1. CONJUNCTIVITIS SUBMITTED TO: SATHEESH.S. GOTTIPATI PRESENTED BY: P. BHARGAVI 16AB1T0021

2. CONTENTS:  INTRODUCTION  CAUSES OF CONJUNCTIVITIS  SYMPTOMS  TYPES OF CONJUNCTIVITIS  DIAGNOSIS  TREATMENT OF CONJUNCTIVITIS  PREVENTIVE MEASURES

3. INTRODUCTION: CONJUNCTIVA: It is a thin,translucent membrane lining the anterior part of the sclera and inside of eyelids It consists of two parts: 1.BULBAR PART : It begins at the edge of the cornea and covers the visible part of the sclera. 2.PALPEBRAL PART: This part lines the inside of eyelids CONJUNCTIVITIS: It is a common condition that causes redness and inflammation of the thin layer of tissue that covers the front of the eye. It is the most common cause of eye.

4. CAUSES OF CONJUNCTIVITS: o Bacterial or viral infection o Infection with a virus that may also cause a fever and sore throat o Sexually transmitted infections (STIs), including chlamydia and gonorrhea o Irritants such as chlorine from swimming pools, shampoo, smoke, fumes or a loose eyelash o Seasonal allergic conjunctivitis and perennial (all year round) allergic conjunctivitis, caused by pollen, dust mites or pet dander o Contact dermatoconjunctivitis, from eye drops, chemicals or make-up o Giant papillary conjunctivitis, from wearing contact lenses, eye surgery stitches or any tubes or things fitted during eye operations.

5. Conjunctivitis is divided into two types: 1.Non infectious;  Allergic conjunctivitis  Toxic conjunctivitis 2.Infectious:  Viral conjunctivitis  Bacterial conjunctivitis It is secondary to immune mediated diseases and neoplastic processes There is also Herpes, Chlamydial, and Gonococcal conjunctivitis.

6. NON INFECTIOUS CONJUNCTIVITIS:  ALLERGIC CONJUNCTIVITIS: Allergic conjunctivitis is caused when your eyes come into contact with allergen.this is known as an allergic conjunctivitis There are four main types of allergic conjunctivis: Seasonal allergic conjunctivitis Perennial allergic conjunctivitis Contact dermatoconjunctivitis Giant papillary conjunctivitis  SEASONAL AND PERENNIAL CONJUNCTIVITIS: These are usually caused by: pollen from grass,trees, or flowers, dustmites,flakes of dead animal skin. These types of conjunctivitis are more common in people who also have other allergies,suchas asthma,and often occur with allergic rhiniitis

7.  CONTACT DERMATOCONJUNCTIVITIS: Contact dermatoconjunctivitis is usually caused by eye drops,but it can also be caused by make-up or chemicals  GAINT PAPILLARY CONUJNCTIVITIS: It is caused by : Contact lenses Stitches used in eye surgery An artificial part of the eye that’s fitted during eye surgery Gaint papillary conjunctivitis is estimated to affect around 1-5% of people who use soft contact lenses and 1% of people who use hard contact lenses.  TOXIC CONJUNCTIVITIS: Topical medications such as antibiotic eye drops,topical antiviral medications, and lubricating eye drops can induce allergic conjunctivitis.

8.  Itching  Watery/serous drainage  Red conjunctiva  Usually will have cobblestone papillae on the upper  tarsal conjunctiva  May also go along with eczema and asthma flare.  Usually bilateral eyes

9.  Fast onset, usually 12-24 hours  Infected by direct contact of infected person  Lasts 7-10 days  If lasts longer than 4 weeks it is considered chronic bacterial conjunctivitis.  Most commonly the Staphylococcal species followed by Streptococcus pneumoniae  Affects children more often than adults, anyone in childcare setting, someone in close contact with conjunctivitis & people who wear contact lenses  BACTERIAL CONJUNCTIVITIS: INFECTIOUS TYPE

10. SYMPTOMS OF BACTERIAL CONJUNCTIVITS  Red eye  Purulent/mucopurulent discharge  Mattering of the eyelids  Can present as beefy red conjunctiva  Burning, stinging, or gritty sensation of eyes

11.  Viral conjunctivitis is the most common type and usually requires no treatment.  Most are caused by Adenoviruses.  Many people are misdiagnosed as bacterial.  Highly contagious  Spread by contact  Can take up to 2-3 weeks to resolve.  VIRAL CONJUNCTIVITIS

12.  Sometimes may caused by herpes viruses mainly of two types:  Herpes simplex virus: Conjunctivitis caused by the virus is usually unilateral. The discharge is thin and watery and vesicular eyelid lesions may be present  Herpes zoster virus: It mainly responsible for shingles, can involve ocular tissue Especially may be the first and second branches of the trigeminal nerve. Corneal complications and uveitis may be present.

13.  Usually begin in 1 eye and spreads to other  Tearing of eyes/watery/serous drainage  Symptoms of URI are usually present such as  runny nose, sore throat, sneezing, and fever.  Photophobia  Pre auricular lymphadenopathy  Feels like something in the eye Symptoms of viral conjunctivitis

14. DIAGNOSIS: Conjunctivitis Corneal Abrasion Iritis-inflammation of the iris A red flag would be if they are not responding to treatment and suspected of having periorbital cellulitis. Follow up and refer to ophthalmologist if not responding to treatment Usually diagnosis is made by physical exam Fluorescein staining if suspect ulcer/abrasion

15. TREATMENT

16. CATEGORYCAUSATIVE AGENT CLASS OF DRUGSEXAMPLESFREQUENCY ACUTE BACTERIAL S.aureus AminoglycosidesGENTAMYCIN (Oint)QID s.pneumoniaeTOBROMYCIN (Oint)TID FluoroquinolonesBESIFLOXACIN (Soln) (2-3)drops QID CIPROFLOXACIN (Oint)TID GATIFLOXACINTID LEVOFLOXACIN (Soln) (2-3)drops QID OXOFLOXACIN (Soln) (2-3) (drops) QID MacrolidesAZITHROMYCIN (Soln) (1drop) BID ERYTHROMYCINQID

17. CATEGORYCAUSATIVE AGENT CLASS OF DRUGS EXAMPLES FREQUENCY SulfonamidesSULFACETAMIDE (Oint) (Soln)(2-3)drops QID Bed time 2-3h/week Combination dropsTRIMETHOPRIM/ POLYMYXIN(2-3) drops QID Hyper acute bacterial in adults Neisseria gonorrheae CEFTRIAXONE (1g IM once)

18. Viral conjunctivitisMostly adeno virusAnti histamines Cold compress Artificial tears Herpes zoster viral conjunctivitis Herpes zoster virusOral acyclovir(800mg) Oral famiciclovir(500mg) Oral valacyclovir(1000mg) 5 times-day 3 times-day Herpes simplex viral conjunctivitis Herpes simplex virusTopical acyclovir Oral acyclovir(400mg) Oral valacyclovir(500mg) 1drop/day 5times-day 3times-day

19. Allergic conjunctivitispollenTopical histaminesAZELASTINE(0.05%) (1drop) 2/day EMEDASTINE(0.05%) (1drop) 4/day Topical mast cell inhibitors CROMOLYN Na(4%) (1-2) drops Every4-6h LODOXAMIDE(0.1%) (1-2 drops) 4/day NEDOCROMIL(2%)2/day NSAIDSKETOROLAC (1 drop)4/day Anti histaminesNAPHAZOLINE/ PHENIRAMINE(1-2 drops) 4/day Combination dropsKETOTIFEN(0.025%) (1 drop) 2-3/day OLOPATADINE(0.1%) (1drop) 2/day

20. TYPES OF CONJUNCTIVITS SIGNS AND SYMPTOMS MANAGEMENT PREVENTION BACTERIAL CONJUNCTIVITIS Red eye Discharge of pus Pain Photophobia Chloramphenicol 0.5% eye drops Gentamycin0.3% eye drops Tetracycline 1% eye ointment Intensive instillation for first day or until symptom and signs reduce Personal hygiene Hand wash Correct cleaning and disinfection of instruments between examinations contact lens hygiene VIRAL CONJUNCTIVITS Red eye Watery discharge Itch /Irritation Sub conjunctival Haemorrhages Cold compresses to relieve discomfort Personal hygiene Hand washing ALLERGIC CONJUNCTIVITS Red eye Lacrimation Mucous build up Itching and Irritation Reassurance Antihistamines (eye drops or orally) Steroid eye drops Cromolyn sodium 4% eye drops Lodoxamide 0.1% eye drops Avoid allergens OVERALL VIEW AND MANAGEMENT

21. PREVENTIVE MEASURES

22. Halloran, L. (2011). Assessment and Treatment of Conjunctivitis. Journal for Nurse Practitioners, 7(9). 783-784. doi:10.1016/j.nurpra.2011.08.008 Papadakis, M. A., McPhee, S, J., and Rabow, M. W. (2015). Disorders of the eyes and lids. In Current medical diagnosis & treatment 2015 (pp. 163-198). New York, NY: McGraw-Hill Educational Medical. REFERENCES: