PSEUDOMEMBRANOUS CONJUNCTIVITIS
It is a type of acute conjunctivitis, characterised by formation of a pseudomembrane (which can be easily peeled off leaving behind intact conjunctival epithelium) on the conjunctiva.
Etiology
It may be caused by following varied factors:
1. Bacterial infection. Common causative organisms are Corynebacterium diphtheriae of low virulence, staphylococci, streptococci, H. influenzae and N.gonorrhoea.
2. Viral infections such as herpes simplex andvadenoviral epidemic keratoconjunctivitis may also be sometimes associated with pseudomembrane formation.
3. Chemical irritants such as acids, ammonia, lime, silver nitrate and copper sulfate are also known to cause formation of such membrane.
Pathology
The above agents produce inflammation of conjunctiva associated with pouring of fibrinous exudate on its surface which coagulates and leads to formation of a pseudomembrane.
Clinical picture
Pseudomembranous conjunctivitis is characterized by:
� Acute mucopurulent conjunctivitis, like features associated with.
� Pseudomembrane formation which is thin yellowish-white membrane seen in the fornices and on the palpebral conjunctiva.
Pseudomembrane can be peeled off easily and does not bleed.
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