CONJUNCTIVITIS.ppt

8/13/2019 CONJUNCTIVITIS.ppt

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DEFINITION Conjunctivitis is an inflammation of the conjunctiva that is

characterized by vascular dilatation, cellular infiltration and

exudation, or inflammation of the mucous membrane covering the

back of the eyelid and eyeball.


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ANATOMY1 Conjunctiva is the outer layer of the eye consisting of a thin mucous membrane

that lines the eyelids

In anatomy classification, the conjunctiva is divided into three parts, conjunctiva

bulbaris, conjunctival palpebra, and conjunctiva fornix

Conjunctival lymph vessels are arranged in layers and the superficial and

profundus layer continuous with the lymph vessels to form a plexus of lymphpalpebra a lot.

Conjunctiva receive innervation from the first branch (ophthalmic) trigeminal

nerve. These nerves are only have a relative few pain fibers


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ANATOMY2 1. Forniks superior & inferior 2. Konjungtiva tarsal sup & inf

3. Kripte henle

4. Gl.Krause 5. Gl.Wolfring

6. Gl.Lakrimal

7. Gl.Manz

8. Tarsus superior


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ANATOMY3

A. anterior ciliary (branch of a.ophtalmica)

A. episclera, anastomosis with a. ciliaryis

posterior longus forming a. circularis major

(iris and ciliary body)A. episclera (sclera, intraocular) Pericorneal

plexus (cornea)

A. posterior conjunctiva supplies the conjunctiva


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ETIOLOGY Infecion (viral,bacterial,or chlamydia)

Allergic reactions to dust, pollen, animal dander

Irritation by the wind, dust, smoke and other air

pollutants; ultraviolet rays from sunlight or electricwelding.


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Signs & Syptomps Symptomps:

Red eyes

Feeling of lump

Dirty eyes

Itchy

Watery

.

Signs Conjunctival injection

Dicharge/secret

There are patologic structure in conjunctiva

Chemosis


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CONJUNCTIVAL INJECTION

Congestion of conjuctival aa/vv(posterior conjunctiva)

Causes: mechanical, irritation, allergy,

infection

Signs:

Mobile from its base

Calibre increases to the periphery

Fresh blood color, constricts with

topical adrenalin


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SILIAR INJECTION

Congestion of pericornea vessels(a. anterior ciliaris)

Causes:- corneal inflammation (keratitis,corneal ulcer)

- uveitis- acute glaucoma- endophthalmitis- panophthalmitis

Signs:- does not follow movement of conjuctiva

- fine, small vessels surrounding the cornea- calibre decreases towards the fornices- dark red color, unchanged with topical adrenalin


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Discharge

Various kind of discharge: Serous (clear liquid)

Mucoid (clear liquid; elastic viscous)

Purulent (cloudy yellow liquid)


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Pathologic Structure


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Classification Causa

Bacteri Virus Chlamydia Alergic Iritation

Clinical pattern Conjungtivitis kataral Conjungtivitis purulent

Conjungtivitis membran Conjungtivitis folikel Conjungtivitis flikten Conjungtivitis vernal Trachoma


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Differential Of The Common types of conjunctivitis1


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Differential Of The Common types of conjunctivitis2


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ExaminationBoth eyes are red with diffuse conjunctival injection

(engorged conjunctival vessels) and there may be a clear discharge. Small

white lymphoid aggregations may be present on the conjunctiva (follicles).

Small focal areas of corneal inflammation with erosions and associated

opacities may give rise to pronounced symptoms, but these are difficult to

see without high magnification. There may be associated head and neck

lymphadenopathy with marked pre-auricular lymphadenopathy

Viral conjunctivitis


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Management

Viral conjunctivitis is generally a self limiting condition, but antibiotic eyedrops (for example, chloramphenicol) provide symptomatic relief and help prevent

secondary bacterial infection. Viral conjunctivitis is extremely contagious, and strict

hygiene measures are important for both the patient and the doctor; for example, washing

of hands and sterilising of instruments.



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Management - The period of infection is often longer than withbacterial pathogens and patients should be warned that symptoms maybe present for several weeks. In some patients the infection may have achronic, protracted course and steroid eye drops may be indicated if the

corneal lesions and symptoms are persistent. Steroids must only beprescribed with ophthalmological supervision, because of the realdanger of causing cataract or irreversible glaucomatous damage.Furthermore, if long term steroids are required, patients should remainunder continuous ophthalmological supervision



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A. Faringokonjungtival FeverInfections caused by adenovirus virus 2.4, and 7.

Sign & Symptomps Fever from 38.3 to 40 C,

sore throat

Follicular conjunctivitis in one or two eyes Red eyes and watery eyes are common, and sometimes a little turbidity

subepithelial area Enlargement lymphadenopathy preaurikuler

Treatment

There is no specific treatment. Konjungtivitisnya recover on their own,generally within about 10 days. Treatment is usually symptomatic andantibiotics to prevent secondary infection


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B. Epidemica Keratoconjunctivitis

Caused by adenovirus virus type 3,7,8, and 19

Signs and symptoms:

Epidemika keratoconjunctivitis generally bilateral

At first the patient feels there is an infection with pain and watery eyes, followed in5-14 days by photophobia,epithelial keratitis, and subepithelial opacities round.

Normal corneal sensation.

Tender lymph preaurikuler which is typical.

Palpebra edema, kemosis, and conjunctival hyperemia mark

the acute phase. Follicles and conjunctival hemorrhage often appear within 48 hours.

Pseudomembrane may form and may be followed by a flat scar or symblepharonformation


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PreventionWash your hands regularly between the inspection and cleaning and sterilization toolstonometer touches the eye in particular is also a must.

Aplanasi tonometer should be cleaned with alcohol or hypochlorite, then rinsed withsterile water and dried carefully

Treatment: Currently there is no specific treatment, but a cold compress will reduce

some symptoms despite having carefully as it will likely lead to the growth of bacteriaor secondary infections. corticosteroids for acute conjunctivitis may prolong cornealinvolvement should be avoided. Antibacterial agent should be given in case of bacterialsuperinfection

Complicationscan occur corneal opacities that persisted

B. Keratokonjungtivitis epidemika1


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C.Herpes simpleks conjunctivitis

Usually in children under the age of 2 yearsaccompanied by ginggivostomatitis.

Signs and symptoms: unilateral dilation of blood vessels, irritation, mucoid bertahi eyes, pain, and

mild photophobia On corneal epithelial lesions appear generally separate fused to form a ulcer or

ulcer-epithelial ulcers are highly branched (dendritic) Herpes vesicles sometimes appeared at the edge palpebra palpebra and,

accompanied by severe edema palpebra. There is a node preaurikuler typicalpainful if pressed


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Treatment

Local and systemic anti-virus should be given to prevent cornea involvemet For corneal ulcers may be required corneal debridement carefully by

rubbing the ulcer with a sterile cotton swab sticks, dripping with antiviraldrugs, and closed for 24 hours.

Topical antiviral should be given 7-10 days: trifluridine every 2 hours whileawake or rabine vida ointment five times a day, or idoxuridine 0.1%, 1 dropevery hour while awake and 1 drop every 2 hours during the night.

Herpes keratitis can also be treated with acyclovir ointment 3% five timesdaily for 10 days or with oral acyclovir, 400 mg five times daily for 7 days

C.Herpes simpleks conjunctivitis


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D.Konjungtivitis Hemoragika Akut Etiologyare Picorna viral and enterovirus 70

Signs and symptoms: eye pain, photophobia, foreign

body sensation, a lot of tears, red, palpebra edema, andhemorrhage subkonjungtival. It sometimes happenskemosis conjunctiva.

Therapy:Treatment is usually symptomatic. The use of antibioticscan be used to prevent secondary infection.


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Bacterial conjunctivitisHistoryThe 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 morningbecause

the discharge sticks the lashes together. There may be a historyof contact with a person with similar symptoms.


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ExaminationThe vision should be normal after the discharge

has been blinked clear of the cornea. The discharge usually is

mucopurulent and there is uniform engorgement of all the

conjunctival blood vessels. When fluorescein drops areinstilled in the eye there is no staining of the cornea.

Bacterial conjunctivitis


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ManagementTopical antibiotic eye drops (for example,chloramphenicol)

should be instilled every two hours for the first 24 hours to hasten recovery,

decreasing to four times a day for one week. Chloramphenicol ointment

applied at night may also increase comfort and reduce the stickiness of the

eyelids in the morning. Patients should be advised about general hygiene

measures; for example, not sharing face towels

Bacterial conjunctivitis


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ExaminationThere is bilateral diffuse conjunctival injection

with a mucopurulent discharge. There are many lymphoid

aggregates in the conjunctiva (follicles). The cornea usually is

involved (keratitis) and an infiltrate of the upper cornea (pannus)may be seen.

Chlamydial conjunctivitis


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ManagementThe diagnosis is often difficult and special bacteriological tests maybe necessary to confirm the clinical suspicions. Treatment with oral tetracycline ora derivative for at least one month can eradicate the problem, but poor compliancecan lead to a recurrence of symptoms. Systemic tetracycline can affect developingteeth and bones and should not be used in children or pregnant women. Associated

venereal disease should also be treated, and it isimportant to check the partner for symptoms or signs of venereal disease (affectedfemales may be asymptomatic). It often is helpful to discuss cases with agenitourinary specialist before commencing treatment, so that all relevantmicrobiological tests can be performed at an early stage.

Chlamydial conjunctivitis


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Various Chlamidya trachomatis serotypes that areobligate intracellular organism causes two eye infectionsare:

a. Trachoma

b. Inclusiuon Conjuctivitis


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TRACHOMA Tracoma is a form of chronic follicular conjunctivitis caused by Clamydia

trachomatis. This disease can affect any age but more common on youngpeople and children

Modes of transmission of this disease is through direct contact withsecretions or through a trachoma patients daily necessities such astowels, toilet articles and deodorized.

The average incubation period of 7 days (range 5 to 14 days)


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According to the classification Mac Callan clinicalpicture of this disease is divided into several stages.

Stage I; called insipien stadium

Stage II; called established

Stage III is called staging grated

Stage IV; called the stage of healing

TRACHOMA


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To ensure trachoma endemic in family or community, a number ofchildren must show at least - least two signs of the following:

(1) Five or more follicles on the tarsal conjunctiva palpebra superior

to the average eye.(2) Grate the tarsal conjunctiva conjunctiva at the superiorcharacteristic.(3) follicles or sekuelenya limbus (Herbert wells).(4) The expansion of blood vessels onto the cornea, the clear upperlimbus.

TRACHOMA


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For control, the World Health Organization hasdeveloped a simple way to check the disease. Itincludes a sign - a sign as follows

TRACHOMA


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TF : five or more follicles on the upper tarsalconjunctiva.

TRACHOMA


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TI : Diffuse infiltrate and hypertrophy papil on theconjuctiva tarsalis superior at least 50% of normaldeep veins.

TRACHOMA


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TS : Trachomatosa conjunctival scarring.TRACHOMA


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TT : Trikiasis or entropion(inverted eyelashes)

TRACHOMA


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CO : Corneal blurred.

TRACHOMA


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Support investigation Inclusi body of chlamydia can be found in the conjunctival scrapings in

sleeping with Giemsa, but not always exist. Outward appearance of f luorescein antibody and immuno - assay test

of enzymes are commercially available and widely used in clinicallaboratorium. This new test has replaced the outward appearance ofGiemsa for preparation and isolation of the klamidial agents in cellcultures

Differential diagnosis

Follicularis conjunctivitis, vernal katarrh.

TRACHOMA


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Complication

a. Secondary infection

b. Corneal opacities due to pannus covering the corneac. Corneal xxerosis with keratitis Sikad. Enteropion and trikiasise. Simblefaron

Treatment

Treatment of trachoma with tetracycline eye ointment 2-4 times a day, 3-4 weeks, acorrection

Surgery should be performed on the eyelashes turn inward to prevent scarring

trachoma. For prevention by vaccination and eat a nutritious and hygienic

good to prevent the spread.

TRACHOMA


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Inclusion Conjunctivitis The disease is transmitted sexually and can last for

chronic (up to 18 months) unless treated adequate


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Sign & Symptomps

Patients often complain of red eyes, pseudo-ptosis, and especially in the morningbelekandays. In neonates showed papillary conjunctivitis and a moderate amount of

exudate,in cases of hyperacute, occasionally formed which can cause scarringpseudomembrane. Patients present with follicular conjunctivitis is mucopurulent andthere mikropanusassociated with subepithelial scarring.

Inclusion Conjunctivitis

1


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Examination SupportRapid diagnostic test direct fluorescent antibody test, ELISA, and PCR wasreplace the outward appearance of Giemsa

Differential diagnosis

Active follicular trachoma

Treatmentin infantsGive erytromycin per oral suspension, 50 mg / kg / day in 4 divided doses sealamsekurangkurangnya14 days.

In adultsHealing is achieved by doxycycline 100 mg orally twice daily for 7 days,or erythromycin 2 g / day for 7 days, or it could be azithromcin 1 g / dose.

Inclusion Conjunctivitis2


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Allergic conjunctivitisHistoryThe main feature of allergic conjunctivitis is itching. Both eyes usually areaffected and there may be a clear discharge. There may be a family history of atopy orrecent contact with chemicals or eye drops. Similar symptoms may have occurred inthe same season in previous years. It is important to differentiate between an acuteallergic reaction and a more long term chronic allergic eye disease.


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Examination

The conjunctivae are diffusely injected and may be oedematous

(chemosis). The discharge is clear and stringy. Because of the fibrous septa

that tether the eyelid (tarsal) conjunctivae, oedema results in round swellings

(papillae). When these are large they are referred to as cobblestones.

Allergic conjunctivitis


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A. Atopic ConjunctivitisSign & Symptomps

Burning sensation,

Dirty eyes,

Red eyes and photophobia.

Palpebrasedge eritemosa, and the conjunctiva was white as milk.

There is a papilla refined, but not growing like a giant papilla onkeratoconjunctivitis vernal, and more often found in the inferior tarsus.


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Usually there is a history of allergies (hay fever, asthma, or eczema) in patientsor her family. Most patients had suffered from atopic dermatitis since infancy.Grate in the folds of flexure folding elbow and wrist and knee often was found.As dermatitisnya, atopic keratoconjunctivitis lasts a prolongedand oftenexperience exacerbations and remissions. such as keratoconjunctivitis vernal,the disease tends to be less active when the patient was aged 50 years.

laboratory Conjunctival scrapings revealed eosinophils, although not as much as that seen

as much on vernal keratoconjunctivitis.

A. Atopic Conjunctivitis1


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Treatment

Oral Antihistamine including terfenadine (60-120 mg 2x a day),astemizole (10

mg four times daily), or hydroxyzine (50 mg bedtime, increased to 200mg) proved to be beneficial. NSAID, such as ketorolac and iodoxamid, it can overcome the

symptoms in these patients. In severe cases, plasmapheresis is an adjunctive therapy. In the case of advanced with severe corneal complications, corneal

transplant may be necessary torestore the sharpness of his eyesight

A. Atopic Conjunctivitis2


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Diagnosis Found any signs of inflammation of the conjunctiva Found any giant papil the superior conjunctiva palpebra Found any tantras dot on the corneal limbus Sometimes accompanied by shield ulcer\ Recurrent

Sign & Symptomps Red eyes (usually recurrent) Sometimes accompanied by intense itching

A history of allergy The existence of diffuse papil hypertrophy especially of the conjunctiva tarsal superior Thickening of limbus with dot tantras Mucoid to mucopurulent discharge if there is secondary infection


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Treatment

Mild cases:educational therapy (avoiding allergens, cold compresses, cool room, lubrication, eye

ointment),giving antihistamines (topical levokabastin, emestadine),

vasoconstrictor (phenileprine, tetrahidrolozine),mast cell stabilizer (4% sodium cromolin alomide)

Moderate-severe cases:

mast cell stabilizer (sodium 4% alomide cromolin),topical steroid anti-inflammatory (ketorolac 0.5%),

topical corticosteroids or agentsmodulator cyclosporine.


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Hypersensitivity reaction to microbial protein (suchas protein M.tbc, Stafilokok, Candida)

Small lesions (1-3mm), hard, red, surrounded by

prominent local hyperemia

If the limbus -> triangular with the peak in thedirection of the cornea -> recover form jar.parut.

D.Flikten Conjunctivitis


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Iatrogenic Conjunctivitis

(Topical drug administration)

Follicular conjunctivitis Conjunctivitis toxic or non-specific infiltrate,which

followed the formation of scar tissue, often caused by long using of dipivefrin,

miotika, idoxuridine, neomycin, and other drugs are prepared in vehikel

preservatives or toxic that cause irritation.

Silver nitrate is dripped into the saccus conjingtiva at birth is often a causes a mildchemical conjunctivitis. If tear production is reduced due to continuous irritation,

conjunctival injury because there would then exist dilution of the agents that damage

when dropped into the saccus conjungtivae.

Conjunctival scrapings often contain keratinized epithelial cells, a few

polymorphonuclear neutrophils, and occasional odd-shaped cells.


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Conjunctivitis caused by Chemicals and irritants1

Acid, alkali, smoke, wind, and almost any irritant substance that makes thesaccus conjungtiva can cause conjunctivitis. Some common irritants isfertilizer, soap, deodorant, hair spray, tobacco, ingredients make-up, andvarious acid and alkali. In certain areas, smog (a mixture of smoke and fog) The

main cause of a mild chemical conjunctivitis. Specific irritant in smog can notbe positively determined, and non-specific treatment. No a permanent effecton the eye, but the affected eye is often red and disturbing is chronic.


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Conjunctivitis caused by Chemicals and irritants On the injury acid, it changes the nature and effect of protein networks

directly. Alkali does not change the nature of the protein and tend to quicklyinfiltrate network and settled into the conjunctival tissue. Here they continuedto damage sustained for hours or days old, depending on molar concentration

of the alkali and the amount of intake. attachment between bulbi conjunctivaand cornea leokoma palpebra and more than likely occur if the cause is analkali agent. At any event, the main symptom chemical injury are pain, bloodvessel dilation, photophobia, and blepharospasm. History of the trigger eventscan usually be disclosed.

.


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Immediate and thorough flushing with water or saccus conjungtivae salt solution is veryimportant, and any solid material must be removed in mechanics. Do not use chemicalantidotum.

Symptomatic common action is a cold compress for 20 minutes every hour, 1% atropinedrops twice day, and give systemic analgesics if necessary. Bacterial conjunctivitis can betreated with appropriate antibacterial agents. Scarring of the cornea may require cornealtransplantation, and symblepharon may require plastic surgery of the conjunctiva.

Severe burns and corneal kojungtiva prognosis poor despite surgery. However, iftreatment is started soon enough, grated formed will be minimal and the prognosis is

better

Conjunctivitis caused by Chemicals and irritants


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TERIMA KASIH

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