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Conjunctivitis - Causes, Symptoms and Treatment

Hyperemia of the conjunctiva from infection, allergy, or chemical reactions characterizes conjunctivitis. Bacterial and viral conjunctivitis are highly contagious, but are also self-limiting after a couple of weeks' duration. Chronic conjunctivitis may result in degenerative changes to the eyelids. In the Western hemisphere, conjunctivitis is probably the most common eye disorder.

Causes of Conjunctivitis

The most common causative organisms are the following:

1) Bacterial: Staphylococcus aureus, Streptococcus pneumoniae, Neisseria gonorrhoeae, Neisseria meningitidis.

2) Chlamydial: Chlamydia trachomatis (inclusion conjunctivitis).

3) Viral: Adenovirus types 3, 7, and 8; herpes simplex virus, type 1.

Other causes include allergic reactions to pollen, grass, topical medications, air pollutants, and smoke; occupational irritants (acids and alkalies); rickettsial diseases (Rocky Mountain spotted fever); parasitic diseases caused by Phthirus pubis, Schistosoma haematobium; and, rarely, fungal infections.

Epidemic keratoconjunctivitis (EKC) is an acute, highly contagious, viral form of conjunctivitis. Health care professionals must be careful to use gloves, wash their hands, and disinfect instruments to prevent the spread of this disease.

Signs and Symptoms of Conjunctivitis

Conjunctivitis commonly produces hyperemia of the conjunctiva, sometimes accompanied by discharge and tearing. It generally doesn't affect vision unless there's corneal involvement, which also causes pain and photophobia. Conjunctivitis usually begins in one eye and rapidly spreads to the other by contamination of towels, washcloths, or the patient's own hand.

In acute bacterial conjunctivitis (pinkeye), the infection usually lasts only 2 weeks. The patient typically complains of burning and the sensation of a foreign body in his eye. The eyelids show a crust of sticky, mucopurulent discharge. If the disorder stems from N. gonorrhoeae, however, the patient exhibits a profuse, purulent discharge.

Viral conjunctivitis produces copious tearing with minimal exudate, and enlargement of the preauricular lymph node. Some viruses follow a chronic course and produce severe disabling disease; others last 2 to 3 weeks .

Diagnosis of Conjunctivitis

Physical examination reveals peripheral injection of the bulbar conjunctival vessels. In children, possible systemic symptoms include sore throat or fever if the conjunctivitis is suspected of being from an adenoviral origin.

Lymphocytes are predominant in stained smears of conjunctival scrapings if conjunctivitis is caused by a virus. Polymorphonuclear cells (neutrophils) predominate if conjunctivitis stems from bacteria; eosinophils, if it's allergy-related. Culture and sensitivity tests identify the causative bacterial organism and indicate appropriate antibiotic therapy.

Treatment for Conjunctivitis

The cause of conjunctivitis dictates the treatment. Bacterial conjunctivitis requires topical application of the appropriate broad-spectrum antibiotic.

Although viral conjunctivitis resists treatment, broad-spectrum antibiotic eye drops may prevent secondary infection.

Herpes simplex infection generally responds to treatment with trifluridine drops, vidarabine ointment, or oral acyclovir, but the infection may persist for 2 to 3 weeks. Treatment of vernal conjunctivitis includes administration of corticosteroid drops followed by cromolyn sulfate and cold compresses to relieve itching and, occasionally, oral antihistamines.

Instillation of a one-time dose of erythromycin into the eyes of newborns prevents gonococcal and chlamydial conjunctivitis.

Special Considerations and Prevention Tips for Conjunctivitis

Apply warm compresses and therapeutic ointment or drops. Don't irrigate the eye - this will only spread infection. Have the patient wash his hands before he uses the medication, and use clean washcloths or towels frequently so he doesn't infect his other eye.

Notify public health authorities if cultures show N. gonorrhoeae.

If ointments are prescribed, remind the patient that ointment blurs vision.

Teach proper hand washing technique because bacterial and viral forms of conjunctivitis are highly contagious. Stress the risk of spreading infection to family members by sharing washcloths, towels, and pillows. Warn against rubbing the infected eye, which can spread the infection to the other eye and to other persons.

Teach the patient to instill eye drops and ointments correctly - without touching the bottle tip to his eye or lashes. Stress the importance of safety glasses for the patient who works near chemical irritants.

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