Conjunctivitis and keratitis in children

Conjunctivitis is an inflammatory reaction of the conjunctiva to various effects. Characterized by hyperemia and edema, discharge from the conjunctiva, formation of follicles or papillae on it; conjunctivitis may be accompanied by edema and itching of the eyelids, damage to the cornea with decreased vision. Conjunctivitis accounts for about 30% of all eye pathology and 68.1% of the total number of inflammatory eye diseases.

Keratitis is a group of diseases in which, as a result of the inflammatory process and deterioration of trophism, an infiltrate is formed in various parts of the cornea, a decrease or loss of transparency of the cornea and a decrease in visual acuity occur. Keratitis diseases account for about 5% of all inflammatory eye pathologies. Among them, the first place (up to 55-60%) belongs to herpes virus keratitis. Up to 50% of persistent vision loss and 60% of corneal blindness are associated with keratitis.

Classification of conjunctivitis

Infectious

• Bacterial:
  • acute staphylococcal and streptococcal: <> pneumococcal;
  • diplobacillary;
  • acute epidemic;
  • diphtheria:
  • gonococcal (gonoblennorrhea).
• Chlamydial:
  • trachoma;
  • chlamydial conjunctivitis in adults (paratrachoma);
  • chlamydial conjunctivitis (ophthalmia) of newborns (epidemic chlamydial conjunctivitis).
• Viral:
  • adenoviral conjunctivitis (pharyngoconjunctival fever);
  • epidemic keratoconjunctivitis;
  • epidemic hemorrhagic conjunctivitis;
  • herpetic conjunctivitis;
  • conjunctivitis in common viral diseases (chickenpox, measles, rubella);
  • conjunctivitis caused by the molluscum contagiosum virus.

Non-infectious

• Allergic:
  • pollinosis (hay conjunctivitis);
  • spring catarrh;
  • hyperpapillary conjunctivitis:
  • drug-induced conjunctivitis;
  • infectious-allergic.

Diagnosis of conjunctivitis

To diagnose bacterial conjunctivitis and rationally select antimicrobial treatment, the following studies are carried out:

• bacterioscopy of smears from the conjunctiva with Gram staining (detection of intracellular gram-negative diplococci confirms the diagnosis of gonococcal conjunctivitis) or Romanovsky-Giemsa (to detect eosinophils and cytoplasmic inclusions of chlamydia, the so-called Prowaczek-Halberstadter bodies);
• bacteriological examination - sowing of discharge from the eyes on nutrient media and determination of sensitivity to antibiotics; sowing on McCaw cell culture (for chlamydial conjunctivitis);
• cytological examination of conjunctival scrapings (bacterial conjunctivitis is characterized by a large number of neutrophils and no changes in epithelial cells);
• immunological and serological studies to detect antibodies to bacterial allergens.

Diagnosis of keratitis

• Conjunctival smear, stained with methylene blue and Gram stain.
• Sowing from the conjunctiva onto nutrient media.
• Scraping with a platinum loop from the ulcer surface and ulcer edges. Microscopy of the scraping material applied to a glass slide or seeding of the material on elective nutrient media provides the most effective analysis in differential diagnostics with fungi and amoebae.
• A smear-print from a corneal ulcer is taken for deep ulcers of the cornea. The isolated microflora is examined for pathogenicity and sensitivity to antibiotics.
• Immunofluorescence examination of conjunctival scrapings to detect herpes simplex virus.

Differential diagnostics

It is necessary to differentiate conjunctivitis from the following diseases:

• keratitis;
• iritis;
• episcleritis;
• attack of glaucoma.

Forecast

• Conjunctivitis caused by Pseudomonas aeruginosa and gonococcus often leads to corneal ulceration, perforation, and loss of the eye.
• In epidemic keratoconjunctivitis, the cornea may be affected, with the formation of coin-shaped opacities that reduce visual acuity.
• In case of spring keratoconjunctivitis with corneal damage (thyroid corneal ulcer, hyperkeratosis), a persistent decrease in visual acuity is possible.
• With other bacterial conjunctivitis, the prognosis is usually favorable.

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