Conjunctivitis describes the inflammatory process that involves the conjunctiva; most causes of conjunctivitis are benign. Cellular infiltration and exudation characterize conjunctivitis on a cellular level. Classification is based on the underlying cause, as visual conjunctivitis, bacterial, fungal.
CAUSES
- Staphylococcus aureus
- Streptococcus pneumonia
- Haemophilus influenzae
- N. gonorrhoeae
- Neisseria meningitidis
- .Rarely Streptococcus sp., Pseudomonas, Branhamella catarrhalis, Coliforms, Klebsiella, Proteus, Corynebacterium diphtheriae, Mycobacterium tuberculosis, Treponema pallidum.
Viral
- Adenoviruses types 3, 4, 7, 8, 11 and 19
- Herpes simplex, Herpes zoster
- Enterovirus type 70
- Coxsackievirus type A24 and A28
- Molluscum contagiosum
- Varicella
- Measles virus
Chlamydial
- Chlamydia trachomatis (trachoma)
- Chlamydia oculogenitalis (inclusion conjunctivitis)
- Chlamydia lymphogranulomatis (lymphogranu-loma venereum)
Allergic
- Rhinoconjunetivitie (hay fever) humoral
- Vemal conjunctivitis
- Giant papillary conjunctivitis
- Autoimmune
Chemicals or irritants
- Topical medication
- Home/industrial chemicals
- Wind, smoke, ultraviolet light
Other
- Rickettsial, fungal, parasitic, tuberculosis, syphilis, Kawasaki disease
- Thyroid disease, gout, carcinoid, sarcoidosis, psoriasis, Stevens-Johnsons syndrome, Ligneous conjunctivitis, Reiter's syndrome.
Signs and Symptoms
- Bacterial conjunctivitis-acute onset, minimal pain, occasional pruritus, and sometimes, exposure history
- Ocular surface diseases predispose the patient to bacterial conjunctivitis.
- Viral conjunctivitis- acute or subacute onset, minimal pain level, and often, exposure history
- Severe photophobia and foreign-body sensation
- Chlamydial conjunctivitis chronic onset, minimal pain level, occasional pruritus, and STD history
- Allergic conjunctivitis -acute or subacute onset, no pain, and no exposure history
- Pruritus
- Shield corneal ulcers.
- Giant papillary conjunctivitis resembles vernal disease; excessive pruritus, mucous production, and increasing intolerance to contact
General
- Increased tearing
- Pain, redness and itching of the eyes
- Gritty feeling in the eyes, blurred vision
- Sensitivity to light
- Crusts that form on the eyelid overnight
Risk Factors
- Trauma
- Chemicals and foreign body
DIAGNOSIS
Differential Diagnosis
- Glaucoma, Acute Angle-Closure
- Herpes Zoster, Herpes Zoster Ophthalmicus
- Iritis and Uveitis
- Scleritis
Investigations
- Gram stain
- Giemsa staining
- Immunofluorescent antibody test
TREATMENT
Pharmacological Treatment
Classes of drugs used are:
- Antibiotics:-Tetracyclines,Cephalosporins,Macrolides
- Mast cell stabilizers
- Decongestants
- Nonsteroidal anti-inflammatory agents (NSAIDs)
PATIENT EDUCATION
Good hygiene can help prevent the spread of conjunctivitis:
- Keep your hands away from the eye.
- Wash hands frequently.
- Change pillowcases frequently.
- Replace eye cosmetics regularly.
- Do not share eye cosmetics, towels or handkerchiefs.
- Proper use and care of contact lenses.
Complications
- Pneumonia
- Conjunctival scarring
- Penetration of the cornea can occur within 2 days in
- patients with untreated N gonorrhea
- Meningitis.
Prognosis
- The prognosis is good. Conjunctivitis typically is self-
- I limited and without long-term complications.