14. Conjunctivitis

OTHER NAMES
Pink eye; inflammation of the conjunctiva
DEFINITION
Conjunctivitis is an inflammation of the conjunctiva (the outermost layer of the eye and the inner surface of the eyelids), most commonly due to an allergic reaction or an infection (usually bacterial or viral).

Blepharoconjunctivitis is the combination of conjunctivitis with blepharitis (inflammation of the eyelids).

Keratoconjunctivitis is the combination of conjunctivitis and keratitis (corneal inflammation).

Episcleritis is an inflammatory condition that produces a similar appearance to conjunctivitis, but without discharge or tearing
PREVENTION
Good hygiene can help prevent the spread of conjunctivitis:
- keep hands away from the eye
- wash the hands frequently
- change pillowcases frequently
- replace eye cosmetics regularly
- do not share eye cosmetics
- do not share towels or handkerchiefs
- proper use and care of contact lenses
SYMPTOMS
- tearing, increased
- eye pain
- redness in the eyes
- gritty feeling in the eyes
- itching of the eye
- blurred vision
- sensitivity to light
- crnsts that form on the eyelid overnight
SIGNS AND TESTS
- examination of eyes
- swab of conjunctiva for analysis

Treatment Options

Treatment Strategy

 Viral conjunctivitis does not respond to antibiotics and is generally self-limiting. Treatment such as vasoconstrictive drops and/or cool compresses ease symptoms. For bacterial conjunctivitis, local antibiotics are indicated.

Drug Therapies

 _... Viral conjunctivitis: Cool compresses tid for one to three weeks; may also use antihistamines to relieve inflammation. Trifluridine 1% drops, every two hours. Acyclovir oral and topical as indicated. _... Allergic conjunctivitis: Attempt to eliminate contact with allergen. Treat with cool compresses, OTC or topical antihistamines, mast cell stabilizers such as cromolyn sodium, NSAIDs (particularly ketorolac). Vasoconstrictor/antihistamine combination of naphazoline 0.05%/antazoline 0.5%. Possibly mild corticosteroids. _... Bacterial conjunctivitis: Polytrim drops (trimethoprim sulfate, polymixin B sulfate, Allergan), 1 drop tid for one week, or polymixin B-bacitracin ointment (Polysporin). Fluoroquinolones as second-line therapy. Tobramycin (0.3%) or gentamicin as drops, or 10% sodium sulfacetamide as drops, every four hours. _... Giant papillary conjunctivitis: Avoid use of lenses until condition clears up and then consider prescribing a different material or design. The NSAID suprofen has been shown to be helpful in treatment, as are antihistamines. A short course of low-dosage topical corticosteroids may be necessary initially to reduce inflammation.

Complementary and Alternative Therapies

 Mild to moderate cases of conjunctivitis may respond well to alternative treatment. Antibiotics may be needed for bacterial infections. For mild cases, begin with compresses. For moderate infection, use an eyewash as well. In the case of chronic or recurrent infection, nutritional support is suggested. Homeopathic remedies may be used for symptomatic relief.

Nutrition

 Doses listed are for adults. Decrease by one-half to two-thirds for children. Vitamin A (10,000 IU/day), vitamin C (1,000 mg tid to qid), and zinc (30 to 50 mg/day) enhance the immune response and promote healing.

EXPECTATIONS (PROGNOSIS)
The outcome is usually good with treatment.
COMPLICATIONS
Reinfection within a household or school may occur if preventive measures are not followed.

Courtesy:

Compiled and Shared By: Habib Anwar 

habib.anwar@hotmail.com