Conjunctivitis , also known as pink eye , is an inflammation of the outermost layer of the whites of the eyes and the inner surface of the eyelid. It makes the eyes appear pink or reddish. There may also be pain, burning, itching, or itchiness. The affected eye may have increased tears or "stuck together" in the morning. Swelling of the whites of the eyes, can also occur. Itching is more common in cases due to allergies. Conjunctivitis may affect one or both eyes.
The most common cause of infection is a virus followed by bacteria. Viral infections may occur along with other symptoms of the common cold. Both cases of viruses and bacteria are easily spread among people. Allergies to pollen or animal hair are also common causes. Diagnosis is often based on signs and symptoms. Sometimes samples of debits are sent for culture.
Partial prevention is done by washing hands. Treatment depends on the underlying cause. In most cases of viral, no special treatment. Most cases due to bacterial infection will also heal without treatment; However, antibiotics can shorten the disease. People who wear contact lenses and those whose infection is caused by gonorrhea or chlamydia should be treated. Allergy cases can be treated with antihistamines or mast cell inhibitor drops.
About 3 to 6 million people experience conjunctivitis every year in the United States. In adults, viral causes are more common, while in children, bacterial causes are more common. Usually people get better in a week or two. If there is vision loss, significant pain, light sensitivity, signs of herpes, or if symptoms do not improve after a week, further diagnosis and treatment may be necessary. Conjunctivitis in the newborn, known as neonatal conjunctivitis, may also require special treatment.
Video Conjunctivitis
Signs and symptoms
Red eyes, conjunctival swelling and eye watering are common symptoms for all forms of conjunctivitis. However, students usually have to be reactive, and normal vision acuity.
Conjunctivitis is identified by irritation and redness of the conjunctiva. Except in pyogenic or toxic/chemical conjunctivitis clear, a gap lamp (biomicroscope) is required to confirm the diagnosis. Conjunctival examination of the eyelid is usually more diagnostic than conjunctival sclera examination.
Viral
Viral conjunctivitis is often associated with infection of the upper respiratory tract, common cold, or sore throat. Symptoms include excessive watering and itching. Infection usually begins in one eye, but can spread easily to the other eye.
Viral conjunctivitis manifests as a smooth, diffuse pink conjunctiva, which is easily mistaken for iris ciliated infections (iritis), but there are usually strong signs in microscopy, especially many lymphoid follicles in the tarsal conjunctiva, and sometimes dappled keratitis.
Allergic
Allergic conjunctivitis is inflammation of the conjunctiva due to allergies. Specific allergens may differ among patients.
Symptoms result from the release of histamine and other active substances by mast cells, and consist of redness (mainly due to vascodilation of small peripheral blood vessels), conjunctival swelling, itching, and increased tear production.
Bacteria
Bacterial conjunctivitis causes rapid onset of conjunctival redness, swelling of the eyelid, and sticky fluid. Usually, the first symptoms occur in one eye, but can spread to other eyes within 2-5 days. Conjunctivitis due to common pus-producing bacteria causes shaking or sharp irritation and stretched, opaque, gray or yellowish mucus that can cause lids to stick together, especially after sleep. Severe crust from infected eyes and surrounding skin may also occur. Spicy or harsh feelings are sometimes quite localized so patients may insist that they have a foreign object in the eye.
Common bacteria responsible for non-acute bacterial conjunctivitis are Staphylococcus , Streptococcus , and Haemophilus . Less commonly chlamydia may be the cause.
Bacteria such as Chlamydia trachomatis or Moraxella can cause non-exudative but persistent conjunctivitis without much redness. Bacterial conjunctivitis may lead to the production of membranes or pseudomembranes concealing the conjunctiva. Pseudomembranes consist of a combination of inflammatory cells and exudate and are loosely attached to the conjunctiva, while the true membrane is more adherent and can not be easily peeled. Cases of bacterial conjunctivitis involving membrane or pseudomembranous production are associated with Neisseria gonorrhoeae ,? -hemolytic streptococci, and Corynebacterium diphtheriae . C. diphtheriae causes membrane formation in the conjunctiva of unimmunized children.
Chemistry
A chemical eye injury can occur when an acid or alkali substance enters the eye. Alkaline burns are usually worse than acid burns. Mild burns will produce conjunctivitis, while more severe burns may cause the cornea to turn white. Litmus paper can be used to test chemical causes. When a chemical cause has been confirmed, the eye or eye should be flushed until the pH is within the range of 6-8. Anesthetic eye drops may be used to relieve pain.
Irritating or toxic conjunctivitis is mainly characterized by redness. If caused by a chemical spark, it is often only in the lower conjunctival sac. With some chemicals, above all with caustic alkali such as sodium hydroxide, there may be conjunctival necrosis characterized by white eyes visible due to veins closure, followed by the decay of the dead epithelium. Examination of the gap lamp will likely show evidence of anterior uveitis.
More
Inclusion of conjunctivitis in newborns (ICN) is a conjunctivitis that may be caused by the bacteria Chlamydia trachomatis , and may cause acute and purulent conjunctivitis. However, it is usually self-healing.
Maps Conjunctivitis
Cause
Infective conjunctivitis is most commonly caused by viruses. Bacterial infections, allergies, other irritants, and drought are also common causes. Both bacterial and viral infections are contagious, passing from person to person or spread through contaminated objects or water.
Viral
Adenovirus is the most common cause of viral conjunctivitis (adenoviral keratoconjunctivitis). Herpes keratoconjunctivitis, caused by herpes simplex virus, can be serious and require treatment with acyclovir. Acute haemorrhagic conjunctivitis is a highly contagious disease caused by one of two enteroviruses, Enterovirus 70 and Coxsackievirus A24. It was first identified in an outbreak in Ghana in 1969, and has spread throughout the world since then, causing several epidemics.
Bacteria
The most common causes of acute bacterial conjunctivitis are Staphylococcus aureus , Streptococcus pneumoniae , and Haemophilus influenzae . Although very rare, hyperacute cases are usually caused by Neisseria gonorrhoeae or Neisseria meningitidis . The case of chronic bacterial conjunctivitis is that lasts more than 3 weeks, and is usually caused by Staphylococcus aureus , Moraxella lacunata , or the gram negative enteric flora. Allergic
Conjunctivitis can also be caused by allergens such as pollen, perfume, cosmetics, smoke, dust mites, Peruvian Balsam, or eye drops.
More
Conjunctivitis is part of the reactive arthritis triad, which is thought to be caused by autoimmune cross reactivity after certain bacterial infections. Reactive arthritis is strongly associated with HLA-B27. Conjunctivitis is associated with autoimmune disease of polychondritis recurrence.
Diagnosis
Cultures are not often taken or needed because most cases improve with time or a typical antibiotic. If bacterial conjunctivitis is suspected but there is no response to topical antibiotics, swabs for bacterial culture should be taken and tested. Viral culture may be appropriate in epidemic cases.
Patch tests are used to identify allergen causes in allergic conjunctivitis.
Although conjunctival flakes for cytology can be useful in detecting chlamydial and fungal infections, allergies, and dysplasia, they are rarely done because of the cost and scarcity of general laboratory staff experienced in handling ocular specimens. Conjunctival incisional biopsy is sometimes performed when granulomatous disease (eg, , sarcoidosis) or dysplasia is suspected.
Classification
Conjunctivitis may be classified either by cause or by the extent of the inflamed area.
Cause
- allergies
- bacteria
- virus
- chemicals
- autoimmune
Neonatal conjunctivitis is often grouped separately from bacterial conjunctivitis because it is caused by different bacteria rather than the more common case of bacterial conjunctivitis.
By engagement
Blepharoconjunctivitis is a dual combination of conjunctivitis with blepharitis (inflammation of the eyelids).
Keratoconjunctivitis is a combination of conjunctivitis and keratitis (inflammation of the cornea).
Blepharokeratoconjunctivitis is a combination of conjunctivitis with blepharitis and keratitis. It is clinically defined by changes in eyelid margins, meibom gland dysfunction, redness of the eyes, conjunctival chemosis and inflammation of the cornea.
Differential diagnosis
There are more serious conditions that may present with red eyes such as infectious keratitis, closed-angle glaucoma, or iritis. This condition requires urgent attention from an ophthalmologist. Signs of such conditions include diminished vision, increased light sensitivity, inability to keep the eyes open, pupils that do not respond to light, or severe headache with nausea. Fluctuations in blurring are common, due to tears and mucoid impurities. Mild photophobia is common. However, if any of these symptoms are prominent, it is important to consider other diseases such as glaucoma, uveitis, keratitis and even meningitis or carotico-cavernous fistulas.
A more comprehensive differential diagnosis for red or painful eyes includes:
- corneal abrasion
- subconjunctival hemorrhage
- pinguecula
- blepharitis
- dacryocystitis
- keratoconjunctivitis sicca (dry eye)
- keratitis
- herpes simplex
- herpes zoster
- episcleritis - an inflammatory condition that results in appearance similar to conjunctivitis, but without debit or tearing
- uveitis
- acute closed corner glaucoma
- endophthalmitis
Prevention
The most effective prevention is good hygiene, especially avoiding rubbing the eyes with infected hands. Vaccination against adenovirus, Haemophilus influenzae , pneumococcus, and Neisseria meningitidis is also effective.
The povidone-iodine eye solution has been found to prevent neonatal conjunctivitis. It is becoming more commonly used globally because of its low cost.
Management
Conjunctivitis heals in 65% of cases without treatment, within two to five days. An antibiotic prescription is not necessary in most cases.
Viral
Viral conjunctivitis usually resolves on its own and requires no special treatment. Antihistamines (eg, diphenhydramine) or mast cell stabilizers (eg, cromolyn) may be used to help treat symptoms. Povidone-iodine has been suggested as a treatment, but in 2008, evidence to support it was poor.
Allergic
For allergic conjunctivitis, cold water flows over the face with its head tilted downward narrowing capillaries, and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, nonsteroidal anti-inflammatory drugs and antihistamines may be prescribed. Persistent allergic conjunctivitis may also require topical steroid drops.
Bacteria
Bacterial conjunctivitis usually disappears without treatment. Topical antibiotics may be necessary only if no improvement is observed after three days. No serious effects were noted either with or without treatment. Because antibiotics do speed healing in bacterial conjunctivitis, its use may be considered.
Antibiotics are also recommended for those who wear contact lenses, which are immunocompromised, have a disease suspected of being chlamydial or gonorrhea, have little pain, or have excessive discharge. Gonorrhea or chlamydial infection requires oral and topical antibiotics.
The choice of antibiotics will vary, based on strains or strains of bacteria that are suspected of causing the infection. Fluoroquinolones, sodium sulfacetamide, or trimethoprim/polymyxin may be used, usually for 7-10 days. Cases of meningococcal conjunctivitis can also be treated with systemic penicillin, as long as the strain is sensitive to penicillin.
When examined as a treatment, the povidone-iodine eye solution has also been observed to have some effectiveness against bacterial and chlamydial conjunctivitis, with roles that may be suggested in locations where topical antibiotics are unavailable or expensive.
Chemistry
Conjunctivitis due to chemicals is treated through irrigation with Ringer lactate or saline solution. Chemical injury, especially alkaline burns, is a medical emergency, as it can cause scarring and severe intraocular damage. People with chemically induced conjunctivitis should not touch their eyes to avoid the spread of chemicals.
Epidemiology
Conjunctivitis is the most common eye disease.
History
Adenovirus was first isolated by Rowe et al. in 1953. Two years later Jawetz et al. published in the epidemic keratoconjunctivitis. "Madras eye" is the everyday term that has been used in India for this disease.
See also
- Suffunctival suffusion
- Ophthalmia
References
External links
- Conjunctivitis in Curlie (based on DMOZ)
Source of the article : Wikipedia
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