CONJUNCTIVITIS

Conjunctivitis is an acute inflammation of the conjunctiva usually caused by viruses, bacteria, allergy, irritation or foreign body. Endemic or epidemic conjunctivitis may be associated with measles or rhinopharyngitis in children. In the absence of hygiene and effective treatment secondary bacterial infection may develop, affecting the cornea (keratitis) and leading to blindness.

General Clinical Features

• Redness

• Irritation

• Photophobia

• Pain

• Swelling of the eyelid

• Lacrimation

The specific features is depending on the course e.g

• Bacterial conjunctivitis present with:

  • Abundant and purulent secretion

  • Eyelids stuck together on waking

  • Unilateral infection at on set

• Viral conjunctivitis present with:

  • Watery (serous) secretion

  • No itching

• Allergic conjunctivitis present with:

  • Excessive lacrimation

  • Eyelids oedema

  • Intense itching

Treatment

There is no known specific treatment, the condition is self-limiting and can be treated symptomatically. Hot compress can be applied to the infected lid to relief swelling and pain, analgesic can be administered. 

Treatment of conjunctivitis depends on the cause. The eyelids should be gently bathed with clean water of cloth to keep them clean and free of discharge.

• Bacterial conjunctivitis:

  • Clean eye 4 to 6 times per day with boiled water or 0.9% sodium chloride (hypertonic solution)

  • Apply 1% occ. TCN 12hrly into both eye for 7days

  • Never use corticosteroid Gutt or occ.

• Viral conjunctivitis:

  • Clean eyes 4 to 6 times per day with boiled water or 0.9% sodium chloride (hypertonic solution)

  • Apply local antibiotic if there is a (risk) of secondary bacterial infection (as above)

• Allergic conjunctivitis:

  • Local treatment as for viral conjunctivitis 

  • Antihistamine for 1 to 3 days 

Note: in the event of a foreign body (injury) occur check tetanus immunization status.

Ophthalmia neonatorum

Ophthalmia neonatorum is the infection of the conjunctiva of the newborn which occur during the first 28 days of a baby’s life. The disease is affecting the baby through birth canal of infected mother or through unhygienic way of handling the baby, if care is not been taken immediately it could lead to corneal perforation as complication and later blindness.

Causative organism: bacterial (Staphylococci)

Clinical manifestation

• Chemosed

• Purulent discharge or milky pus

• Swelling of the eyelid

• Redness of the conjunctiva

Management

• Irrigation – wash properly with sterilized syringe and cotton wool.

• Intensive Penicillin – dilute crystalline penicillin with 2mls of water for injection; withdraw 1ml add into 49mls of water for injection to make 50mls of the solution.

Procedure of administering the solution

• 1 drop every 1 minute for 5 minutes

• 1 drop every 5 minutes for 15 minutes

• 1 drop every 15 minutes for 30 minutes

• 1 drop every 30 minutes for 1 hour

• 1 drop every 1 hour for 24 hours

Then continue with Gutt CPL 6hrly x 12 hours or Gutt Gentalek 1 drop q8h x 1/52

Occ. CPL or TCN at night x 2/52

Prevention and control measures

• Mass public mobilization about STI’s 

• Proper screening of all expectant mothers

• Prompt treatment of infected mothers

• Ensure hygienic way of attending delivery

• Clean eyes of newborn as soon as the head is delivered

• Apply antibiotic preferably occ. TCN 1% before the eyes newborn are opened

• Discourage traditional practices in this regards 

Hordeolum external (Stye)

Stye is an infection usually a staphylococcal infection of one or more of the glands at the edge of the eyelid or under it. An abscess forms and tends to rupture, releasing a small amount of pus. Stye sometimes forms simultaneously with or as a result of blepharitis (inflammation of eyelid). A person may have one or two styes in a lifetime but some people develop them repeadly.

Sign and symptoms

• Swelling of the eyelid

• Redness

• Pain and possible discharge

• Non-malignant tumor (boil formation) at the root of eyelashes

Management

• Improve personal hygiene

• Hot compress to dilate the blood vessels

• Remove the affected eyelashes

• Antibiotic e.g occ. TCN 1%

• Simple analgesic

Hordeolum internal (chalazion)

Chalazion is an enlargement of a long thin oil gland in the eyelid that results from an obstruction of the gland opening at the edge of the eyelid. It characterized with painless swelling found in the upper and lower away from the eyelid but within eyelashes at first it resemble stye a few days the symptoms disappear leaving the round painless in the eyelid that growth slowly for the first week. A red or grey area may develop underneath the eyelid (more to the cornea).

Most chalazion disappears without treatment after a few months. If hot compress are applied several times a day, they may disappear sooner.

Further management involved

• Incision and curettage (I & C)

• Incision and drainage (I & D)

Non-cancerous growths: Two kind of non-cancerous (benign) growths can develop on the conjunctiva. A Pinguecula, and Pterygium.

• Pinguecula: A raised yellowish – white growth in the vulva conjunctiva next to the cornea, caused by elastic degeneration. Is unsightly but generally doesn’t cause any serious problem and needn’t be removed. 

• Pterygium: This refers to a whitish, triangular growth of fibro vascular tissue extending slowly from the fornix conjunctiva (medial cantus) to the cornea. It occurs most frequently in patients who are exposed to wind, dust or rid climate and never disappear spontaneously, the fleshy growth may spread across the cornea and distort its sharpness. Possibly causing astigmatism (irregular curvature of cornea) and other visual changes. It looks apex and base. 

Clinical features and treatment (Two stages)

• Benign Pterygium develops slowly/ does not reach the pupil: No treatment

• Progressive vascularized Pterygium: Red and inflamed growth covers the pupil and may impair vision.

  • Clean eye with sterile water or 0.9% sodium chloride

  • Surgical removal if skills and facilities are available preferably by an eye doctor (ophthalmologist)