Conjunctivitis or the inflammation of the conjunctiva is a very common disease and its severity varies from mild inflammation with lacrimation to severe inflammation that causes damage and decay of the tissue.
Conjunctiva (the outermost layer of the eye and the inner surface of the eyelids) is a transparent, smooth and shiny membrane that connects the rear surface of the eyelid and the eyeball.
Most common causes of conjunctivitis are various external factors which affect the eye adversely. They may be physical (heat, draught), chemical (acids, alkalis), bacterial, viral, allergic and other.
Types of conjunctivitis:
It is differentiated between viral conjunctivitis, bacterial conjunctivitis, gonococcal conjunctivitis, allergic conjunctivitis and chemical conjunctivitis.
The cause of inflammation of conjunctiva in this type is a viral infection. A great number of different types of viruses may be responsible for the infection. Symptoms of viral conjunctivitis manifest in watery discharge from the eye, and the infection is often associated with symptoms of cold, such as nasal discharge.
Swollen eyelids are a common occurrence, and photophobia may also appear, i.e. eye sensitivity to light. Viral conjunctivitis does not require antibiotic treatment with drops, but it usually passes itself from 7 to 10 days. This type of conjunctivitis is highly contagious; therefore, it is recommended to be wary of the possible transmission of the infection from one person to another.
The bacteria that mostly cause conjunctivitis are staphylococci, pneumococci and streptococci. Symptoms of bacterial conjunctivitis include pain in the eye, swelling, redness and discharge from the eye which is typically of yellow-green color.
The discharge usually amasses during night, and in the morning it is difficult to open the eyes due to the dried discharge. It is treated with antibiotic eye drops and eye ointment. The treatment with antibiotics ought not to last for too long, because it can prolong the irritation of conjunctiva and lead to the development of chronic conjunctivitis.
Gonococcal conjunctivitis is an acute conjunctivitis which usually affects both eyes. The cause is gonococci bacteria. The newborn child becomes infected during the passing through the birth canal of the infected mother. In most countries there is the prophylaxis of instilling one-per cent solution of silver-nitrate after birth.
Adults are infected by the transmission of infection from the genitourinary system. The disease begins with redness of the conjunctiva, after which appears the swelling of eyelids followed by purulent discharge. Development of complications is possible, which can lead to damaging of the deeper structures of the eye. It is treated by cautiously washing the eye with warm saline solution and by instilling solution of penicillin into the eye.
Allergic conjunctivitis is the allergic inflammatory reaction of the conjunctiva. About 70 per cent of patients suffering from allergic conjunctivitis have conjoined allergic diseases, such as allergic rhinitis, asthma or dermatitis.
Main types of allergic conjunctivitis:
- 1.Seasonal Allergic Conjunctivitis (SAC)
- 2.Vernal Keratoconjunctivitis (VKC)
- 3.Phlyctenular Keratoconjunctivitis – chronic (PKC)
- 4.Giant Papillary Conjunctivitis (GPC)
- 5.Atopic Keratoconjunctivitis (AKC)
Usual symptoms of acute allergic conjunctivitis are itching and burning of the eye, photophobia and feeling an alien object in the eye; and signs of allergic conjunctivitis include hyperemia and edema of conjunctiva, papillary hypertrophy, increased secretion of discharge, blepharospasm and swelling of the eyelids.
Seasonal Allergic Conjunctivitis is usually linked to periodic occurrence of allergens in the environment, such as pollen, grass, weed etc. On contrary, patients with Phlyctenular Keratoconjunctivitis may experience the symptoms during the whole year, and the causes do not have to be exclusively seasonal allergens; they are mostly house dust, mites and animal hair. There are hyperemia, edema of the conjuctiva, papillary or follicular hyperplasia of conjunctiva present; and the symptoms are itching, photophobia and eye burning. It is very often conjoined with allergic changes on skin and respiratory tract, such as hives, running nose and sneezing. Vernal Keratoconjunctivitis is a chronic bilateral inflammation of the conjunctiva, and it is linked with positive personal or family history of atopy. As provocative factors mentioned are UV radiation, pollen etc. Mucosa is hyperemic with milky quality. Photophobia and lacrimation are expressed.
For now, allergies of the eye cannot be permanently cured, so the treatment of allergies is focused on reduction of symptoms with minimal side effects. Treatment consists of removing the etiological factor, the application of local and oral drug therapy, as well as mechanical protection of the eye and its rehydration.
Local mast cell stabilizers prevent the release of chemical mediators of inflammation. They are effective in all cases of allergic conjunctivitis. Preparations are particularly good at treating vernal and allergic conjunctivitis. Local anti-inflammatory medications – steroid drops are reserved for severe cases because of known side effects: they increase intraocular pressure and can cause cataract, they also increase bleeding tendency. Otherwise, they inhibit the synthesis of leukotrienes and prostaglandins. Non-steroid anti-rheumatics inhibit prostaglandin synthesis, and their side effects are similar to those caused by corticosteroids.
Chemical conjunctivitis occurs as a result of eye irritation caused by chemical substances. The most common irritants in this case are cleaning products, smoke, smog and industrial pollutants. After contact with irritants it is necessary to wash the eye with a greater amount of water, and contact the doctor in order to prevent greater eye damage.
According to clinical image it is differentiated between:
Acute catarrhal conjunctivitis
It is characteristic for hyperemia of the conjunctiva, sparse mucopurulent discharge, burning, and the feeling of having an alien object in the eye. It is a mild conjunctivitis, which is in practice mostly encountered. Its cause is usually viral and it disappears spontaneously after several days. For treatment are given sulfacetamide or antibiotic drops which reduce discomfort, but of course, have no effect on viruses.
Papillary conjunctivitis is characterized by numerous vascularized papillae the size of 0.1 mm on the conjunctiva which give it a velvety appearance. The causes are pyogenic bacteria (usually staphylococcus), allergies (when accompanied by itching), prolonged usage of contact lenses, and toxic factors.
It is characterized by numerous transparent nodules the size of 1 mm on the conjunctiva, which gives it appearance of cobblestones. Follicles are the lymph nodes caused by a virus, chlamydia or granulomatous inflammation. Cornea is very often also affected. Sometimes it is accompanied by sensitivity of preauricular lymph nodes, and lasts longer than a papillary form.
Epidemic Keratoconjunctivitis (Nummular Keratitis)
It is accompanied by pain, photophobia, an increase of preauricular lymph nodes and corneal infiltrates which can last for months. Secretion is mucopurulent, very abundant – it is characteristic for eyelids to be glued with secretion after waking. It is highly contagious during two weeks. It is caused by adenovirus types 8 and 19. As with faringoconjunctival fever, antiviral drugs have no effect.
Vernal Conjunctivitis or spring Catarrhal Conjunctivitis
It is seasonal, recurrent, bilateral allergic conjunctivitis of the children’s age. It typically occurs in spring, during flowering. It is accompanied by heavy itching, lacrimation, photophobia, the feeling of an alien object in the eye. It is characterized by giant papillae on tarsal conjunctiva (like cobblestones), and pathognomonic white freckles like crumbs of chalk (Trantas dots) on the corneal limbus. It is treated with steroid and anti-allergic drops. The prognosis is good, but the disease can recur through the years.
It is characterized by follicular hyperplasia and mucopurulent discharge. It is often conjoined with cervicitis and urethritis. It is spread by sexual contact and genital or conjunctiva discharge. It is treated with antibiotics (e.g. erythromycin), orally and locally during three weeks.
How to prevent spreading the disease?
Although it is difficult to prevent conjunctivitis, there are measures that can be taken to reduce the possibility of developing or spreading the disease to others, and those are: avoiding sharing cosmetics with others, avoiding sharing towels with others, frequently washing hands and avoiding touching the eyes, and not using medications (ointments and eye drops) that are prescribed to others. It should also be noted that the spread of disease can occur in non-chlorinated pools and stagnant waters. After the appearance of conjunctivitis it is necessary to see a doctor who will prescribe medications that are adequate, and also new and sterile so there will be no possibility of further infection.
How to apply eye medications?
Before applying eye drops or ointment it is necessary to wash the hands. During the process it is best to take lying position or a position with the head tilted backwards. Lower eyelid is moved away from the eye using cotton rolls, and then one to two drops are instilled into the middle part of the eye while the patient is looking up. More drops than this are not necessary because they cannot fit into the eye and therefore, they spill.
Drops are instilled into the bottom corner of the eyelid, not onto the eye. One should be careful not to touch the eye while instilling, so that the infection does not transfer to the vial of drops and create a new source of infection there. After instilling the drops the patient should keep the eyes closed for several minutes in order for the cure to deploy properly, and also to retain it because blinking removes tears and also the cure with them. Drops should be instilled at least 5-6 times a day because the tears wash them off and after a couple of hours there is no more medication in the eyes.
Ointments are placed into the lower part of the eye, after moving away the lower eyelid from the eye with a cotton roll. It is sufficient to put only a small amount of ointment. After putting the ointment it is necessary to close the eyes and with gently massaging eyelids to deploy the ointment over the eye. The ointment takes effect about 4 hours so it need not be used as often as eye drops. Most often the drops are taken during day, and ointments before sleep. After placing the drops and ointments it is necessary to wash the hands so that the infection would not be transferred to the other eye or other people.