Ординатура / Офтальмология / Английские материалы / Ophthalmology A Short Textbook_Lang_2000

Symptoms: Typical symptoms include severe reddening, swelling of the conjunctiva, and purulent discharge that leads to formation of yellowish crusts.

Diagnostic considerations: Bacterial conjunctivitis can usually be reliably diagnosed from the presence of typical symptoms. Laboratory tests (conjunctival smear) are usually only necessary when the conjunctivitis fails to respond to antibiotic treatment.

Bacterial conjunctivitis is diagnosed on the basis of clinical symptoms. Smears are obtained only in severe, uncertain, or persistent cases.

Treatment: Bacterial conjunctivitis usually responds very well to antibiotic treatment. A wide range of well tolerated, highly effective antibiotic agents is available today. Most of these are supplied as ointments (which are longer acting and suitable for overnight therapy) and as eyedrops for topical therapy. Substances include gentamicin, tobramycin, Aureomycin, chloramphenicol,1 neomycin, polymyxin B in combination with bacitracin and neomycin , Terramycin, kanamycin, fusidic acid, ofloxacin, and acidamphenicol.1

Preparations that combine an antibiotic and cortisone can more rapidly alleviate subjective symptoms when findings are closely monitored. These include medications such as gentamicin and dexamethasone; neomycin, polymyxin B, and dexamethasone; or tetracycline, polymyxin B, and hydrocortisone.

In severe, uncertain, or persistent cases requiring microbiological examination to identify the pathogen, treatment with broad-spectrum antibiotics or topical antibiotic combination preparations that cover the full range of Gram-positive and Gram-negative pathogens should begin immediately. This method is necessary because microbiological identification of the pathogen and resistance testing of the antibiotic are not always successful and may require several days. It is not advisable to leave the conjunctivitis untreated for this period.

In the presence of severe, uncertain, or persistent conjunctivitis, treatment with broad-spectrum antibiotics or topical antibiotic combination preparations should be initiated immediately, even before the laboratory results are available.

Clinical course and prognosis: Bacterial conjunctivitis usually responds well to antibiotic treatment and remits within a few days.

4.4.2.2Chlamydial Conjunctivitis

Chlamydia are Gram-negative bacteria.

1 See Appendix for side effects of medications

92 4 Conjunctiva

Inclusion Conjunctivitis

Epidemiology: Inclusion conjunctivitis is very frequent in temperate countries. The incidence in western industrialized countries ranges between 1.7% and 24% of all sexually active adults depending on the specific population studied.

Etiology: Oculogenital infection (Chlamydia trachomatis serotype D–K) is also caused by direct contact. In the newborn (see neonatal conjunctivitis), this occurs at birth through the cervical secretion. In adults, it is primarily transmitted during sexual intercourse, and rarely from infection in poorly chlorinated swimming pools.

Symptoms: The eyes are only moderately red and slightly sticky from viscous discharge.

Diagnostic considerations: Tarsal follicles are observed typically on the upper and lower eyelids, and pannus will be seen to spread across the limbus of the cornea. As this is an oculogenital infection, it is essential to determine whether the mother has any history of vaginitis, cervicitis, or urethritis if there is clinical suspicion of neonatal infection. Gynecologic or urologic examination is indicated in appropriate cases. Chlamydia may be detected in conjunctival smears, by immunofluorescence, or in tissue cultures. Typical cytologic signs include basophilic cytoplasmic inclusion bodies (Fig. 4.13).

Treatment: In adults, the disorder is treated with tetracycline or erythromycin eyedrops or ointment over a period of four to six weeks. The oculogenital mode of infection entails a risk of reinfection. Therefore, patients and sexual

Chlamydial conjunctivitis.

Fig. 4.13 Cytologic smear showing typical basophilic cytoplasmic inclusion bodies.