Monday, December 26, 2016

Membranous and pseudo-membranous conjunctivitis notes

Pseudo-membranous conjunctivitis: mild form
Membranous conjunctivitis: severe form

Causative agents:
Corynebacterium diphtheriae
Beta- hemolytic streptococci
Streptococcus pneumoniae
Neisseria gonorrheae

Associated conditions:
Erythema multiforme
Stevens- Johnson syndrome

- Lid swelling
- mucopurulent bloody discharge
- white membrane
- easily peel off without bleeding

- Lids are hardened
- semisolid exudates: result in necrosis of conjunctiva and cornea
- difficult to peel off
- associated with bleeding from the undersurface

Important points to be noted:-
- The membrane forms more commonly over palpebral conjunctiva beginning from the edge of lid.
- There is enlarged preauricular lymph nodes with suppurative discharge.
- Marginal corneal ulcer due to secondary infection (especially streptococci).
- high risk of symblephron (adhesion between palpebral and bulbar conjunctiva)

- Penicillin (10,000 units/ ml) is the doc for acute diphtherial infection. Systemic administration and a quick injection of anti- diphtheritic serum (4,000- 10,000 units BD) 
- Removal of the membranes is not advised because of the risk of adhesion (symblephron).
- Local and systemic administration of bacitracin and penicillin is recommended in case of streptococcal infection.

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