3. • Conjunctiva:
thin and delicate membrane that lines the eyelid and surrounds the
eyeball. It is one of the most sensitive parts of the body that gets
easily infected by environmental agents and microorganisms, leading
to conjunctivitis
• Inflammation of conjunctiva:-
the inflammation has 2 forms:
1-acute generalized hyperplasia
2-lymphocyte aggregation in adenoid layer (acute/chronic) due to
toxic or allergic response to drugs e.g:Atropine
4. • Definition of Follicular conjunctivitis:
It is conjunctivitis associated with hypertrophic lymphoid tissue as pinkish
round bodies in the conjunctival fornices ; can be acute or chronic.
• Histology of Follicular conjunctivitis:
-regular follicles
-plasma cells
-pannus
-pmnc
-infeltration by lymphocyte
-no true capsule
7. 1-Acute Adenovirus Conjunctivitis
• Adenoviruses are known to produce acute follicular
conjunctivitis as seen in pharyngoconjunctival fever (PCF)
and epidemic keratoconjunctivitis (EKC).
8. **Pharyngoconjunctival Fever:
Pharyngoconjunctival fever primarily affects children and appears in
epidemic form. It is due to adenovirus serotypes 3, 4 and 7. The
conjunctivitis is self-limiting and there is no specific treatment but
topical antibiotics should be used to control secondary bacterial
infection.
** Epidemic Keratoconjunctivitis:
keratoconjunctivitis occurs in widespread epidemics that mostly
spreads through infected ophthalmic instruments especially
tonometers.Etiology:Epidemic keratoconjunctivitis is caused by
adenovirus serotypes 3, 7, 8 and 19.
9. • C/P:
photophobia, acute follicular or membranous conjunctivitis,
subepithelial infiltrates in the cornea, scanty discharge and
preauricular lymphadenopathy.
Pseudomembrane on the palpebral conjunctiva develops
predominantly. Petechial hemorrhages on bulbar conjunctiva and
subconjunctival hemorrhages can occur.
Diffuse punctate epithelial keratitis is the earliest corneal lesion.
Stromal corneal infiltrates develop within two weeks’ time due to
immune response to the adenovirus.
10. • Treatment:
1-nonspecific and symptomatic.
2-Broad-spectrum antibiotics are often used to prevent secondary
infections.
3-Topical corcosteroids are recommended in patients with
conjunctival membrane or photophobia.
11. 2-Herpes Simplex Virus Conjunctivitis
• Acute follicular conjunctivitis may be caused by HSV type 1 .
• Signs:
unilateral, blepharoconjunctivitis with vesicular lesions on the lids,
intense papillary hypertrophy of The conjunctiva and classical
dendritic lesion on the cornea. There occurs marked enlargement of
the preauricular lymph glands.
•Treatment:
self limited.
12. 3-Newcastle Conjunctivitis
• Newcastle conjunctivitis is a rare disorder occurring in small
epidemics among poultry workers and is caused by Newcastle virus.
4-Acute trachoma in foreigners
• it occurs when a non immunized person is exposed to heavy dose of
infection by chlamydia trachomatis.
15. trachoma
• Def:
trachoma is a chronic infective disease which affects the conjunctiva
and cornea of humans
It means roughness in Greek
caused by Chlamydia trachomatis (serotypes A,B,C )
it is endemic in Egypt
transmitted by contact with conjunctival discharge
16. • Pathology:
trachomatous agent secretes toxins that diffuse to subepithelial tissue
leading to a chronic inflammatory reaction (follicle)
follicles increase in size forming papillae
healing occurs by fibrosis (cicatrisation)
hyaline degeneration then calcification,in secretions that are retained
between papillae
17. • Classification:
McAllen's classification:
Stage 1(incipient trachoma): Characterized by:-
-minimal papillary hyperplasia &immature follicles on the upper
palpebral conjunctiva
-may be associated with micropannus
Stage 2 (manifest trachoma): Characterized by:-
-Mature soft follicles on the superior tarsal conjunctiva
-Papillary hypertrophy and gross pannus--limbal follicles or
herbert's pits
18. Stage 3 (Healing trachoma):Characterized by:-
-Cicatrization or scarring develops around the ncrotizing
trachomatous follicles
-Signs of stage 2 may be present
Stage 4 (Healed trachoma): Characterized by:-
-follicles and papillary hypertrophy disappear
-pannus resolves
-Herbert's pits may be seen or not at limbus-palpebral conjunctiva is
completely cicatrized and smooth, the scar may be thin or thick
19. Who classification: Includes 5 stages
TF:
-trachomatous follicular inflammation
-5 or more follicles in upper tarsal conjunctiva
TI:
-Trachomatous inflammation
-inflammatory thickening of the upper tarsal conjunctiva that
includes several tarsal deep vessels
TS:
-Trachomatous scarring
-presence of scarring in tarsal conjunctiva
20. TT:
-Trachomatous trichiasis
-in which eyelashes are rubbing on the eyeball
CO:
-Corneal opacity
-easily visible corneal opacity that involves a part of the pupillary
margin
21. • C/P:
Incubation period: 5 to 12 days
Insidious: onset
Symptoms:
foreign body sensation, watering, itching, photophobia , redness and
scanty mucopurulent discharge
22. Signs:
The conjunctiva:
A-The active stage : upper palpebral conjunctiva and fornix show:
1-immature,non-expressible,yellowish ,not raised follicles
2-mature,expressible,large follicles
3-fine,pink,finger-like papillae. giving the surface velvety
appearance
B-The healing stage: there is:
1-irregular,white,fibrous patches (linear or star shaped)
2-Arlet line :a white line of fibrosis in sulcus subtarsalis
3-PTDs, and PTCs :numerous white spots
23. The cornea:
1- Herbert’s rosettes:
- multibleyellow follicles in the upper cornea . caused by aggregation
of inflammatory cells between epithelial cells and Bowman’s
membrane
- on healing:they leave depressed pits (Herbert’s pits)
2- trachomatous pannus:
- pannus means:vascularization and infiltration by chronic
inflammatory cells in the superficial layers of cornea
- stages:progressive/regressive/healed
3- trachomatous ulcers:
- typical:related to pannus on its surface or at its edges .
linear,horizontaland superficial
- atypical: has any shape and size
25. • Diagnosis:
The clinical diagnosis of trachoma requires the presence of at least
two of the following signs:
(i) follicles or Herbert’s pits
(ii) epithelial or subepithelial keratitis
(iii) pannus
(iv) cicatrization
The diagnosis can be confirmed by direct demonstration of the
inclusion bodies in conjunctival scrapings and staining with Giemsa
or iodine stain
DNA amplification techniques that use the polymerase chain
reaction (PCR) or the ligase chain reaction (LCR) are very sensitive
for diagnosing trachoma. However, these tests are time consuming
and expensive.
26. • Treatment:
(All cases of active trachoma must be treated)
Ciprofloxacin, erythromycin, tetracycline, ofloxacin and azithromycin
are quite effective against TRIC agent
Instillation of ciprofloxacin 0.3% or ofloxacin 0.3% eye drop 4 times a
day and application of 1% erythromycin or tetracycline ointment at
bed time for 6 weeks control the infection in most cases
250 mg erythromycin or tetracycline 4 times a day or doxycycline
100 mg twice a day) for 3 weeks provides dramatic results
27. It is claimed that a single dose of azithromycin 20 mg per kg body
weight for children and a single dose of 1-1.5 g for adults gives
superior cure rate of trachoma. Further, azithromycin has fewer side
effects than tetracycline and sulfonamides.
Chloramphenicol and penicillin are less effective.
Aqueous soluble sulfonamide (20-30%) topically and long-acting
sulfonamide orally may be used. However, sulfa drugs may cause
allergic reaction in some patients.
28. To combat trachomatous blindness, the WHO has developed the SAFE
strategy
It is an acronym for: S: Surgery for trichiasis A: Antibiotic treatment of
active infection F: Facial cleanliness E: Environmental improvement To
eliminate trachoma and its blindness
each component of the SAFE strategy must be implemented
A follow-up examination is necessary to assess the complete cure of the
disease
In Persistent trachoma follicles:
combination of local and systemic antibiotic therapy is preferred no
matter one has to continue the drug for a longer time.
29. • Control:
Trachoma is a specific communicable keratoconjunctivitis which is a
public health problem in the developing countries
The disease is closely associated with personal hygiene and
environmental sanitation
Trachoma often spreads by the transfer of infected conjunctival
secretions through fingers, common towel and flies
Therefore, mothers are instructed not to apply eye cosmetics (Kajal)
to all children of the family with the same finger.
31. Molluscum contagiosum
• Molluscum contagiosum is caused by a virus and it causes a low grade
follicular conjunctivitis
• The conjunctival lesions and corneal vascularization occur due to the
release of viral proteins and other substances in the tear film. More
than one molluscum nodules may be present on the lid margin
• Molluscum nodules on the skin of the eyelids are small and smooth
with an umblicated core
• Treatment:
excision or cryo application to the eyelid nodule
33. • a condition characterized by the development of a large number of
lymph follicles, which may or may not be associated with an infection
• In conjunctival folliculosis the large number of lymph follicles may
give the conjunctival sac a granular appearance
• affects children in association with enlarged tonsils and adenoids
• the follicles are present in the lower palpebral conjunctiva and are
arranged in parallel rows
