Chronic conjunctivitis is a prolonged, persistent conjunctival catarrh of non–infectious or infectious etiology. Subjectively, chronic conjunctivitis is manifested by constant itching, burning, photophobia, a feeling of “sand” behind the eyelids, eye fatigue; objectively – hyperemia and scanty mucopurulent discharge. Diagnosis is carried out on the basis of analysis of complaints, biomicroscopy data and refraction studies, bacteriological seeding from the conjunctiva, allergy tests. In the treatment of this disease, the elimination of the cause of inflammation, the local use of etiopathogenetic and symptomatic drugs (drops, ointments) is of paramount importance.
H10.4 Chronic conjunctivitis
Conjunctivitis accounts for about a third of all ocular pathology in clinical ophthalmology and is the most common inflammatory lesion of the eyes. Unlike acute conjunctivitis, which often develop in children, people of middle and elderly age are more susceptible to chronic conjunctivitis. Disease can be combined with blepharitis, keratitis, meibomeitis, dry eye syndrome and other eye lesions.
According to the etiology, this disease is divided into infectious and non-infectious; endogenous and exogenous. Non-infectious exogenous chronic conjunctivitis in most cases are associated with the following factors:
- prolonged eye irritation by physical or chemical factors: dust, smoke, alkali and acid vapors, cosmetics, intense and prolonged visual work in low light, etc.;
- industrial hazards – occur in workers employed in the coal, cement, flour, sawmill, wool, paper industry, in hot shops, chemical industries;
- mechanical irritation of the eye by foreign bodies (incorrectly growing eyelashes with trichiasis, grains of sand, particles of loose substances, etc.);
The causes of endogenous chronic conjunctivitis are:
- uncorrected refractive errors (astigmatism, hyperopia, presbyopia), dry eye syndrome, snow blindness (electrophthalmia);
- helminthic invasion;
- demodecosis, seborrhea;
- chronic gastrointestinal diseases (gastritis, enetrocolitis, cholecystitis);
- vitamin deficiency;
- hyperglycemia and diabetes mellitus.
Allergic conjunctivitis occurs in a chronic type. In this case, ocular manifestations can be combined with allergic rhinitis, bronchial asthma, atopic dermatitis and have seasonal dependence.
Infectious chronic conjunctivitis can be caused by inflammatory eye diseases (blepharitis, meibomeitis, dacryocystitis), diseases of the ENT organs (sinusitis, chronic tonsillitis, etc.). In some cases, inadequate treatment of acute conjunctivitis leads to chronization of the process. In cytograms and crops from the conjunctiva in patients with this disease, staphylococcal flora, proteus, enetrobacteria, pseudomonas, moraxella, chlamydia and pathogenic microorganisms are usually detected.
The symptoms of chronic conjunctivitis increase gradually and persist for a long time. Patients are concerned about the heaviness of the eyelids, burning sensations and “clogging” of the eye, photophobia and lacrimation, rapid eye fatigue when reading and visual work. All these manifestations usually increase in the evening and with the use of artificial lighting. Depending on the etiology of this disease, the discharge of the conjunctival cavity may be scanty or moderate, more often it is mucous or mucopurulent in nature. Objectively, an unexpressed hyperemia of the conjunctiva, a slight roughness of the mucosal surface is revealed.
Chronic allergic conjunctivitis occurs with the formation of papillae or follicles on the conjunctiva, which are accompanied by itching, sometimes with visual impairment and corneal damage. In some cases, allergic conjunctivitis is combined with allergic dermatitis of the eyelids, blepharitis, keratitis, uveitis, retinitis, neuritis. Chronic conjunctivitis has a long persistent course and can last for years.
A feature of chronic conjunctivitis is the discrepancy between the severity of clinical signs and objective changes, which makes it difficult to identify the cause of the disease. It is possible to establish the correct diagnosis only with a face-to-face consultation with an ophthalmologist, clarification of complaints and concomitant diseases, external eye examination, special ophthalmological and laboratory diagnostics:
- Ophthalmological tests. Visometry in chronic conjunctivitis can reveal a decrease in visual acuity or its relative norm.
- Examination of the anterior segment of the eye. Biomicroscopy reveals changes in the conjunctiva and transitional folds of the eyelids: slight hyperemia, looseness, velvety surface, papillary growths, etc.
- The study of refraction. Skiascopy and refractometry are performed to exclude refractive errors.
- Samples and tests. If a concomitant dry eye syndrome is suspected, tests are performed for the study of tear production: Norn test, Schirmer test, fluorescein instillation test.
- Laboratory tests. To determine the causative agents of chronic conjunctivitis, bacteriological sowing of a smear from the conjunctiva is indicated.
With chronic conjunctivitis caused by concomitant diseases, additional consultations may be required (otolaryngologist, gastroenterologist, endocrinologist, dermatologist, allergist) and studies (radiography of the paranasal sinuses, nasopharyngeal bacposev; RIF, PCR, ELISA studies for chlamydia; determination of blood sugar, skin allergy tests, examination of eyelashes for demodecosis, etc.).
Treatment for chronic conjunctivitis can be successful only if the cause of the eye disease is detected and eliminated. So, when detecting ametropia, glasses or contact lenses are selected, laser vision correction is recommended. With constant eye irritation, it is necessary to eliminate provoking factors, remove foreign bodies from the conjunctival arch, and perform eyelash epilation. It is mandatory to treat the identified concomitant chronic pathology under the supervision of a specialist of the appropriate profile.
Locally, with chronic conjunctivitis, cold lotions of astringent solutions and herbs (tea infusion, chamomile, resorcinol solution) are prescribed. Instillations of disinfecting, antibacterial, vitamin drops, corticosteroids, artificial tears are performed in the conjunctival cavity. At night, ointment applications are applied for the eyelids. Treatment of chronic conjunctivitis is long-term, which often requires a change of medications to avoid addiction.
Prognosis and prevention
Chronic conjunctivitis is curable with difficulty, often there are relapses of inflammation. Successful treatment is possible only if the causes are completely eliminated and persistent systematic therapy is carried out. Long-term (for many months and years) the course of chronic conjunctivitis may limit the aptitude and ability to work of patients.
Prevention requires the elimination of occupational hazards, the use of personal protective equipment at work, timely correction of refractive visual impairment, treatment of concomitant diseases.