Conjunctivitis With a Pseudomembrane

AUTHORS:
Reetu Grewal, MD, Ross Jones, MD, and Carlos Arango, MD

CITATION:
Grewal R, Jones R, Arango C. Conjunctivitis with a pseudomembrane. Consultant. 2014;54(10):812.

History

A 21-year-old female initially presented to her primary care physician with a 1-week history of right eye redness, eyelid swelling, thin drainage, and a gritty sensation in her eye. 

Physical Examination

The patient had right-sided conjunctival injection, her vision was normal, and pupils were equally reactive. She presented a week later with minimal improvement, spread of the original symptoms to the left eye, and a “growth” originating from her superior and inferior right eyelids and extending into her right conjunctiva (Figures).

Figures. Pseudomembrane formation

Discussion

Viral conjunctivitis is a common cause of red eye, often caused by adenovirus, and is highly contagious. It often occurs bilaterally, with watery discharge, normal visual acuity, and may also present with preauricular lymphadenopathy. Viral upper respiratory tract infections often accompany viral conjunctivitis. Most cases of viral conjunctivitis are mild and resolve spontaneously within 2 weeks.¹ Severe cases of viral conjunctivitis can cause subepithelial corneal opacities and pseudomembrane formation.²

Treatment

Treatment for viral conjunctivitis is generally supportive, with artificial tears and compresses for the eyelids. Emphasizing good hand-washing is important to prevent spread. An ophthalmology referral is needed if symptoms do not resolve after 7 to 10 days, or if there is corneal involvement.¹ Steroid eye drops are reserved for severe cases, and should be used under the supervision of an ophthalmologist.²

Differential Diagnosis

Other considerations include acute bacterial conjunctivitis and chlamydial trachoma. Acute bacterial conjunctivitis is characterized by conjunctival injection, recurrent production of mucopurulent discharge, and often bilateral involvement. Vision is preserved, and eyelid edema may occur. Treatment of acute bacterial conjunctivitis involves topical antibiotics and warm compresses.

Chlamydial trachoma often occurs in young adults, and should be suspected in sexually active adults in whom conventional treatment for acute bacterial conjunctivitis fails.³ Symptoms of chlamydial trachoma are similar to those of acute bacterial conjunctivitis, but differing symptoms include longer duration of symptoms usually several weeks to months, decreased purulent discharge, and more cobbled appearance of the epithelium.⁴

Treatment includes topical erythromycin and either oral azithromycin or doxycycline to cover for genital infection.⁵

Outcome of the Case

Our patient was referred to ophthalmology, and underwent a course of steroid eye drops. Her symptoms, including pseudomembrane formation, fully resolved within 1 week.

Reetu Grewal, MD, Ross Jones, MD, and Carlos Arango, MD, are assistant professors at the University of Florida College of Medicine in Jacksonville, FL. 

References:

1. Wirbelauer C. Management of the red eye for the primary care physician. Am J Med. 2006;119(4):302-306.
2. Cronau H, Kankkanala R, Mauger T. Diagnosis and management of red eye in primary care. Am Fam Physician. 2010;81(2):137-144.
3. Hovding G. Acute bacterial conjunctivitis. Acta Opthalmol. 2008;86(1):5-17.
4. Tarabishy AB, Jeng B. Bacterial conjunctivitis: a review for internists. Cleveland Clinic J Med. 2008;75(7):507-512.
5. Libowitz HM. The red eye. N Engl J Med. 2000;343(5):345-351.