Conjunctivitis

 Conjunctivitis

Conjunctivitis is redness and inflammation of membrane (conjunctiva) covering the whites of eye.

It can occur in both eyes, pink appearance (pink eye) because of subconjunctival blood vessel hemorrhage.

Causes of Conjunctivitis

1. Exogenous conjunctivitis

Due to introduce foreign object, chemicals, microorganisms in conjunctival sac.

2. Endogenous conjunctivitis

Due to blood borne infection or allergic reaction response.

Types of Conjunctivitis

1. Bacterial conjunctivitis

Staphylococcus aureus

Staphylococcus pneumoniae

Haemophilus influenzae

Chlamydia 

1. Acute-muco purulent conjunctivitis

Affect mucus membrane of conjunctiva.

2. Acute purulent conjunctivitis

Purulent discharge from conjunctiva.

Caused by Neisseria gonorrhoea in adult.

In new born as ophthalmia neonatorum.

3. Membranous conjunctivitis

Caused by Corynebacterium diphtheria.

Membrane formation on the conjunctiva. 

4. Pseudo membranous conjunctivitis

Caused by Staphylococcus, Streptococcus, Pneumococcus.

Exudates adhere to surface of inflamed conjunctiva.

5. Angular conjunctivitis

Whitish discharge at the outer canthus.

Clinical Manifestations of Bacterial Conjunctivitis

1. Foreign body sensation

2. Eye pain

3. Eye discomfort

4. Burning sensation

5. Photophobia

6. Swelling and redness

7. Gritty feeling in eye 

8. Large amount of eye discharge

9. Eylids stick together after sleeping 

2. Viral conjunctivitis

Adenovirus

Herpes simplex virus (HSV)

Upper respiratory tract infection/common cold/sore throat.

Clinical Manifestations of Viral Conjunctivitis 

1. Watery discharge

2. Itching

3. Redness in eye

4. Enlarged lymph gland in front of eye

5. Sensitivity to light

6. Swelling of eye

3. Allergic Conjunctivitis

Inflammation of conjunctiva due to hypersensitivity reaction or allergic reaction.

1. Simple allergic conjunctivitis 

a. Seasonal allergic conjunctivitis (SAC)

b. Perennial allergic conjunctivitis (PAC)

2. Vernal keratoconjunctivitis (VKC)

Type l hypersensitivity reaction of conjunctiva to exogenous allergens.

3. Atopic keratocongiuntivitis (AKC)

Associated with atopic dermatitis, provoked by pollens, inhalants.

4. Phlyctenular conjunctivitis

Type  IV delayed hypersensitivity reaction of endogenous toxins, bacterial origin.

5. Contact dermoconjunctivitis

Type IV delayed hypersensitivity reaction to prolonged contact with chemicals and drugs.

4. Toxic or Chemical Conjunctivitis 

When the irritating substance enters the eyes, suchas as; hair spray, chlorine in swimming pool, foreign object in eye, industrial pollutants.

5. Subconjunctival hemorrhage

When tiny vessels covering whites of eyes ruptured from trauma or change in pressure within head.  The local area of white portion of eye become red.

6. Conjunctivitis associated with other disease condition

Cytomegalovirus (CMV), Systemic lupus erythematous (SLE), Crohn's disease, ulcerative colitis.

Diagnostic Evaluation

1. Patient history and Physical examination

2. Taking culture or smear of conjunctival tissue

3. Visual acuity measurement

4. Evaluate type of discharge; watery, mucoid, purulent, or mucopurulent.

5. Diagnose type of conjunctival reaction

Management

1. Bacterial conjunctivitis

1. Wash eye ith warm normal saline, help to remove discharge and organism.

2. Ask to lie affected side, so that discharge from affect eyes drain easily and not enter to other eye.

3. Ask patient to don't touch eye

4. Antibiotics eye drops 

1% tetracycline or oxytetracycline

5. Astringent drops protargol 5% used. They destroy surface epithelium cells which often contains organism.

6. If cornea involved atropine sulphate 1% drop used.

If cornea not involved, ceftriaxone injection given.

2. Viral Conjunctivitis 

1. Warm compresses

2. Advise avoid touching eyes

3. Use cold compression to soothe the pain 

4. Eye drops zinc sulphate 1% with boric acid 2% solution to relieves congestion.

5. Antiviral eye drops

Acyclovir

Trifluridine

6. Astringent solution used to prevent bacterial infection.

3. Allergic Conjunctivitis

1. Allergy removed

2. Wash eye with cold water

4. Antihistamine eye drops

5. Dexamethasone eye drops

6. If cornea involved, atropine sulphate 1% ointment used.

7. Cold compression, ice packs used to decrease swelling.

4. Chemical conjunctivitis

1. Continue irrigation with ringer's lactate or saline solution

2. Antibiotic eye drops

3. Eye drops to paralyze eye to reduce spasm 

4. Antihistamine eye drops

5. Chemical injury are mediacal emergency, delaying can lead to severe scarring and intraocular damage.