Tuesday, 6 December 2016

Ophthalmia Neonatorum/Neonatal Conjunctivitis

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Ophthalmia Neonatorum/Neonatal Conjunctivitis


Age of onset
First month of life.
Acquired during
Birth from infected birth canal(MC),
After birth
Bacterial (Staph,Pneumococcus,Hemophilus)
Time of onset- 2-5 days.
Pain,tenderness,Mucopurulent discharge,Swollen lids,Chemosis,Conjunctival hyperemia.
Management-topical erythromycin,tobramycin,fluoroquinolone.
Neisseria gonorrhoeae
Time of onset - 24-48 hrs.
B/L,copious purulent discharge,chemosis,lid edema,corneal ulceration & perforation.
Treatment - IV Ceftriaxone,penicillin + Saline lavage.
Chlamydia trachomatis D-K
Time of onset - 5-14days.
uni/bilateral,mucopurulent discharge,conjunctival hyperemia.
Unlike adults,no follicles in newborn till 8 weeks(lack lymphoid tissue).
Treated with oral & topical erythromycin.

Herpes simplex virus
Time of onset - 6-14days.
Watery blepharoconjunctivitis,cornea involved.
Systemic manifestations present.
Chemical
Time of onset - first 36hrs.
Secondary to the use of silver nitrate(crede's method),povidone iodine,erythromycin.
B/L,minimal/no edema,serous/mucoid/watery discharge,Conjunctival Hyperemia.
Self limited(1 to 2days postpartum).

Prophylaxis
0.5% Erythromycin & 1% Tetracycline Ointment.
Crede’s method(outdated) - 1% silver nitrate.
im/iv single Ceftriaxone to infants of mothers with untreated gonococcal infection.
Chlamydia trachomatis D-K cause
Inclusion conjunctivitis
Ophthalmia neonatorum can cause
blindness

Viral Conjunctivitis and others

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Viral Conjunctivitis

Typical viral lesion is
Viral KeratoConjunctivitis
CF
Watery discharge,Subconjunctival hemorrhage,follicles,pre auricular lymphadenopathy.
Lasts longer
Management
Cold compresses,lubricant eye drops,antibiotic drops(for sec. Bacterial infection)
Adenoviral : Follicular conjunctivitis
Adenoviral : Subepithelial infiltrates
Molluscum eyelid lesion
Follicular conjunctivitis with a molluscum lesion
Adenoviral Keratoconjunctivitis
Occupational hazard for ophthalmologists.
Epidemic keratoconjunctivitis - serotypes 8,19,37.
Can lead to anterior stromal infiltrates(fade over months).
Topical steroids are used here.

Giant papillary conjunctivitis


d/t
Mechanical trauma(exposed sutures,prosthesis,filtering bleb) or
Hypersensitivity to contact lens wear(soft CLs>Rigid Hard lens)
Giant papillae
>1 mm diameter
management
Remove mechanical irritation,
change/refit lenses,topical antiallergics/corticosteroids

Superior limbic Keratoconjunctivitis


a/w
Graves disease
CF
Pain,redness,watering,superior bulbar conjunctival congestion,corneal pannus,filamentary keratitis
Management
Lubricant eye drops,
Cyclosporine eye drops,
Silver nitrate on cotton bud for 1-2 sec followed by thorough irrigation and antibiotic ointment

Parinaud's oculoglandular conjunctivitis


Age
MC in children
CF
U/L,granulomatous nodules & follicles on palpebral conjunctiva,fever,swollen preauricular & submandibular nodes
Etiology
Bartonella henselae - cat scratch disease(MC),
tularemia,TB<lymphoma,sarcoid,syphilis
Management
Treat cause

A.israelii conjunctivitis


CF
Chronic u/l congestion at medial angle of eye with infection of lacrimal system.
Pressure on canaliculus express whitish granular matter.


Conjuctivitis - Other types

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Adult Inclusion Conjunctivitis/Swimming pool granuloma

Etiology
Chlamydia trachomatis D-K
Age
Sexually active young adults
Type
Follicular conjunctivitis
course
Benign
May progress to chronic follicular conjunctivitis

Angular Conjunctivitis/Diplobacillus Conjunctivitis

At risk
Chronic alcoholism
malnutrition
Management
Tetracycline ointment,
Zinc sulphide eye drops

Acute Membranous Conjunctivitis

In acute membranous conjunctivitis, membrane is formed especially on
Palpebral conjunctiva
True membrane
Firmly adherent
Bleeds on peeling

Ligneous Conjunctivitis


Age
MC in Children and young adults
Etiology
unknown
CF
Woody membrane(Recurrent membrane formation due to deficiency of plasminogen)
Management
Surgical removal of membranes(recur).
Topical cyclosporine,hyaluronidase or corticosteroids

Pseudomembranous Conjunctivitis


d/t
Coagulation of fibrinous exudates
Easily peeled off
Leaves intact epithelium
Pseudomembrane

Trachoma/Rough Eye/Egyptian Ophthalmia - General Features

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Trachoma/Rough Eye/Egyptian Ophthalmia - General Features

Cleared Controversies

  1. Follicles on bulbar conjunctiva is pathognomonic.
  2. Treatment of choice - Azithromycin
  3. Mass treatment(WHO new guidelines)(Blanket Therapy)
    1. Indication - >10% prevalence of severe and moderate trachoma in <10yrs.
    2. Treatment - Azithromycin.
                   Classification of C.trachomatis

Type
Chronic keratoconjunctivitis.

c/b
mixed follicular & papillary conjunctivitis.
Caused by
chlamydia trachomatis A,B,Ba,C.
Produce
HALBERSTAEDTER PROWAZEK BODIES(intracytoplasmic inclusion bodies)
Shadow cells of Humphrey are seen
Trachoma
IP
5-12 days
MC affected age group
2-5yrs

Trachoma is a
Disease of low infectivity.
Modes of transmission
Contact with ocular discharges,Flies,Venereal
Predisposing factors
Direct Sunlight,
Dust,
Smoke,
irritants(kajal,surma)
Max no. of cases seen in
UP
Least no. of cases seen in
Orissa


Saturday, 3 December 2016

Hordeolum

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Hordeolum internum

Hordeolum internum
  • Acute Suppurative inflammation of meibomian glands
hordeolum internum.jpg

CF
  • Severe pain
  • Yellow point visible on everting the lid
Management
  • Incision & drainage
  • Antibiotics & analgesics

Hordeolum externum/Stye


Hordeolum externum/stye
  • Acute suppurative inflammation of glands of zeis and moll
CF
  • Acute pain & swelling
  • Localized,hard,tender swelling near the lid margin
Management
  • Hot fomentation,Antibiotics
  • Removal of eye lash