Purulent conjunctivitis
The content of the article:
- Causes and risk factors
- Symptoms
- Diagnostics
- Purulent conjunctivitis treatment
- Potential consequences and complications
- Forecast
- Prevention
Purulent conjunctivitis is an inflammation of the conjunctiva caused by gram-negative or gram-positive bacteria and is manifested by lacrimation, photophobia, hyperemia and swelling of the mucous membrane, pinpoint hemorrhages and mucopurulent discharge.
Source: zrenie.online
In the general structure of ophthalmic morbidity, conjunctivitis accounts for about 30%, of which acute purulent conjunctivitis is 73%. The disease is much more common in the cold season. In adults, it occurs in the form of sporadic cases, and in children attending organized groups, it can be in the nature of epidemic outbreaks.
Causes and risk factors
On the surface of the conjunctiva and the edges of the eyelids, opportunistic microorganisms (diphtheroids, propionibacteria, staphylococci, streptococci) are always present. The active components of the tear fluid (beta-lysine, lysozyme, lactoferrin, compliment components, immunoglobulins) protect the mucous membrane of the eyes from their effects. During blinking movements, the conjunctiva is moistened with tear fluid, and bacteria from its surface are removed mechanically.
Most often, with purulent conjunctivitis, the eyes are affected by staphylococci (saprophytic, golden, epidermal), pneumococci, streptococci, Escherichia coli, Pseudomonas aeruginosa, gonococci, Haemophilus influenzae, corynebacterium diphtheria, Koch-Weeks bacteria.
In patients using contact lenses, the causative agent of purulent conjunctivitis is most often Pseudomonas aeruginosa.
In children, purulent conjunctivitis is often caused by a mixed infection (bacterial-fungal, viral-bacterial, bacterial-viral-fungal).
The most common cause of the disease is eye infection due to non-compliance with the rules of personal hygiene, ophthalmologists call purulent conjunctivitis "a disease of dirty hands."
The contributing factors are:
- acute respiratory viral infections (ARVI);
- diseases of the ENT organs (tonsillitis, otitis media, sinusitis);
- foreign bodies of the eyes;
- mechanical eye injury;
- eye diseases (damage to the lacrimal duct, dry eye syndrome, blepharitis);
- decrease in general and local immunity;
- hypothermia;
- stress;
- long-term therapy with corticosteroids, including local;
- erythema multiforme.
Risk factors for the development of purulent conjunctivitis in newborns:
- prematurity;
- intrauterine infection of the fetus;
- inflammatory diseases of the genital organs in the mother (tuberculosis, gonorrhea).
Symptoms
Purulent conjunctivitis develops rapidly. From the moment the pathogenic microflora enters the mucous membrane of the eyes to the appearance of pronounced clinical signs of the disease, usually no more than a day passes. The main symptoms are:
- swelling and hyperemia of the conjunctiva;
- sensation of a foreign body in the eye;
- pain in the eye;
- punctate hemorrhages on the conjunctiva;
- profuse discharge of a mucopurulent nature from the conjunctival sac;
- the appearance of crusts on the edges of the eyelids that stick together the eyelashes.
Edema of the conjunctiva can be significant, which leads to the development of chemosis - infringement of the mucous membrane of the eyes at the time of closing the eyelids in the palpebral fissure.
With purulent conjunctivitis, one eye is initially affected, then the infection spreads to the other eye.
In rare cases, the infectious process is accompanied by signs of general intoxication:
- subfebrile temperature;
- headache;
- arthro-, myalgia;
- sleep disorders;
- decreased appetite.
Depending on the etiological factor, the clinical picture of purulent conjunctivitis may have some features.
Pneumococcal conjunctivitis usually develops 1-2 days from the onset of ARVI and has the following manifestations:
- sharp conjunctival hyperemia;
- intense lacrimation;
- severe photophobia;
- pinpoint hemorrhages on the mucous membrane;
- moderate purulent discharge.
Purulent conjunctivitis caused by the Koch-Weeks bacillus is characterized by the following symptoms:
- pronounced edema and hyperemia of the conjunctiva;
- profuse mucopurulent discharge;
- the appearance of brown films on the conjunctiva;
- the appearance in the conjunctiva of the upper eyelid of multiple follicles.
Purulent conjunctivitis of gonorrheal etiology (gonoblenorrhea) has the following symptoms:
- sharp edema, infiltration and hyperemia of the conjunctiva;
- copious discharge from the conjunctival sac (at the initial stages of the disease it looks like "meat slops", and then becomes purulent);
- pronounced swelling of the eyelids;
- ulceration of the cornea.
Purulent conjunctivitis caused by a diphtheria bacillus (eye diphtheria) is characterized by the following symptoms:
- pronounced edema and infiltration of the conjunctiva;
- hyperemia of the mucous membrane of the eyes with a cyanotic shade;
- the formation of diphtheria films that are difficult to remove;
- copious discharge, initially serous-hemorrhagic, and later purulent.
Diphtheria purulent conjunctivitis is usually combined with diphtheria of some other localization.
Diagnostics
The diagnosis of purulent conjunctivitis does not cause difficulties and is carried out on the basis of the characteristic clinical symptoms of the disease. In order to identify the causative agent of the infectious process, as well as to determine its sensitivity to antibiotics, a bacteriological study of the discharge from the conjunctival sac is performed. If a corneal lesion is suspected, an instillation test with fluorescein is indicated.
Purulent conjunctivitis treatment
Purulent conjunctivitis is treated on an outpatient basis. A thorough toilet of the eyes is carried out several times a day using antiseptic solutions (boric acid, furacilin). Separate syringes, cotton balls, eye sticks and pipettes should be used for each eye to prevent transmission of infection.
After cleansing the eyelids and the conjunctival cavity from the accumulation of purulent masses, eye drops containing an antibiotic (Ofloxacin, Lincomycin, Neomycin, Levomycetin, Tetracycline) are instilled. Instillation should be carried out in the daytime every 2-3 hours. At night, an antibiotic eye ointment, for example, tetracycline, is placed behind the eyelids.
With pronounced edema of the mucous membrane, eye drops with antiallergic effect are used.
Bandages should not be applied to the eyes, as they impede the outflow of purulent discharge and contribute to the involvement of the cornea in the inflammatory process.
The duration of treatment for purulent conjunctivitis should be at least 10-12 days, until persistent and complete relief of all symptoms of the disease.
Potential consequences and complications
With untimely or inadequate treatment, purulent conjunctivitis can lead to the development of complications:
- chronic blepharitis;
- scarring of the conjunctiva;
- ulceration and perforation of the cornea;
- hypopyon (accumulation of purulent masses in the anterior chamber of the eyeball).
Corneal lesions with purulent conjunctivitis often occur in debilitated patients suffering from bronchoadenitis, hypovitaminosis, anemia, dystrophy.
Complications of purulent conjunctivitis in preschool children often become dacryocystitis, keratitis, phlegmon of the lacrimal sac, phlegmon of the orbit.
Forecast
The prognosis for the timely start of treatment for purulent conjunctivitis is favorable. The disease ends with complete recovery within 10-14 days.
Prevention
Prevention of purulent conjunctivitis is based on careful adherence to the rules of personal hygiene (frequent and thorough hand washing, use of individual towels, handkerchiefs).
At the first signs of the disease, measures should be taken to prevent the transfer of infection to the other eye (use separate instruments and dressings for each eye).
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
