CONJUNGTIVITIS

DITA LATISHA SAVIRA

PRECEPTOR :
dr. Rahmat Syuhada, Sp.M (K)
 ANATOM
Y
● Three parts of conjunctiva:
● Conjunctiva palpebralis
○ Marginal conjunctiva
○ Tarsal conjunctiva
○ Orbital conjunctiva
● Conjunctiva bulbaris : Cover part of
the anterior surface of the eyeball.
Separated from the sclera anteriorly by
episclera tissue and Tenon's capsule
● Fornix
Conjunctivitis is inflamation of conjunctiva.
With the clinical signs and symptoms:
1. Conjunctival vascular dilatations
2. Cellular infiltration
3. Exudation/ Discharge
According to the causes are:
1. Bacterial
o Purulent : Neisseria gonorrhoea
Neisseria meningitidis
o Acute Catarrhal : Pneumococcus (streptococcus pneumonia)
Haemophilus aegyptius (Koch-Week Basilus)
o Sub Acute Catarrhal : Haemophilus influenzae
o Chronic (includes Blepharo Conjunctivitis) : Staphilococcus aureus
Moraxella Lacunata
2. Chlamydial
C. trachomatis

3. Viral

4. Immunologic (allergic)
Differentiation of the common types of conjunctivitis

VIRAL BACTERIAL CLAMYDIAL ALLERGIC

Itching Minimal Minimal Minimal Severe
Hyperemia Generalized Generalized Generalized Generalized
Lacrimation Profuse Moderate Moderate Moderate
Discharge Minimal Profuse Profuse Minimal
Pre-auricular nodule Common Uncommon Common only in None
inclusion
In stained scrapings & Monocyte Bacteria, PMN PMN, Plasma cell, Eosinophil
exudate inclusion
Pharyngitis & fever Occasionally Occasionally Never Never
Symptomes of Sign of
Conjunctivitis Conjunctivitis
1. Foreign body sensation 1. Hyperemia
in the eye 2. Lacrimation
2. Burning or scratching 3. Chemosis
sensation 4. Exudation/discharge
3. Fullness around the eye 5. Pseudoptosis
4. Itching 6. Hypertrophy papil
5. Photofobia (if cornea 7. Follicle
involved) 8. Pseudo/membrane
9. Granuloma
10. Pre-auricalar adenopathy
 Bacterial
Conjunctivitis

History

The patient usually has discomfort and a purulent

discharge in one eye that characteristically spreads
to the other eye. The eye may be difficult to open in
the morning because the discharge sticks the lashes
together. There may be a history of contact with a
person with similar symptoms.
 Bacterial
Conjunctivitis Management

o Irrigation with normal saline

Examination
several times a day
The vision should be normal o Causal antibiotic theraphy if
after the discharge has been
blinked clear of the cornea. The don’t give broad spectrum
discharge usually is
antibiotic like, sodium
mucopurulent and there is
uniform engorgement of all the sulfacetamide 10-15%,
conjunctival blood vessels.
neosporin, chloramphenicol.
When fluorescein drops are
instilled in the eye there is no o Do not patch the eye
staining of the cornea.
Chlamydial
Conjunctivitis

History
Patients usually bilateral
conjunctivitis with a
mucopurulent discharge.
There may be associated Examination
symptoms of venereal
disease There is bilateral diffuse
conjunctival injection with a
mucopurulent discharge
Chlamydial
Associated venereal disease should also
Conjunctivitis be treated, and it is important to check
the partner for symptoms or signs of
venereal disease (affected females may
Management be asymptomatic). It often is helpful to
discuss cases with a genitourinary
The diagnosis is often difficult and specialist before commencing treatment,
special bacteriological tests may be so that all relevant microbiological tests
necessary to confirm the clinical can be performed at an early stage.
suspicions. Treatment with oral
tetracycline or a derivative for at least
one month can eradicate the problem,
but poor compliance can lead to a
recurrence of symptoms. Systemic
tetracycline can affect developing teeth
and bones and should not be used in
children or pregnant women.
 Viral
Conjunctivitis

Viral conjunctivitis commonly is associated with

upper respiratory tract infections and is usually
caused by an adenovirus. This is the type of
conjunctivitis that occurs in epidemics of “pink
eye.”
Viral Conjunctivitis

History

The patient normally complains of both Examination

eyes being gritty and uncomfortable,
although symptoms may begin in one eye.
Both eyes are red with diffuse
There may be associated symptoms of a
conjunctival injection
cold and a cough. The discharge is (engorged conjunctival vessels)
usually watery. and there may be a clear
discharge. hadenopathy
Viral Conjunctivitis
Management

Viral conjunctivitis is generally a

self limiting condition, but
antibiotic eye drops (for example,
chloramphenicol) provide
symptomatic relief and help
prevent secondary bacterial
infection.
 Allergic Management
Conjunctivitis Topical antihistamine and vasoconstrictor
eye drops provide short term relief. Eye
drops that prevent degranulation of mast
Examination cells also are useful, but they may need to
be used for several weeks or months to
The conjunctivae are diffusely injected and
achieve maximal effect. Oral
may be oedematous (chemosis). The discharge
is clear and stringy. Because of the fibrous antihistamines may also be used,
septa that tether the eyelid (tarsal) conjunctivae, particularly the newer compounds that
oedema results in round swellings (papillae). cause less sedation. Topical steroids are
When these are large they are referred to as effective but should not be used without
cobblestones. regular ophthalmological supervision
because of the risk of steroid induced
cataracts and glaucoma
Allergic
Conjunctivitis
History
The main feature of allergic
conjunctivitis is itching. Both eyes
usually are affected and there may
be a clear discharge. There may be a
family history of atopy . Similar
symptoms may have occurred in the
same season in previous years.
THANKS
!