Plica Semilunaris Herpes

Topical: broad-spectrum antibiotic (gentamicin, polymyxin B, chloramphenicol)*

Gram-negative Pseudomonas aeruginosa (Bacillus pyocyaneus)

Haemophilus Subacute Serous, mucopurulent influenzae discharge; especially conjunctivitis common in children.

Corneal involvement is rare.

Haemophilus influenzae:

Gram-negative rods

Topical: broad-spectrum antibiotic (see above)

Haemophilus influenzae:

Gram-negative rods

Haemophilus Acute Highly infectious con-

aegyptius junctivitis prevalent in

(Koch-Weeks) warm countries, rare conjunctivitis in temperate coun tries; eyelid swelling, Chemosis, subconjunctival hemorrhaging, pseudomembranes, corneal ulceration

Topical: broad-spectrum antibiotic (tetracycline, kanamycin, gentamicin)

Haemophilus aegyptius

(Koch-Weeks): fine Gram-negative rods

Moraxella Subacute Minimal discharge, conjunctivitis moderate irritation

(circumscribed in the angle of the eye with accompanying blepharoconjunctivitis). Corneal ulceration may occur.

Moraxella lacunata (Morax-Axenfeld diplobacillus): large Gram-negative diplobac illi

Topical: broad-spectrum antibiotic

Q 0.25-0.5% zinc sulfate eyedrops are considered to be an effective specific treatment

Continued-

Table 4.2 (Continued)

Cause

Clinical course

Symptoms and findings

Pathogen

Treatment

Chlamydia

Inclusion conjunctivitis

Acute to chronic

Moderately reddened eye, typical viscous discharge, sticky eyes, tarsal follicles on the upper and lower eyelids, superficial punctate keratoconjunctivitis, spread of pannus across the limbus of the cornea, occasional peripheral subepithelial corneal infiltrates

Chlamydia trachomatis

(serotype D-K)

♦ Topical: erythromycin or tetracycline for 2 - 3 weeks

* Systemic: erythromycin or tetracycline for at least 3 weeks

Beware: disorder will recur if medication is discontinued too early n o

Trachoma Chronic Rare in temperate countries but endemic in warm climates. Lymph follicles on the palpebral conjunctiva of the upper eyelid, cicatricial entropion, ptosis, trichiasis, corneal scarring, xerosis of the conjunctiva. Four stages of the disorder are distinguished.

Chlamydia trachomatis

(serotype A-C)

As in inclusion conjunctivitis

Chlamydia trachomatis

(serotype A-C)

Epidemic Acute Highly contagious con-

kerato- junctivitis. Watery conjunctivitis mucoid discharge, chemosis, eyelid edema, reddening and swelling of the plica semilunaris and lacrimal caruncle (characteristic sign), swollen preauricular lymph nodes; often there will be a moderate influenza infection. Nummular keratitis will appear after 8-15 days (characteristic sign).

Adenovirus (adenoid pharyngeal conjunctival); types 18 and 19 are most frequent.

No specific treatment is possible. Symptomatic moistening treatment. Prophylaxis: meticulous hygiene. Human interferon (Berofor) prevents infection in exposed patients (extremely expensive).

Herpes simplex Acute, Keratitis and keratoconjunctivitis mild conjunctivitis always Herpes zoster accompanied by crops ophthalmicus of vesicles on an erythematous base on the eyelids

Herpes virus Varicella-zoster virus

Topical: acyclovir ointment

* Systemic: acyclovir IV if necessary n o

Herpes virus Varicella-zoster virus

Table 4.2 (Continued)

Table 4.2 (Continued)

Cause

Clinical

Symptoms and

Pathogen

Treatment

course

findings

Onchocerciasis Chronic (river blindness)

Loa loa

Onchocerciasis Chronic (river blindness)

Conjunctivitis from microfilaria, progressing to keratitis, iridocyclitis, uveitis, and conjunctival scarring. This is most freguent cause of blindness in Africa.

Systemic treatment with Ivermectin now available (treatment takes years)

Onchocerca volvulus (transmitted by the flies of the genus Simulium)

Loa loa

Chronic Conjunctivitis from microfilaria. The parasites are visible with the naked eye under the conjunctiva and will flee the light of the slit lamp). The disorder is endemic in west Africa

Surgical removal of the worms from the conjunctiva

Nodose Chronic Very rare conjunctivi-

conjunctivitis tis. Caterpillar hairs accidentally find their way into the conjunctival sac. The hairs have barbs and work their way deep into the tissue. Granulomas develop on the conjunctiva. Blindness can result when these hairs penetrate into the interior of the eye.

Caterpillar hairs

Surgical removal of the caterpillar hairs, topical steroid therapy

Caterpillar hairs

Mycotic Acute Frequently associated conjunctivitis with mycotic keratitis or secondary to mycotic canaliculus

Hyphae

As with mycotic keratitis: systemic and topical antimycotic therapy

Hyphae

See Appendix for side effects of medications

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