WHAT IS INFECTIVE CONJUNCTIVITIS ?
Infective conjunctivitis is a condition in which the conjunctival sac is infected with pathogenic organism.
Acute catarrhal or acute muco-purulent conjunctivitis is the commonest cause for the "RED EYE".
It can occur at any age..
- There is no preference for any particular sex.
- It may occur in association with eruptive fevers like Measles.
- It is highly contagious and bad hygienic conditions and dirty habits help the infection to establish.
- Any organisms which affects the mucus membrane anywhere in the body, can also invade the conjunctiva.
The conjunctival discharge consists of:
- Epithelial cells.
If the inflammation is very severe particularly in children, diapedisis of red blood cells (R.B.C) may occur and the discharge becomes blood stained.
If inflammation continues for sometime, new vessels are formed particularly in the tarsal conjunctiva in the form of minute tufts of capillaries which run perpendicularly to the plane of the superficial vessels.
- Discomfort in eye and foreign body sensation due to engorgement of blood vessels.
- Photo-phobia or difficulty to tolerate light, and watering of the eye.
- Mistiness of vision, due to thin layer of discharge on mucus of the cornea.
- Sticking together of the lid margins during sleep due to the discharge.
- Rainbow halo around the light due to the thin layer of discharge on the corneal surface which brakes white light into it's component parts.
- Usually it starts in one eye and due to it the other eye is affected.
- Conjunctival type of congestion.
- Chemosis of the conjunctiva and mild oedema (swelling) of the lids if inflammation is severe.
- Petechial sub conjunctival haemorrhage particularly when the causative agent is pneumococcus(bacterial organism).
- Muco-purulent discharge seen accumulated on the inner and outer canthus, lower fornix or at the roots of the eye lashes causing matting of the lashes.
CLINICAL CRITERIA OF ACUTE MUCO-PURULENT CONJUNCTIVITIS:
- History of sticking together of the eye lids during sleep.
- Conjunctival type of congestion.
- Presence of muco-purulent discharge.
- The conditions may pass on to chronic stage.
- Marginal corneal ulcer due to interferance of nutrition following oedema of conjunctiva.
- Blepharitis, i.e inflammation of the lid margin.
- Rarely chronic dacryocystitis.
- Curative .
a) Prophylaxis against the good eye, if only one eye is affected, infection of the good eye can be prevented in two ways:
- By using a Buller's sheild to cover the normal eye.
- By asking the patient to lie on the affected side, so that discharge from the affected eye may not come into contact with the good eye.
b) Prophylaxis against other members of the family:
- The personal belongings of the patient like towel, handkerchief, etc, should be kept separate.
- The patient should be if possible kept isolated.
a) The conjunctival sac should be washed with warm normal saline three times a day. The wash helps to remove the discharge and the organisms with it. Frequent eye wash is not desirable, as that dilutes the Lysozyme present in the tears, which has a definite antibacterial property . Also 1.4% saline which is isotonic with tears may be used for wash.
b) Mild astringent drops like Lotio argyrol 5% or lotio protargol 5% may be used three times a day. These organic silver preparations destroy the surface epithelial cells which often contain the organisms.
c) Mild chemotherapeutic agents like Sulphacetamide 10% drops three to four times a day.
d) Broad spectrum antibiotic in the form of 1% tetracycline or oxytetracycline ointment at bed time, which exerts a prolonged action and prevents the lids from sticking together.
e) If cornea is involved in the form of a marginal ulcer, atropine sulphate 1% drops twice daily to be used.
f) No pads has to be used as warmth caused by the the pads aggravates the infection. Dark glasses should be used instead.
g) Steroids are Contraindicated.
The ideal treatment is of course to take a conjunctival swab for culture, to isolate the organism and to find it's sensitivity to any antibiotic and then to use that antibiotic.