Conjunctivitis Keratitis and Ophthalmia Neonatorum

Most cases of conjunctivitis have bacterial, viral, or allergic etiologies and are easily treated. Allergic conjunctivitis is usually seasonal, recurrent, and bilateral and presents with pruritus and watery discharge.

Bacterial conjunctivitis is neither pruritic nor seasonal and presents with a purulent discharge, early morning crusting of the eyelid, and a beefy red conjunctiva. Staphylococcus spp., Streptococcus pneumoniae, and Haemophilus infiuenzae, the most common causes of bacterial conjunctivitis, rarely bring about significant sequelae and are treated with topical antibiotics. However, infection with Pseudomonas aeruginosa and Neisseria gonorrhoeae are considered medical emergencies, since both can penetrate and perforate the cornea within 24 hours. Contact lens wearers are prone to Acanthamoeba and P.aeruginosa.

Viral conjunctivitis presents with a watery discharge and follicular hypertrophy. Although adenovirus remains the leading viral cause of viral conjunctivitis, herpes simplex 1 and 2 and herpes zoster can lead to scarring and blindness with recurrence. In the elderly, ocular complications occur in 50% with recurrent V1 distribution herpes zoster (always consider with vesicular rash around the eye or tip of nose).

N gonorrhoeae, Chlamydia trachomatis, and herpes simplex 1 and 2 must be considered as a cause of ophthalmia neonatorum. N. gonorrhoeae generally occurs within 2 to 4 days of life and Chlamydia within 5 to 13 days. Neonatal C. trachomatis carries a 50% risk of pneumonia over the ensuing , 2 to 3 months. Herpetic infections develop in half of neonates exposed to genital herpes during birth, and of these, ocular herpes develops in 20%.

A fungal cause should be considered in patients who are immunocompromised and those with a history of trauma involving organic matter.

Causes

• Causes of conjunctivitis may be considered in patients such as including parasitic, autoimmune, and systemic diseases (eg, sarcoidosis, tuberculosis, Reiter syndrome, Kawasaki disease).
• Bacterial conjunctivitis is an infection caused by bacteria such as including staphylococci, streptococci or haemophilus.
• If you have allergic disease such as including hay fever, asthma and eczema, then it may cause allergic conjunctivitis. The conjunctivitis is often caused by antigens including pollen, dust mites or cosmetics.

Symptoms

Bacterial and viral etiologies present similarly.

• Ocular pain and redness
• Photophobia (with keratitis)
• Foreign body sensation
• Crusting, discharge
• Decreased vision

N. gonorrhoeae

• Initially unilateral +++++
• Thick discharge

C. trachomatis

• Watery discharge +++
• Mucopurulent discharge +++

Herpes simplex

• Unilateral +++++
• Watery discharge, less with recurrence
• Risk factors: immunosuppression, sunlight, local trauma, stress

Signs

N. gonorrhoeae

• Hyperpurulent discharge
• Severe chemosis

C. trachomatis

• Lid edema ++++
• Conjunctival hyperemia
• Hypertrophic papillae without follicles

Primary herpes simplex keratitis

• Punctate lesions (more common in primary infection) on fluorescein staining, often not typical dendritic pattern.
• Lid lesions, periocular dermatitis ++++
• Decreased corneal sensitivity +++
• Uveitis (very rare)
• Isolated ocular involvement in neonates (rare); search for disseminated disease

Herpes zoster ophthalmicus

• Punctate lesions or dendritic ulcers on fluorescein staining ++++
• Lesions along nasociliary branch of trigeminal nerve (tip of the nose) +++

Treatment

• Fot the treatment of chlamydial conjunctivitis, Erythromycin ointment may be beneficial as an adjunctive therapy.
• You can treat bacterial conjunctivitis with antibiotic eye drops or ointments that cover a broad range of bacteria.
• Allergic conjunctivitis, it may be treated using topical antihistamine drops. Drops such as includes sodium cromoglicate can be used to prevent the allergic response.