H10.22 Pseudomembranous conjunctivitis

Name of the Condition

• Pseudomembranous conjunctivitis

Summary

Pseudomembranous conjunctivitis is a severe form of conjunctival inflammation characterized by the formation of a pseudomembrane, a layer of inflammatory exudate that adheres to the conjunctiva. It typically presents with marked redness, irritation, and discharge, and may affect one or both eyes. The condition is often associated with significant discomfort and requires prompt clinical attention.

Causes

Pseudomembranous conjunctivitis can result from various infectious or inflammatory processes. Common causes include bacterial infections (e.g., Corynebacterium diphtheriae, Streptococcus pneumoniae), viral infections (e.g., adenovirus), or severe allergic reactions. The pseudomembrane forms due to the accumulation of fibrin, inflammatory cells, and debris on the conjunctival surface.

Risk Factors

• Severe bacterial or viral infections of the eye.
• Untreated or poorly managed conjunctivitis.
• Immunocompromised states, which may increase susceptibility to severe infections.
• Exposure to highly virulent pathogens or allergens.
• Delayed or inadequate treatment of underlying conditions.

Symptoms

• Intense redness and swelling of the conjunctiva.
• Thick, purulent or mucopurulent discharge.
• Formation of a pseudomembrane on the conjunctiva, which may be adherent or easily removable.
• Severe irritation, burning, or foreign body sensation.
• Photophobia (sensitivity to light).
• Eyelid swelling or crusting.

Diagnosis

Diagnosis is based on a clinical evaluation, including a detailed history of symptoms and potential exposures. A healthcare provider may examine the eye using a slit lamp to assess the presence and characteristics of the pseudomembrane, evaluate discharge, and rule out other causes of conjunctivitis. Laboratory tests (e.g., cultures, PCR) may be performed to identify the underlying pathogen.

Treatment Options

Treatment focuses on addressing the underlying cause and managing symptoms. For bacterial infections, topical or systemic antibiotics may be prescribed. Antiviral medications are used for viral etiologies. Severe cases may require debridement of the pseudomembrane. Supportive care includes lubricating eye drops, cool compresses, and pain management. Allergic cases may benefit from antihistamines or corticosteroids.

Prognosis and Follow-Up

With appropriate treatment, most cases resolve within 1–2 weeks. However, severe or untreated infections can lead to complications. Follow-up is recommended to monitor healing, ensure resolution of symptoms, and prevent recurrence. Patients should be advised to complete the full course of prescribed therapy.

Complications

• Corneal involvement (e.g., keratitis, ulceration).
• Vision impairment if the cornea is affected.
• Chronic conjunctivitis or scarring of the conjunctiva.
• Spread of infection to other ocular structures.
• Systemic complications in severe bacterial infections (e.g., diphtheria).

Lifestyle & Prevention

• Practice good hand hygiene to avoid spreading infections.
• Avoid touching or rubbing the eyes with unwashed hands.
• Use protective eyewear in environments with potential irritants or allergens.
• Seek prompt treatment for any signs of conjunctivitis to prevent progression.
• Follow prescribed treatment regimens and attend follow-up appointments.

When to Seek Professional Help

Seek immediate medical attention if you experience:

• Sudden or severe eye pain.
• Vision changes or blurriness.
• Increasing redness, swelling, or discharge.
• Fever or systemic symptoms (e.g., in cases of suspected bacterial infection).
• Failure to improve with home care or over-the-counter treatments.

Tips for Medical Coders

When coding for pseudomembranous conjunctivitis (H10.22), ensure documentation supports the presence of a pseudomembrane and the underlying cause (e.g., bacterial, viral, or allergic). Note the affected eye(s) and any associated complications. Verify that the diagnosis aligns with clinical findings and that all relevant details (e.g., treatment, follow-up) are documented to support accurate coding.