ACUTE MUCOPURULENT CONJUNCTIVITIS AND OTHER TYPES OF CONJUNCTIVITIS

CLINICAL TYPES OF BACTERIAL
CONJUNCTIVITIS

Depending upon the causative bacteria and the
severity of infection, bacterial conjunctivitis may
present in following clinical forms:

•  Acute catarrhal or mucopurulent conjunctivitis. (DISCUSSED BELOW)
•  Acute purulent conjunctivitis (visit link)
•  Acute membranous conjunctivitis (visit link)
•  Acute pseudomembranous conjunctivitis (visit link)
•  Chronic bacterial conjunctivitis (visit link)
•  Chronic angular conjunctivitis (DISCUSSED IN COMING POSTS)

ACUTE MUCOPURULENT CONJUNCTIVITIS
Acute mucopurulent conjunctivitis is the most
common type of 
acute bacterial conjunctivitis. It is
characterised by marked conjunctival hyperaemia and
mucopurulent discharge from the eye.

Common causative bacteria are: Staphylococcus
aureus, Koch-Weeks bacillus, Pneumococcus and
Streptococcus. Mucopurulent conjunctivitis
generally accompanies exanthemata such as measles
and scarlet fever.

Clinical picture
Symptoms

•  Discomfort and foreign body sensation due to engorgement of vessels.
•  Mild photophobia, i.e., difficulty to tolerate light.
•  Mucopurulent discharge from the eyes.
•  Sticking together of lid margins with discharge during sleep.
•  Slight blurring of vision due to mucous flakes in front of cornea.
•  Sometimes patient may complain of coloured halos due to prismatic effect of mucus present on cornea.

Signs (Fig.1)

• Conjunctival congestion, which is more marked in palpebral conjunctiva, fornices and peripheral part of bulbar conjunctiva, giving the appearance of ‘fiery red eye’. The congestion is typically less marked in circumcorneal zone.
• Chemosis i.e., swelling of conjunctiva.
• Petechial haemorrhages are seen when the causative organism is pneumococcus.

• Flakes of mucopus are seen in the fornices, canthi and lid margins.
• Cilia are usually matted together with yellow crusts.
  
  

Clinical course. Mucopurulent conjunctivitis
reaches its height in three to four days. If untreated,
in mild cases the infection may be overcome and the
condition is cured in 10-15 days; or it may pass to
less intense form, the ‘chronic catarrhal
conjunctivitis’.

Complications. Occasionally the disease may be
complicated by marginal corneal ulcer, superficial
keratitis, blepharitis or dacryocystitis.
Differential diagnosis
1. From other causes of acute red eye .
2. From other types of conjunctivitis. It is made out
from the typical clinical picture of disease and is
confirmed by conjunctival cytology and
bacteriological examination of secretions and
scrapings (Table 4.1).

Treatment
1. Topical antibiotics to control the infection
constitute the main treatment of acute
mucopurulent conjunctivitis. Ideally, the antibiotic
should be selected after culture and sensitivity
tests but in practice, it is difficult. However, in
routine, most of the patients respond well to
broad specturm antibiotics. Therefore, treatment
may be started with chloramphenicol (1%),
gentamycin (0.3%) or framycetin eye drops 3-4
hourly in day and ointment used at night will not
only provide antibiotic cover but also help to
reduce the early morning stickiness. If the patient
does not respond to these antibiotics, then the
newer antibiotic drops such as ciprofloxacin
(0.3%), ofloxacin (0.3%) or gatifloxacin (0.3%)
may be used.

2. Irrigation of conjunctival sac with sterile warm
saline once or twice a day will help by removing
the deleterious material. Frequent eyewash (as advocated earlier) is however contraindicated as
it will wash away the lysozyme and other
protective proteins present in tears.

3. Dark goggles may be used to prevent photophobia.

4. No bandage should be applied in patients with
mucopurulent conjunctivitis. Exposure to air keeps
the temperature of conjunctival cul-de-sac low
which inhibits the bacterial growth; while after
bandaging, conjunctival sac is converted into an
incubator, and thus infection flares to a severe
degree within 24 hours. Further, bandaging of
eye will also prevent the escape of discharge.

5. No steroids should be applied, otherwise infection
will flare up and bacterial corneal ulcer may
develop.

6. Anti-inflammatory and analgesic drugs (e.g.
ibuprofen and paracetamol) may be given orally
for 2-3 days to provide symptomatic relief from
mild pain especially in sensitive patients.