Angular conjunctivitis Aetiology : Moraxella lacunata – Gram negative diplobacillus –

produce a proteolytic ferment, which acts by macerating the epithelium. Also can be caused by Staphylococci

Incubation period – 4 days

C/F :

- Reddening of conj limited to intermarginal strip at inner and outer canthi

- excoriation of skin at inner and outer palpebral angles

- slight mucopurulent discharge, frequent blinking

- if untreated condition becomes chronic and causes blepharitis

- shallow marginal corneal ulcers may rarely develop

Treatment: tetracycline eye ointment, eyedrops containing zinc

inhibit the proteolytic ferment.

Angular conjunctivitis

Viral conjunctivitis

Serous / clear watery discharge Usually produce follicular reaction Systemic viral illnesses like influenza,

mumps, measles and chickenpox may be accompanied by a non-specific conjunctivitis.

Follicular conjunctivitis Acute Follicular conjunctivitis : Chlamydial

inclusion conjunctivitis, epidemic karatoconjunctivitis, pharyngoconjunctival fever, Newcastle conjunctivitis, hemorrhagic conjunctivitis, primary herpetic conjunctivitis, recurrent herpes simplex conjunctivitis.

Subacute/ chronic follicular conjunctivitis : generally drug-induced (pilocarpine users), secondary to lid lesions (molluscum contagiosum), trachoma

Adenoviral conjunctivitis Causative viruses :

1. Pharyngoconjunctival Fever :

- adenovirus types 3,4 and 7

- transmitted by droplets (respiratory/ ocular secretions)

- affects children (epidemics) who also develop an URTI

(pharyngitis, fever)

- keratitis also develops in 30 % but is usually mild

2. Epidemic Keratoconjunctivitis :

- adenovirus types 8 and 19.

- transmitted by hand to eye contact, instruments and solutions

- does not cause systemic symptoms

- keratitis develops in 80 % of cases, may be severe

- markedly contagious, seen in epidemics

Adenoviral conjunctivitis Incubation period : 4 – 10 days Following the onset of the

conjunctivitis, the virus is shed for about 12 days.

Diagnosis is based on immunoflourescent tests that detects the adenoviral group antigens and on rising Ig titres in blood

Adenoviral conjunctivitis C/F :

Conjunctivitis :

1. Symptoms : acute watering, redness, discomfort, photophobia

2. Signs : eyelid edema, watery discharge, conj. follicles, subconj hemorrhages, chemosis, pseudomembranes (rarely)

preauricular lymphadenopathy

3.Treatment :

- spontaneous resolution occurs within 2 weeks

- artificial tears 4 – 6 times/day to relieve the discomfort.

- antiviral agents are ineffective

- topical steroids should be avoided unless inflammation is very severe.

Adenoviral conjunctivitis Keratitis

1. Signs :

a. Stage 1 : occurs within 7 days of onset.

punctate epithelial keratitis

resolves within 2 weeks

b. Stage 2 : focal, white, subepithelial opacities

represents immune response to the virus

c. Stage 3 : anterior stromal infiltrates

gradually fade over months to years

2. Treatment :

- Artificial tears 4 – 6 times/day to relieve discomfort

- Topical steroids indicated only if visual acuity is diminished by stage 3 lesions. Steroids do not shorten the course of the disease but merely suppress the corneal inflammation.

New castle conjunctivitis : clinically indistinguishable from the conjunctivitis of pharyngoconjunctival fever.

Newcastle virus is derived from contact with diseased fowls.

Hemorrhagic conjunctivitis (Apollo conjunctivitis) :

- picornavirus (coxsackie virus, enterovirus 70)

- pandemic form

- violent conjunctivitis with subconj hemorrhages, preauricular lymphadenopathy.

Herpetic conjunctivitis May occur as a primary manifestation of Herpes in

children or as recurrent Herpes simplex in adults. May be associated with vesicular lesions on the face Preauricular adenopathy Corneal dendritic lesions may be present Reduced corneal sensation. Detection of viral antigen in epithelial cells by

flourescent antibody technique, rising serum antibody titre, isolating the virus

Treatment : artificial tears, usually resolves by 1-2 weeks, frequent followups to detect corneal involvement, Acyclovir/Vidarabine 3% ointment for skin/corneal involvement