dr.s.veni priya 11.2.16 chronic conjunctivitis
TRANSCRIPT
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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