CONJUNCTIVITIS

(INCLUSION) vs
ACUTE BACTERIAL
CONJUNCTIVITIS
By: Atinaja, Jean mark ; acquioben,
Mae ; Bermudez, Karen
Power point by: Wales, Kenny f.

Conjunctivitis (inclusion)
• • is an oculogenital infection
usually caused by serovars
(serological variants) D-K of C.
trachomatis, and affects 5–
20% of sexually active young
adults in western countries.
Transmission is by
autoinoculation from genital
secretions although eye-to-
eye spread probably accounts
for about 10% of cases. The
incubation period is about 1
week.
ACUTE BACTERIAL
CONJUNCTIVITIs
• usually benign and self-
limited, lasting no more
than 14 days.
• • A conjunctivitis
characterized by an acute
onset of conjunctival
hyperemia and a
moderate amount of
mucopurulent discharge.
Chlamydial Conjunctivitis Acute bacterial conjunctivitis

• Epidemiology • Epidemiology
• Age Prevalence (United
• Age prevalence-young States):
adults • • more prevalent in children
than in adults;
• Sex prevalence- • • 23% of cases are reported in
females (Oxford children aged 0-2 years, 28%
in children aged 3-9 years, and
Handbook of 28% in children aged 10-19
Ophthalmology) years
• • Adults account for 36% of
cases
Chlamydial conjunctivitis
• Race-Western countries
• • about 1 in 300 persons with
genital chlamydial infection
develops the eye disease
• • no difference in frequency of
disease between the sexes
• • condition is observed in the
young sexually active
population, ages 15-35 years
Acute bacterial conjunctivitis
• Sex Prevalence
• • Males and females
have equal natural
resistance to bacterial
conjunctivitis.
• Race Prevalence
• • Bacterial conjunctivitis
occurs in persons of all
races
Chlamydial conjunctivitis
• Risk factors
• • Being sexually active
• *partner having a genital
chlamydial infection(urethritis
in males, cervicitis in females)
• *Transmission: oral-genital
sexual practices, hand to eye
transmission
• • Infection with genitally
transmitted chlamydial strains
• → 54% of men and 74% of
women have concurrent
genital chlamydial infection
Acute bacterial conjunctivitis
Associated predisposing factors:
• Neonate: vaginal delivery by
infected mother; inadequate
prenatal care
• Infant: Nasolacrimal duct
obstruction, concomitant bacterial
otitis media or pharyngitis,
exposure to infected individual
• Child: contact with infected
individual; concomitant bacterial
otitis media, sinusitis or pharyngitis
• Adult: contact with infected
individual, oculogenital spread, lid
malposition, immunosuppression
and trauma.
Chlamydial conjunctivitis Acute bacterial conjunctivitis

History/symptomatology • HISTORY: Symptomatology

-acute or subacute (2- • • Mild to moderate pain
with stinging sensation, red
4wk)onset eye with foreign body
-unilateral (but may be sensation.
bilateral) • • mild to moderate
purulent discharge,
-disharge especially in the mucopurulent secretions
mornings bilateral glued eyes upon
-redness awakening
Chlamydial conjunctivitis
• PE
• -pseudoptosis
• -papillae and follicles in the
conjunctiva of both tarsi esp
the lower tarsus
• -superficial kearatitis noted
superiorly
• -small superior micropannus
(<1-2mm)=late sign
• -subepithelial opacities
• -nontender lymphadenopathy
Acute bacterial conjunctivitis
• Physical Examination:
• • Eyelid edema,
preserved visual acuity,
conjunctival injection,
normal pupil reaction, no
corneal mild to moderate
purulent discharge,
mucopurulent secretions
involvement
Chlamydial conjunctivitis
• Diagnostic/ Laboratory test to
confirm
• Sensitivity
• Direct immunofluorescence -
detects free elementary bodies with
about 90% sensitivity and specificity
• ELISA & PCR - direct antigen
detection
• Specificity
• McCoy cell culture - highly specific;
glycogen positive inclusion bodies
Acute bacterial conjunctivitis
• Diagnostics/Laboratory test to
confirm
• • Bacterial conjunctivitis can
usually be reliably diagnosed
from the presence of typical
symptoms
• • Conjunctival Scrapings and
Cultures
• o Conjunctival smear are usually
only necessary when the
conjunctivitis fails to respond to
antibiotic treatment
• -This reveals numerous
polymorphonuclear neutrophils
• ➢ Smears are obtained only in
severe, uncertain, or persistent
cases.
• *Conjunctival scrapings for microscopic
examination and culture are recommended for all
cases and are mandatory if the disease is purulent,
membranous, or pseudomembranous
Chlamydial conjunctivitis Acute bacterial conjunctivitis
• Treatment • Supportive
• Supportive
• -Topical antibiotics such as • • Apply warm/cool
erythromycin or tetracycline compress to eyes, lids and
ointment are sometimes used lashes qid for 15 min.
to achieve rapid relief of ocular
symptoms. • • Clean eyelids with warm
• Definitive water and cotton swab
• 1) Medical
• -Azithromycin 1 g • • Protect eye (eg,
repeated after 1 week is sunglasses)
generally the drug of choice
• -Doxycycline 100 mg • • Artificial tears for dryness
b.d. for 10 days
• -Erythromycin,
amoxicillin and ciprofloxacin are
alternatives
Chlamydial conjunctivitis Acute bacterial conjunctivitis

• Medical
• • Broad-spectrum antibacterial
agent (eg, polymyxintrimethoprim)
• • In purulent and mucopurulent
conjunctivitis, the conjunctival sac
should be irrigated with saline to
remove the conjunctival secretions.
• • Povidone-iodine solution 1.25%
ophthalmic solution may be a safe
and viable alternative to topical
antibiotics, in resource-poor
countries.
Chlamydial conjunctivitis Acute bacterial conjunctivitis

• Surgical (none)
• • The mainstay of
treatment for bacterial
conjunctivitis is topical
antibiotic therapy.
Chlamydial conjunctivitis
• PREVENTION
• • Good hygiene (washing hands
with soap and water) and
avoidance of touching eyes
• • abstinence of sexual contact
until completion of treatment (1
week after azithromycin)
• • Screening at increased risk of
infection and in all women
younger than 25 years.
• • Referral to a genitourinary
specialist for the exclusion of
other sexually transmitted
infections
Acute bacterial conjunctivitis
• PREVENTION
• • Good hygiene (washing
hands with soap and
water) and avoidance of
touching eyes , especially
after exposure to
infectious people
• • Proper contact lens
with proper cleaning
 References
• Vaughan & Asbury’s General Ophthalmology 18th
edition,Chapter 5
• http://emedicine.medscape.com/article/1191730-
overview
• American Academy of Ophthalmology/ External Diseaase
panel.Preferred practice guidelines. Conjunctivitits,
CA:(2013):www.aao.org/ppp
• Diagnosis and treatment of ChlamydiaTrachomatis
Infection. KARL E. MILLER, M.D . American Fam Physician
Journal. 2006 Apr 15. Volume 73 No. 8. page1411
• (http://www.dovemed.com/adult-chlamydial-
conjunctivitis/)