Chemical
Usually self-limiting; possibly irrigation with warm saline
Gonococcal
Hospitalization; isolation (at least 24 h after therapy is initiated)
IV aqueous penicillin G 100,000 units/kg/day in four doses daily for 7 days
Saline irrigation
Topical antibiotics – not exceeded with IVRx; effective against gonococcus
Antibiotic sensitivities; if penicillin therapy fails, sensitivities used to dictate actiona
Chlamydial
Oral erythromycin syrup, 30–50 mg/kg/day in four doses daily for 2 weeks (Optional: topical 1 % tetracycline or 10 % sulfonamide four to six times daily)
Herpetic
Topical trifluridine 1 % every 2 h for 7 days (not longer than 2 weeks) or acyclovir 10 mg/kg IV every 8 h for 10 days
Other bacteria
0.5 % erythromycin ointment or 1 % tetracycline ointment every 4 h for 7 days; smear is Gram-positive cocci
0.3 % gentamicin or tobramycin 1 drop every 4 h for 7 days; smear is Gram-negative cocci
Conjunctival scrapings and cultures are essential in neonatal conjunctivitis. Corneal scrapings stained with Gram and Giemsa may show Gram-negative intracellular diplococci in polymorphonuclear cells in cases of Neisseria gonorrhoeae. In Chlamydial conjunctivitis, also known as inclusion blenorrhea, conjunctival scrapings show basophilic paranuclear cystoplasmic inclusion bodies. Lymphocytes, plasma cells, and macrophages with epithelial debris known as Leber’s cells.
In herpetic conjunctivitis, multinucleated epithelial cells are seen with mononuclear cellular infiltration. In patients with other bacterial infections, Gram-positive or Gram-negative cocci or bacilli may be seen. Neonatal conjunctivitis due to chemical reaction may show neutrophils and occasional lymphocytes on Giemsa stain. Chemical conjunctivitis occurs to some degree in eyes treated prophylactically with 1 % silver nitrate. Silver nitrate 1 % eyedrops can bind to bacterial protein but at the same time adhere to conjunctival cellular protein and can cause irritation and inflammation.
6.8 Bartonella Conjunctivitis (Cat-Scratch Disease)
Bartonella conjunctivitis (cat-scratch disease) is a cause of Parinaud’s oculoglandular conjunctivitis. The disease is usually unilateral, and the conjunctival granuloma occurs over the palpebral conjunctiva with preauricular lymph node. The most common cause is Bartonella henselae, but other infectious agents may cause Parinaud’s oculoglandular conjunctivitis including Pasteurella (Francisella) tularensis, Mycobacterium tuberculosis, Treponema pallidum, Yersinia species, Haemophilus ducreyi, lymphogranuloma venereum, sporotrichosis, Coccidioides immitis, mumps, and Epstein-Barr virus (Table 6.2) [4]. Bartonella oculoglandular disease can lead to chronic conjunctivitis. The disease is caused by Gram-negative pleomorphic bacterium known as Bartonella henselae.
Table 6.2
Etiology of oculoglandular conjunctivitis
Cause | Organism | Disease |
|---|---|---|
Bacteria | Bartonella henselae | Parinaud’s oculoglandular conjunctivitis (cat-scratch disease) |
Francisella tularensis | Tularemia | |
Mycobacterium tuberculosis | Tuberculosis | |
Treponema pallidum | Syphilis | |
Yersinia spp.a | Yersinia infection | |
Haemophilus ducreyi a | Chancroid | |
Listeria monocytogenes a | Listerellosis | |
Chlamydiae | Lymphogranuloma venereum agent | Lymphogranuloma venereum |
Inclusion conjunctivitis agent | Inclusion conjunctivitis | |
Fungi | Sporotrichum schenckii a | Sporotrichosis |
Coccidioides immitis | Coccidioidomycosis | |
Actinomyces israelii a | Actinomycosis | |
Blastomyces dermatitidis a
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