Conjunctivitis and keratitis in children

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

Keratitis is a group of diseases in which the infiltration in various parts of the cornea is formed as a result of the inflammatory process and the deterioration of the trophism, the corneal transparency is reduced or lost and the visual acuity is reduced. The share of keratitis diseases accounts for about 5% of all inflammatory ocular pathology. Among them, the first place (up to 55-60%) belongs to herpes-viral keratitis. With keratitis associated with up to 50% of persistent decline in vision and 60% of corneal blindness.

Classification of conjunctivitis

Infectious

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

Non-infectious

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

Diagnosis of conjunctivitis

For the diagnosis of bacterial conjunctivitis and the rational choice of antimicrobial treatment, the necessary studies are carried out:

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

Diagnosis of keratitis

• Smear with conjunctiva, color methylene blue and Gram.
• Seeding with conjunctiva on nutrient media.
• Soskob platinum loop from the ulcer surface and the edges of the ulcer. The microscopy of the scraping material deposited on the slide, or sifting the material onto elective nutrient media, gives the most effective analysis in differential diagnosis with fungi and amoebae.
• A smear-imprint with corneal ulcers is taken with deep ulcers of the cornea. The isolated microflora is investigated for pathogenicity and sensitivity to antibiotics.
• Immunofluorescence study of scrapings with conjunctiva for the detection of herpes simplex virus.

Differential diagnostics

It is necessary to differentiate conjunctivitis from the following diseases:

• keratitis;
• irit;
• episcleritis;
• an attack of glaucoma.

Forecast

• Conjunctivitis caused by Pseudomonas aeruginosa and gonococcus often leads to ulceration of the cornea, its perforation and loss of the eye.
• With epidemic keratoconjunctivitis, it is possible to damage the cornea with the formation of coin-like opacities that reduce visual acuity.
• With spring keratoconjunctivitis with corneal involvement (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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