Acute Purulent Conjunctivitis - Causes, Types, Symptoms, Diagnosis, and Management

What Is Conjunctivitis?

Conjunctivitis is defined as the inflammation of the conjunctiva of the eyes. Conjunctiva is the outer membrane that lines the inner eyelid and continues to cover the eye's sclera and cornea. It helps in lubricating and protecting the eyes by producing tears.

What Is the Structural Anatomy of the Conjunctiva?

The conjunctiva is a thin layer of elastic tissue. It is primarily composed of two parts:

• The palpebral conjunctiva.

• The bulbar conjunctiva.

The palpebral conjunctiva covers the inner lining of the eyelids. In contrast, the bulbar conjunctiva covers the sclera (the white outermost layer of the eyes), episclera (it is the clear thin tissue covering the opaque sclera), and the uvea (it forms the middle layer of the eyes and consists of the iris, ciliary body, and choroid.

How Is Common Bacterial Conjunctivitis of the Eyes?

Adult bacterial conjunctivitis is a self-limiting condition. It accounts for 19 to 57 % of all acute conjunctivitis.

What Causes Conjunctivitis of the Eyes?

Conjunctivitis, or the pink eye of the eyes, is of multifactorial origin. The several factors responsible for causing conjunctivitis are:

• Bacteria.

• Virus.

• Fungus.

• Allergy.

• Immunological.

• Mechanical irritation.

• Medications.

• Chemicals.

• Pollutants.

Who Is at Increased Risk of Acquiring Bacterial Conjunctivitis?

People who are more vulnerable to acquiring conjunctivitis of the eyes are:

• People with poor hygiene habits.

• Poor contact lens hygiene.

• Use of contaminated eye cosmetics.

• Chronic topical medication use.

• Immunocompromised patients.

• Neonates.

• People with a recent history of ocular surgery.

How Does Conjunctivitis Spread?

Bacterial conjunctivitis is the most contagious of all conjunctivitis. It can spread from an infected person to another individual by:

• Direct contact with the infected person's hand.

• From inanimate objects.

• From mother to child during vaginal delivery.

What Are the Different Types of Conjunctivitis?

Conjunctivitis can be divided based on the time of onset.

• Acute conjunctivitis.

• Hyperacute bacterial conjunctivitis.

• Chronic conjunctivitis.

• Recurrent conjunctivitis.

What Is Acute Purulent Conjunctivitis?

Bacterial conjunctivitis can be acute or chronic conjunctivitis. However, the acute form of bacterial conjunctivitis is the most common form of conjunctivitis. The acute form of the is caused by:

• Staphylococcus aureus.

• Streptococcus pneumoniae.

• Hemophilus influenzae.

What Is Hyperacute Bacterial Conjunctivitis?

Hyperacute conjunctivitis of the eyes is a serious vision-threatening condition. It is characterized by the discharge of yellow to green purulent material from the eyes. It occurs suddenly and has rapid progress. Patients with hyperacute bacterial conjunctivitis also present with:

• Severe redness of the eyes.

• Irritation.

• Excessive edema of the eyes.

• Preauricular lymphadenopathy.

• Serous discharge.

• Perforation of cornea.

Which Organisms Are Responsible for Hyperacute Conjunctivitis?

The organisms that are mainly involved in the initiation and progression of the condition are:

• Neisseria gonorrhoeae.

• Neisseria meningitidis.

What Are the Signs and Symptoms of Acute Purulent Conjunctivitis?

The acute form of bacterial conjunctivitis presents with profuse purulent discharge. Initially, only one eye is affected; later, the other eye gets involved. Other clinical presentations of acute purulent conjunctivitis are:

• Moderate eyelid edema.

• Redness of the eyes.

• Watery discharge from the eyes.

• Sensitivity to light (photophobia).

• Enlargement of the preauricular lymph nodes (nodes before the ear).

• Bulging of the conjunctiva (chemosis due to irritation).

• Matted eyes due to the presence of purulent discharge.

What Are the Different Types of Conjunctival Discharge?

The discharge coming out of the eyes due to conjunctivitis is mainly of two types:

• The mucopurulent discharge.

• The serious discharge.

The mucopurulent discharge is seen in people suffering from the bacterial type of conjunctivitis, and the serous discharge is observed in people with viral conjunctivitis.

How Is Acute Bacterial Conjunctivitis Diagnosed?

The diagnosis of acute bacterial conjunctivitis is primarily based on the clinical signs and symptoms. Other measures which help in diagnosing and differentiating bacterial conjunctivitis from viral and fungal conjunctivitis are:

• Bacterial smears.

• Cultures.

Smears and cultures are prescribed for immunocompromised patients, in cases where the conventional therapy did not work, or in patients with the presence of a vulnerable eye (patients with corneal transplants or in patients with Graves disease).

What Are the Complications of Acute Purulent Conjunctivitis?

Acute purulent conjunctivitis, if left untreated, can result in several rare complications, such as:

• Ulceration of the corneal tissue.

• Abscess formation.

• Perforation.

• Inflammation of the entire eyeball along with its surrounding structures (panophthalmitis).

• Blindness.

When Should We Consult a Doctor for Conjunctivitis?

Adult bacterial conjunctivitis is mostly mild to moderate in nature. However, there is a need to consult an ophthalmologist under the following conditions:

• Light sensitivity.

• Intense redness of the eyes.

• Profuse discharge of the eyes.

• Intense pain in the eyes.

How Is Acute Purulent Bacterial Conjunctivitis Managed?

Topical and systemic antibiotics remain the mainstay of treating acute purulent conjunctivitis. In addition, systemic antibiotics are prescribed, especially in gonococcal and chlamydial infections.

• Moxifloxacin drops 0.5 % thrice daily and is prescribed for patients with acute bacterial conjunctivitis. Ceftriaxone 1 g intramuscular (IM) plus Azithromycin 1 g orally once in case of Penicillin allergy.

• Silver nitrate eye drops or ointments are used for neonatal conjunctivitis.

• The most commonly used antibiotics include; fluoroquinolones like Ciprofloxacin 0.3 % drops, macrolides like Erythromycin 0.5 5 ointment, and aminoglycosides like Tobramycin 0.3 % drops.

What Conditions Mimic Bacterial Conjunctivitis?

Conditions that are to be ruled out before forming a definitive diagnosis of pink eye are:

• Allergic conjunctivitis.

• Viral conjunctivitis.

• Obstruction of the nasolacrimal duct.

• Non granulomatous inflammation of the uvea.

How to Prevent the Spread of Acute Bacterial Conjunctivitis?

The spread of acute bacterial conjunctivitis can be prevented by:

• Wash the hands for a minimum of twenty seconds before touching the eyes.

• Avoid frequent touching of the eyes.

• Avoid touching non-infected eyes after touching the infected eye.

• Avoid sharing towels and using public swimming pools.

• Disinfect materials used by conjunctivitis patients.

Conclusion

Acute purulent conjunctivitis of the eyes is a type of bacterial conjunctivitis. It is characterized by the presence of thick yellowish-green discharge from the eyes. Although, adult bacterial conjunctivitis is a self-limiting condition and resolves in a few days. The acute purulent form of the disease requires special attention to prevent further ocular complications. The diagnosis of the state is made easily by clinical examination and bacterial cultures. Treatment is mainly based on topical and systemic antibiotics.