ACUTE MEMBRANOUS CONJUNCTIVITIS
It is an acute inflammation of the conjunctiva, characterized by formation of a true membrane on the conjunctiva.
Now-a-days it is of very-very rare occurrence, because of markedly decreased incidence of diphtheria. It is because of the fact that immunization against diptheria is very effective.
Etiology
The disease is typically caused by Corynebacterium diphtheriae and occasionally by virulent type of Streptococcus haemolyticus.
Pathology
Corynebacterium diphtheriae produces a violent inflammation of the conjunctiva, associated with deposition of fibrinous exudate on the surface as well as in the substance of the conjunctiva resulting in formation of a membrane.
Usually membrane is formed in the palpebral conjunctiva. There is associated coagulative necrosis, resulting in sloughing of membrane. Ultimately healing takes place by granulation tissue.
Clinical features
The disease usually affects children between 2-8 years of age who are not immunised against diphtheria.
The disease may have a mild or very severe course. The child is toxic and febrile. The clinical picture of the disease can be divided into three stages:
1. Stage of infiltration is characterised by:
* Scanty conjunctival discharge and severe pain in the eye.
*� Lids are swollen and hard.
*� Conjunctiva is red, swollen and covered with a thick grey-yellow membrane. The membrane is tough and firmly adherent to the conjunctiva, which on removing bleeds and leaves behind a raw area.
*� Pre-auricular lymph nodes are enlarged.
2. Stage of suppuration.
In this stage, pain decreases and the lids become soft. The membrane is sloughed off leaving a raw surface.
There is copious outpouring of purulent discharge.
3. Stage of cicatrisation.
In this stage, the raw surface covered with granulation tissue is epithelised. Healing occurs by cicatrisation, which may cause trichiasis and conjunctival xerosis.
Complications
1. Corneal ulceration is a frequent complication in acute stage. The bacteria may even involve the intact corneal epithelium.
2. Delayed complications due to cicatrization include symblepharon, trichiasis, entropion and conjunctival xerosis.
Diagnosis
Diagnosis is made from typical clinical features and confirmed by bacteriological examination.
Treatment
A. Topical therapy
1. Broad-spectrum antibiotics eye drops should be instilled every half hourly.
2. Antidiphtheric serum (ADS) should be instilled every one hour.
3. Atropine sulfate 1 percent ointment should be added if cornea is ulcerated.
4. Broad spectrum antibiotic ointment should be applied at bed time.
B. Systemic therapy
1. Crystalline penicillin 5 lac units should be injected intramuscularly twice a day for 10 days.
2. Antidiphtheric serum (ADS) (50 thousand units) should be given intramuscularly stat.
C. Prevention of symblepharon
Once the membrane is sloughed off, the healing of raw surfaces will result in symblepharon, which should be prevented by applying contact shell or sweeping the fornices with a glass rod smeared with ointment.
Prophylaxis
1. Isolation of patient will prevent family members from being infected.
2. Proper immunization against diphtheria is very effective and provides protection to the community.
OPTOMETRY-SHARP VISION
Optometrist