Acute bacterial conjunctivitis is an infectious lesion of the mucous membrane of the eye caused by gram–positive or gram-negative bacteria. In acute conjunctivitis, pronounced photophobia and lacrimation, swelling and hyperemia of the eye mucosa, spot hemorrhages, mucopurulent discharge from the conjunctival cavity are noted. Diagnosis of acute conjunctivitis of bacterial etiology includes biomicroscopy of the anterior segment of the eye, staining of the cornea with fluorescein, bacteriological seeding of the discharge from the conjunctiva. In acute bacterial conjunctivitis, local antimicrobial treatment (eye drops and ointments) is carried out, taking into account the sensitivity of the pathogen to drugs.
Conjunctivitis accounts for up to 30% of all eye pathology in ophthalmology. Among them, bacterial conjunctivitis accounts for 73%; allergic conjunctivitis – 25%; viral conjunctivitis – 2%, respectively. Acute bacterial conjunctivitis is often combined with infectious blepharitis and keratitis. The incidence of acute conjunctivitis has a seasonal dependence (it is more often observed in the autumn-winter period). Acute infectious conjunctivitis, due to its high contagiousness, most often develops in children 2-7 years old and in children’s groups often acquires the character of epidemic outbreaks. The danger of acute bacterial conjunctivitis in children is the likelihood of developing keratitis, dacryocystitis, lacrimal sac phlegmons and orbital phlegmons.
Even in healthy people, various microorganisms are present in the microflora of the edges of the eyelids and the surface of the conjunctiva: staphylococci, propionibacteria, diphteroids, etc. The resistance of the conjunctiva to infections is provided mainly due to the antibacterial activity of the lacrimal fluid containing protective factors – immunoglobulins, complement components, lactoferrin, lysozyme, beta-lysine. The blinking movements of the eyelids contribute to the renewal of tear fluid and the mechanical removal of bacteria from the surface of the eye.
The main causative agents of acute bacterial conjunctivitis are staphylococci (epidermal, golden, saprophytic), Streptococcus, Pneumococcus, Pseudomonas aeruginosa and E. coli, Hemophilus bacillus, Koch—Weeks bacterium, Diphtheria Corynebacteria, Gonococcus. Special difficulties for treatment are mixed infections: viral-bacterial, viral-bacterial-fungal conjunctivitis.
The development of acute bacterial conjunctivitis is facilitated by the weakening of the general and local immune response, mechanical damage to the eyes, ingestion of foreign bodies into the eyes, transferred viral diseases, stress, hypothermia, prolonged local use of glucocorticoids, etc. The occurrence of acute bacterial conjunctivitis may be associated with skin diseases (erythema multiforme), ENT organs (otitis media, tonsillitis, sinusitis), eye pathology (blepharitis, dry eye syndrome, damage to the tear ducts). Transmission of infection occurs through objects contaminated with purulent discharge (shawls, towels, bed linen, toys), hands, water.
Acute conjunctivitis caused by pseudomonas infection is often found in people using contact lenses. If the recommendations for lens care are violated, the pathogen can be seeded from the surface of the lenses, from solutions, storage containers. Acute conjunctivitis of newborns develops more often in children with intrauterine infection, prematurely born, born from a mother with inflammatory diseases of the genitals (gonorrhea, tuberculosis, etc.).
Acute conjunctivitis develops rapidly and violently – from the moment of introduction of the pathogen to the appearance of detailed clinical symptoms, it takes from several hours to several days.
The course of various forms of bacterial conjunctivitis is characterized by hyperemia, infiltration and swelling of all parts of the conjunctiva, burning sensation, “sand” and itching, pain in the eye, abundant mucopurulent discharge from the conjunctival sac. In acute conjunctivitis, conjunctival injection is pronounced, hemorrhages, papillae and follicles formation on the mucous membrane of the eye are noted. With significant edema, conjunctival chemosis may develop – its infringement in the eye slit when closing the eyelids. Eye damage in infectious conjunctivitis is initially unilateral; the second eye is involved in inflammation somewhat later.
Acute conjunctivitis occurs with copious separation of purulent secretions from the conjunctival cavity, which glues the eyelashes, dries at the edges of the eyelids, forming crusts. Acute conjunctivitis is dangerous in terms of the development of infectious corneal lesions – bacterial keratitis, purulent corneal ulcer with the threat of perforation. Deep keratitis and ulcerative lesions of the cornea occur mainly against the background of weakening of the body – with anemia, dystrophy, hypovitaminosis, bronchoadenitis, etc.
Sometimes with acute conjunctivitis there is a general malaise – subfebrility, headache, insomnia, respiratory tract lesions. The duration of the disease is 10-14 days.
The diagnosis of acute conjunctivitis is established by an ophthalmologist on the basis of epidemiological data and clinical manifestations. In order to clarify the etiology of infectious conjunctivitis, microscopic and bacteriological examination of a smear from the conjunctiva with an antibioticogram is performed.
Examination of the anterior segment of the eye using a slit lamp (biomicroscopy of the eye) reveals hyperemia and looseness of the conjunctiva, vascular injection, papillary and follicular growths, corneal defects. To exclude ulcerative lesions of the cornea, an instillation test with fluorescein is carried out.
In acute infectious conjunctivitis, local treatment is prescribed, taking into account the type of isolated pathogen and its antibiotic sensitivity. A thorough eye toilet is carried out: wiping the eyelids, jet washing of the conjunctival sac with antiseptic solutions (furacilin, boric acid). At the same time, separate cotton balls, pipettes, eye sticks, douches are used for each eye.
After thorough mechanical cleansing of the eyelids and conjunctival cavity, instillations of antibacterial eye drops (solutions of tetracycline, levomycetin, neomycin, lincomycin, ofloxacin, etc.) are performed every 2-3 hours. At night, it is recommended to put an antibacterial ointment behind the eyelids. With severe edema and inflammatory changes in the conjunctiva, anti-allergic and anti-inflammatory drops are added to the treatment.
In acute bacterial conjunctivitis, it is strictly forbidden to put a bandage on the eyes, since this makes it difficult to evacuate the contents from the conjunctival cavity and increases the likelihood of infection of the cornea. Treatment of acute conjunctivitis is carried out for 10-12 days until the complete and persistent disappearance of symptoms, after which it is desirable to conduct repeated bacteriological control of the contents of the conjunctival cavity.
Prognosis and prevention
Etiologically justified and timely therapy of acute conjunctivitis allows to achieve a stable cure of inflammation. With an unfavorable outcome, the course of acute infectious conjunctivitis can be complicated by bacterial keratitis, corneal opacity, decreased vision, the development of corneal ulcers, orbital cellulite. The transition of the acute form to chronic conjunctivitis is possible.
Prevention of acute bacterial conjunctivitis consists in compliance with hygiene standards, prevention of eye injuries, proper care of contact lenses, timely sanitation of foci of infection of the skin and nasopharynx. In children’s groups where acute conjunctivitis is registered, it is necessary to prescribe preventive treatment to all contact persons (instillation of antiseptic eye drops).