CONJUNCTIVITIS

Conjunctivitis (inflammation of the conjunctiva) is the most common ocular disease worldwide. It is characterized by a pink appearance because of subconjunctival blood vessel congestion. It is also known as pinkeye.

What causes Pinkeye? Pinkeye has a number of different causes, including:

Viruses Bacteria (such as gonorrhea or chlamydia) Irritants such as shampoos, dirt, smoke, and pool chlorine Allergies, like dust, pollen, or a special type of allergy that affects some contact lens wearers

Pinkeye caused by some bacteria and viruses can spread easily from person to person, but are not a serious health risk if diagnosed promptly.

What are the signs and symptoms of Pinkeye? The symptoms of pinkeye differ based on the cause of the inflammation, but may include:

Redness in the white of the eye or inner eyelid. Increased amount of tears. Thick yellow discharge that crusts over the eyelashes, especially after sleep. Green or white discharge from the eye. Itchy eyes. Burning eyes. Blurred vision. Increased sensitivity to light.

Risk factors

Exposure to an allergen for allergic conjunctivitis Exposure to someone infected with the viral or bacterial form of conjunctivitis Using contact lenses, especially extended-wear lenses

The biggest risk factor of pink eye is being exposed to someone infected with either the viral or bacterial form of conjunctivitis. Someone with conjunctivitis may be contagious for seven to 14 days after signs and symptoms first appear.

Types of Conjunctivitis Viral Viral conjunctivitis is often associated with an infection of the upper respiratory tract, a common cold, and/or a sore throat. Its symptoms include watery and itch. The infection usually begins with one eye, but may spread easily to the other. Viral conjunctivitis, commonly known as "pink eye", shows a fine, diffuse pinkness of the conjunctiva, which is easily mistaken for the ciliary injection of iritis, but there are usually corroborative signs on microscopy, particularly numerous lymphoid follicles on the tarsal conjunctiva, and sometimes a punctate keratitis. Bacterial Bacterial conjunctivitis due to common pyogenic (pus-producing) bacteria causes marked grittiness/irritation and a stringy, opaque, greyish or yellowish mucopurulent discharge that may cause the lids to stick together, especially after sleep. Another symptom that could be caused by bacterial conjunctivitis is severe crusting of the infected eye and the surrounding skin. However, contrary to popular belief, discharge is not essential to the diagnosis. Bacteria such as Chlamydia trachomatis or Moraxella can cause a non-exudative but persistent conjunctivitis without much redness. The gritty and/or scratchy feeling is sometimes localized enough for patients to insist they must have a foreign body in the eye. The more acute pyogenic infections can be painful. Like viral conjunctivitis, it usually affects only one eye but may spread easily to the other eye. Corynebacterium diphtheriae causes membrane formation in conjunctiva of non immunized children. Chemical/Toxic Chemical eye injury is due to either an acidic or alkali substance getting in the eye. Alkalis are typically worse than acidic burns.[5] Mild burns will produce conjunctivitis while more severe burns may cause the cornea to turn white.[5] Litmus paper is an easy way to rule out the diagnosis by verifying that the pH is within the normal range of 7.07.2.[4] Large volumes of irrigation is the treatment of choice and should continue until the pH is 68.[5] Local anaesthetic eye drops can be used to decrease the pain.[5]
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Irritant or toxic conjunctivitis show primarily marked redness. If due to splash injury, it is often present only in the lower conjunctival sac. With some chemicals, above all with caustic alkalis such as sodium hydroxide, there may be necrosis of the conjunctiva with a deceptively white eye due to vascular closure, followed by sloughing of the dead epithelium. This is likely to be associated with slit-lamp evidence of anterior uveitis. Allergic Allergic conjunctivitis is inflammation of the conjunctiva (the membrane covering the white part of the eye) due to allergy.[1] Although allergens differ between patients, the most common cause is hay fever. Symptoms consist of redness (mainly due to vasodilation of the peripheral small blood vessels), odema of the conjunctiva, itching

and increased lacrimation (production of tears). If this is combined with rhinitis, the condition is termed allergic rhinoconjunctivitis.

Diagnostic tests Cultures are done infrequently because most cases of conjunctivitis are treated empirically and (eventually) successfully, but often only after running the gamut of the common possibilities. Swabs for bacterial culture are necessary if the history and signs suggest bacterial conjunctivitis, but there is no response to topical antibiotics. Research studies indicate many bacteria implicated in low-grade conjunctivitis are not detected by the usual culture methods of medical microbiology labs, so false negative results are common. Viral culture may be appropriate in epidemic case clusters. Conjunctival scrapes for cytology can be useful in detecting chlamydial and fungal infections, allergy and dysplasia, but are rarely done because of the cost and the general lack of laboratory staff experienced in handling ocular specimens. Conjunctival incisional biopsy is occasionally done when granulomatous diseases (e.g., sarcoidosis) or dysplasia are suspected.

Prevention and Management Allergic For the allergic type, cool water poured over the face with the head inclined downward constricts capillaries, and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, nonsteroidal anti-inflammatory medications and antihistamines may be prescribed. Persistent allergic conjunctivitis may also require topical steroid drops. Bacterial Bacterial conjunctivitis usually resolves without treatment. Antibiotics, eye drops, or ointment are thus only needed if no improvement is observed after three days.[9] In patients receiving no antibiotics, recovery was in 4.8 days, with immediate antibiotics it was 3.3 days, and with delayed antibiotics 3.9 days. No serious effects were noted either with or without treatment.[10][11][edit] Viral Although there is no specific treatment for viral conjunctivitis, symptomatic relief may be achieved with cold compresses[12] and artificial tears. It is often advisable to avoid touching the eyes or sharing towels and washcloths. Chemical Conjunctivitis is due to chemicals is treated via irrigation with Ringer's lactate or saline solution. Chemical injuries (particularly alkali burns) are medical emergencies, as

they can lead to severe scarring, and intraocular damage. People with chemicallyinduced conjunctivitis should not touch their eyes, regardless of whether or not their hands are clean, as they run the risk of spreading the condition to another eye. Allergic There is no ideal treatment and some drugs used are harmful. Cold compresses can help with mild symptoms. Astringent drops, e.g., zinc sulphate, will not cure the problem but may relieve symptoms. Topical steroids such as prednisolone eye drops are frequently used and although complications are uncommon it is vital to be aware of them. For example, corneal ulcers can be made worse, particularly herpes simplex (dendritic ulcers). Vernal catarrah causes corneal shield ulcers, which can become secondarily infected and made worse by steroids. Cataract and raised intraocular pressure leading to glaucoma are also complications of long term steroids. However, in severe cases of vernal conjunctivitis systemic steroids may be needed. Other drops deal with the allergic response at different parts of the immune cascade. Antihistamines are only partially effective. Mast cell stabilisers2 such as cromolyn sodium 4% and more recently lodoxamide 0.1% are effective if used continuously for many months. These drugs are safe but expensive. Cromolyn powder is available for local production of eye drops. Sodium cromoglycate 2% (Opticrom) may also be available.

Complications If left untreated, some infections (e.g., herpes simplex viral infections) can cause corneal ulceration and lead to blindness. Infection with gonococcal bacteria may cause corneal ulceration, abscess, perforation, destruction of the eye, and blindness. In underdeveloped countries with limited availability of treatment, chlamydia infection (trachoma) can lead to inversion of the eyelids; this results in irritation, infection of the cornea, scarring, and damage to the cornea that may lead to blindness.

REPORTED BY: FRANZEL B. BASQUEZ BSN IIIA