TYPES OF

CONJUNCTIVITI
S
PRESENTED BY:
Dr. Vijay Kumar Singh
Career Medical College
Conjunctiva- A thin mucous membrane over ocular surface

Conjunctivitis- Term used for inflammation of

conjunctiva, characterized by hyperaemia and increased
secretions.
Classification:
A. Based on aetiology
- Infective: bacterial, viral, fungal, parasitic.
- Non-infective: allergic, autoimmune, dry eye, toxins,
irritants.
B. Based on discharge
- Serous: viral & allergic conjunctivitis.
- Catarrhal: allergic conjunctivitis.
- Purulent or Mucopurulent: bacterial & chylamydial.
- Pseudomembranous: bacterial.
C. Based on conjunctival response
- Follicullar: viral, chlamydial.
- Papillary: allergic.
- Granulomatous: tuberculosis, syphills, sarcoidosis,
parasitic, actinomycosis, foregin body.

D. Based on durations
- Acute conjunctivitis: resolving in <4 weeks.
- Subacute or Chronic cunjunctvitis: persisting for
>4 weeks.
 Bacterial conjunctivitis
 These are types of infective conjunctivitis caused becausae of bacterial
infections.
 Common predispossing factors:
~ flies, hot dry climate, poor sanitation &
poor hygine.
 Mode of infection:
- Exogenous: contamined water, air, hand, towels.
- Endogenous: through blood.
- Local spread: from srrounding structures such as
lacrimal sac & lids.
 Various clinical types:
- Acute mucopurulent conjunctivitis
- Acute purulent conjunctivitis
- Acute membranous or pseudomembranous conjunctivitis
- Chronic bacterial conjunctivitis
- Chronic angular conjunctivitis
 Acute Mucopurulent conjunctivitis
 Most common
 Characterized by mucopurulent discharge & hyperaemia.
 Causative organism: Staphylococcus aures,
Streptococcus,
Pneumococcus
 Clinical features:
- symptoms:
mucopurulent discharge leading to matting of lid margins.
photophobia & foregin body sensation.
blurring of vision due tomucous over cornea.
- signs:
conjunctival congestion.
mucous flakes present at lid margins.
chemosis- swellimg of conjunctiva.
 Treatment:
- broad spectrum anti-biotics(fluoroqunilones) eye drop or ointments 4 to 6
times/day.
- systemic anti-inflammatory & analgesics drugs to relive pain & decrease
inflammation.
- supportive- dark glasses.
- removal of deleterious material from sac by irrigation with warm saline.
 Acute purulent conjunctivitis of adults
 Affecting adult males.
 Mainly caused by: Gonococcal infection.
 Gonococcus can penetrate into intact cornea.
 Clinical features:
- symptoms:
watery-to-thick purulent discharge.
photophobia with foregin body sensation.
blurring of vision.
- signs:
ocular- tender eyeball
conjunctiva shows congestion & chemosis
systemic- associated with arthritis & endocarditis
 Treatment:
- broad specterum antibiotics to patient and his/her sexual
partner.
- tropical atropine if cornea is involved.
 Opthalmia Neonatorum
Type of acute purulent conjunctivitis in new born.
Defined as bilateral conjunctival inflammation with
mucoid, mucopurulent or purulent discharge from one
or both eyes in infancy.
Sources of infection during at the time & after birth.
Causative agents:
- birth to 2 days:- Gonococcus & chemical
(silver nitrate).
- 2-5 days:- Staphylococcus aureus, Streptococcus.
- 5-7 days:- Herpes Simplex-II
- after 7 days:- serotype D to K of Chlamydia
Trachomatis
 Acute Membrnous and
pseudomembranous conjunctivitis
 Characterized by membrane formations.
 True membrane, it is Membranous.
 False membrane (easily removed without bleeding & leaving behind
intact epithelium of conjunctiva), it is Pseudomembranous.
 Common causative agents:
- Corynebacterium diptheriae
- Streptococcus haemolyticus
 Clinical features:
- symptoms: discharge, pain & swelling of eyelids.
- signs: lid tenderness, thick greenish yellow membrane
over conjunctiva.
 Treatment:
- Penicillin eye dropd & broad spectrum antibiotics
ointment at bed time.
- isolation of patient & immunization against Diptheria. IM
injection of Crystalline Penicillin can be given.
 Chlamydial conjunctivitis
Chlamydia share features of both bacteria & viruses.
like viruses, they obligate intracellular & filterable, but
like bacteria they contain both DNA & RNA, multiply by
binary fission & are sensitive to antibiotics.
Jones classification of chlamydial infections:
- Class 1: Blinding trachoma (caused by C. trachomatis
serotypes A, B, Ba & C), associated with
secondary bacterial infections.
- Class 2: Nonblinding trachoma, usually not
associated with secondary becterial infections.
- Class 3: Paratrachoma (oculogenital chlamydial disease).
 Trachoma
 Leading cause of preventable blindness in the world.
 It is choronic keratoconjunctivitis (affecting both conjunctiva & cornea).
 Charaterized by follicular & papillary reactions in conjunctiva.
 Causative organism: Chlamydia trachomatis
 Predisposing factors:
- age: no age bar
- sex: females
- climate: dry & dusty weather
- socioeconomic status: poor classes due to unhygienic
living conditions.
- environmental factors: exposure to dust, smoke, irritants, sunlight,
etc.
 Modeof infections:
- conjunctival discharge of affected person is the most common source.
- direct spread through air or water: vector transmission, material
transfer through contaminated
fingers, instruments, etc
Clinical features:
- symptoms: mild foregin body sensation, lacrimation
scanty mucoid discharge, photophobia,
blurring of vision.
- signs:
Conjunctival signs:
~ congestion seen in conjunctiva.
~ conjunctival follicles resembling bolied
sago grains.
~ centre of the follicles contains
mononuclear histocytes, lymphocytes &
large nucleated cells(Leber cells). Leber
cells, signs of necrosis and fibrosis in
follicles &presence of follicles on bulbar
conjunctiva are pathognomic features.
Corneal signs:
~ superfical keratitis is seen.
~ corneal ulcer may be seen.
~ corneal opacity is seen.
 Adult Inclusion Conjunctivitis
AKA swimming pool conjunctivitis
Caused by: serotype D to K ofchlamydia trachomatis.
The organism may be transferred from genitals by fingers or
through contaminated swimming pool water.
Clinical features:
- symptoms: mucopurulent discharge, photophobia,
foregin body sensation, blurring of vision
- signs: conjunctival hyperaemia, acute follicular
hypertrophy with inclusion bodies
Treatment:
- tropical: Tetracycline 1% & Azithromycin ointment
- systemic: Tetracycline/ Erythromycin/ Doxycycline
- patient’s sexual partner should be examined & treated.
- improvement in personal hygiene & regular chlorination
of swimming pool water are prophylaxis management.
 Viral Conjunctivitis
Mostly caused by:
- Adeno viruses
- Herpes viruses
- Poxviruses
The characteristic feature is the involvement of
both conjunctiva & cornea.
Clinical presentations:
- Acute serous conjunctivitis
- Acute haemorrhagic conjunctivitis
- Acute and chronic follicular conjunctivitis
 Acute Heamorrhagic Cunjunctivitis
Commonly caused by Picornaviruses(enterovirus type 70) and
coxsackievirus.
Clinical features:
- symptoms: pain, redness, watering, mild
photophobia, visual blurring, lid
swelling
- signs: conjunctival congestion, chemosis, multiple
haemorrhages in bulbar conjunctiva, folicullar
hyperplasia, lid oedema, epithelial keratitis
Treatment:
- usually self-limiting but being contagious, there is high
risk of cross-infection.
- broad spetrum-spectrum antibiotic eye drops to prevent
secondary bacterial infections.
 Allergic Conjunctivitis
This counctival inflammation because of allergic
or hypersensitivity reactions which may be
immediate (humoural) or delayed (xellular).
It includes:
- Simple allergic conjunctivitis
- Vernal keratoconjunctivitis (VKC)
- Atopic keratoconjunctivitis (AKC)
- Giant papillary conjunctivitis (GPC)
- Contact dermatoconjunctivitis (CDC)
 Vernal Keratoconjunctivitis (VKC)
or Spring Catarrh
 bilateral, recurrent, allergic conjunctivitis
 characterized by ropy discharge & intense itching.
 common in boys of 4-20 years of age, summer seasons & tropics.
 It is found more in patients with family history of asthma, hay fever & other atopic
diseases.
 It is a type I hypersensitivity (IgE mediated) reactions to pollens.
 Clinical features:
- symptoms:
marked burning & itching which is usually
intolerable & increases in heat & humidity.
Stringy (ropy) discharge, sticking of eyelids
mild photophobia, lacrimation, heaviness of lids.
- signs:
conjunctival signs: congestions, gelatinous
thickening of tissue around limbus and
discrete white raised dots along limbus
are seen.
corneal signs: ulcerative vernal keratitis (shield
ulcer) characterized by shallow transverse
ulcer in upper part of cornea.
subepithelial scarring or corneal opacity.
Investigations:
- conjunctival scraping shows marked eosinophils.
- skin & serum testing is done for allergens.
Treatment:
~ local therapy:
- tropical weak steroid for short periods.
- mast cell stabilizers such as sodium
cromoglycate(2%) & tropical antihistaminics.
~ systemic:
- oral antihistamics in severe cases
- oral steroids for short duration
~ treatment of vernal keratopathy:
- large vernal plaque: surgical excision
- severe shield ulcer resistant to conservative
measure:
debridement, superficial keratectomy, laser
keratectomy, amniotic membrane transplant.
 Contact Dermatoconjunctivitis
It is delayed hypersensitivity (type IV) response to prolonged contact
with chemicals or drugs such as atropine, penicillin, neomycin or
gentamicin.
Clinical features:
- Cutaneous involvement: Eczematous reaction,
involving areas of contact
- Cunjunctival response: hyperaemia with generalized
papillary response.
Treatment:
- Discontinuation of causative agent
- Topical steroids
- Local steroid application on affected skin
 Mucous membrane pemphigoid
It is a group of chronic autoimmune type 2(cytotoxic) hypersensetivity
mucocutaneous blistering diseases.
Generally affecting women older than 50 years and of insidious onset with remissions
and excerbations.
Clinical features :
- fine subconjunctival fibrosis
- necrosis
- dry eye
- trichiasis, chronic blepharitis and lid margin
kretanization
- corneal epithelial defects, infiltration, peripheral
vascularization
- systemic mucosal involvement & skin lesions
Treatment:
- tropical treatment by artificial tears, steroids & antibiotics ointments.
- systemic:
~ Dapsone
~ Antimetabolites
~ steroids
~ immunoglobulin therapy
- contact lenses to protect cornea from trichiatic lashes & from dehydration.
Thank you