# Conjunctivitis Conjunctivitis Symptoms are grittiness, redness and discharge. Causes are infective, chemical, allergic or traumatic. In the newborn it can be serious; gonococcal and chlamydial infection must be excluded. Bacterial conjunctivitis is purulent, usually self- limiting and treated with topical broad-spectrum antibiotics. Chlamydial and adenovirus infections must be considered. Adenoviral infections are common and usually a ff ect one eye much more in severity and onset, tending to be more watery than sticky , and are often associated with a palpable preauricular gland. V ernal conjunctivitis ( Figure 49.25 ) is a form of allergic conjunctivitis that is characterised by itchy eyes, usually worse Moritz Kaposi , 1837–1902, Professor of Dermatology , Vienna, Austria, described pigmented sarcoma of the skin in 1872. allergic problems such as hay fe ver. Clinically , most signs are under the upper lid, which may have a cobblestone appearance instead of a smooth surface. Giant papillary conjunctivitis with large papillae under the upper lid may be seen in soft contact lens wearers. This is usu - ally caused by an allergy to the sterilising solutions and lens protein and may be helped by either using a preservative-fr ee solution or using daily-wear disposable lenses. Kaposi’s sarcoma, often associated with human immuno - deficiency virus (HIV) infection, can rar ely present like a sub - conjunctival haemorrhage ( Figure 49.26 ). Considerable conjunctival and corneal irritation can be caused by the lids turning in (entropion) ( Figure 49.27 ) or turning out (ectropion) ( Figures 49.28 and 49.29 ), and by ingrowing lashes. T he lids should be repaired surgically to their normal position. Figure 49.25 Vernal conjunctivitis (spring catarrh) showing cobble - stone appearance under the upper lid. Figure 49.26 Kaposi’s sarcoma of conjunctiva. Vision is not commonly a ff ected in conjunctivitis but, with some viral infections, a keratitis may be present and result in visual impairment and pain. All of the other conditions below are painful and usually a ff ect vision. Rose Bengal (or Bengal Rose) is dichlorotetraiodofluorescein. Hulusi Behçet , 1889–1948, Professor of Dermatology , Istanbul, Turkey , described this disease in 1937. Hans Conrad Julius Reiter , 1881–1968, President of the Health Service and Honorary Professor of Hygiene at the University of Berlin, Germany , described this disease in 1916. Herpes simplex infection presents as a dendritic (branching) ulcer, shown easily by staining with fluorescein or Rose Bengal. It is treated with aciclovir ointment five times per day . The use of steroid drops must be avoided as this can make the condition much worse ( Figure 49.30 ). Corneal ulceration may occur as a result of ingrowing lashes or corneal foreign bodies, marginal ulceration and infected abrasions. Infected ulcers can occur in patients wear - ing soft contact lenses or elderly immunocompromised indi - viduals. Herpes zoster (shingles) may a ff ect the ophthalmic division of cranial nerve V and can give rise to a keratitis and uveitis. It is important to avoid the use of steroid drops until a diagnosis has been made. Local anaesthetic drops should also not be given on a regular basis. Figure 49.27 Entropion (courtesy of J Beare, FRCS). Figure 49.28 Ectropion, lower lid (courtesy of J Beare, FRCS). Figure 49.29 Ectropion, upper lid – chronic staphylococcal infection (courtesy of J Beare, FRCS). Conjunctivitis Symptoms are grittiness, redness and discharge. Causes are infective, chemical, allergic or traumatic. In the newborn it can be serious; gonococcal and chlamydial infection must be excluded. Bacterial conjunctivitis is purulent, usually self- limiting and treated with topical broad-spectrum antibiotics. Chlamydial and adenovirus infections must be considered. Adenoviral infections are common and usually a ff ect one eye much more in severity and onset, tending to be more watery than sticky , and are often associated with a palpable preauricular gland. V ernal conjunctivitis ( Figure 49.25 ) is a form of allergic conjunctivitis that is characterised by itchy eyes, usually worse Moritz Kaposi , 1837–1902, Professor of Dermatology , Vienna, Austria, described pigmented sarcoma of the skin in 1872. allergic problems such as hay fe ver. Clinically , most signs are under the upper lid, which may have a cobblestone appearance instead of a smooth surface. Giant papillary conjunctivitis with large papillae under the upper lid may be seen in soft contact lens wearers. This is usu - ally caused by an allergy to the sterilising solutions and lens protein and may be helped by either using a preservative-fr ee solution or using daily-wear disposable lenses. Kaposi’s sarcoma, often associated with human immuno - deficiency virus (HIV) infection, can rar ely present like a sub - conjunctival haemorrhage ( Figure 49.26 ). Considerable conjunctival and corneal irritation can be caused by the lids turning in (entropion) ( Figure 49.27 ) or turning out (ectropion) ( Figures 49.28 and 49.29 ), and by ingrowing lashes. T he lids should be repaired surgically to their normal position. Figure 49.25 Vernal conjunctivitis (spring catarrh) showing cobble - stone appearance under the upper lid. Figure 49.26 Kaposi’s sarcoma of conjunctiva. Vision is not commonly a ff ected in conjunctivitis but, with some viral infections, a keratitis may be present and result in visual impairment and pain. All of the other conditions below are painful and usually a ff ect vision. Rose Bengal (or Bengal Rose) is dichlorotetraiodofluorescein. Hulusi Behçet , 1889–1948, Professor of Dermatology , Istanbul, Turkey , described this disease in 1937. Hans Conrad Julius Reiter , 1881–1968, President of the Health Service and Honorary Professor of Hygiene at the University of Berlin, Germany , described this disease in 1916. Herpes simplex infection presents as a dendritic (branching) ulcer, shown easily by staining with fluorescein or Rose Bengal. It is treated with aciclovir ointment five times per day . The use of steroid drops must be avoided as this can make the condition much worse ( Figure 49.30 ). Corneal ulceration may occur as a result of ingrowing lashes or corneal foreign bodies, marginal ulceration and infected abrasions. Infected ulcers can occur in patients wear - ing soft contact lenses or elderly immunocompromised indi - viduals. Herpes zoster (shingles) may a ff ect the ophthalmic division of cranial nerve V and can give rise to a keratitis and uveitis. It is important to avoid the use of steroid drops until a diagnosis has been made. Local anaesthetic drops should also not be given on a regular basis. Figure 49.27 Entropion (courtesy of J Beare, FRCS). Figure 49.28 Ectropion, lower lid (courtesy of J Beare, FRCS). Figure 49.29 Ectropion, upper lid – chronic staphylococcal infection (courtesy of J Beare, FRCS). Conjunctivitis Symptoms are grittiness, redness and discharge. Causes are infective, chemical, allergic or traumatic. In the newborn it can be serious; gonococcal and chlamydial infection must be excluded. Bacterial conjunctivitis is purulent, usually self- limiting and treated with topical broad-spectrum antibiotics. Chlamydial and adenovirus infections must be considered. Adenoviral infections are common and usually a ff ect one eye much more in severity and onset, tending to be more watery than sticky , and are often associated with a palpable preauricular gland. V ernal conjunctivitis ( Figure 49.25 ) is a form of allergic conjunctivitis that is characterised by itchy eyes, usually worse Moritz Kaposi , 1837–1902, Professor of Dermatology , Vienna, Austria, described pigmented sarcoma of the skin in 1872. allergic problems such as hay fe ver. Clinically , most signs are under the upper lid, which may have a cobblestone appearance instead of a smooth surface. Giant papillary conjunctivitis with large papillae under the upper lid may be seen in soft contact lens wearers. This is usu - ally caused by an allergy to the sterilising solutions and lens protein and may be helped by either using a preservative-fr ee solution or using daily-wear disposable lenses. Kaposi’s sarcoma, often associated with human immuno - deficiency virus (HIV) infection, can rar ely present like a sub - conjunctival haemorrhage ( Figure 49.26 ). Considerable conjunctival and corneal irritation can be caused by the lids turning in (entropion) ( Figure 49.27 ) or turning out (ectropion) ( Figures 49.28 and 49.29 ), and by ingrowing lashes. T he lids should be repaired surgically to their normal position. Figure 49.25 Vernal conjunctivitis (spring catarrh) showing cobble - stone appearance under the upper lid. Figure 49.26 Kaposi’s sarcoma of conjunctiva. Vision is not commonly a ff ected in conjunctivitis but, with some viral infections, a keratitis may be present and result in visual impairment and pain. All of the other conditions below are painful and usually a ff ect vision. Rose Bengal (or Bengal Rose) is dichlorotetraiodofluorescein. Hulusi Behçet , 1889–1948, Professor of Dermatology , Istanbul, Turkey , described this disease in 1937. Hans Conrad Julius Reiter , 1881–1968, President of the Health Service and Honorary Professor of Hygiene at the University of Berlin, Germany , described this disease in 1916. Herpes simplex infection presents as a dendritic (branching) ulcer, shown easily by staining with fluorescein or Rose Bengal. It is treated with aciclovir ointment five times per day . The use of steroid drops must be avoided as this can make the condition much worse ( Figure 49.30 ). Corneal ulceration may occur as a result of ingrowing lashes or corneal foreign bodies, marginal ulceration and infected abrasions. Infected ulcers can occur in patients wear - ing soft contact lenses or elderly immunocompromised indi - viduals. Herpes zoster (shingles) may a ff ect the ophthalmic division of cranial nerve V and can give rise to a keratitis and uveitis. It is important to avoid the use of steroid drops until a diagnosis has been made. Local anaesthetic drops should also not be given on a regular basis. Figure 49.27 Entropion (courtesy of J Beare, FRCS). Figure 49.28 Ectropion, lower lid (courtesy of J Beare, FRCS). Figure 49.29 Ectropion, upper lid – chronic staphylococcal infection (courtesy of J Beare, FRCS).