Conjunctivitis is a polyetiological inflammatory lesion of the conjunctiva – the mucous membrane covering the inner surface of the eyelids and sclera. Various forms of conjunctivitis occur with hyperemia and swelling of the transitional folds and eyelids, mucous or purulent discharge from the eyes, lacrimation, burning and itching in the eyes, etc. The diagnosis is carried out by an ophthalmologist and includes: external examination, biomicroscopy, instillation test with fluorescein, bacteriological examination of a smear from the conjunctiva, cytological, immunofluorescence, enzyme immunoassay of a scraping from the conjunctiva, additional consultations (infectious disease specialist, dermatovenerologist, ENT, phthisiologist, allergist) according to indications. Treatment is mainly local medication with the use of eye drops and ointments, washing of the conjunctival sac, subconjunctival injections.
Conjunctivitis is the most common eye disease – they account for about 30% of all eye pathology. The frequency of inflammatory lesions of the conjunctiva is associated with its high reactivity to various exogenous and endogenous factors, as well as the availability of the conjunctival cavity to adverse external influences. The term “conjunctivitis” in ophthalmology combines etiologically heterogeneous diseases occurring with inflammatory changes in the mucous membrane of the eyes. The course may be complicated by blepharitis, keratitis, dry eye syndrome, entropion, scarring of the eyelids and cornea, corneal perforation, hypopion, decreased visual acuity, etc.
The conjunctiva performs a protective function and, due to its anatomical position, is constantly in contact with a variety of external stimuli – dust particles, air, microbial agents, chemical and temperature influences, bright light, etc. Normally, the conjunctiva has a smooth, moist surface, pink color; it is transparent, vessels and meibomian glands shine through it; the conjunctival secret resembles a tear. With conjunctivitis, the mucosa becomes turbid, rough, and scars can form on it.
All conjunctivitis is divided into exogenous and endogenous. Endogenous lesions are secondary, occurring against the background of other diseases (natural and chickenpox, rubella, measles, hemorrhagic fever, tuberculosis, etc.). Exogenous ones arise as an independent pathology with direct contact of the conjunctiva with an etiological agent.
Depending on the course, chronic, subacute and acute conjunctivitis are distinguished. According to the clinical form, conjunctivitis can be catarrhal, purulent, fibrinous (filmy), follicular.
Due to inflammation , conjunctivitis is isolated:
- bacterial etiology (pneumococcal, diphtheria, diplobacillar, gonococcal (gonoblennorrhea), etc.)
- chlamydial etiology (paratrachoma, trachoma)
- viral etiology (adenovirus, herpetic, viral infections, contagious mollusc, etc.)
- fungal etiology (with actinomycosis, sporotrichosis, rhinosporodiosis, coccidiosis, aspergillosis , candidiasis, etc.)
- allergic and autoimmune etiology (with pollinosis, spring catarrh, conjunctival pemphigus, atopic eczema, demodecosis, gout, sarcoidosis, psoriasis, Reiter’s syndrome)
- traumatic etiology (thermal, chemical)
- metastatic in general diseases.
Bacterial conjunctivitis, as a rule, occurs when infected by household contact. At the same time, bacteria begin to multiply on the mucosa, which are normally few or not at all part of the normal conjunctival microflora. Toxins secreted by bacteria cause a pronounced inflammatory reaction. The most common causative agents of bacterial conjunctivitis are staphylococci, pneumococci, Streptococci, Pseudomonas aeruginosa, E. coli, Klebsiella, proteus, Mycobacterium tuberculosis. In some cases, it is possible to infect the eyes with pathogens of gonorrhea, syphilis, diphtheria.
Viral conjunctivitis can be transmitted by household contact or airborne droplets and are acute infectious diseases. Acute pharyngoconjunctival fever is caused by adenoviruses of types 3, 4, 7; epidemic keratoconjunctivitis is caused by adenoviruses of types 8 and 19. Viral conjunctivitis can be etiologically associated with herpes simplex viruses, herpes zoster, chickenpox, measles, enteroviruses, etc.
Viral and bacterial conjunctivitis in children often accompany diseases of the nasopharynx, otitis media, sinusitis. In adults, conjunctivitis can develop against the background of chronic blepharitis, dacryocystitis, dry eye syndrome.
The development of chlamydial conjunctivitis of newborns is associated with infection of the child in the process of passing through the birth canal of the mother. In sexually active women and men, chlamydial eye damage is often combined with diseases of the genitourinary system (in men – with urethritis, prostatitis, epididymitis, in women — with cervicitis, vaginitis).
Fungal conjunctivitis can be caused by actinomycetes, mold, yeast-like and other types of fungi.
Allergic conjunctivitis is caused by hypersensitivity of the body to any antigen and in most cases serve as a local manifestation of a systemic allergic reaction. The causes of allergic manifestations may be medications, alimentary (food) factors, helminths, household chemicals, plant pollen, demodex mite, etc.
Non-infectious conjunctivitis can occur when the eyes are irritated by chemical and physical factors, smoke (including tobacco), dust, ultraviolet light; metabolic disorders, vitamin deficiency, ametropia (hyperopia, myopia), etc.
Specific manifestations of the disease depend on the etiological form of the disease. Nevertheless, the course of the disease of various genesis is characterized by a number of common signs. These include: swelling and hyperemia of the mucous membrane of the eyelids and transitional folds; secretion of mucous or purulent secretions from the eyes; itching, burning, lacrimation; feeling of “sand” or a foreign body in the eye; photophobia, blepharospasm. Often the main symptom is the inability to open the eyelids in the morning due to their gluing with a dried-out detachable. With the development of adenovirus or ulcerative keratitis, visual acuity may decrease. With conjunctivitis, as a rule, both eyes are affected: sometimes inflammation occurs in them alternately and proceeds with varying degrees of severity.
The acute form manifests suddenly with pain and pain in the eyes. Hemorrhages are often noted against the background of conjunctival hyperemia. Conjunctival injection of the eyeballs, swelling of the mucous membrane are pronounced; an abundant mucous, mucopurulent or purulent secret is secreted from the eyes. With acute conjunctivitis, the general well-being is often disturbed: malaise, headache appear, body temperature rises. Acute conjunctivitis can last from one to two to three weeks.
The subacute form is characterized by less pronounced symptoms than the acute form of the disease. The development of chronic conjunctivitis occurs gradually, and the course is persistent and prolonged. There are discomfort and sensations of a foreign body in the eyes, rapid eye fatigue, moderate hyperemia and loose conjunctiva, which acquires a velvety appearance. Against the background of chronic conjunctivitis, keratitis often develops.
A specific manifestation of the disease of bacterial etiology is a purulent opaque viscous discharge of yellowish or greenish color. There is a pain syndrome, dryness of the eyes and skin of the ocular region.
The viral variant often occurs against the background of upper respiratory tract infections and is accompanied by moderate lacrimation, photophobia and blepharospasm, scanty mucous discharge, submandibular or parotid lymphadenitis. In some types of viral eye lesions, follicles (follicular conjunctivitis) form on the mucous membrane of the eyes or pseudomembranes (filmy conjunctivitis).
Allergic conjunctivitis, as a rule, occurs with severe itching, pain in the eyes, lacrimation, swelling of the eyelids, sometimes allergic rhinitis and cough, atopic eczema.
Features of the clinic of fungal conjunctivitis are determined by the type of fungus. With actinomycosis, catarrhal or purulent conjunctivitis develops; with blastomycosis, it is filmy with grayish or yellowish easily removable films. Candidiasis is characterized by the formation of nodules consisting of clusters of epithelioid and lymphoid cells; aspergillosis occurs with conjunctival hyperemia and corneal lesions.
With conjunctivitis caused by toxic effects of chemicals, severe pain occurs when moving the gaze, blinking, trying to open or close the eyes.
Diagnosis of conjunctivitis is carried out by an ophthalmologist on the basis of complaints and clinical manifestations. To clarify the etiology of conjunctivitis, anamnesis data are important: contact with patients, allergens, existing diseases, connection with the change of season, exposure to sunlight, etc. External examination reveals hyperemia and swelling of the conjunctiva, injection of the eyeball, the presence of discharge.
To establish the etiology, laboratory tests are carried out: cytological examination of a scrape or smear, bacteriological examination of a smear from the conjunctiva, determination of the titer of antibodies (IgA and IgG) to the suspected pathogen in lacrimal fluid or blood serum, demodex examination. In case of an allergic form, skin-allergic, nasal, conjunctival, sublingual tests are resorted to.
If a disease of a specific etiology is detected, it may be necessary to consult an infectious disease specialist, venereologist, phthisiologist; with an allergic form of the disease, an allergist; with a viral form, an otolaryngologist. Of the special ophthalmological examination methods for conjunctivitis, biomicroscopy of the eye, fluorescein instillation test, etc. are used.
Differential diagnosis of conjunctivitis is carried out with episcleritis and scleritis, keratitis, uveitis (iritis, iridocyclitis, choroiditis), acute attack of glaucoma, foreign body of the eye, canalicular obstruction in dacryocystitis.
The treatment regimen for conjunctivitis is prescribed by an ophthalmologist taking into account the pathogen, the severity of the process, and the existing complications. Topical treatment requires frequent washing of the conjunctival cavity with medicinal solutions, instillation of medicines, laying eye ointments, performing subconjunctival injections.
It is forbidden to put bandages on the eyes, because they worsen the evacuation of the discharge and can contribute to the development of keratitis. To exclude autoinfection, it is recommended to wash your hands more often, use disposable towels and napkins, separate pipettes and eye sticks for each eye.
Before the introduction of drugs into the conjunctival cavity, local anesthesia of the eyeball with novocaine (lidocaine, trimecaine) is performed, then the toilet of the ciliary edges of the eyelids, conjunctiva and eyeball with antiseptics (furacilin, potassium permanganate) is performed. Before receiving information about the etiology of conjunctivitis, eye drops of 30% sulfacetamide are instilled into the eyes, eye ointment is laid at night.
When bacterial etiology is detected, gentamicin sulfate is applied topically in the form of drops and eye ointment, erythromycin eye ointment. For the treatment of viral conjunctivitis, virusostatic and virusocidal agents are used: trifluridine, idoxuridine, leukocyte interferon in the form of instillations and acyclovir – topically, in the form of ointment, and orally. Antimicrobials may be prescribed to prevent the addition of bacterial infection.
If chlamydial conjunctivitis is detected, in addition to local treatment, systemic administration of doxycycline, tetracycline or erythromycin is indicated. Therapy of allergic conjunctivitis includes the appointment of vasoconstrictive and antihistamine drops, corticosteroids, tear substitutes, and the use of desensitizing drugs. With conjunctivitis of fungal etiology, antimycotic ointments and instillations (levorin, nystatin, amphotericin B, etc.) are prescribed.
Timely and adequate therapy makes it possible to achieve recovery without consequences for visual function. In the case of secondary corneal damage, vision may decrease. The main prevention is the fulfillment of sanitary and hygienic requirements in medical and educational institutions, compliance with personal hygiene standards, timely isolation of patients with viral lesions, anti-epidemic measures.
Prevention of chlamydial and gonococcal conjunctivitis in newborns provides for the treatment of chlamydial infection and gonorrhea in pregnant women. With a tendency to allergic conjunctivitis, preventive local and general desensitizing therapy is necessary on the eve of the expected exacerbation.