dr.s.veni priya 11.2.16 chronic conjunctivitis
TRANSCRIPT
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CHRONIC CONJUNCTIVITIS DR.S. VENI PRIYA, M.S.
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Revision of previous class Submission of assignment
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OUTLINE - CHRONIC CONJUNCTIVITIS
Definition Infective causes Allergic conjunctivitis Steven Johnson syndrome
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DEFINE Duration of more than 4 weeks chronic
conjunctivitis
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OUTLINE TRACHOMA GRANULOMATOUS CONJUNCTIVITIS FUNGAL CONJUNCTIVITIS NON SPECIFIC CONJUNCTIVITIS
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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
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CHLAMYDIA
CHLAMYDIA
TRACHOMA – A,B,Ba,C
PARATRACHOMA – D K
LGV –L1,L2,L3
C.PSITTACOSIS
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Chlamydia trachomatis Bacterium – prokaryotic, obligatory
intracellular organism In Conjunctival epithelial cells as
colonies – HALBERSTEADTER – PROWAZEK INCLUSION BODIES
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LIFE CYCLE OF TRACHOMA
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TRACHOMA REPEATED
CONJUNCTIVITIS
• Does not cause defective vision CHRONIC
INFALMMATION &
SCARRING
• Complications
Lid abnormalitie
sCorneal
complications
• Loss of vision
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Trachoma RISK FACTORS: living in crowded & unhygienic
conditions Transmitted by Fingers , Fomites &
FLIES
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CLINICAL FEATURES ACTIVE STAGE CHRONIC STAGE COMPLICATIONS
ACTI
VE1st decade
CHRO
NIC2nd
decade CO
MPL
ICAT
IONS4th /
5th decade
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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
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UPPER TARSAL FOLLICLES
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FOLLICLES
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TRACHOMA - CORNEACORNEA: Superficial keratitis – upper k – epithelial
erosions with infiltration TRACHOMATOUS PANNUS corneal ulcers LIMBUS – HERBERT FOLLICLES –
HERBERT PITS
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TRACHOMATOUS PANNUS Defn: lymphoid infiltration with
vascularisation of the corneal margin – upper cornea
2 types : 1. progressive pannus 2. regressive pannus
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PANNUS
Progressive pannus regressive pannus
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PANNUS
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Corneal ulcer Usually occur at the advancing edge of
the pannus Shallow but more symptomatic
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Chronic stage Cicatrization starts (SCARRING) Follicles - stellate scars Conjunctival scarring – Arlt line
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COMPLICATIONS LIDS : entropion, trichiasis, ptosis, tylosis,
madarosis & ankyloblepharon CONJUNCTIVA: dry eyes, concretions, symblepharon CORNEA: opacity, ectasia, xerosis, pannus Chronic dacryocystitis , chronic
dacryoadenitis
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video
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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
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Maccallan classificationSTAGES FEATURESI IMMATURE FOLLICLES , SPK
IIA MATURE FOLLICLES
IIB PANNUS, LIMBAL FOLLICLES, SUPERFICIAL KERATITISIII FOLLICLES + SCARRING
IV SCARRING
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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
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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
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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
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TREATMENT – ACTIVE STAGE TOPICAL: 1% tetracycline / erythromycin e/o
4 times /day 6 weeks
1% tetracycline e/o bed time6 weeks
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TREATMENTSYSTEMIC: Tetracycline / erythromycin 250mg q.i.d
3-4 wks Doxycycline 100 mg b.d 3-4 weeks Azithromycin 1 gm single dose
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COMPLICATIONS LID ABNORMALITIES lid surguries , EPILATION – trichiasis CORNEAL OPACITY keratoplasty , optical iridectomy
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TREATMENT- “nutshell” SAFE STRATEGY S – surgery for trichiasis & entropion A – antibiotic (erythromycin) F – face washing E – environmental hygiene
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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
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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
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QUESTIONS TRACHOMA – essay Clinical features & complications of
trachoma WHO classification of trachoma / FISTO
classification Management & prevention of trachoma SAFE strategy
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GRANULOMATOUS CONJUNCTIVITIS
Rare, Unilateral , localised conjunctival granuloma
Associated with LYMPHADENOPATHY PARINAUD’S OCULOGLANDULAR SYNDROME
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GRANULOMATOUS CONJUNCTIVITIS
Pathogens causing systemic disease
Enter through the conjunctiva
Granulomatous conjunctivitis
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CAUSES CAT SCRATCH DISEASE TULAREMIA TB SYPHILIS INFECTIOUS MONONUCLEOSIS FUNGAL LGV NON INFECTIOUS SARCOID, LYMPHOMA,
LEUKAEMIA
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PARINAUD’S OCULOGLANDULAR SYNDROME
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CLINICAL FEATURES SYSTEMIC: fever, malaise & skin rash LOCAL: redness, foreign body
sensation & mucopurulent discharge
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OPHTHALMIA NODOSA Nodular conjunctivitis caused by
caterpillar hair Semitranslucent nodules on conjunctiva,
k or iris Hair surrounded by giant cells &
lymphocytes Rx : excision
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Ophthalmia nodosa
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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%
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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
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Non specific conjunctivitis Signs: lower lid congestion sticky mucous membraneRx: Short course of antibiotics Eliminate the cause Lubricants
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IMPORTANT QUESTIONS TRACHOMA TRACHOMA TRACHOMA
Ophthalmia nodosa , Parinaud oculoglandular syndrome.
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Thank u