Conjunctivitis ligneous
Overview
A rare disorder characterized by the formation of thick, tough, woody (ligneous) lesions on mucous membranes
Symptoms
* Thick woody lesions * Eye lesions * Laryngeal lesions * Vocal chord lesions * Nose lesions * Tracheal lesions * Bronchial lesions * Vaginal lesions * Cervical lesions * Gum lesions
Causes
The most common causative organisms include: * bacterial — Staphylococcus aureus, Streptococcus pneumoniae, Neisseria gonorrhoeae, Neisseria meningitidis * chlamydial — Chlamydia trachomatis (inclusion conjunctivitis) * viral — adenovirus types 3, 7, and 8; herpes simplex virus, type 1.
Diagnosis
Test the patient’s visual acuity and intraocular pressure (IOP) only if his eyelids can be opened without applying pressure. Place a metal shield over the affected eye to protect it if necessary. If the patient’s condition permits, examine the affected eye. First, determine the location and severity of conjunctival injection. Is it circumcorneal or localized? Peripheral or diffuse? Note any conjunctival or lid edema, ocular deviation, conjunctival follicles, ptosis, or exophthalmos. Also note the type and amount of any discharge. Next, test the patient’s visual acuity to establish a baseline. Note if the patient has had vision changes: Is his vision blurred or his visual acuity markedly decreased? Next, test pupillary reaction to light. Perform IOP measurements. To gauge increased IOP without a tonometer, gently place your index finger over the closed eyelid; if the globe feels rock-hard, IOP is elevated.
Treatment
reatment for conjunctivitis varies with the cause. Bacterial conjunctivitis requires topical application of the appropriate broad-spectrum antibiotic. Although viral conjunctivitis resists treatment, a sulfonamide or broad-spectrum antibiotic eyedrops may prevent a secondary infection. Patients may be contagious for several weeks after onset. The most important aspect of treatment is preventing transmission. Herpes simplex infection generally responds to treatment with trifluridine drops or vidarabine ointment or oral acyclovir, but the infection may persist for 2 to 3 weeks. Treatment for vernal (allergic) conjunctivitis includes administration of corticosteroid drops followed by cromolyn sodium, cold compresses to relieve itching and, occasionally, oral antihistamines. Instillation of a one-time dose of erythromycin or 1% silver nitrate solution (Credé’s procedure) into the eyes of neonates prevents gonococcal conjunctivitis.