Medical expert of the article
New publications
Diphtheria of the eye
Last reviewed: 04.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
[ Causes and epidemiology of ocular diphtheria
The causative agent of diphtheria is the Loeffler bacillus, which secretes an exotoxin. The source of infection is a sick person or a carrier. Currently, the main source of infection is carriers, which can be healthy people. The Loeffler bacillus is excreted from the body of a sick person or carrier with pharyngeal and nasal mucus. The route of transmission is airborne.
Pathogenesis of diphtheria of the eye
The pathogen, having penetrated the body, remains at the site of the entry gate (pharynx, upper respiratory tract, conjunctiva), causing necrosis of the mucous membrane with the formation of fibrinous films tightly fused with the underlying tissues. The exotoxin secreted by the bacillus causes both local and general signs of the disease, absorbed into the blood, it damages various organs.
Symptoms of diphtheria of the eye
The incubation period is from 2 to 10 days. Children aged 2-10 years are most often affected. Clinically, several forms of the disease are distinguished: diphtheria of the pharynx, larynx, nose, eye, and combined forms. Diphtheria of the eyes is a rare form and is mainly combined with diphtheria of the upper respiratory tract. Primary independent diphtheria lesion of the skin of the eyelids and mucous membrane of the eyes is extremely rare (Fig. 15).
Diphtheria of the eyelid skin occurs after damage or in the presence of diphtheria of the pharynx, nose, and eye mucosa. It is characterized by hyperemia of the eyelid skin and the appearance of transparent blisters. The blisters quickly burst and in their place there remains a grayish scab, which gradually increases and turns into a painless ulcer. The outcome is cicatricial changes, leading in some cases to deformation of the eyelids.
Diphtheritic conjunctivitis is more common than eyelid skin lesions and can clinically manifest itself in various forms: diphtheritic, croupous and catarrhal.
The diphtheritic form is the most severe. It begins with a sharp swelling, compaction and hyperemia of the eyelids, especially the upper one. The eyelids are so dense that they cannot be everted. The discharge from the conjunctival cavity is insignificant, mucopurulent. After 1-3 days, the eyelids become softer, the amount of discharge increases. The appearance of dirty-gray films, tightly fused with the underlying tissue, on the mucous membrane of the eyelid cartilages, transitional folds, in the intercostal space, on the skin of the eyelids, sometimes on the mucous membrane of the eyeball is characteristic. When attempting to remove them, a bleeding and ulcerated surface is exposed. From the appearance of films to their spontaneous rejection, 7-10 days pass. During the period of rejection of films, the discharge becomes purely purulent. As a result of the disease, stellate scars are formed on the mucous membrane. Sometimes fusion of the eyelids with the eyeball develops (symblepharon). Inversion of the eyelids and trichiasis are possible. One of the most serious complications of diphtheritic conjunctivitis is the appearance of corneal ulcers due to a violation of its trophism, the effect of diphtheria toxin, and the accumulation of pyogenic infection. In some cases, panophthalmitis may develop with subsequent wrinkling of the eyeball. According to E. I. Kovalevsky (1970), this form of the disease occurs in 6% of cases of diphtheria of the mucous membrane of the eye.
The croupous form is observed much more often (80%). In the croupous form, inflammatory phenomena are expressed less strongly. Films are formed mainly on the mucous membrane of the eyelids, rarely - transitional folds. They are delicate, grayish-dirty in color, superficial, easily removed, exposing a slightly bleeding surface. Scars remain in place of the films only in rare cases. The cornea, as a rule, is not involved in the process. The outcome is favorable.
The mildest form of diphtheritic conjunctivitis is the catarrhal form, which is observed in 14% of cases. In this form, there are no films, only hyperemia and edema of the conjunctiva of varying intensity are observed. General phenomena are expressed insignificantly.
The diagnosis of conjunctival diphtheria is made on the basis of the general and local clinical picture, data from a bacteriological examination of smears from the mucous membrane of the eye, nasopharynx and epidemiological history.
Where does it hurt?
What's bothering you?
What do need to examine?
How to examine?
What tests are needed?
Differential diagnosis of ocular diphtheria
The disease should be distinguished from membranous pneumococcal, diphtheria-like adenovirus conjunctivitis and epidemic Koch-Weeks conjunctivitis. The first is characterized by catarrh of the upper respiratory tract or pneumonia, the presence of pneumococci in the discharge of the conjunctival cavity. The diphtheria-like form of adenovirus conjunctivitis in some cases also occurs with the formation of films and clinically resembles the diphtheritic or croupous form of diphtheria of the eye, but unlike the latter, the patient develops catarrh of the upper respiratory tract, there is an increase in and soreness of the preauricular lymph nodes; mainly infants and young children are affected. The films in the diphtheria-like form of adenovirus conjunctivitis are gray, tender, and easily removed. The discharge is very scanty, mucopurulent and does not contain Leffler's bacilli.
Epidemic conjunctivitis Koch-Weeks is more common in areas with a hot climate. Films are yellow-brown. Characteristic are pronounced chemosis of the mucous membrane, subconjunctival hemorrhages, hyaline degeneration of the mucous membrane according to the open eye slit. Bacteriological examination reveals Koch-Weeks bacilli.
It should be noted that diphtheria may cause complications from the organ of vision. These are primarily toxic lesions of the oculomotor nerves, leading to paralysis of accommodation, ptosis, development of strabismus (usually convergent), as a result of paresis or paralysis of the abducens nerve. With paralysis of the facial nerve, lagophthalmos is observed. Toxic diphtheritic neuritis of the optic nerve in children is rare.
In diagnosing diphtheria of any localization, the leading role belongs to bacteriological examination, which is carried out in bacteriological laboratories. Usually, mucus from the pharynx, nose, discharge from the conjunctival cavity, etc. is examined. The material must be delivered to the laboratory no later than 3 hours after collection. Bacteriological examination (staining smears with aniline dye) is used only as a preliminary method. It is not informative enough due to the frequent presence of xerosis bacilli in the conjunctival cavity, morphologically similar to the diphtheria bacilli.
Who to contact?
Treatment of diphtheria of the eye
A patient with diphtheria of the eye is necessarily sent to an infectious diseases hospital by special transport. Treatment begins with immediate administration of antidiphtheria antitoxic serum using the Bezredka method. The amount of serum administered depends on the localization of the process and the severity of the disease. For localized diphtheria of the eye, as well as the pharynx and nose, 10,000-15,000 AE are administered (up to 30,000-40,000 AE per course), with widespread diphtheria, the doses are increased. Along with the serum, tetracycline antibiotics and erythromycin are prescribed in age-appropriate doses for 5-7 days. Detoxification therapy (hemodez, polyglucin), vitamin therapy (vitamins C, group B) are indicated. Before applying local eye treatment measures, it is necessary to take discharge from the conjunctival cavity, from the surface of the film for bacteriological examination. Local treatment of the eyes consists of frequent washing of the eyes with warm disinfectant solutions, instillation of antibiotic solutions, and application of eye ointments with tetracycline antibiotics behind the eyelids. Depending on the condition of the cornea, mydriatics or miotics are prescribed.
If diphtheria of the eye is suspected, the patient is hospitalized in the diagnostic department of the infectious diseases hospital, where they conduct an examination and clarify the diagnosis. The office where the patient with diphtheria was received is subject to special disinfection.
Prevention of diphtheria of the eye
Prevention of ocular diphtheria consists of isolation, timely and correct treatment of patients with diphtheria of the upper respiratory tract, active immunization, early detection of carriers of the bacteria and their treatment.
The prognosis for diphtheria of the eye is serious due to frequent complications involving the cornea.