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TABLE I MAIN CLINICAL DIAGNOSTIC GUIDELINES

TABLE II MAIN DIAGNOSTIC GUIDELINES

Cause

Main causing factor

Duration

Main ocular manifestations

Systemic manifestations

Bacterial

Usually Strepto- cocci and Sta- phylococci, less frequently Haemophilus (children) and enteric gram- negative orga- nisms

5 – 7 days

Sticky purulent discharge, moderate conjunctival hyperaemia, crustings on the eyelids and/or lashes, lids sticking in the morning upon waking due to puru- lent discharge. Corneal involvement is very uncommon.

None

Hyper-acute bacterial

Often caused by Neisseria species (N. gonorrhoeae, meningitides) less often by other bacteria e.g. Pseudomonas aeruginosa

Develops usually in new- borns and less often in adult patient. Bilateral, severe, fulminating conjunctivitis with profuse lid and con- junctival oedema, very copious, yellow-green, purulent discharge. There is a high risk of corneal infil- tration and corneal perfora- tion within hours. Can lead to blindness.

In neonates, septicae- mia with arthritis and meningitis may deve- lop. In adults, septi- caemia with arthritis and pelvic inflamma- tory disease (rarely). Examine the patient and his/her sexual partner (venereal disease).

Viral

Usually adeno- viruses, herpes simplex viruses, less frequently varicella-zoster viruses, picorna- viruses, molu- scum contagio- sum, or pox and papilloma viru- ses

2 – 3 weeks

Significant conjunctival hyperaemia, copious, clear, watery, serous discharge, eyelid oedema, follicular conjunctival reaction, sub- and conjunctival haemor- rhages (picornaviruses). Typical vesicular eyelid rash in herpes simplex and vesi- cular skin eruptions in zoster, umbilical eyelid lesions in molluscum infec- tions, verrucae in papilloma virus infection. Often cor- neal involvement (keratitis). Very contagious.

Frequent history of recent fever, upper respiratory tract infections or pharyn- gitis. Enlarged preau- ricular lymph nodes, adenopathia.

Chlamydial

Chlamydia tra- chomatis, psit- taci and pneu- moniae

More than 3 weeks with exa- cerbations and remis- sions

Mucopurulent discharge, moderate hyperaemia, folli- cular conjunctival reaction, pseudoptosis. Often corneal involvement (keratitis and pannus). Corneal changes and con- junctival cicatrization the most frequent in trachoma.

Pneumonia and otitis (in children), cervicitis and/or vaginitis (in women), symptoma- tic or non-symptoma- tic urethritis (in men), enlarged preauricular lymph nodes. Examine the patient and his/her sexual part- ner (venereal disease).

58

INFECTIOUS CONJUNCTIVITIS

TABLE III INTERPRETATION OF CONJUNCTIVAL CYTOLOGY RESULTS IN DIFFERENT TYPES OF CONJUNCTIVITIS

INFECTIOUS CONJUNCTIVITIS

59

Bacterial

Diagnosed on the basis of medical history and eye exa- mination. Diagnostic tests are indicated in neonatal bac- terial conjunctivitis, difficult clinical cases, recurrent con- junctivitis and in patients not responding to medication.

Hyper-acute bacterial

It is mandatory to perform slide stains, cultures and anti- biotic sensitivity as a matter of urgency.

Viral

Diagnosed on the basis of medical history and eye exa- mination. Tests (viral cultures and immunodiagnostic) are not very helpful but can be performed in diagnosti- cally difficult cases only.

Chlamydial

If diagnosis can not been made on a clinical basis per- formance of cytology (Halberstaedter – von Provazek bodies), direct immunofluorescent antibody test, ELISA and PCR tests of ocular specimens may be helpful.

Bacterial

Polymorphonuclear leucocytes

Viral

Mononuclear cells (lymphocytes and monocytes)

Chlamydial

Polymorphonuclear leucocytes, monocytes and perinu- clear inclusions (Halberstaedter – von Provazek bodies)

Allergic

Eosinophils and basophils

Fungal

Polymorphonuclear leucocytes and giant cells with orga- nisms

Acanthamoeba

Corneal cysts

Type of conjunctivitis

Suggested diagnostic tests

Type of conjunctivitis

Cytology of the conjunctival smear

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