CONJUNCTIVITIS - Disease Management

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

Bacterial

• 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.