dr.s.veni priya 11.2.16 chronic conjunctivitis

CHRONIC CONJUNCTIVITIS DR.S. VENI PRIYA, M.S.

Revision of previous class Submission of assignment

OUTLINE - CHRONIC CONJUNCTIVITIS

Definition Infective causes Allergic conjunctivitis Steven Johnson syndrome

DEFINE Duration of more than 4 weeks chronic

conjunctivitis

OUTLINE TRACHOMA GRANULOMATOUS CONJUNCTIVITIS FUNGAL CONJUNCTIVITIS NON SPECIFIC CONJUNCTIVITIS

TRACHOMA The leading cause of preventable

blindness in the world 15 – 20% world’s blindness Caused by chlamydia trachomatis A , B,

Ba & C Self limiting disease Repeated infections + secondary

infection blindness

CHLAMYDIA

CHLAMYDIA

TRACHOMA – A,B,Ba,C

PARATRACHOMA – D K

LGV –L1,L2,L3

C.PSITTACOSIS

Chlamydia trachomatis Bacterium – prokaryotic, obligatory

intracellular organism In Conjunctival epithelial cells as

colonies – HALBERSTEADTER – PROWAZEK INCLUSION BODIES

LIFE CYCLE OF TRACHOMA

TRACHOMA REPEATED

CONJUNCTIVITIS

• Does not cause defective vision CHRONIC

INFALMMATION &

SCARRING

• Complications

Lid abnormalitie

sCorneal

complications

• Loss of vision

Trachoma RISK FACTORS: living in crowded & unhygienic

conditions Transmitted by Fingers , Fomites &

FLIES

CLINICAL FEATURES ACTIVE STAGE CHRONIC STAGE COMPLICATIONS

ACTI

VE1st decade

CHRO

NIC2nd

decade CO

MPL

ICAT

IONS4th /

5th decade

TRACHOMA CONJUNCTIVA Congestion, papillae & FOLLICLES UPPER TARSUS Follicles - > 5 mm in diameter along the upper border of the upper

tarsus NEVER ON THE BULBAR CONJUNCTIVA MINUTE STELLATE SCARS HISTOPATH – aggregations of lymphocytes with

necrosis & leber cells - follicles

UPPER TARSAL FOLLICLES

FOLLICLES

TRACHOMA - CORNEACORNEA: Superficial keratitis – upper k – epithelial

erosions with infiltration TRACHOMATOUS PANNUS corneal ulcers LIMBUS – HERBERT FOLLICLES –

HERBERT PITS

TRACHOMATOUS PANNUS Defn: lymphoid infiltration with

vascularisation of the corneal margin – upper cornea

2 types : 1. progressive pannus 2. regressive pannus

PANNUS

Progressive pannus regressive pannus

PANNUS

Corneal ulcer Usually occur at the advancing edge of

the pannus Shallow but more symptomatic

Chronic stage Cicatrization starts (SCARRING) Follicles - stellate scars Conjunctival scarring – Arlt line

COMPLICATIONS LIDS : entropion, trichiasis, ptosis, tylosis,

madarosis & ankyloblepharon CONJUNCTIVA: dry eyes, concretions, symblepharon CORNEA: opacity, ectasia, xerosis, pannus Chronic dacryocystitis , chronic

dacryoadenitis

video

investigations mcCoy cell cultures, monoclonal antibody test

& IgA-IPA light microscopy – best combination CLINICAL DIAGNOSIS: any 2 of the signs 1.follicles on the upper tarsus 2.superficial keratitis – upper k 3.pannus – upper k 4.limbal follicles/ Herbert pits 5.stellate scars/Arlt’s line – upper tarsus

Maccallan classificationSTAGES FEATURESI IMMATURE FOLLICLES , SPK

IIA MATURE FOLLICLES

IIB PANNUS, LIMBAL FOLLICLES, SUPERFICIAL KERATITISIII FOLLICLES + SCARRING

IV SCARRING

WHO CLASSIFICATION [ FISTO]STAGES FEATURES TREATMENTFOLLICLES ≥5 FOLLICLES, >0.5MM IN

UPPER TARSUSNEEDS TREATMENT NO SCARRING

INTENSE >50% PALPEBRAL BLOOD VESSELS NOT SEEN

UREGENT TREATMENTCOMPLICATIONS +

SCARRING TARSAL CONJ SCARRING WITH WHITE FIBROUS BANDS

INACTIVE

TRICHIASIS ATLEAST ONE TRICHIATIC LASH

CORRECTIVE SURGERY

OPACITIES K OPACITY COVERING PUPILLARY REGION

WHO CLASSIFICATION [ FISTO]STAGES FEATURES TREATMENTFOLLICLES ≥5 FOLLICLES, >0.5MM IN

UPPER TARSUSNEEDS TREATMENT NO SCARRING

INTENSE >50% PALPEBRAL BLOOD VESSELS NOT SEEN

UREGENT TREATMENTCOMPLICATIONS +

SCARRING TARSAL CONJ SCARRING WITH WHITE FIBROUS BANDS

INACTIVE

TRICHIASIS ATLEAST ONE TRICHIATIC LASH

CORRECTIVE SURGERY

OPACITIES K OPACITY COVERING PUPILLARY REGION

MANAGEMENT – PREVENTION How will you prevent this disease ? Manage the risk factors Frequent face wash & hand wash Prophylactic topical antibiotic therapy -

BLANKET THERAPY: - In endemic areas -1% tetracycline e/o 2 times / day –5

days a month 6 months

TREATMENT – ACTIVE STAGE TOPICAL: 1% tetracycline / erythromycin e/o

4 times /day 6 weeks

1% tetracycline e/o bed time6 weeks

TREATMENTSYSTEMIC: Tetracycline / erythromycin 250mg q.i.d

3-4 wks Doxycycline 100 mg b.d 3-4 weeks Azithromycin 1 gm single dose

COMPLICATIONS LID ABNORMALITIES lid surguries , EPILATION – trichiasis CORNEAL OPACITY keratoplasty , optical iridectomy

TREATMENT- “nutshell” SAFE STRATEGY S – surgery for trichiasis & entropion A – antibiotic (erythromycin) F – face washing E – environmental hygiene

Management in a community prevalence of trachoma in children 1-10 yrs

treatment Eye health promotion

TF≥20%TI≥5%

MASS TOPICALIF SEVERE- SYSTEMIC

SANITATION, FLIES CONTROL, PERSONAL HYGIENE,AB RX DURING OUTBREAKS

TF 5-20% MASS TOPICALIF SEVERE - SYSTEMIC

AS ABOVE

TF< 5% INDIVIDUAL TOPICAL RX

CASE FINDING

IMPORTANT POINTS (must know) By chlamydia trachomatis (HP bodies) 3Fs – fomites , flies, fingers upper tarsal follicles stellate scars,

Arlt’s line Trachomatous pannus corneal opacity Lid trichiasis, entropion corneal opacity FISTO SAFE STRATEGY

QUESTIONS TRACHOMA – essay Clinical features & complications of

trachoma WHO classification of trachoma / FISTO

classification Management & prevention of trachoma SAFE strategy

GRANULOMATOUS CONJUNCTIVITIS

Rare, Unilateral , localised conjunctival granuloma

Associated with LYMPHADENOPATHY PARINAUD’S OCULOGLANDULAR SYNDROME

GRANULOMATOUS CONJUNCTIVITIS

Pathogens causing systemic disease

Enter through the conjunctiva

Granulomatous conjunctivitis

CAUSES CAT SCRATCH DISEASE TULAREMIA TB SYPHILIS INFECTIOUS MONONUCLEOSIS FUNGAL LGV NON INFECTIOUS SARCOID, LYMPHOMA,

LEUKAEMIA

PARINAUD’S OCULOGLANDULAR SYNDROME

CLINICAL FEATURES SYSTEMIC: fever, malaise & skin rash LOCAL: redness, foreign body

sensation & mucopurulent discharge

OPHTHALMIA NODOSA Nodular conjunctivitis caused by

caterpillar hair Semitranslucent nodules on conjunctiva,

k or iris Hair surrounded by giant cells &

lymphocytes Rx : excision

Ophthalmia nodosa

FUNGAL CONJUNCTIVITIS By aspergillus, candida, nocardia,

leptothrix, sporothrixModes of presentation: Follicular conjunctivitis with

lymphadenopathy Ulcerative / pseudomembranous Granulomatous actinomycosis,

sporotrichosis, rhinosporidiosis Rx : topical miconazole or clotrimazole

1%

NON SPECIFIC CONJUNCTIVITIS Continuation of simple conjunctivitis Chronic irritation: smoke, dust, heat,

alcohol abuse,etc Hypersensitivity to allergen Concretion, trichiasis, blepharitis,

dacryocystitis, chronic rhinitis Symptoms: burning & grittiness ^^ in the

evening

Non specific conjunctivitis Signs: lower lid congestion sticky mucous membraneRx: Short course of antibiotics Eliminate the cause Lubricants

IMPORTANT QUESTIONS TRACHOMA TRACHOMA TRACHOMA

Ophthalmia nodosa , Parinaud oculoglandular syndrome.

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