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Conjunctiva sac :
Bulbar conjunctiva
fornix
medial semilunar fold
palpebral conjunctiva
(tarsal conjunctiva)
Histology :
conjunctival epithelium :
stratified cuboidal (over tarsus)
columnar (over fornix)
squamous (over globe)
Substansia propia :
adenoid layer
fibrous layer
Bacteriology :
Never free from microorganism
Bacteria do not propagate
(proliferate) easily, due to :
relatively low temperature (exposure)
evaporation lacrimal fluid
bacteriostatic
lysozyme enzyme
mechanic (washing)
Bacteriology :
Microorganism that could be found in
normal conjunctival sac :
Staph. epidermis
Staph. aureus
Micrococcus sp
Corynebacterium sp
Propionibacterium acnes
Streptococcus sp
Haemophylus influenza
In children
Moraxella sp
Enteric gram (-) bacilli
Bacilus sp
Anaerobic bacteria
Yeast
Filamentous fungi
Demodex sp
Clinical terms :
hyperemia = focal / diffuse dilatation
of subepithelial plexus of conjunctival
blood vessels
chemosis = conjunctival edema
tearing = excess tears from increased
lacrimation or impaired lacrimal
outflow
discharge = exudates on the
conjunctival surface: serous, mucoid,
mucopurulent, purulent
hyperemia
secret
Secret :
serous : viral
mucous, mucopurulent : bacteria
purulent : beware of gonococcus
Infection of the
conjunctiva
Acute :
serous
catarrhal
mucopurulent
purulent
membranous
chronic :
simple chronic conjunctivitis
angular conjunctivitis
follicular conjunctivitis
Acute Catarrhal or
muco-purulent conjunctivitis
Hyperemia that associated with a mucous discharge
---> gums lid together (especially in the morning)
The whole conjunctiva is a fiery red (pink eye)
Reaches its height in 3 - 4 days
Rare complication, but cornea abrasion may occur
Etiology :
Staphylococci (most common)
Haemophilus aegyptius
Pneumococcal
Treatment :
bacteriostatic drop
the eyes should not be bandaged
dark google should be worn if photophobia
is present
care must be taken due to contagious
disease
Prognosis :
Most of cases are good
Neglected cases are treated as chronic
conjunctivitis
Purulent conjunctivitis
Occurs in two forms :
Babies : ophthalmia neonatorum
Adult : conjunctivitis
Treatment :
appropriate systemic and topical antibiotic
the eyes should be irrigated with warm
saline and intensive solution of crystalline
benzylpenicilin if any purulent discharge
present
should be directed first to protection of to
other eye
In Cicendo Eye Hospital :
cefotaxime I.m.
gentamycine or sulfacetamide eye drops
Ophtalmia Neonatorum
found in newborn children due to
maternal infection
responsible for 50% of blindness in
children
E/ :
Severe : N. gonorrhea
Mild :Chlamydia oculogenitalis,
Streptococcus pneumonia
Clinical findings :
conjunctiva : inflamed, bright red, swollen,
yellow pus
at severe muco-purulent conjunctivitis :
infiltration at bulbar conjunctiva & lids are
swollen and tense
corneal ulceration if untreated
Prophylaxis:
Treatment
Membranous conjunctivitis
Known also as diphtheritic
conjunctivitis
E/ : diphtheria bacillus,
pneumococcus & streptococcus
occur esp. at children who have not
been immunized, after measles,
scarlet fever w/ impetigo
Clinical findings :
mild cases : swelling of the lids, muco-purulent
or serous discharge
severe cases : lids are more brawny, conjunctiva
is permeated w/ semisolid exudates, tend to
necrotize conjunctiva and cornea
Treatment :
treated as diphtherial : penicillin and
antidiphtheritic serum (4-6-10.000 units
repeated in 12 hours)
Simple chronic
conjunctivitis
Continuation of simple
acute conjunctivitis
Etiology :
irritation : smoke, dust,
alcohol, etc
hypersensivity
Symptoms :
burning and grittiness
(especially in the evening)
difficult to keep eyes open
posterior conjunctival
vessels are seen to be
congested
Treatment :
This consist in eliminating the cause and
restoring the conjunctiva to its normal
condition.
Swab should be taken
short course of suitable antibiotic
Follicular conjunctivitis
Inclusion conjunctivitis
Relatively acute onset
hypertrophy is always prominent in
the lower lid
E/ : chlamydial infection
relatively benign
healing spontaneously in from 3 to 12
months
topical broad spectrum antibiotics
systemic Antibiotics (tetracycline 250
mg every 6 hours for 14 days)
Epidemic kerato-konjunctivitis
characterized by a rapidly developing follicular
conjunctiva
associated with pre-auricular adenopathy
may lead to corneal complication
associated with adenovirus
Treatment by adenine arabinoside (Ara-A) is promising
Trachoma
E/ : Chlamydia trachomatis
occuring in 4 stage
trachomatous pannus may
develops at a later stage
Stage of Trachoma
Stage 1: earliest stage, before clinical
diagnosis is possible
WHO:
TF: folicular conjunctival inflammation
TI: diffuse conjunctival inflammation
TS: tarsal conjunctival scarring
TT: trichiasis or enteropion
CO: corneal opacification
Treatment :
the ideal has not been developed
tetracycline, erythromycin, rifampicin
and sulfonamides are efective
pannus requires no special treatment
corneal complication (ulcers) must be
treated on general principles
Eczematous conjunctivitis
characterized by one or more small grey or
yellow nodules on the bulbar conjunctiva
frequently complicated by muco-purulent
conjunctivitis
E/ : endogenous bacterial protein
Symptoms : discomfort and irritation
associated with reflex lacrimation
Treatment : Steroid drop or ointment
Vernal conjunctivitis
two types :
palpebral form
bulbar form
Treatment :
symptomatic
steroid drops or ointment
cryotherapy (for nodule)
mast cell stabillizer
Disodium cromoglycate 2%
(adjuvant to topical steroid)