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Lecture notes, cheat sheets
Eye diseases. Clinical features and principles of treatment of some conjunctivitis and conjunctival tumors (lecture notes)
Directory / Lecture notes, cheat sheets Table of contents (expand) LECTURE No. 11. Clinical features and principles of treatment of some conjunctivitis and tumors of the conjunctiva 1. Acute epidemic conjunctivitis (Koch-Wicks conjunctivitis) In children, mainly toddlers, often in the morning, after sleep, against the background of general symptoms characteristic of conjunctivitis, pronounced swelling (chemosis) of the lower transitional folds, petechial hemorrhages in the conjunctiva of the eyelids and transitional folds can be observed. In older children, against the background of hyperemic mucous membrane of the eyeball, ischemic densified white areas in the form of two triangles are formed, the base facing the cornea. When examining the cornea, infiltrates can be detected. This clinical picture is characteristic of acute epidemic conjunctivitis (Koch-Wicks). Young children may experience general symptoms. Recovery occurs within five to seven days. 2. Pneumococcal conjunctivitis Sometimes, along with the general symptoms of conjunctivitis in children, pinpoint hemorrhages are found in the conjunctiva of the eyeball and transitional folds, and gentle pinpoint infiltrates are visible on the cornea near the limbus. With such changes, one can think of acute pneumococcal conjunctivitis. The presence of delicate gray films on the conjunctiva of the eyelids and vaults, weakly associated with the underlying tissue and, when removed, do not leave bleeding surfaces, will indicate a false-membrane form of pneumococcal conjunctivitis. If conjunctivitis develops at the end of the first week of a child's life, is characterized by lacrimation and a tearful appearance of the child, then there is reason to diagnose lachrymal conjunctivitis of newborns. The illness lasts up to two weeks. 3. Blennorrheal conjunctivitis There is a sharp swelling of both eyes on the second or third day after birth; when the palpebral fissure opens, watery fluid is ejected almost like a fountain from the conjunctival cavity, the conjunctiva is thickened and bleeds slightly. This clinical picture is typical for the initial period of gonoblenorrhea. If the disease lasts more than a week, then a sharp infiltration of the conjunctiva and pyorrhea are observed, swelling and hyperemia of the eyelids decrease at this stage. The discharge is purulent, yellowish-green in color. The conjunctiva of the eyeball is swollen and surrounds the cornea in the form of a shaft. During this period, changes in the cornea are possible due to disruption of its nutrition due to severe infiltration of the eyelids and mucous membrane, as well as as a result of the melting effect of pus on its tissue. In the third or fourth week of the disease, papillary hypertrophy of the conjunctiva may be detected. The eyes are almost calm, the swelling of the eyelids and conjunctiva is slight, and a liquid greenish discharge appears again. Papillae form on the conjunctiva, it becomes uneven and rough. The process can be protracted or chronic. However, usually in the second month the phase of reverse development of all signs of the disease begins, resulting in clinical recovery. 4. Diphtheria conjunctivitis There may be cases when, during an urgent home call or at the time of going to the clinic, a child experiences severe swelling and cyanosis of the eyelids. The eyelids resemble plums in appearance; upon palpation they are dense and painful. The conjunctiva is pale due to compression of the vessels, or there are grayish-yellow films with numerous hemorrhages on it. Removal of films is accompanied by bleeding. When the disease lasts seven to ten days, sloughing films and granulation tissue with a large amount of pus are visible. This is a typical diphtheritic form of conjunctivitis. Subsequently, star-shaped scars form at the site of granulation. Sometimes less pronounced symptoms of eyelid edema, more delicate films on the conjunctival cartilage and scanty discharge are observed. This is how the lobar form of diphtheria conjunctivitis manifests itself. In children under one year of age, diphtheria of the eyes, as a rule, is manifested only by a slight swelling and hyperemia of the conjunctiva with a cyanotic tint, there are almost no films. This is the catarrhal form of diphtheria. 5. Treatment of bacterial conjunctivitis I. Toilet of the eyelids: washing the conjunctival cavity with weak solutions of disinfectants (2% boric acid solution, furatsilin solution at a dilution of 1: 5000, etc.). II. Local effect on the pathogen, taking into account its sensitivity to various drugs. For this, drops and ointments with antibiotics and sulfonamides are prescribed. The frequency of instillations is determined by the severity of the disease. In severe cases, drops are prescribed every hour. The ointment is applied in the morning, afternoon and evening. III. To prevent damage to the cornea, various antibacterial and vitamin ointments are shown. IV. General therapy. 6. Adenopharyngoconjunctival fever (AFCL) At an outpatient appointment, a child may meet with symptoms of conjunctivitis, which, according to the anamnesis, developed against the background of pharyngitis and fever. In this case, photophobia and blepharospasm are sometimes detected. The conjunctiva is hyperemic, edematous, but the discharge is poor, mucous. You should remember about the age-related features of AFCL. Thus, in children one to two years old, edema and hyperemia are moderate, scanty serous mucous discharge is noted, there may be films on the conjunctiva of the eyelids, usually tender, they are easily removed (membranous form). The duration of the illness is about ten days. In schoolchildren, conjunctival hyperemia is combined with the presence on the mucous membrane of the eyelids and transitional folds (usually below) of grayish-pink gelatinous follicles and papillae (follicular form). The follicles disappear without a trace after two weeks. In school-age children, swelling of the eyelids, hyperemia and slight swelling of the conjunctiva with a delicate grayish-bluish coating (catarrhal form) are more often observed. The illness lasts eight to ten days. 7. Epidemic follicular keratoconjunctivitis (EFCC) Acute inflammation of the conjunctiva, sharp hyperemia of the conjunctiva of the eyelids, transitional folds, eyeball, a large number of small grayish-pink follicles and papillae, scanty mucous discharge, enlargement and tenderness of the preauricular and submandibular lymph nodes allow one to suspect an adenoviral disease. These signs may be accompanied by pinpoint or coin-shaped superficial subepithelial infiltrates in the cornea after a week, and sometimes after one to two months. The epithelium over them is often preserved and not stained. The disease lasts from two to seven weeks and is called epidemic follicular keratoconjunctivitis. 8. Treatment of adenovirus conjunctivitis Children with adenoviral conjunctivitis should undergo treatment in boxed hospital departments. They are isolated from children's groups for a period of twenty days. In order to prevent complications and fight secondary infections, tetracycline antibiotics are prescribed in the form of 1% ointments. Instillations of a 0,050,1% solution of deoxyribonuclease are used as a virusostatic agent. In severe cases, globulin is injected locally and intramuscularly. Local and general use of vitamins B, D, C and absorbable drugs is also indicated. 9. Tumors of the conjunctiva Sometimes blurry bluish areas are found on the conjunctiva of the eyelids and the eyeball, somewhat rising above the level of the rest of the conjunctiva, which increase with straining and crying, they grow rapidly in the first year of a child's life. This clinical picture is typical for hemangioma. When examining the conjunctiva of the eyeball at the limbus, transparent, yellowish, slightly raised formations with or without vessels, so-called pigmentless nevi, can be found. If such formations contain inclusions of pigment, and their color varies from light brown to black, and they often tend to grow, then they speak of pigmented nevi. Sometimes, in the inferolateral segment of the eyeball, a round or oval-shaped formation of a whitish-yellow color and dense elastic consistency is detected, on the surface of which there are hairs. Treatment of benign tumors of the mucous membrane consists in their prompt removal. In the treatment of small non-pigmented and especially pigmented nevi in non-limbal localization, photocoagulation is used. Author: Shilnikov L.V. << Back: Diagnosis, clinical picture and treatment of conjunctival diseases (General provisions. Conjunctivitis) >> Forward: Trachoma
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