Bacterial Conjunctivitis

Bacterial Conjunctivitis:
- Due to disruption of host defense mechanism:

 Secondary to eyelid abnormality
 Tear film abnormality
 Systemic immunosuppression
- Can be classified into 3 types:
 Hyperacute
 Acute
 Chronic
- MC: Staph aureus > Strep. Pneumoniae in adults
- MC in children: Hemophilus > Strep. > Moraxella
- MC in neonates: Chlamydia trachomatis
- Symptoms:
 Redness
 Foreign body sensation
 Purulent discharge
- Signs:
 Injection (the redness is most intense on the inside of the eyelids and peripherally on the bulbar
conjunctiva, while the eye is paler towards the corneoscleral limbal area)
 Purulent discharge perhaps only in the inferior fornix or as yellow incrustations on the eyelid
margins
(https://onlinelibrary.wiley.com/doi/full/10.1111/j.1600-0420.2007.01006.x
# Hyperacute bacterial conjunctivitis:
- Characterized by abrupt onset of conjunctival injection, chemosis, continuous and copious purulent discharge
(yellow-green) and eyelid edema.
- MC caused by Neisseria gonorrhoeae, especially in sexually active patients and hence genital infections are also
concomitantly present
- Sometimes pseudo-membrane formation may occur.
- Tender pre-auricular lymphadenopathy
- Corneal involvement might occur
- Milder in case of Neisseria meningitidis
# Acute bacterial conjunctivitis:
- Conjunctivitis with symptoms lasting less than 4 weeks

- Acute bacterial conjunctivitis typically presents abruptly with red eye and purulent drainage without significant
eye pain, discomfort, or photophobia.
# Chronic bacterial conjunctivitis:
- Symptoms lasting more than 4 weeks

- Mild to moderate symptoms.
- This type of conjunctivitis often develops in association with blepharitis, which is a common but often
unrecognized inflammatory condition related to bacterial colonization of the eyelid margins.
- It can even act as a nidus for dacryocystitis
Treatment:
Hyperacute IM ceftriaxone 1gm f/b Oral Erythromycin or tetracyclin

for 2-3 weeks
(for Neisseria gonorrhoeae)
Penicillin (333000 units/day) or bacitracin or
erythromycin ointment every 2hr
Acute
Blepharitis:
- Inflammation of eyelid margin is called blepharitis

- Blepharitis is characterized by an intricate relationship between ocular flora and meibomian gland dysfunction
leading to signs of lid inflammation, corneal and conjunctival changes, and symptoms of ocular discomfort
- Usually divided as anterior and posterior.
 Anterior – Bacterial (Staphylococcal) , Seborrheic, Mixed
 Posterior – Meibomitis (meibomian gland dysfxn)
- Anterior blepharitis involves eyelashes and follicles
- Posterior blepharitis involves meibomian gland
# Pathogenesis:
- The pathophysiology of blepharitis is supposed to be multifactorial

- Considerable overlap is seen in ant and post blepharitis
- Bacteria are seen to play significant role in causing blepharitis
- Staph epidermidis, staph aureus, Propionibacterium acne are most common organisms isolated from infective
cases of blepharitis
- Blepharitis may also be associated with systemic diseases like: seborrheic dermatitis, rosacea.
- Bacterial Ag and exotoxins that may be secreted initiate inflammatory cascade which can cause ant. Blepharitis
- To explain posterior blepharitis, bacterial enzymes like lipases, esterase changes the chemical structure of
secretions of meibomian gland, increases cholesterol concentration and hence favors bacterial growth. This
causes meibomitis
- Alteration in structure of meibum causes instability of tear film, drying of eye and further other ocular
complications
- In seborrheic blepharitis, there may actually be excess lipid production initially, but this leads to encrustation of
the lid margin, which eventually blocks the orifices of Zeiss and meibomian gland. (Meibomian gland is usually
rarely involved by seborrheic dermatitis)
- Finally, scarring, retraction and pouting of orifice of gland occurs.
Inf ====== exotoxins ===== ant. Blepharitis

\\ enzymes like lipases ==== post. Blepharitis
Seborrheic dermatitis ==== gland of zeiss === ant.

\\ Meibomian gland === post.
Symptoms:
Burning
itching
irritation,
foreign body sensation
epiphora
photophobia
decreased or fluctuating vision.
Signs:
Staphylococcal Seborrheic Posterior
Eyelid deposition Collarette (hard exudates Dandruff like scales (Scurf) Thick foamy lipid deposits
with crusts extending from along lid margin and around with plugged and pouting
base of a lash like a sleeve) lashes. meibomian gland orifices
Eyelid ulceration Ulcers which bleed easily on On removal, eyelid appears
removal of crusts greasy without ulceration
Loss of lashes/ breakage frequent rare Rare
Conjunctivitis Mild Papillary with Follicular or papillary tarsal Mild to moderate
occasional purulent reaction with mild hyperemia with papillary
discharge hyperemia if gets a/w reaction on tarsal
infection conjunctiva
Glaucoma:
Gonioscopy is done in an undilated pupil
Normal CDR= 0.6

Diffn b/n 2 disc: 0.1
Avg.: 0.3-0.4

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Bacterial Conjunctivitis:

- Due to disruption of host defense mechanism:

# Hyperacute bacterial conjunctivitis:

# Acute bacterial conjunctivitis:

- Conjunctivitis with symptoms lasting less than 4 weeks

# Chronic bacterial conjunctivitis:

- Symptoms lasting more than 4 weeks

Hyperacute IM ceftriaxone 1gm f/b Oral Erythromycin or tetracyclin

- Inflammation of eyelid margin is called blepharitis

- The pathophysiology of blepharitis is supposed to be multifactorial

Inf ====== exotoxins ===== ant. Blepharitis

Seborrheic dermatitis ==== gland of zeiss === ant.

Gonioscopy is done in an undilated pupil

Normal CDR= 0.6

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