This document discusses conjunctivitis (inflammation of the conjunctiva). It begins by defining the conjunctiva and describing typical symptoms and signs of conjunctivitis such as redness, discharge, irritation and pain. It then differentiates between bacterial, viral, allergic and other causes of conjunctivitis, providing details on common causes, symptoms and treatment for each type. Trachoma, a leading cause of blindness, is also explained. The document concludes with sections on prevention of conjunctivitis through proper hand washing and avoiding sharing personal items with infected individuals.

1. THE EYES ARE THE WINDOW OF THE SOUL
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THE EYES ARE USELESS WHEN THE MIND IS BLIND

2. CONJUNCTIVITIS
Muhammad Ibrahim
MPH 2nd Semester
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3. LEARNING OUTCOMES
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After attending this presentation, the audience will be
able to:
 Differentiate different types of conjunctivitis
 Interpret signs and symptoms of different types of
conjunctivitis
 Devise management of different types of
conjunctivitis
 Design prevention plan for conjunctivitis

4. THE CONJUNCTIVA
 Palpebral or tarsal
conjunctiva
 Bulbar or ocular
conjunctiva
 Fornix conjunctiva
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Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap2, page 17, London, RE&PP Ltd.

5. CONJUNCTIVITIS
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 Irritation
 Itching
 Watering and
discharge
 Redness
 Discomfort
 Pain and photophobia
in keratoconjunctivitis
 Vasodilatation
 Increased secretions
 Edema
 Follicles
 Papillae
 Keratinization
 Membrane formation
 Scarring (fibrosis)
Typical symptoms Typical signs
 Infection or inflammation of the conjunctiva
 More common in hot climates
Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 83, London, RE&PP Ltd.

6. BACTERIAL CONJUNCTIVITIS
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 The bacteria may invade
a normal, healthy
conjunctiva to produce a
primary bacterial
conjunctivitis
 The bacteria may invade
because the conjunctival
defense against
infection is weakened,
called secondary
bacterial conjunctivitis
Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 86, London, RE&PP Ltd.

7. BACTERIAL CONJUNCTIVITIS
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SIGNS AND SYMPTOMS
 Key characteristic,
mucopurulent discharge
 In severe cases it is like
yellow pus
 In mild cases the eyelids
may be stuck together on
waking
 There is always
vasodilatation of
conjunctiva
 In severe cases there may
be chemosis of the
conjunctiva, edema of
eyelids and general
malaise
COMMON CAUSATIVE AGENTS
 Staphylococcus cause acute
primary conjunctivitis
 Haemophilus influenza cause
seasonal conjunctivitis
 Gonococcus comes form
genital discharges and cause
severe conjunctivitis
 Moraxella lacunata causes
mild angular conjunctivitis
 Other bacteria,
pneumococcus,
meningococcus,
streptococcus etc.
Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 88, London, RE&PP Ltd.

8. TRACHOMA
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 Trachoma ( Ancient
Greek “ Rough eye”)
 Leading infectious
cause of blindness
world wide
 WHO estimates 2.2
million people visually
impaired world wide
due to trachoma
 Caused by one of the
chlamydia group
organism the “
chlamydia trachomatis”
WHO.Trachoma fact sheet N*382,March 2014

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Symptoms
 Mild itching and irritation of the
eye
 Watering
 Mucopurrulent discharge from
the eye
As the disease progresses, later
trachoma symptoms include:
 Marked light sensitivity
(photophobia)
 Blurred vision
 Eye pain
Signs
Conjunctiva:
 Follicular conjunctivitis (tarsal
conj, fornices)
 Limbal follicles
 Conjunctival scarring
 Herbert's pits (after resolution
of follicles)
TRACHOMA
WHO.Trachoma fact sheet N*382,March 2014

10. CONT.…
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Cornea:
 Keratitis (corneal ulcer)
 Corneal opacity (end
stage)
Lids:
 Entropion
 Trichiasis
WHO.Trachoma fact sheet N*382,March 2014

11. TRANSMISSION
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12. TRACHOMA
Treatment
 Tetracycline, topical (2 months) and oral (3 weeks)
 Oral azithromycin
SAFE Strategy
 Surgery for correction of trichiasis
 Antibiotics
 Face cleaning
 Environmental improvement
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WHO.Trachoma fact sheet N*382,March 2014 (GET 2020)

13. VIRAL CONJUNCTIVITIS
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 Viruses live in the epithelial
cells and often invade the
epithelial cells of the cornea
 Viruses live inside the body
cells so they are all immune to
antibiotics
 Disease may be so mild that it
is impossible to recognize it
clinically
 It may be a severe and
disabling condition
TYPICAL SIGN AND SYMPTOMS
 Gritty foreign body sensation
and photophobia
 Watery and not purulent
secretions called serous
secretion
 Blood vessels are dilated and
there is hypertrophy of the
lymphoid follicles
 There may be papillary
hypertrophy on the upper tarsal
conjunctiva
Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 89, London, RE&PP Ltd.

14. ADENOVIRUS CONJUNCTIVITIS
 Most common viral infection of the conjunctiva
 There are many different strains of the virus, all the
strains are very contagious
 Usually bilateral but often affects one eye more
severely than other
 Superficial punctate keratitis and psuedomembrane
are specific signs
 The infection is easily spreads from person to
person by direct contact specially in workers
examining eyes 14
VIRAL CONJUNCTIVITIS
Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 90, London, RE&PP Ltd.

15. VIRAL CONJUNCTIVITIS
MEASLES
 Generalized viral infection
 Also invades the conjunctival and corneal epithelium
 It can cause serious corneal ulceration and blindness
MOLLUSCUM CONTAGIOSUM
 Viral wart which appears on the margins of the eyelids
 Virus particles are discharged from the wart into the
conjunctiva and cause a typical follicular conjunctivitis
 Treatment is to remove the wart
either by excision, cautery or curettage
15
Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 91, London, RE&PP Ltd.

16. VIRAL CONJUNCTIVITIS
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HERPES SIMPLEX
VIRUS
 Wide spread virus
 Cause follicular
conjunctivitis, corneal ulcer,
multiple vesicles on the
face, mouth, or eyelids
 Spread by direct contact
 The virus remain dormant
until years and cause
recurrent infections
 Anti viral treatment
 Debridement and chemical
cauterization techniques are
used for corneal epithelial
removal
Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 88, London, RE&PP Ltd.

17. GRANULOMATOUS CONJUNCTIVITIS
 Also called parinaud’s syndrome
 Unilateral with a local inflammatory granuloma in
the conjunctiva
 Usually means the conjunctiva has become by
chance the route of entry into the body for some
micro organism
Possible causes:
 Tuberculosis
 Syphilis
 Actinomycosis ( fungal disease)
 Sporotrichosis ( fungal disease)
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Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 88, London, RE&PP Ltd.

18. ALLERGIC CONJUCTIVITIS
It can occur in four forms
A. Vernal conjunctivitis
 Originally called spring catarrh
 May occur through out the year
 Common in children
 Not caused by specific allergen
 Most likely agent is some material in the
atmosphere such as pollen
 Belong to same group of diseases as allergic
rhinitis, asthma and eczema atopic diseases
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Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 93, London, RE&PP Ltd.

19. ALLERGIC CONJUCTIVITIS
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SYMPTOMS AND SIGNS
 Severe and persistent itching
and irritation in both eyes
 Feeling string or worms in the
eyes
 Sticky white discharge
 Thickening of conjunctiva with
formation of papillae
 Giant papillae in the advance
stage, spaces between papillae
filled with mucus
 Cobblestone appearance
 Superficial punctate keratitis
 Shield ulcer
MANAGEMENT
 Steroids
 Antihistamine
 Cryotheraphy
 Diathermy and cautery
 Beta radiation given with a
strontium 90 applicator
Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 94, London, RE&PP Ltd.

20. ALLERGIC CONJUCTIVITIS
B. Hay fever conjunctivitis
 Acute allergic reaction to pollen in the air
 Usually associated with acute rhinitis
 Non of the structural changes like in the vernal conjunctivitis
C. Phlyctenular conjunctivitis
 Phlycten is Greek word for a blister
 Localized hypersensitivity reaction to bacterial
proteins in the bloodstream, mostly tubercular
 Phlycten appears as a raised pinkish nodule
surrounded by an area of hyperemia
 It then develops a necrotic grey center surrounded
by reactive inflammation
D. Allergies to drugs and cosmetics
 Medications , chemical preservatives, cosmetics can provoke an
allergic reaction
 Diagnosed by taking careful history
 Stop the provoking agent
 Topical steroids will relieve the symptoms
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Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 95, London, RE&PP Ltd.

21. ENDOGENOUS CONJUNCTIVITIS
 Cause of the inflammation may be an inflammation
arising from within the body itself
 Exact mechanism is not known but in most cases it
is a type of auto immune disease
KERATOCONJUNCTIVITIS SICCA
 Common specially in old people
 Often associated with rheumatoid arthritis
 The lacrimal gland and accessory conjunctival
glands become inflammed so produce fewer tears
 The eyes are sore and gritty
 Schirmer’s test 21
Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 97, London, RE&PP Ltd.

22. ENDOGENOUS CONJUNCTIVITIS
OCULAR PEMPHIGOID
 Some times called essential shrinkage of the
conjunctiva
 Gradual shrinkage and fibrosis of the conjunctiva
 Symblepharon in advance cases
STEVEN-JOHNSON SYNDROME
 Acute ulceration of the conjunctiva and other mucous
membranes like the mouth and vagina
 Followed by severe scarring of the membranes
 Often caused by sensitivity to drugs, particularly
sulphonamides
 Topical and systemic steroids in acute stage may help
22
Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 98, London, RE&PP Ltd.

23. NEONATAL CONJUCTIVITIS
( OPHTHALMIA NEONATORUM)
 Conjunctivitis in a newborn child
 GONOCOCCUS is most serious cause
 Baby may be infected during delivery if the
mother genital tract is infected
 Cause acute conjunctivitis within the first few
days of birth
 May cause corneal ulceration, scarring and
eventually blindness
 CHLAMYDIA, Organism similar to trachoma
 May be present in the female genital tract
 Cause conjunctivitis within the first 2 weeks of
birth
 STAPHYLOCOCCUS and other organism of a
non genital origin may also infect the infant
conjunctiva
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Smith, J. S. (1997). Eye diseases in hot climates (third edition),chap6, page 99, London, RE&PP Ltd.

24. PREVENTION OF CONJUNCTIVITIS
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If you have infectious
conjunctivitis, you can
help limit its spread to
other people by following
these steps:
 Wash your hands often
with soap and warm
water
 Avoid touching or
rubbing your eyes
 Wash any discharge
from around the eyes
several times a day
 Wash hands after
applying eye drops or
ointment

25. PREVENTION OF CONJUNCTIVITIS
 Do not use the same eye drop dispenser/bottle for
infected and non-infected eyes—even for the same
person
 Wash pillowcases, sheets, washcloths, and towels in hot
water and detergent; hands should be washed after
handling such items
 Avoid sharing articles like towels, blankets, and
pillowcases
 Clean eyeglasses, being careful not to contaminate
items (like towels) that might be shared by other people
 Do not share eye makeup, face make-up, make-up
brushes, contact lenses and containers, or eyeglasses
 Do not use swimming pools
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26. PREVENTION OF CONJUNCTIVITIS
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If you are around someone
with infectious conjunctivitis,
you can reduce your risk of
infection by following these
steps:
 Wash your hands often with
soap and warm water
 Wash your hands after
contact with an infected
person or items he or she
uses
 Do not share items used by
an infected person; for
example, do not share
pillows, washcloths, towels,
eye drops, eye or face
makeup, and eyeglasses

27. PREVENTION OF CONJUNCTIVITIS
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If you have infectious
conjunctivitis, there are steps you
can take to avoid re-infection
once the infection goes away:
 Throw away and replace any
eye or face makeup you used
while infected
 Throw away contact lens
solutions that you used while
your eyes were infected
 Throw away disposable contact
lenses and cases that were
used while your eyes were
infected
 Clean extended wear lenses as
directed
 Clean eyeglasses and cases
that were used while infected

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