ACUTE MEMBRANOUS CONJUNCTIVITIS

It is an acute inflammation of the conjunctiva,
characterized by formation of a true membrane on the
conjunctiva. Now-a-days it is of very-very rare
occurrence, because of markedly decreased
incidence of diphtheria. It is because of the fact that
immunization against diptheria is very effective.

Etiology
The disease is typically caused by Corynebacterium
diphtheriae and occasionally by virulent type of

Streptococcus haemolyticus.

Pathology
Corynebacterium diphtheriae produces a violent
inflammation of the conjunctiva, associated with
deposition of fibrinous exudate on the surface as well
as in the substance of the conjunctiva resulting in
formation of a membrane. Usually membrane is formed
in the palpebral conjunctiva. There is associated
coagulative necrosis, resulting in sloughing of
membrane. Ultimately healing takes place by
granulation tissue.

Clinical features
The disease usually affects children between 2-8
years of age who are not immunised against
diphtheria. The disease may have a mild or very severe
course. The child is toxic and febrile. The clinical
picture of the disease can be divided into three stages:
1. Stage of infiltration is characterised by:

•  Scanty conjunctival discharge and severe pain in the eye.
•  Lids are swollen and hard.
•  Conjunctiva is red, swollen and covered with a thick grey-yellow membrane (Fig. 1). The membrane is tough and firmly adherent to the conjunctiva, which on removing bleeds and leaves behind a raw area.

  

  Fig. 1. Acute membranous conjunctivitis.

  
  
  
  
•  Pre-auricular lymph nodes are enlarged.

2. Stage of suppuration. In this stage, pain
decreases and the lids become soft. The
membrane is sloughed off leaving a raw surface.
There is copious outpouring of purulent
discharge.

3. Stage of cicatrisation. In this stage, the raw
surface covered with granulation tissue is
epithelised. Healing occurs by cicatrisation, which
may cause trichiasis and conjunctival xerosis.

Complications
1. Corneal ulceration is a frequent complication in
acute stage. The bacteria may even involve the
intact corneal epithelium.
2. Delayed complications due to cicatrization include
symblepharon, trichiasis, entropion and
conjunctival xerosis.

Diagnosis
Diagnosis is made from typical clinical features and
confirmed by bacteriological examination.

Treatment
A. Topical therapy
1. Penicillin eye drops (1:10000 units per ml) should
be instilled every half hourly.
2. Antidiphtheric serum (ADS) should be instilled
every one hour.
3. Atropine sulfate 1 percent ointment should be
added if cornea is ulcerated.
4. Broad spectrum antibiotic ointment should be
applied at bed time.

B. Systemic therapy
1. Crystalline penicillin 5 lac units should be
injected intramuscularly twice a day for 10 days.
2. Antidiphtheric serum (ADS) (50 thousand units)
should be given intramuscularly stat.

C. Prevention of symblepharon
Once the membrane is sloughed off, the healing of
raw surfaces will result in symblepharon, which should
be prevented by applying contact shell or sweeping
the fornices with a glass rod smeared with ointment.

Prophylaxis
1. Isolation of patient will prevent family members
from being infected.
2. Proper immunization against diphtheria is very
effective and provides protection to the
community.