CONJUNCTIVITISDescription:Definition: Conjunctivitis is an inflammation (redness) of the conjunctiva. The conjunctiva is the membrane that lines the white part of the eye and the underside of the eyelid. Conjunctivitis can be caused by infection, an allergic reaction, or a physical agent, such as infrared or ultraviolet light. It is often referred to as pink eye because the infection causes the eye to become very bloodshot.Alternative name: Pinkeye.Conjunctivitis, also called pinkeye, is inflammation or infection of the thin membrane that lines the eyelids and covers the white part of the eye (sclera). This membrane, which is called the conjunctiva, produces mucus to keep the eye moistened. When the conjunctiva becomes infected, the blood vessels enlarge, making the eye appear pink or red, and the eye produces excess mucus.There are several types of it, including the following:Allergic.
Pinkeye can also be caused by exposure to a chemical substance. In infants, conjunctivitis can result from a partially blocked tear duct.Viral conjunctivitis, which is the most common form of pinkeye, can affect both children and adults. Bacterial conjunctivitis is more common in children.Newborns (infants from birth to 3 months of age) are highly susceptible to pinkeye and can develop more serious complications if the condition goes untreated. As a preventive measure, all newborns are treated with antibiotic eye drops or ointment immediately after birth.Usually, conjunctivitis is a self-limited disease, either clearing up on its own or after a course of antibiotics, however, certain forms of conjunctivitis can become serious and become sight-threatening. They include conjunctivitis caused by gonorrhea or chlamydia.Infective conjunctivitis is highly contagious, therefore, there is no surefire way to avoid getting it. However, maintaining proper hygiene should minimize transmission. With regards to allergic conjunctivitis, avoiding allergens and taking proper care of your contact lenses can help reduce your risk. If someone in your household has conjunctivitis, be sure to wash your hands often and thoroughly. Avoid sharing washcloths, towels, pillowcases, mascara or eyeliner with them.Symptoms:Symptoms of conjunctivitis can range from mild to serious. They can affect one eye or both. Some common symptoms include redness of the eye, swelling of the eyelid, and a discharge from the eye. The discharge is watery and either yellow or green in color. Some kinds of viruses cause more serious reactions. They may cause the eye to feel scratchy and have a pus-like discharge. These infections also can cause swelling and tenderness of the lymph nodes behind the ear.The symptoms of infectious conjunctivitis caused by a bacteria or viruses are:Eye pain.
Swelling of the eyes.
Redness in the eyes.
Yellow, green or watery discharge from the eyes which collects overnight and crusts over the eye.
A gritty feeling in the eye.
Itching of the eye.
An enlarged lymph gland in front of the ear.
The symptoms of conjunctivitis caused by allergies are:Intense itching of the eye.
Excessive tearing of the eye.
Swelling of the eye.
Redness of the eye.
Symptoms for the other causes of noninfectious conjunctivitis are dependent on the circumstances (i.e., if the conjunctivitis is caused by smog, the person may experience itchy, red eyes; if the conjunctivitis is caused by a chemical in the eye, the person may experience burning, red eyes and blurred vision).Causes and Risk factors:Conjunctivitis may be caused by a viral infection, such as a cold, acute respiratory infection, or disease such as measles, herpes simplex, or herpes zoster. Symptoms include mild to severe discomfort in one or both eyes, redness, swelling of the eyelids, and watery, yellow, or green discharge. Symptoms may last anywhere from several days to two weeks. Infection with an adenovirus, however, may also cause a significant amount of puslike discharge and a scratchy, foreign body-type of sensation in the eye. This may also be accompanied by swelling and tenderness of the lymph nodes near the ear.Bacterial conjunctivitis can occur in adults and children and is caused by organisms such as Staphylococcus, Streptococcus, and Hemophilus. Symptoms of bacterial conjunctivitis include a puslike discharge and crusty eyelids after awakening. Redness of the conjunctiva can be mild to severe and may be accompanied by swelling. Persons with symptoms of conjunctivitis who are sexually active may possibly be infected with the bacteria that cause either gonorrhea or chlamydia. There may be large amounts of puslike discharge, and symptoms may include intolerance to light (photophobia), watery mucous discharge, and tenderness in the lymph nodes near the ear that may persist for up to three months.Conjunctivitis may also be caused by environmental hazards, such as wind, smoke, dust, and allergic reactions caused by pollen, dust, or grass. Symptoms range from itching and redness to a mucous discharge. Persons who wear contact lenses may develop allergic conjunctivitis caused by the various eye solutions and foreign proteins contained in them.Other less common causes of conjunctivitis include exposure to sun lamps or the electrical arcs used during welding, and problems with inadequate drainage of the tear ducts.Risk Factors:Viral and bacterial conjunctivitis are highly contagious. Family members and people who are in close contact with each other, such as in schools, daycare centers, and summer camps, often spread the infection from person to person.Children who wear contact lenses, especially extended-wear lenses, may be more prone to developing bacterial conjunctivitis.Diagnosis:Conjunctivitis usually is diagnosed by history and physical examination. Lab tests typically are reserved for patients that do not improve in 48-72 hours despite treatment. Lab studies include the following:
Gram stain is considered the criterion standard for determining the bacterial cause of conjunctivitis. Simple conjunctivitis does not require a Gram stain. Eosinophils seen on Gram stain are indicative of allergic conjunctivitis but can be seen in parasitic causes.
Culture and sensitivity of conjunctival scrapings typically are not performed for simple conjunctivitis. Obtain cultures in all newborns, neonates, persons who are immunosuppressed, or when N gonorrhoeae is under consideration as the etiology. When performed, collect exudate from the lower conjunctival fornix with a calcium alginate swab moistened with saline. Sheep blood and mannitol agar plates routinely are used. Expect viral and chlamydial causes in culture-negative conjunctivitis.
Giemsa staining is performed to look for the inclusion bodies of Chlamydia versus a viral etiology in culture-negative conjunctivitis. This technique has a low yield, except in neonatal inclusion conjunctivitis. The presence of eosinophils is diagnostic of allergic conjunctivitis.
Immunofluorescent antibody testing of the conjunctival discharge can be performed to detect the immunoglobulin G (IgG) or immunoglobulin M (IgM) antibodies to Chlamydia. Consider chlamydial etiology when conjunctivitis persists beyond 14 days and in all sexually active individuals. A high index of suspicion is necessary in patients aged 15-50 years.
Treatment:Treatment for conjunctivitis or "pink eye" can vary widely, depending on what causes the eye condition.Antibiotics usually are the mainstay of treatment for bacterial forms of conjunctivitis, while relief of symptoms often is the best approach for viral types of pink eye that must simply run their course.Warm compresses placed on closed eyelids may help soothe your eyes if you have viral or bacterial conjunctivitis. Because these two types of pink eye are contagious, you also should practice good hygiene such as frequent hand washing to keep from infecting your other eye or people who share your environment.If your eyes are itchy, scratchy and irritated most of the time, you may need eyedrops or pills to treat eye allergies associated with this form of non-contagious pink eye.Whenever you have symptoms such as eye redness, runny eyes or sensitivity to light (photophobia), however, it's always best to consult your eye doctor for advice about proper treatment.Antibiotic Treatments for Bacterial Conjunctivitis: Usually, a broad-spectrum antibiotic treatment in the form of eye ointments or drops is used to treat conjunctivitis or "pink eye" infections caused by bacteria. In certain cases where an underlying infection elsewhere in the body may be causing your eye symptoms, you may be prescribed antibiotics to swallow in tablet form.Standard antibiotic treatments often will work for ordinary bacterial infections related to staphylococcus (staph) or streptococcus (strep) infections, which are the usual causes of bacterial conjunctivitis in adults.In children, Haemophilus influenza bacteria — unrelated to common flu, which is viral — also may cause pink eye.A typical antibiotic treatment often will work for these types of bacterial infections without the need to swab the eye and send off a sample (culture) for evaluation. If the initial treatment doesn't work, then a culture may be needed so that treatment can be changed to a more specialized type of antibiotic.Your eye doctor might prescribe an eye cleanser to keep your eyes clean or to prevent a bacterial infection from starting. Artificial tears are another common prescription for pink eye, to relieve dryness and discomfort.Treatments for Pink Eye Caused by Sexually Transmitted Diseases (STDs): If the discharge from the eye is severe, gonococcal (gonorrhea) conjunctivitis may be an underlying cause, particularly in newborn babies who, while being born, contact mothers who have been infected with a sexually transmitted disease.Ideally, a mother-to-be should be tested before her baby is born to make sure any pre-existing infection can be cleared up with antibiotics to avoid the possibility of transmitting it to the baby.If gonococcal conjunctivitis is confirmed in a newborn infant, then antibiotic treatment must be given intravenously (through veins) or through muscles, as well as in the form of topical eyedrops or ointments.Any newborn baby with pink eye must be evaluated for gonococcal and chlamydial conjunctivitis (STDs). However, staphylococcus, streptococcus and other infectious agents should be considered as well, so appropriate treatment can begin.Again, not all instances of conjunctivitis that occur right after or within a few weeks of birth (ophthalmia neonatorum) are caused by sexually transmitted disease. A baby's eyes can become infected from exposure to other types of bacteria during the birth process. Also, babies who are only a few weeks old can be exposed to pink eye from other bacterial sources after they go home.Measures such as applying silver nitrate and antibiotic ointments to the eyes of newborn infants within an hour of birth have greatly reduced the rate of gonococcal conjunctivitis in the U.S. — from 10 percent of births decades ago to only 0.3 percent currently, according to Principles and Practice of Pediatric Infectious Diseases and other references.This preventive method does not stop chlamydia-based conjunctivitis, however, which must be treated with antibiotics after diagnosis.Antibiotic treatment for conjunctivitis related to chlamydia or gonorrhea also may be needed for sexually active adults exposed to secretions containing these infectious agents.Viral Conjunctivitis Treatments: Because many forms of conjunctivitis are viral, for which there is no curative treatment, it's important to pinpoint exact symptoms to determine the underlying cause of pink eye before treatment (if any) is considered.Usually, a person with viral conjunctivitis has redness in one or both eyes along with watery or a small amount of mucus discharge. Generally, vision is good.If you or your child first had an upper respiratory infection such as a common cold, then resulting pink eye may be due to an adenovirus that commonly invades moist, membrane-like tissue lining nasal passages and eyes.This is why viral conjunctivitis spreads easily when infected children sharing close quarters with family members or classmates start sneezing and coughing. It is often the cause of pink eye epidemics.Virus-based illnesses such as measles and mumps, while not nearly as common as they once were, also can lead to viral forms of pink eye.If you have viral conjunctivitis, usually the condition itself can't be treated. But you may need certain types of eyedrops to help your eyes feel better.Examples:
Antihistamines can help relieve eye itchiness and irritation.
Vasoconstrictors compress blood vessels in the eye to reduce redness.
Sometime steroids are prescribed to control these symptoms and speed recovery. But it is quite possible that once the steroids are discontinued, the disease may continue to run its course. Furthermore, long-term steroid use may be associated with development of cataracts or glaucoma.
Some symptoms may take several months and even a year or longer to disappear. However, most ordinary cases of viral conjunctivitis will run their course without treatment within several days or weeks.Relief for Allergic Conjunctivitis: Itchy eyes are nearly always a sign of allergic conjunctivitis. A stringy but scant mucous discharge and red eyes also may be present. Other common allergic symptoms are a stuffy, runny nose (rhinitis), "scratchy" throat and dry, hacking cough. Vision is rarely affected.The diagnosis of allergic conjunctivitis is confirmed by the lack of infectious signs on microscopic examination in the eye doctor's office. Treatment is designed to control symptoms, which may be chronic in some cases.Depending on the degree of symptoms, many people get relief from over-the-counter vasoconstrictor and antihistamine eyedrop combinations for relief of red eyes and itchiness.If this approach is ineffective or symptoms are more severe, a mild steroid eyedrop medication may be used temporarily. Eventually, an eyedrop medication known as a mast-cell stabilizer may be substituted. Mast cells release histamine and other causes of eye inflammation and ultimately are responsible for itching.People whose allergic conjunctivitis symptoms can be controlled only with steroids and who require ongoing treatment must be monitored for potential increases in eye pressure and cataract development that are potential side effects of steroids.Giant Papillary Conjunctivitis Remedies:Soft contact lens wearers represent the great majority of people afflicted with giant papillary conjunctivitis (GPC).GPC is related to immune responses and inflammation associated with a contact lens, artificial eye (ocular prosthesis) or even an exposed stitch (suture) in the eye in some postoperative patients. Symptoms include tearing, significant mucus production and itching of the involved eye. Often, both eyes are involved. A bumpy surface on the underside of the upper eyelid indicates presence of giant papillae.Remedies for GPC include:Removing the foreign body, such as a contact lens, that has caused the abnormal immune response and leaving it out for at least a month or longer. After the condition resolves, wearing soft contact lenses only for limited time periods or switching to gas permeable contact lenses to decrease the risk that GPC might recur.Using strict contact lens hygiene (such as using appropriate contact lens solutions) and changing lenses frequently to help reduce the chance of GPC.Finally, irrigating the eye's surface with a sterile salt water (saline) solution several times daily may give additional relief. For those with particularly severe GPC, a short course of corticosteroid eyedrops may be prescribed.People interested in continuing to wear contact lenses and who already have had GPC might consider using mast-cell stabilizing agents in eyedrops to help suppress release of mediators (histamine, etc.) of inflammation in the eye, caused by the body's immune responses.Prevention:
Good hygiene can help prevent the spread of conjunctivitis:
Change pillowcases frequently.
Do not share eye cosmetics.
Do not share towels or handkerchiefs.
Handle and clean contact lenses properly.
Keep hands away from the eye.
Replace eye cosmetics regularly.
Wash your hands often.
Medicine and medications:Ciprofloxacin ophthalmic (Ciloxan).
Azithromycin ophthalmic (AzaSite).
Erythromycin ophthalmic (Ilotycin).
Tobramycin ophthalmic (Tobrex).
Gatifloxacin ophthalmic (Zymar).
Gentamicin ophthalmic (Gentak).
Bacitracin ophthalmic (AK-Tracin).
Naphazoline ophthalmic (Naphcon).
Levocabastine ophthalmic (Livostin).
Sulfacetamide sodium ophthalmic (Bleph-10).
Cromolyn ophthalmic (Crolom, Opticrom).
Dexamethasone-tobramycin ophthalmic (Tobradex).
Gramicidin/neomycin/polymyxin B ophthalmic (AK-Spore).
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