Page 38 - NAME OF CONDITION: REFRACTIVE ERRORS

6. Nummular keratitis gives a clue for diagnosis as it is often caused by

adenovirus and HZV

b) Investigations:

Conjunctivitis usually is diagnosed by history and physical examination. A regular
microbiological useful in patients with recurrent conjunctivitis and in some cases of
epidemic conjunctivitis the material is obtained by taking conjunctival swabs from
lower forniceal and upper tarsal conjunctiva after instilling a topical anesthetic agent
(4% lignocaine). Two smears are initially prepared one with gram staining and the
other with giemsa. Gram stain is considered the criterion standard for determining
the bacterial cause of conjunctivitis. Eosinophils seen on Giemsa stain are indicative
of allergic conjunctivitis but can be seen in parasitic causes also.
Giemsa staining is also performed to look for the inclusion bodies of Chlamydia

trachomatis.

c) Treatment:

Treatment of conjunctivitis is ideally directed at the root cause. Indiscriminate use of
topical antibiotics or corticosteroids should be avoided, because antibiotics can induce
toxicity and corticosteroids can prolong adenoviral infections and worsen herpes simplex
virus infections. A careful counselling of the dosages of the individual medicine should
be adequately explained to the patient and an accompanying person so that it will be
applied in the right manner. Regular irrigation of the eye with clean water remains the
corner stone of the treatment for all forms of conjunctivitis. The following table shows
various modalities of management in different types of conjunctivitis.

Type Management
1]Bacterial conjunctivitis  Chloramphenicol 0.5%eye drops (or)
 Ciprofloxacin 0.3%eye drops
Intensive instillation every 15 to 30 min until symptoms and
signs are reduced and gradually tapered.
2]Viral conjunctivitis  Advice the patient to clean the eye by washing with normal
saline frequently.

 Cold compression.
 Topical anti-histaminics
 Frequent application of preservative free artificial tears.
 Topical antibiotics in cases of suspected secondary bacterial
infection.

 Severe inflammation, presence of sub-epithelial infiltrate,

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