ANGULAR CONJUNCTIVITIS is a type of chronic conjunctivitis characterised by mild grade inflammation confined to the conjunctiva and lid margins near the angles (hence the name) associated with maceration of the surrounding skin.
Etiology
1. Predisposing factors are same as for 'simple chronic conjunctivitis'.
2. Causative organisms. Moraxella Axenfeld is the commonest causative organism. MA bacilli are placed end to end, so the disease is also called
'diplobacillary conjunctivitis'. Rarely, staphylococci may also cause angular conjunctivitis.
3. Source of infection is usually nasal cavity.
4. Mode of infection. Infection is transmitted from nasal cavity to the eyes by contaminated fingers or handkerchief.
Etiology
1. Predisposing factors are same as for 'simple chronic conjunctivitis'.
2. Causative organisms. Moraxella Axenfeld is the commonest causative organism. MA bacilli are placed end to end, so the disease is also called
'diplobacillary conjunctivitis'. Rarely, staphylococci may also cause angular conjunctivitis.
3. Source of infection is usually nasal cavity.
4. Mode of infection. Infection is transmitted from nasal cavity to the eyes by contaminated fingers or handkerchief.
Pathology
The causative organism, i.e., MA bacillus produces a proteolytic enzyme which acts by macerating the epithelium. This proteolytic enzyme collects at the
angles by the action of tears and thus macerates the epithelium of the conjunctiva, lid margin and the skin the surrounding angles of eye. The maceration is followed by vascular and cellular responses in the form of mild grade chronic inflammation. Skin may show eczematous changes.
Clinical picture
Symptoms
The causative organism, i.e., MA bacillus produces a proteolytic enzyme which acts by macerating the epithelium. This proteolytic enzyme collects at the
angles by the action of tears and thus macerates the epithelium of the conjunctiva, lid margin and the skin the surrounding angles of eye. The maceration is followed by vascular and cellular responses in the form of mild grade chronic inflammation. Skin may show eczematous changes.
Clinical picture
- Irritation, smarting sensation and feeling of discomfort in the eyes.
- History of collection of dirty-white foamy discharge at the angles.
- Redness in the angles of eyes.
Signs (Fig. 1) include:
- Hyperaemia of bulbar conjunctiva near the canthi.
- Hyperaemia of lid margins near the angles.
- Excoriation of the skin around the angles.
- Presence of foamy mucopurulent discharge at the angles.
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| (Fig. 1) Signs of angular conjunctivitis. |
Complications include: blepharitis and shallow
marginal catarrhal corneal ulceration.
A. Prophylaxis includes treatment of associated nasal infection and good personal hygiene.
B. Curative treatment consists of :
1. Oxytetracycline (1%) eye ointment 2-3 times a day for 9-14 days will eradicate the infection.
2. Zinc lotion instilled in day time and zinc oxide ointment at bed time inhibits the proteolytic ferment and thus helps in reducing the maceration.
good work.
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