Catarrhal, purulent, membranous and pseudomembranous conjunctivitis
Purulent (hyperacute) Conjunctivitis: characterized by a violent inflammatory response Occurs in 2 forms:
- Adult purulent conjunctivitis (in adults)
- Causative Agents: N.gonorrhoae and N.meningitidis
- Profouse purulent discharge
- Quickly progressing
- Strongly marked palpebral oedema
- Chemosis (oedema of the conjunctiva), especially around the limbus □ Probable corneal involvement □ Treatment: ○ Systemic antibiotic therapy: e.g norfloxacin, spectinomycin ○ Topical antibiotic therapy: e.g. oflaxacin eye drops ○ Irrigation of the eyes frequently with sterile saline
- Ophthalmia neonatorum (in infants)
- Bilateral inflammation of the conjunctiva in infants (<30days old)
- Infection may occur before, during, or after birth
- Causative agents: chemical (silver nitrates), gonococcal infections □ Clinical signs/symptoms: ○ Pain and tenderness in the eyeball, purulent conjunctival discharge, swollen eyelids, hyperemia and chemosis of the conjunctiva, corneal involvement.
Acute Membranous conjunctivitis:
- Acute inflammation of the conjunctiva
- Characterized by formation of a true membrane (deposition of fibrinous exudate) on the conjunctiva
- Usually affects children (2-8 yrs old) who are not immunized against diphteria □ Causative agents: C. diphtheria □ Clinical features: three stages:
- Stage of infiltration: scanty conjunctival discharge and severe pain in the eye, swollen and hard lids, conjunctiva is red, swollen and covered with thick grey-yellow membrane which bleeds when removed and leaves behind a raw area. ○ Stage of suppuration: pain decreases and the lids become soft. The membrane is sloughed off leaving a raw surface. Purulent discharge
- Stage of cicatrisation □ Treatment:
- Topical therapy: penicillin eye drops, antidiphteric serum, broad spectrum antibiotic ointments
- Systemic therapy: crystalline penicillin, antidiphteric serum (i.m)
Pseudomembranous conjunctivitis:
- Type of acute conjunctivitis, characterized by formation of a pseudomembrane (which can be easily peeled off leaving behind intact conjunctival epithelium) on the conjunctiva.
- Etiology:
- Bacterial infection: C.diphteriae, Staphylococci, streptococci, H.influenza ○ Viral infections: herpex simplex and adenovirus ○ Chemical irritants: acids, ammonia, silver nitrate
- Pathology: the above agents produce inflammation of the conjunctiva associated with pouring of fibrinous exudate on its surface which coagulates and leads to formation of a pseudomembrane □ Clinical picture:
- Pseudomembrane formation which is thin yellowish-white membrane seen in the fornices and on the palpebral conjunctiva. It can be peeled off easily and does not bleed.
Chronic Catarrhal Conjunctivitis:
- Characterized by mild catarrhal inflammation of the conjunctiva □ Etiology:
- Chronic exposure to dust, smoke, and chemical irritants ○ Foreign body
- Causative agents: S.aureus (common), E.coli, klebsiella pneumonia □ It may occur as: