papillary hyperplasia of conjunctiva:
Trachoma stage 1
infiltration in the symptomless Papillary cicatrization.
adenoid layer of disease which hyperplasia of The follicles of
the conjunctiva. undergoes conjunctiva
Localized spontaneous involves
aggregations of regression in mainly the
lymphocytes persons with upper palpebral
form follicles good personal conjunctiva that
which undergo hygiene. appears
necrotizing Acute or congested, red
change. The subacute onset and thickened.
follicle (Fig. 12) of trachoma is
Follicle is the
is invaded by seen in adults
characteristic
multinucleated which resembles
lesion of
macrophages bacterial
(Lebers cells) conjunctivitis in trachoma Fig. 14: Trachoma follicles:
Granuloma
Granuloma of the conjunctiva may develop
either on the palpebral or on the bulbar
conjunctiva (Fig. 37) The granuloma may
Fig. 37: Granuloma of bulbar conjunctiva
develop following strabismus surgery, retained
foreign body and extrusion of chalazion
through the conjunctiva. It may appear as a
cauliflower-like (Fig. 38) or fungating mass of
granulation tissue. Granuloma often needs
surgical removal.
Malignant Tumors
Squamous Cell Carcinoma
Squamous cell carcinoma or epithelioma
(Fig. 39) is a fleshy vascular gelatinous mass
with feeder vessels usually seen at the limbus
or at the lid margins. Treatment includes
surgical excision with adjunctive cryotherapy
or topical MMC. Intraocular spread of tumor Fig. 38: Granuloma of palpebral conjunctiva
Intraepithelial Epithelioma
Intraepithelial epithelioma or Bowens
carcinoma is a rare epibulbar tumor with low
malignant potential. Epithelioma can involve
an extensive conjunctival area and may rarely
cause perforation of the globe. Treatment
consists of free excision of conjunctiva with
adjunctive cryotherapy or topical MMC or 5-
fluorouracil to avoid recurrence.
Malignant Melanoma
BIBLIOGRAPHY
1 . Basic and Clinical Science Course sec 8: External
Diseases and Cornea. American Academy of
Ophthalmology, 2004.
2 . Feign RD, Cherry JD (Eds). Textbook of Pediatric
Infectous Diseases. 4th ed. Philadelphia, Saunders,
1998.
3 . Lang GK. Ophthalmology. Stuttgart, Thieme, 2000.
4 . Remington JS, Klein JO (Eds). Infectous Diseases of
Fetus and Newborn Infants. 5th ed. Philadelphia,
Saunders, 2001.
5 . Wilson LA. External Diseases of the Eye. London,
Fig. 40: Oculodermal melanosis Harper and Row, 1979.