Conjunctivitis

Conjunctivitis (commonly called " pinkeye " in the USA and " Madras Eye " in India ) is an inflammation of the conjunctiva (the outermost layer of the eye and the inner surface of the eyelids ), often due to infection. The three most common types of conjunctivitis are: viral , allergic , and bacterial . Each requires different treatments. Classification usually is based on cause, including viral, bacterial, fungal, parasitic, toxic, chlamydial, chemical, and allergic agents. When you wake up in the morning, your eyes may seem to be pasted shut from the discharge coming from your eyes. Viral conjunctivitis is spread by aerosol or contact of a variety of contagious viruses, including many that cause the common cold , so that it is often associated with upper respiratory tract symptoms. As with any mucous membrane, infectious agents may adhere to the conjunctiva, thus overwhelming normal defense mechanisms and producing clinical symptoms of redness, discharge, irritation, and possibly photophobia. Pink eye and red eye are terms commonly used to refer to all types of conjunctivitis. Allergic conjunctivitis may also be caused by intolerance to substances such as cosmetics, perfume, or drugs But because pink eye can be contagious, it should be diagnosed and treated early. This is especially important for preschool-age children, who commonly develop both viral and bacterial conjunctivitis.

Conjunctivitis is one of the most common and treatable eye infections in children and adults. Most causes of conjunctivitis are benign, and the role of the emergency physician is to separate those few conditions requiring more vigorous treatment from the majority that can be handled satisfactorily in the ED.Acute conjunctivitis is redness and soreness (inflammation) of the clear covering (the conjunctiva) which coats the white of the eye and lines the inside of the eye lids. The viral type is often associated with an upper respiratory tract infection, cold, or sore throat. The whites of your eyes may begin to have a pink discoloration, and you may not see as clearly as you did before. The accessory lacrimal glands (Krause and Wolfring), along with goblet cells, are contained within the conjunctiva and are responsible for keeping the eye lubricated. Bacterial conjunctivitis is often caused by bacteria such as staphylococcus and streptococcus.Though the inflammation of pink eye makes it an irritating condition, it rarely affects your sight. If you suspect pink eye, you can take steps to ease your discomfort. Viral etiologies are more common than bacterial, and incidence of viral conjunctivitis increases in the late fall and early spring. Pink eye caused by bacteria, viruses, and STDs can spread easily from person to person, but is not a serious health risk if diagnosed promptly.

Causes of Conjunctivitis

The common Causes of Conjunctivitis :

Gram-positive for the following cocci - Staphylococcus epidermidis, Streptococcus pyogenes, and Streptococcus pneumoniae
Vernal conjunctivitis is a bilateral recurrent hypersensitivity that occurs during the warm months of the year, particularly in hot climates.
Virus infection may also occur.
Allergic reactions, eg hayfever , may cause conjunctivitis, but do not usually cause a sticky discharge.
A chemical splash in the eye
This type of conjunctivitis can spread rapidly between people and may cause an epidemic of conjunctivitis.
A foreign object in the eye
Viral (e.g. from cold viruses)
Irritants such as shampoos, dirt, smoke, and pool chlorine
Allergies, like dust, pollen, or a special type of allergy that affects some contact lens wearers

Symptoms of Conjunctivitis

Some common Symptoms of Conjunctivitis :

The eye is red, with the blood vessels over the white of the eye more visible and swollen. The lining of the eyelids also looks redder or pinker than usual.
The eye is sticky, with a discharge, which is worse when you wake up.
Infection usually begins with one eye, but may spread easily to the fellow eye
Swollen eyelids
Swelling of the conjunctiva
A gritty feeling in one or both eyes
Blurred vision and sensitivity to light
Thick yellow discharge that crusts over the eyelashes, especially after sleep.
Green or white discharge from the eye.
Increased sensitivity to light.

Treatment of Conjunctivitis

Patients who wish to return to hydrogel (soft) CLs should use peroxide disinfection systems or daily disposable hydrogel CLs.
Topical mast cell-stabilizing solutions (eg, cromolyn sodium, lodoxamide) may offer a pharmacological alternative for these patients, although CL cessation is the most effective treatment.
Don't share washcloths, towels or pillowcases with anyone else, and wash these items after each use.
Conjunctivitis caused by bacteria, including STDs, is treated with antibiotics, in the form of eye drops, ointments, or pills.
There are proprietary eye washes and lotions which may soothe the eyes, and at least one eye treatment which is for mild infections, but in general these are merely a temporary measure.
Bacterial conjunctivitis is usually treated with antibiotic eye drops or ointments that cover a broad range of bacteria.
A physical examination usually reveals redness and swelling of blood vessels in the conjunctiva.
Just as a cold must run its course, so must this form of conjunctivitis, which will last from 4 to 7 days.
Allergy-associated conjunctivitis should be evaluated by your ophthalmologist and an allergist.
There is no effective treatment for viral conjunctivitis but the eyes may be made more comfortable by using a lubricant ointment such as Lacri-Lube

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