Pseudomembranous Conjunctivitis
Pseudomembranous conjunctivitis is a severe form of conjunctival inflammation that can be visually dramatic and requires prompt attention. Let's break it down:
🧪 Pseudomembranous Conjunctivitis
🔍 Definition
Pseudomembranous conjunctivitis is a condition where a false membrane (pseudomembrane) forms on the palpebral conjunctiva (inner eyelid surface), typically due to severe inflammation, infection, or toxins.
The pseudomembrane is composed of fibrin, inflammatory cells, and necrotic epithelial debris — unlike a true membrane, it can usually be peeled off without bleeding.
🔬 Causes / Etiology
| Cause Type | Examples |
|---|---|
| Infectious | Adenovirus (especially EKC), Corynebacterium diphtheriae, Streptococcus, Neisseria gonorrhoeae |
| Toxic reactions | From medications or chemicals |
| Allergic / immune-mediated | Stevens-Johnson syndrome, ocular cicatricial pemphigoid |
👁️ Clinical Features
| Feature | Description |
|---|---|
| Red eye | Intense conjunctival injection |
| Foreign body sensation | Due to rough membrane rubbing on conjunctiva |
| Mucopurulent discharge | Thick, sticky discharge |
| Eyelid swelling | Often marked |
| Pseudomembrane | White/yellow film over conjunctiva (may peel) |
| Conjunctival chemosis | Swelling of conjunctiva |
| Pain & photophobia | Moderate to severe |
| Subconjunctival hemorrhages | Especially in viral causes (e.g., adenovirus) |
🔍 Differentiating Pseudomembrane vs True Membrane
| Feature | Pseudomembrane | True Membrane |
|---|---|---|
| Composition | Fibrin, WBCs, necrotic debris | Deeply adherent necrosis, vascularized |
| Removal | Can be peeled with no bleeding | Peeling causes bleeding |
| Associated with | Adenovirus, gonorrhea, drug reactions | Diphtheria, severe burns |
🔬 Diagnosis
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Clinical examination (eyelid eversion to visualize membrane)
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Swab for culture & sensitivity (if bacterial suspected)
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PCR or antigen test (for adenovirus)
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Rule out systemic diseases (if autoimmune suspected)
💊 Treatment
| Treatment Component | Notes |
|---|---|
| Removal of pseudomembrane | Gentle peeling with sterile forceps |
| Lubricant drops | For comfort and corneal protection |
| Topical steroids | To reduce inflammation and prevent scarring (if no active infection) |
| Topical antibiotics | Empirical or based on culture (e.g., moxifloxacin, ciprofloxacin) |
| Antivirals (if HSV suspected) | e.g., Acyclovir |
| Systemic antibiotics | In gonococcal or diphtheritic conjunctivitis |
⚠️ Steroids should be used cautiously: contraindicated in herpetic infections unless under strict supervision.
🧠 Complications to Watch For
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Conjunctival scarring
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Symblepharon (adhesion between eyelid and eyeball)
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Corneal involvement → keratitis, ulcer
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Vision loss (rare but possible if untreated)
🧼 Supportive Care & Prevention
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Maintain good hygiene and avoid eye rubbing
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Isolate if viral cause suspected (e.g., epidemic keratoconjunctivitis)
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Use protective eyewear in high-risk environments (chemical exposure)
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Monitor for systemic signs if autoimmune condition suspected
🎯 Summary Table
| Feature | Pseudomembranous Conjunctivitis |
|---|---|
| Main feature | False membrane on conjunctiva |
| Common causes | Adenovirus, diphtheria, gonorrhea, drugs |
| Discharge type | Mucopurulent |
| Removal of membrane | Easy, usually no bleeding |
| Treatment | Remove membrane + lubricants + antibiotics ± steroids |
| Risk of complications | Moderate (scarring, symblepharon) |
Would you like:
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A clinical image or diagram of pseudomembranous conjunctivitis?
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A comparison chart with other types of conjunctivitis?
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Or a case study format to help remember it better?
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