Mucopurulent Conjunctivitis Research Articles

A rare presentation of measles and post-measles complications in a neonate: case report

BackgroundMeasles is a common infection in children. Measles infection in children less than 6 months of age is very rare since maternal antibodies play a major role in the prevention of the disease.Case presentationHere we present a rare case of a 34-day-old infant, who had a history of fever with a rash on the 18th day of life and significant history of measles contact with mother and elder brother. The patient presented to us with septic shock and multiorgan involvement in the form of pneumonia, acute gastroenteritis with severe dehydration, mucopurulent conjunctivitis, and post-measles encephalitis. The patient had a strong measles contact and epidemiological linkage to the measles epicenter, Govandi (a locality in the Mumbai region of western India), so measles IgM antibody was obtained which were significantly raised.The patient was successfully revived from this critical presentation with early and appropriate resuscitation, timely ionotropic support, and the use of empirical broad-spectrum antibiotics. The patient required intensive unit care for four days and was started on feeds and discharged after 12 days of hospital stay. On follow-up, the patient is doing well and gaining weight.ConclusionUncommon presentation and the epidemiology of the disease should alert the clinician of having a high index of suspicion. Early intervention and prompt treatment can help reduce morbidity and mortality.

Bilateral peripheral ulcerative keratitis

A 13-year-old girl presenting with mucopurulent conjunctivitis (left > right) was diagnosed with Behçet's disease. Intraoperatively, the left eye had 360° culture-negative marginal corneal ulcer with scleral necrosis, managed with a scleral patch graft. Postoperatively, the right eye also developed a peripheral corneal lesion that resolved with immunosuppressants along with the skin lesions. Subsequently, wound gaping and uveal prolapse were noted in the left eye and was managed with a lamellar corneal graft and later with a corneoscleral patch graft. Following this, the patient improved very well in terms of visual acuity. Peripheral ulcerative keratitis can be a clinical presentation in pediatric Behçet's disease despite the unusual occurrence. Hence, any pediatric case with peripheral ulcerative keratitis should be thoroughly investigated for Behçet's disease, for which immunosuppressants may prove to be beneficial.

Воспалительные изменения глаз у пациентов с сахарным диабетом

Target. To determine the level of predisposition of patients with diabetes mellitus to inflammatory reactions of the adnexa of the eyes. Material and methods. 72 patients with diabetic retinopathy of different stages and concomitant inflammatory eye diseases were analyzed. The scientific studies confirming the importance of timely diagnosis of diabetes mellitus and associated inflammatory lesions of the eyes and adnexa of the eyes are compared. Results. 72 patients (144 eyes) with diabetic retinopathy of different stages were examined. The most common clinical manifestations of inflammatory pathology of the eyes and adnexa of the eye were: blepharitis – 50 % of cases; recurrent chalazion – 5 % of cases, blepharoconjunctivitis – 11 % of cases; mucopurulent conjunctivitis – 7 % of cases; keratoconjunctivitis – 8 % of cases; keratitis – 18 % of cases; iridocyclitis – 4 %; DES – in 10 % of cases. The conducted studies confirm the presence of a correlation between the appearance of keratitis, dry eye syndrome and conjunctivitis with the progression of diabetes mellitus and diabetic retinopathy. It has also been established that using modern diagnostic capabilities in ophthalmology, it is possible to timely identify and prescribe effective treatment of systemic vascular pathologies, as a result of which the prognosis in the management of these diseases is significantly improved. Conclusion. Inflammatory lesions of the eye and adnexa of the eyes are directly related to trophic changes characteristic of diabetes mellitus against the background of polyneuropathy and microcirculatory disorders. Keywords: diabetes mellitus, diabetic retinopathy, inflammation, keratitis, conjunctivitis

Mycoplasma-Induced Rash and Mucositis or Steven-Johnson Syndrome.

Mycoplasma-induced rash and mucositis (MIRM), has been recently distinguished as an entity distinct from the spectrum of Steven-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). It is characterized by a younger age of onset, predominant mucosal lesions and sparse skin involvement, in contrast to widespread cutaneous lesions in TEN/SJS. While therapy with azithromycin and a short course of corticosteroids suffices in the majority of cases, intravenous immunoglobulin and cyclosporine may be useful in refractory cases. The authors report a 6-y-old girl with mucopurulent conjunctivitis, hemorrhagic oral mucosal crusting, maculopapular skin rash, and positive serology for Mycoplasma pneumoniae. The girl recovered following therapy with azithromycin and oral prednisolone. The index case is instructive in highlighting a rare complication of a common infection, and delineates the importance of clinical suspicion and a systematic approach to evaluation and management of MIRM in patients with unusual mucosal lesions and skin rash.

Adult gonococcal keratoconjunctivitis: early detection is key

We describe a case of a 52-year-old male presenting with severe mucopurulent conjunctivitis of the right eye. Corneal ulceration and associated anterior chamber activity was noted later in the course of the disease. Neisseria gonorrhoeae was positive on polymerase chain reaction (PCR) testing earlier than traditional microscopy and culture. He was successfully treated with ceftriaxone 500 mg intravenously and azithromycin 1 g orally as single doses in addition to ofloxacin ophthalmic solution 0.3% hourly to the right eye. This case highlights the need to consider the possibility of gonococcus in cases of suspected bacterial conjunctivitis, careful monitoring for corneal involvement and the importance of early detection with PCR.

Eye care in the intensive care unit for COVID-19 patients

Purpose: To assess eye manifestations and ensure the importance of eye care for COVID-19 patients in the intensive care unit, they need regular ophthalmological examination and follow-up. Patients and Methods: In this case series study, 43 patients' (86) eyes with COVID-19 were included in the study. The ocular history was taken from hospital-registered data. They were ophthalmologically examined using a portable slit lamp or by a by-side examination (diffuse illumination), and the anterior segment was evaluated. Schirmer's test was done for all patients to assess dryness. A Tono-Pen™ Tonometer was used in all cases to measure intraocular pressure with full infection control measures. Results: Sixteen (18.6) per cent of eyes were affected either by dryness due to exposure, infection (mucopurulent conjunctivitis), and subconjunctival hemorrhage with no apparent vision affection, and two were on antiglaucoma medications before the infection and advised to continue their medication. Conclusion: Eye care is mandatory for patients in ICU with COVID-19.

Ophthalmological perspectives of toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) is as rare as two cases per million per year, but the ocular manifestations and sequelae are very severe. We present a case series of seven patients admitted to the intensive care unit in a tertiary hospital with a diagnosis of TEN describing the extent of ocular involvement, its response to treatment, and appearance of sequelae. All seven were drug-induced with moderate-to-severe skin, mucosal, ophthalmic involvement, and systemic involvement. Ocular findings on presentation were eyelid skin detachment, adherent lid margins, bilateral mucopurulent conjunctivitis with inflammatory membranes, and punctate epithelial keratitis in all patients. Large persistent corneal epithelial defect was seen in four patients. On follow-up, five had severe keratoconjunctivitis sicca and entropion with trichiasis. Photophobia was the major debilitating sequelae. Early management was the key to reduce severity, cicatrization, and sequelae. Corticosteroids topically and systemically, topical cyclosporine, and lubricants were the mainstay of management.

Greater Total Dose and Duration of Treatment with Bortezomib Are Associated with Higher Incidence of Chalazion and Other Ocular Side Effects

▪Background: Use of the proteasome inhibitor bortezomib has been anecdotally noted to be associated with a number of ocular side effects, including chalazion, vascular events and conjunctivitis. This type of adverse event has not been characterized in the literature on bortezomib to date. In this retrospective study, we report the incidence of bortezomib-associated eye disease among patients treated at Memorial Sloan Kettering Cancer Center, and identify risk factors for development of ocular side effects.Methods: A retrospective review was conducted to identify all patients treated with bortezomib at Memorial Sloan Kettering Cancer Center between February 1999 and August 2013. Patients with bortezomib-associated eye disease were identified using ICD-9 diagnosis codes as shown in table 1. Patients were included if eye disease occurred after the first date of bortezomib administration and until one week after the last date of administration. Other data collected included dates, total dose and route of bortezomib administration. To identify statistically significant correlations between disease incidence and other variables, FisherÕs exact test was applied to discrete variables, and Wilcoxon rank sum test was applied to continuous variables.Table 1Diagnosis codes used for identification of bortezomib-associated ocular disease.Diagnosis codes identified as “chalazion”Diagnosis codes identified as “other eye disease”Hordeolum Externum Blepharitis Chalazion BlepharoconjunctivitisConjunctival Hemorrhage Conjunctivitis Acute Conjunctivitis Optic Neuritis Conjunctiva Vascular Abnormality Retinal Hemorrhage Eye Swelling or Mass Purulent Endophthalmitis Disorders of Eyelid Keratoconjunctivitis Arterial Branch Occlusion Retinal Vasculitis Vitreous Hemorrhage Mucopurulent Conjunctivitis Retinal Vascular Occlusion Conjunctivitis NEC Inflammation Eyelid NOSResults: 1122 patients were administered bortezomib between February 1999 and August 2013 at Memorial Sloan Kettering Cancer Center. Patients received bortezomib as IV (78.5%) or SC (19.9%) injections (1.6% (18 patients) received both IV and SC injections). Total doses of bortezomib ranged from 5.1mg to 505.2mg (median dose 60.56 mg). 53 patients (4.7%) developed eye disease during the period of bortezomib administration. Of these, 23 (2.0%) developed chalazion, while 30 (2.7%) developed other eye disease. The median dose administered prior to the first episode of eye disease was 34.41mg (range 2.10-147.40mg). The median time from first dose of bortezomib to the first event was 106 days (range 1-2154 days). Incidence of eye disease was positively correlated both with higher cumulative dose of bortezomib (p<0.0001) and with greater total time on bortezomib (p<0.0001). In addition, patients who received bortezomib both intravenously and subcutaneously were statistically more likely to develop eye disease than those who received bortezomib only via one route (p<0.0001). Patients who were documented as having relevant eye disease preceding bortezomib administration were not found to be more likely to develop eye disease during bortezomib therapy than those with no prior history of eye disease. There was also no correlation between the incidence of multiple episodes of eye disease during bortezomib therapy and any of the variables tested.Conclusions: Bortezomib is an important part of treatment regimens for many patients with multiple myeloma and lymphoma. However, its use is associated with side effects, most notably neuropathy, which sometimes necessitates dose reduction or drug discontinuation. In this study we document the incidence of bortezomib-associated eye disease in the total cohort of patients treated with bortezomib over 14.5 years at a large academic medical center. We find that the development of eye disease is associated with higher total dose and greater duration of bortezomib administration. DisclosuresMoskowitz:Seattle Genetics, Inc.: Consultancy, Research Funding; Genentech: Research Funding; Merck: Research Funding. Hamlin:Gilead, Spectrum, Seattle Genetics, Genentech: Consultancy; Spectrum, GSK, Jansen and Jansen/Pharmacyclics, Portola, Seattle Genetics: Research Funding.

Management of Pittaj Abhishyanda (Acute Muco-Purulent Conjunctivitis) by ‘Nimb-Lodhra Ashchyotan’ (Topical Instilation)

Conjunctivitis is commonly caused by an allergic reaction or an inflammation either caused by bacteria or virus. It is further classified as infective and non-infective types. Acute muco-purulent conjunctivitis that belongs to family of bacterial conjunctivitis is a contagious disease, which if remains untreated lead to corneal ulceration that further cause complications such as permanent opacity ending up in blindness. The conventional line of treatment includes topical antibacterial eye drops instillation along with systemic anti biotic and anti-inflammatory drugs. However, overuse of these antibiotics lead to resistance to the drugs making them in effective. So the need of alternative approaches is a need of the hour. From an Ayurvedic perspective, due to similarity in clinical features, the disease Pittaj Abhishyanda can be safely compared to muco-purulent conjunctivitis. As AcharyaVagbhat has given prime importance to ‘Ashchyotan therapy’ (topical instillation) in all eye diseases, we decided to use and prove efficacy of ‘Nimb-Lodhra Ashchyotan’ (topical instillation) in the management of Pittaj Abhishyanda with respect to acute muco-purulent conjunctivitis. The study proves immense potential for reduction of symptoms such as Netra daha (burning of eyes), Netra lalima (congestion), Kleda (mucopurulent discharge), Netra toda (pain and foreign body sensation in eye) etc.Â

Keratoconjunctivitis caused by an unusual retained conjunctival foreign body: a frequently unrecognized entity.

Purpose:The purpose of this study is to describe a case series of keratoconjunctivitis caused by a retained bindi (dot) in six children who presented to a tertiary eye care facility in Southern India.Patients and Methods:Over a period of 11 years (January 2000 and January 2012), six children (all female, ranging in age from 6 months to 3 years) were diagnosed with ocular manifestations subsequent to a retained bindi.Results:All patients presented with redness, photophobia, extensive lacrimation, and blepharospasm. Two patients presented with mucopurulent conjunctivitis, three patients with suppurative keratitis and one patient presented with corneal epithelial defect. After removal of the foreign body the response to topical antibiotics was good in five of six cases, whereas one patient required therapeutic keratoplasty.Conclusions:Young children presenting with unilateral keratitis and conjunctivitis should alert the clinician to the possibility of a retained foreign body in the eye.

Listeria monocytogenes endophthalmitis following keratoconjunctivitis

Endophthalmitis due to endogenous or exogenous bacteria is a rare infection of the eye. We report a case of endophthalmitis following Listeria monocytogenes keratoconjunctivitis in a 27-year-old healthy white male presenting with hand motion visual acuity, right eye mucopurulent conjunctivitis, elevated intraocular pressure, and pigmented hypopyon 6 months post-keratectomy. The conjunctivitis was unresponsive to a 5-day course of topical tobramycin eye drops, and the patient developed keratitis with pain that progressed to endophthalmitis after 21 days. Diagnostic B-scan revealed vitreous exudates. Intraocular fluid specimen showed Gram-positive organisms and the aqueous culture grew penicillin-/aminoglycoside-sensitive L. monocytogenes. The patient was given intravitreal and systemic vancomycin and ceftazidime. The eye was unresponsive to intravenous penicillin and gentamicin; the anterior chamber progressively flattened and developed phthisis bulbi. L. monocytogenes keratoconjunctivitis may lead to bacterial endophthalmitis. Prompt culture and early antibiotic therapy are recommended.

Tarsoconjunctival Crypts: Unrecognized Cause of Chronic Mucopurulent Conjunctivitis

To describe 3 patients with chronic mucopurulent conjunctivitis found to have an unrecognized sequestration of bacteria within tarsoconjunctival crypts of the upper eyelid. Review of 3 noncomparative cases. settings: Institutional. study population: Three consecutive patients with tarsoconjunctival crypts. intervention procedure: Marsupialization of the individual crypts. main outcome measures: Resolution of chronic discharge and resolution of signs and symptoms. One patient with Stevens-Johnson syndrome and 2 patients with floppy eyelids had chronic mucopurulent conjunctivitis that was refractory to multiple medical and surgical interventions. Retention of a yellowish coagulum within the fistulous tracts of the tarsal conjunctiva was the site of pathologic features in all patients. The diagnosis was confirmed by squeezing out of the coagulum from the fistulous tracts by pinching the eyelid horizontally. Pseudomonas aeruginosa was isolated in 1 patient and Staphylococcus aureus was isolated in the other 2 patients. A Bowman probe could be passed through the fistulous opening to unveil the full extent of the conjunctival tunnels on the epitarsal surface. Each tract was marsupialized, and no relapse was found during a follow-up period of 12 to 96 months. Patients with chronic, relapsing, purulent conjunctivitis should have their upper eyelid everted to search for tarsoconjunctival crypts as the source of bacteria-laden coagulum. The formation of the crypts is likely the result of tarsal conjunctiva trauma with lamellar de-epithelialization, followed by re-epithelialization to form an epithelialized tunnel as a potential space for harboring bacteria. Marsupialization of the crypts obliterates the potential space and is curative.

Bilateral symmetrical corneal melting following intravesical Bacille Calmette-Guerin therapy for bladder carcinoma

A 63-year-old man with unremarkable previous ocular history presented with bilateral symmetrical corneal ulceration along with mucopurulent conjunctivitis and dry eye 10 days after the fourth dose of intravesical Bacille Calmette-Guerin (BCG) instillation for treatment of bladder carcinoma. Slit lamp examination revealed thinning of the cornea at the base of the ulcer in both eyes. Conjunctival swab and scraping from ulcer sent for Gram and acid fast bacilli stain and culture were negative. On the basis of history, clinical examination, and laboratory investigations, we diagnosed it as bilateral immune mediated sterile corneal ulceration along with mucopurulent conjunctivitis and dry eye. He was treated with topical antibiotics, cycloplegics, cyclosporine, lubricant gel, and bandage contact lens. There was progressive stromal melting, descemetocele formation, and perforation in the inferior part of cornea in both the eyes. He was treated with pulse steroid and paramedian tarsorraphy in both eyes. The patient was subsequently lost to follow-up. We report this case to highlight this rare complication of BCG therapy, in order to improve their management protocol in patients with similar clinical profile. We could not find a similar case after thorough PubMed search.

Lacrimal Gland Ductulitis Caused by Probable Actinomyces Infection

To describe the clinical characteristics and management of a group of patients who had chronic mucopurulent conjunctivitis that was probably due to Actinomyces infection of the lacrimal gland ductules. A retrospective, interventional case series. Seven patients (2 male; 29%) between 34 and 52 years of age (mean, 48.7 years; median, 49 years) who presented to the lacrimal clinic. Surgical excision of the infective focus (6 cases) or fenestration and expression of infective debris (1 case) from the affected lacrimal gland ductule--typically the most inferolateral of the ductules. The clinical features of this previously unrecognized cause of chronic conjunctivitis and its response to treatment. All cases settled rapidly after surgery. There was often a major delay in diagnosis, with the patients having symptoms for between 2 and 42 months before referral (mean, 13.3 months; median, 9 months); 5 patients received prolonged or ineffectual topical medical therapy before referral. Infective lacrimal gland ductulitis, commonly from Actinomyces infection, should be considered in patients with unexplained chronic mucopurulent conjunctivitis; the condition settles rapidly with surgery. Proprietary or commercial disclosure may be found after the references.

Effect of Rasanjana Madhu Ashchyotana in Netra Abhishyanda (Mucopurulent Conjunctivitis)

To evaluate the comparative efficacy of Ayurvedic formulation a Rasanjana Madhu (RM) eye drops and Honey Rose (HR) water eye drops in Netra Abhishyanda in mucopurulent conjunctivitis, the current study is planned. Total of 35 patients attending the outpatient department of Shalakya Tantra at R. G. G. Postgraduate Ayurvedic College, Paprola, Distt. Kangra, Himachal Pradesh with characteristic features of Netra Abhishyanda were selected for the present study. Twenty patients were given trial drug, i.e., RM eye drops, while 15 patients were given HR eye drops. Random sampling technique was adopted for the present study. The duration of the treatment was 7 days with 1 week follow-up. Patients receiving the trial group demonstrated reduction of redness, burning sensation, lacrimation, photophobia, foreign body sensation, discharge, and congestion, which were statistically significant with 93% patients cured or markedly improved category. Signs and symptoms stated above were also statistically reduced with HR eye drops, probably because of well-documented hygroscopic and bacteriocidal properties of honey. Based on the study, it can be concluded that, RM eye drops are very effective in the management of Netra Abhishyanda viz. Infective conjunctivitis.

Ocular myasis and associated mucopurulent conjuctivitis acquired occupationally: A case study

Ocular myasis and associated mucopurulent conjunctivitis in human eyes is a rare phenomenon. However, if the sheep bot fly abounds and poor hygienic environment prevails, the Oestrous ovis deposits its larvae in the conjunctival eye sac of human. The present paper reports a case study of ocular myasis among sheep farm workers caused by Oestrous ovis. The ocular myasis and the associated mucopurulent conjunctivitis are occupationally acquired in these cases. This study also suggests the treatment of patients and the recovery of the larvae.

New Steps toward Eliminating Blinding Trachoma

Despite long-standing efforts to control it, trachoma remains the leading cause of preventable blindness in the world. According to the most recent estimates, some 84 million people have active trachoma (the infectious stage) in 55 countries in which the disease is endemic (Figure 1), and 7.6 million people have trachomatous trichiasis, the blinding stage of this infectious disease. Trachoma is a chronic keratoconjunctivitis caused by repeated reinfection with the ocular serotypes A, B, Ba, and C of Chlamydia trachomatis, an obligate intracellular bacterium. The infection causes a mucopurulent conjunctivitis that is generally self-healing without sequelae.Repeated episodes of chlamydial infection, . . .

Comparative double-blind randomized placebo-controlled clinical trial of a herbal eye drop formulation ( Qatoor Ramad) of Unani medicine in conjunctivitis

Qatoor Ramad (QR) is an ophthalmic formulation of Unani medicine. It is reputed for its beneficial effects in the treatment of the inflammatory conditions of the eyes. The effect of QR eye drops was studied by a double-blind, randomized, prospective, placebo-controlled clinical trial, conducted in 70 patients (20–60 yrs) suffering from different types of conjunctivitis, namely mucopurulent, phlyctenular and allergic conjunctivitis. Local application of two drops (3–4 times/day) of QR was applied to the affected eyes for up to 14 days. Patients were examined at the time of diagnosis and after 2, 7 and 14 days. Clinical efficacy was measured as the cumulative sum score of several signs and symptoms of different types of conjunctivitis. Side effects, if any, were also noted during the study. In mucopurulent conjunctivitis QR showed excellent results. In the few cases of phlyctenular and allergic conjunctivitis it controlled the deterioration and seems to help in improvement. There were no side effects observed during the course of the study and the eye drop was well tolerated by the patients. It is considered to be a useful drug in all conditions studied.

Effective treatment of ligneous conjunctivitis with topical plasminogen

PURPOSE: The etiology of ligneous conjunctivitis is now known to be due to an underlying type 1 plasminogen deficiency. We hereby report the clinical features of three cases and their response to topically administered plasminogen. DESIGN: Observational case series. METHODS: Two Caucasian females aged 5 years and an 18-month male of north African descent presented with a membranous conjunctivitis, which recurred after surgical excision. Case 1 presented before the association with plasminogen deficiency was known with a bilateral chronic membranous mucopurulent conjunctivitis from the age of 14 months associated with bronchiolitis and gingival hyperplasia. A diagnosis of ligneous conjunctivitis was entertained and a number of drops were instituted. At the age of 4 years plasminogen levels were ordered. Case 2 presented at the age of 4 years with a unilateral chronic membranous conjunctivitis. Plasminogen levels were requested as soon as a diagnosis of ligneous conjunctivitis was suspected. Case 3 was born with congenital hydrocephalus. Conjunctivitis was treated with antibiotics from the age of 1 month. He presented to the eye clinic at the age of 5 months when a clinical diagnosis of ligneous conjunctivitis was entertained and treated with a number of medications. Plasminogen levels were available at 9 months of age. RESULTS: The two female patients returned plasminogen levels of 0.25 U/ml and 0.3 U/ml, well below the normal level of 0.7–1.0 U/ml. Functional plasminogen levels in the male infant were not recordable with plasminogen antigen levels of 0.125 U/ml (normal range, 0.52–1.82). All cases have responded well to excision of the membranes and institution of topical plasminogen drops. There has been no recurrence with more than 12 months’ follow-up. CONCLUSIONS: With the knowledge of the etiology of ligneous conjunctivitis, efforts are underway to identify the best method of delivery of plasminogen. Topical plasminogen concentrate from fresh frozen plasma holds promise as the definitive treatment for this chronic membranous conjunctivitis

Association of Moraxella ovis with keratoconjunctivitis in mule deer and moose in Wyoming.

Six cases of infectious keratoconjunctivitis (IKC) in mule deer (Odocoileus hemionus) and moose (Alces alces) in Wyoming (USA) were investigated during fall and winter of 1995 and 1996. Excessive lacrimation, mucopurulent conjunctivitis, keratitis, and corneal opacity were observed in mule deer. Moose had severe mucopurulent conjunctivitis, keratitis, and corneal ulceration. Hemolytic, non-piliated Moraxella ovis was isolated from two mule deer and two moose. We attempted to reproduce IKC in three mule deer fawns using an isolate of M. ovis from a clinically affected mule deer. These fawns did not develop clinical signs of infection and the bacterium was not reisolated from inoculated deer. Inoculated deer may not have developed clinical signs because deer were not exposed to ultraviolet light or mechanical insult before inoculation. In addition, the isolate used for inoculation may have lost virulence factors through passage, or M. ovis may not have been the primary pathogen responsible for clinical disease in the natural cases of IKC we investigated. The etiology of IKC in free-ranging wild ruminants remains poorly understood.