ACUTE MUCOPURULENT CONJUNCTIVITIS
Acute mucopurulent conjunctivitis is the most common type of acute bacterial conjunctivitis.
It is characterised by marked conjunctival hyperaemia and mucopurulent discharge from the eye.
Common causative bacteria are: Staphylococcus aureus, Koch-Weeks bacillus, Pneumococcus andS treptococcus.
Mucopurulent conjunctivitisg enerally accompanies exanthemata such as measles and scarlet fever.
Clinical picture
Symptoms
�* Discomfort and foreign body sensation due to engorgement of vessels.
�* Mild photophobia, i.e., difficulty to tolerate light.
*� Mucopurulent discharge from the eyes.
�* Sticking together of lid margins with discharge during sleep.
�* Slight blurring of vision due to mucous flakes in front of cornea.
*� Sometimes patient may complain of coloured halos due to prismatic effect of mucus present on cornea
Signs
*� Conjunctival congestion, which is more marked in palpebral conjunctiva, fornices and peripheral part of bulbar conjunctiva, giving the appearance of ‘fiery red eye’. The congestion is typically less marked in circumcorneal zone.
�* Chemosis i.e., swelling of conjunctiva.
�* Petechial haemorrhages are seen when the causative organism is pneumococcus.
* Flakes of mucopus are seen in the fornices, canthi and lid margins.
�* Cilia are usually matted together with yellowcrusts.
Clinical course.
Mucopurulent conjunctivitis reaches its height in three to four days.
If untreated, in mild cases the infection may be overcome and the condition is cured in 10-15 days; or it may pass to less intense form, the ‘chronic catarrhal conjunctivitis’.
Complications.
Occasionally the disease may be complicated by marginal corneal ulcer, superficial keratitis, blepharitis or dacryocystitis.
Differential diagnosis
1. From other causes of acute red eye.
2. From other types of conjunctivitis. It is made out from the typical clinical picture of disease and is confirmed by conjunctival cytology and bacteriological examination of secretions and scrapings.
Treatment
1. Topical antibiotics to control the infection constitute the main treatment of acute mucopurulent conjunctivitis.
Ideally, the antibiotic should be selected after culture and sensitivity tests but in practice, it is difficult. However, in routine, most of the patients respond well to broad specturm antibiotics.
Therefore, treatment may be started with chloramphenicol (1%), gentamycin (0.3%) or framycetin eye drops 3-4 hourly in day and ointment used at night will not only provide antibiotic cover but also help to reduce the early morning stickiness.
If the patient does not respond to these antibiotics, then the newer antibiotic drops such as ciprofloxacin (0.3%), ofloxacin (0.3%) or gatifloxacin (0.3%) may be used.
2. Irrigation of conjunctival sac with sterile warm saline once or twice a day will help by removing the deleterious material.
Frequent eyewash (as advocated earlier) is however contraindicated as it will wash away the lysozyme and other protective proteins present in tears.
3. Dark goggles may be used to prevent photophobia.
4. No bandage should be applied in patients with mucopurulent conjunctivitis. Exposure to air keeps the temperature of conjunctival cul-de-sac low which inhibits the bacterial growth; while after bandaging, conjunctival sac is converted into an incubator, and thus infection flares to a severe degree within 24 hours. Further, bandaging of eye will also prevent the escape of discharge.
5. No steroids should be applied, otherwise infection will flare up and bacterial corneal ulcer may develop.
6. Anti-inflammatory and analgesic drugs (e.g. ibuprofen and paracetamol) may be given orally for 2-3 days to provide symptomatic relief from mild pain especially in sensitive patients.
OPTOMETRY-SHARP VISION
Optometrist