A Gonococcal Conjunctivitis in Objective-C

Paint Quick Response Code in Objective-C A Gonococcal Conjunctivitis

Gonococcal conjunctivitis, usually acquired through contact with infected genital secretions, typically causes copious purulent discharge It is an ophthalmologic emergency because corneal involvement may rapidly lead to perforation The diagnosis should be confirmed by stained smear and culture of the discharge A single 1-g dose of intramuscular ceftriaxone is usually adequate Topical antibiotics such as erythromycin and bacitracin may be added Other sexually transmitted diseases, including chlamydiosis, syphilis, and HIV infection, should be considered

1 Trachoma (Chlamydia trachomatis serotypes A C) Trachoma is a major cause of blindness worldwide Recurrent episodes of infection in childhood are manifest as bilateral follicular conjunctivitis, epithelial keratitis, and corneal vascularization (pannus) Cicatrization of the tarsal conjunctiva leads to entropion and trichiasis in adulthood, with secondary central corneal scarring Immunologic tests or polymerase chain reaction on conjunctival samples will confirm the diagnosis but treatment should be started on the basis of clinical findings Single-dose therapy with oral azithromycin, 20 mg/kg, is effective Alternatively, oral tetracycline or erythromycin, 250 mg four times a day, or doxycycline, 100 mg twice a day, is given for 3 4 weeks Local treatment is not necessary Surgical treatment includes correction of eyelid deformities and corneal transplantation

Kumaresan J Can blinding trachoma be eliminated by 20/20 Eye 2005 Oct;19(10):1067 73 [PMID: 16304586]

3 Dry Eyes (Keratoconjunctivitis Sicca)

This is a common disorder, particularly in elderly women A wide range of conditions predispose to or are characterized by dry eyes Hypofunction of the lacrimal glands, causing loss of the aqueous component of tears, may be due to aging, hereditary disorders, systemic disease (eg, Sj gren s syndrome), or systemic and topical drugs Excessive evaporation of tears may be due to environmental factors (eg, a hot, dry, or windy climate) or abnormalities of the lipid component of the tear film, as in blepharitis Mucin deficiency may be due to malnutrition, infection, burns, or drugs Hormone replacement therapy may increase the risk of dry eyes

The patient complains of dryness, redness, or a scratchy feeling of the eyes In severe cases, there is persistent marked discomfort, with photophobia, difficulty in moving the eyelids, and often excessive mucus secretion In many cases, inspection reveals no abnormality, but on slitlamp examination there are subtle abnormalities of tear film stability and reduced volume of the tear film meniscus along the lower lid In more severe cases, damaged corneal and conjunctival cells stain with 1% rose bengal, which is to be avoided in severe cases because of the intense pain In the most severe cases, there is marked conjunctival injec-

2 Inclusion conjunctivitis (C trachomatis serotypes D K) The agent of inclusion conjunctivitis is a common cause of genital tract disease in adults The eye is usually involved following accidental contact with genital secretions The disease starts with acute redness, discharge, and irritation The eye findings consist of follicular conjunctivitis with mild keratitis A nontender preauricular lymph node can often be palpated Healing usually leaves no

tion, loss of the normal conjunctival and corneal luster, epithelial keratitis that may progress to frank ulceration, and mucous strands Schirmer s test, which measures the rate of production of the aqueous component of tears, may be helpful

Treatment depends on cause In most early cases, the corneal and conjunctival epithelial changes are reversible Aqueous deficiency can be treated by replacement of the aqueous component of tears with various types of artificial tears The simplest preparations are physiologic (09%) or hypo-osmotic (045%) solutions of sodium chloride Balanced salt solution is more physiologic but also more expensive All of these drop preparations can be used as frequently as every half-hour, but in most cases are needed only three or four times a day More prolonged duration of action can be achieved with drop preparations containing methylcellulose (eg, Isopto Plain), polyvinyl alcohol (eg, Liquifilm Tears or HypoTears), or polyacrylic acid (carbomers) (eg, GelTears or Viscotears) or by using petrolatum ointment (Lacri-Lube) Such mucomimetics are particularly indicated when there is mucin deficiency If there is tenacious mucus, mucolytic agents (eg, acetylcysteine, 20% six times daily) may be helpful The presence of ocular surface and lacrimal gland inflammation in dry eyes has prompted the use of topical cyclosporine Lacrimal punctal occlusion by canalicular plugs or surgery is useful in severe cases Blepharitis is treated as described above Associated blepharospasm responds to botulinum toxin injections Artificial tear preparations are generally very safe and without side effects However, the preservatives necessary to maintain their sterility are potentially toxic and allergenic and may cause keratitis and cicatrizing conjunctivitis in frequent users Furthermore, the development of such reactions may be misinterpreted by both the patient and the doctor as a worsening of the dry eye state requiring more frequent use of the artificial tears and leading in turn to further deterioration, rather than being recognized as a need to change to a preservative-free preparation

Sanchez-Guerrero J et al Prevalence of Sj gren s syndrome in ambulatory patients according to the American-European Consensus Group criteria Rheumatology (Oxford) 2005 Feb;44(2):235 40 [PMID: 15509625] Stonecipher K et al The impact of topical cyclosporine A emulsion 005% on the outcomes of patients with keratoconjunctivitis sicca Curr Med Res Opin 2005 Jul;21(7):1057 63 [PMID: 16004673]

Allergic conjunctivitis is a benign disease, occurring usually in late childhood and early adulthood It may be seasonal, developing usually during the spring or summer, or perennial Clinical signs are limited to conjunctival hyperemia and edema (chemosis), the latter at times being marked and sudden in onset Vernal keratoconjunctivitis also tends to occur in late childhood and early adulthood It is usually seasonal, with a predilection for the spring Large cobblestone papillae are noted on the upper tarsal conjunctiva There may be lymphoid follicles at the limbus Atopic keratoconjunctivitis is a more chronic disorder of adulthood Both the upper and the lower tarsal conjunctivas exhibit a fine papillary conjunctivitis with fibrosis, resulting in forniceal shortening and entropion with trichiasis Staphylococcal blepharitis is a complicating factor Corneal involvement, including refractory ulceration, is frequent during exacerbations of both vernal and atopic keratoconjunctivitis The latter may be complicated by herpes simplex keratitis