Conjunctivitis #cocci
Purulent conjunctivitis
Mucopurulent MPC Ophthalmia neonatorum Memberanous Viral
in adult
Acute infective conjunctivitis Severe form of Acute conjunctivitis
Acute conjunctivitis Acute conjunctivitis
ch by copious purulent discharge, Usually affect children 2-8 years
Def ch by hyperemia & edema of conjunctiva
tendency to corneal involvement,
occur in newborn infant
who are not immunized
+Mucopurulent discharge (first 4 weeks of life)
General manifestation & LN Enlargement against Diphtheria
◼Predisposing factors ◼Predisposing factors ◼Infection from maternal passages ◼Predisposing factors
-poor hygiene -poor hygiene -Gonococci (dangerous, Less common) -poor hygiene
-dirty towels -dirty towels -C.trachomatis (inclusion conjunctivitis) -dirty towels
-flies -flies -HSV type 2 -flies
◼Causative agent ◼Causative agent ◼Infection from Contaminated towels, ⬛Causative agent ◼Causative agent
-Koch week's bacillus (H.aegypticus) -Gonococci 80% instruments C. Diphtheria -adenovirus
Etiology -staph -staph -Gonococci -molluscum contagiosum,...
-pneumococci -pneumococci -staph aureus
-H.influenza (rare) -B.coli(rare) -strept viridans
-E.coli
◼Mode ◼Mode ◼Chemical irritation
-droplet -from eye to eye by Prophylactic Antibiotic
-contact -from genital gonorrhea (rare)
🔴Symptoms 🔴Gonococcal conjunctivitis 🔴Symptoms
-Discharge (sticky eyelid in the morning)
🔴Symptoms
🔴Symptoms -3 to 5d after birth -watery discharge
-Acute onset of Redness
-copious purulent discharge -purulent discharge -FB sensation, pain
-gritty & burning sensation
-Discharge (purulent & extensive) -Marked bilateral eyelid edema -Red eye -diffuse conjunctival injection
-Red eye -FAHM & Lymphadenopathy
🔴Signs -FAHM
🔴Chlamydia conjunctivitis 🔴Adenoviral keratoconjunctivitis
C/P
◼conjunctiva -6 to 12 d after birth
look Down 👇
-Mucopurulent discharge
-chemosis (conjunctival edema) -Mucopurulent discharge
🔴True membrane on conjunctiva
-conjunctival injection (most Marked in
fornices)
🔴Acute hemorrhagic
- petechiae hemorrhage ⚫Differential Diagnosis from conjunctivitis
◼
(in pneumococcal case)
👇 🔸Negative regurge test
congenital Dacryocystitis by
-intense conjunctival hyperemia
👇
Look Down -superficial punctate keratitis
Eyelid
-edema,
lashes are glued together by discharge
🔸Any discharge in first 3 weeks of life Look Down -Pre-auricular lymphadenitis
-subconjunctival hemorrhage
🔴2ry corneal ulcer 🔴2ry corneal ulcer
🔴2ry corneal ulcer 🔸marginal ulcer (most common)
🔸ring ulcer (Very serious 👉corneal -bacteria may invade
🔴Dacryocystitis
(uncommon, superficial, marginal)
🔸central & paracentral ulcer (
necrosis) Intact epithelium
👉perforation) Acute hemorrhagic conjunctivitis
Complications
🔴Delayed complications
why?! is self limited
-Gonococci can invade Intact epithelium disappear in 2weeks
👉 🔸Entropion
-conjunctival edema press on limbal capillaries due to cicatrization
✔
Fate
🔸Trichiasis
Impair corneal nutrition
✔
disappear in 2weeks
👉 🔸Symblepharon
-Formation of gutter around Cornea
become Chronic
Enhance accumulation of organisms +
toxins
🍬Prophylactic 🍬Prophylactic
Prophylactic 🍬Prophylactic -eradication of flies -proper ttt of mother before labor
🍬Prophylactic
🔸DPT vaccine
-use Separate towels -wash infant with head up
-eradication of flies
ttt -Good personal hygiene -Antibiotic eye drop after birth
-use Separate towels
-avoid infection of other eye (tobramycin or fluoroquinolones)
by Antibiotic eye drop in both eyes
◼Antibiotic ◼Antibiotic 🍬Patient is isolated
◼Antibiotic 🔸broad spectrum Antibiotic eye drop 🔸broad spectrum Antibiotic eye drop 🍬Topical corticosteroid
🔸broad spectrum Antibiotic eye drop 🍬Notification of health authorities
🔸Antibiotic eye ointment 🔸Antibiotic eye ointment
during the day during the day drop & ointment
🔸Antibiotic eye ointment
during the day
🍬A smear is taken -used under supervision
🔸Systemic Antibiotic 🔸Systemic Antibiotic
before sleep before sleep before sleep
antidiphtheria serum IM 💉
-Give 20,000-40,000 units of
-Prevent sickness of lid during sleep
-Prolong duration of action of Antibiotic Ciprofloxacin 500mg every 12h for 5days Ceftriaxone 25mg/Kg IM or IV
-if smear is +ve Give another dose
erythromycin 12.5mg/kg oral
🍬Crystalleine penicillin 🍬Topical Antibiotic eye drop
1 million unit IM 💉 twice daily
◼hot fomentation ◼Cold compress ◼Cold compress -to protect from 2ry bacterial inf
Curative
ttt 👉VD 👉⬆BL Flow 🍬Vitamins & tonics
👉⬆Antibodies & leucocyte 🍬Topical
◼Frequent removal of discharge ◼Frequent removal of discharge 🔸Antidiphtheria serum drops
by irrigating solution (saline or boric acid) 🔸Penicillin eye drops
🔸Broad spectrum Antibiotic ointment 🍬Artificial tears eye drops
by irrigating solution (saline or boric acid)
◼dark glasses to avoid Photophobia *Pass a Glass rod with ointment
◼Atropine ointment in case of corneal ulcer ◼Atropine ointment in case of corneal ulcer in fornices to prevent symblepharon
◼Atropine ointment for corneal ulcer
🔴Bandage is Contraindicated. 🍬Cold fomentation
🔴Avoid hot fomentation 🔴Avoid hot fomentation 🔴Avoid canthotomy
as it ⬆ surface of abs of toxin
🔴Signs of purulent conjunctivitis
C/P
Infilteration Discharge Chronic
AdenoViral keratoconjunctivitis
Time 2-3 d 2-3w
Pharyngo
Simple follicular Epidemic
conjunctival
lid Marked edema Marked edema Edema subsides conjunctivitis keratoconjunctivitis
fever
-edema subsides
Marked Chemosis & hyperemia -intense conjunctival
injection & chemosis
👉
-injection is only in fornices
Follicular
conjunctivitis
✔ ✔ ✔
👉
Conjunctiva -palpebral conjunctiva papillae
-profuse purulent discharge
-Discharge Less,
-corneal ulcer -pseudomembrane
full of Gonococci, pt is carrier Systemic
FAHM
❌ FAHM, pharyngitis FAHM, pharyngitis
Mild fever
General periauricular Lymphadenopathy
(enlarged +tender)
Mild improvement LN ❌ Pre-auricular
lymphadenitis
Pre-auricular & submandibular
lymphadenitis
🔸Superficial punctate keratitis
+
🔸Sub-epithelial corneal infilterate
Differential Diagnosis of Memberanous conjunctivitis
Etiology
Adhesion to If removed
Etiology Membrane
epithelium with forceps
Necrotic epithelium Leaves raw
Memberanous Diphtheria Adherent
+fibrin+bacilli bleeding surface
🔸Pneumococci
🔸Herps, adenovirus
🔸Atropine sensitivity
Coagulated discharge
Pseudomemberanous Not adherent NO raw bleeding surface
🔸Caustics (lime, silver nitrate)
rich in fibrin
