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Eye Disorder – Conjunctivitis

Conjunctivitis (also called pink eye) refers to inflammation of the conjunctiva (the outermost layer of the eye and the inner surface of the eyelids). It is most commonly due to an infection (usually viral, but sometimes bacterial) or an allergic reaction.

TYPES OF CONJUNCTIVITIS

  • Allergic conjunctivitis
  • Bacterial conjunctivitis
  • Viral conjunctivitis
  • Chemical conjunctivitis
  • Neonatal conjunctivitis

SIGNS AND SYMPTOMS

Red eye (hyperaemia), irritation (chemosis) and watering (epiphora) of the eyes are symptoms common to all forms of conjunctivitis. However, the pupils should be normally reactive and the visual acuity normal.

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 discharge and variable itch. The infection usually begins with one eye, but may spread easily to the other.

BACTERIAL

Bacterial conjunctivitis due to common pyogenic bacteria causes marked irritation and a stringy, opaque, greyish or yellowish mucopurulent discharge that may cause the lids to stick together, especially after sleep. 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.

CHEMICAL

Chemical conjunctivitis is due to either an acidic or alkali substance getting in the eye. Mild burns will produce conjunctivitis while more severe burns may cause the cornea to turn white. Large volumes of irrigation is the treatment of choice . Local anaesthetic eye drops can be used to decrease the pain.

OTHER

Inclusion conjunctivitis of the newborn (ICN) is a conjunctivitis that may be caused by the bacteria Chlamydia trachomatis, and may lead to acute, purulent conjunctivitis. However, it is usually self-healing.

CAUSES

Conjunctivitis is most commonly caused by viral infection, but bacterial infections, allergies, other irritants and dryness are also common etiologies for its occurrence.

The most common cause of viral conjunctivitis is adenoviruses. Herpetic keratoconjunctivitis (caused by herpes simplex viruses) can be serious and requires treatment with acyclovir. Acute hemorrhagic conjunctivitis is a highly contagious disease caused by one of two enteroviruses, Enterovirus 70 and Coxsackievirus A24. These were first identified in an outbreak in Ghana in 1969, and have spread worldwide since then, causing several epidemics.

DIAGNOSIS

Cultures are done infrequently because most cases of conjunctivitis are treated empirically. Swabs for bacterial culture are necessary if the history and signs suggest bacterial conjunctivitis and there is no response to topical antibiotics.

MANAGEMENT

Conjunctivitis resolves in 65% of cases without treatment, within two to five days. The prescribing of antibiotics to most cases is not necessary.

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. Due to the contagious nature of pink eye travel is banned to some countries.

Bacterial

Bacterial conjunctivitis usually resolves without treatment. Antibiotics, eye drops, or ointment are thus only needed if no improvement is observed after three days.

Viral

Although there is no specific treatment for viral conjunctivitis, symptomatic relief may be achieved with cold compresses and artificial tears.

Chemical

Conjunctivitis 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.

PREVENTION 0f Conjunctivitis

  • People with chemically-induced 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.
  • With either type of conjunctivitis, hand washing is the best means of preventing the spread of disease.
  • People are often advised to avoid touching their eyes or sharing towels and washcloths.
  • During home care, eyes should be cleansed gently to remove exudates and the cleansing tissues disposed of using standard precautions.
  • Avoid shaking hands with other people.
  • Use separate medication bottles or tubes for each eye.