Wikipedia

Conjunctivitis

"Pinkeye" redirects here. For other uses, seePinkeye (disambiguation).

Conjunctivitis,also known aspink eyeorMadras eye,[4][5]isinflammationof theoutermost layer of the white part of the eyeand the inner surface of theeyelid.[6]It makes the eye appear pink or reddish.[1]Pain, burning, scratchiness, or itchiness may occur.[1]The affected eye may have increased tears or be "stuck shut" in the morning.[1]Swelling of thewhite part of the eyemay also occur.[1]Itching is more common in cases due to allergies.[3]Conjunctivitis can affect one or both eyes.[1]

Conjunctivitis
Other namesPink eye
An eye with viral conjunctivitis
SpecialtyOphthalmology,optometry
SymptomsReddish eye,scratchiness[1]
DurationViral conjunctivitis: up to two weeks[2]
CausesViral,bacterial,allergies[3]
Diagnostic methodBased on symptoms,microbial culture[1]
PreventionHandwashing[1]
TreatmentBased on underlying cause[3]
Frequency3–6 million per year (US)[1][3]

The most common infectious causes in adults are viral, whereas in children bacterial causes predominate.[7][3]The viral infection may occur along with other symptoms of acommon cold.[1]Both viral and bacterial cases are easily spread between people.[1]Allergies to pollen or animal hair are also a common cause.[3]Diagnosis is often based on signs and symptoms.[1]Occasionally, a sample of the discharge is sent forculture.[1]

Prevention is partly byhandwashing.[1]Treatment depends on the underlying cause.[1]In the majority of viral cases, there is no specific treatment.[3]Most cases due to a bacterial infection also resolve without treatment; however,antibioticscan shorten the illness.[1][3]People who wearcontact lensesand those whose infection is caused bygonorrheaorchlamydiashould be treated.[3]Allergic cases can be treated withantihistaminesormast cell inhibitordrops.[3]

About 3 to 6 million people get acute conjunctivitis each year in the United States.[1][3]Typically, people get better in one or two weeks.[1][3]If visual loss, significant pain, sensitivity to light or signs ofherpesoccur, or if symptoms do not improve after a week, further diagnosis and treatment may be required.[3]Conjunctivitis in a newborn, known asneonatal conjunctivitis,may also require specific treatment.[1]

Signs and symptoms

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Bloodshot eyes

Red eye,swelling of the conjunctiva,andwateringof the eyes are symptoms common to all forms of conjunctivitis. However, the pupils should be normally reactive, and the visual acuity normal.[8]

Conjunctivitis is identified by inflammation of the conjunctiva, manifested by irritation and redness. Examination using aslit lamp(biomicroscope) may improve diagnostic accuracy. Examination of the palpebral conjunctiva, that overlying the inner aspects of the eyelids, is usually more diagnostic than examination of the bulbal conjunctiva, that overlying the sclera.[citation needed]

Viral

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Viral conjunctivitis

Approximately 80% of cases of conjunctivitis in adults and less than 20% in children are due to viruses, with 65% to 90% of these cases being attributed to adenoviruses.[3][7] Viral conjunctivitis is often associated with an infection of the upper respiratory tract, a common cold, or a sore throat. Other associated signs may includepre-auricularlymph node swelling and contact with another person with a red eye.[7]Eye pain may be present if the cornea is also involved.[7]Its symptoms include excessive watering and itching. The discharge in viral conjunctivitis is usually (but not always) watery in nature.[7]The infection usually begins in one eye but may spread easily to the other eye.[citation needed]

Viral conjunctivitis manifests as a fine, diffuse pinkness of the conjunctiva which may be mistaken foriritis,but corroborative signs onmicroscopy,particularly numerouslymphoid follicleson thetarsalconjunctiva, and sometimes apunctate keratitisare seen.[citation needed]

Allergic

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An eye withallergic conjunctivitisshowing conjunctival edema

Allergic conjunctivitisisinflammationof the conjunctiva due to allergy.[9]The specificallergensmay differ among patients. Symptoms result from the release ofhistamineand other active substances bymast cells,and consist of redness (mainly due tovasodilationof the peripheral small blood vessels), swelling of the conjunctiva, itching, and increased production of tears.[citation needed]

Bacterial

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An eye with bacterial conjunctivitis

Bacteria are responsible for approximately 70% of conjunctivitis in children and less than 20% of cases in adults.[7]Common bacteria responsible for bacterial conjunctivitis areStaphylococcusincludingStaph aureus,Streptococcussuch asstrep pneumoniae,[10]Haemophilusspecies andMoraxella catarrhalis.[7]Less commonly,Chlamydiaspp. and Niesseria species (Neisseria gonorrhoeaeandNeisseria meningitidis) may be the cause.[7][11]Infection withEscherichia colimay also cause conjunctivitis, particularly in theneonatalsubtypeophthalmia neonatorum.[12]Bacterial conjunctivitis usually causes a rapid onset of conjunctival redness, swelling of the eyelid, and a sticky discharge. Typically, symptoms develop first in one eye, but may spread to the other eye within 2–5 days. Conjunctivitis due to commonpus-producingbacteria causes marked grittiness or irritation and a stringy, opaque, greyish or yellowishdischargethat may cause the lids to stick together, especially after sleep. Severe crusting of the infected eye and the surrounding skin may also occur. The gritty or scratchy feeling is sometimes localized enough that patients may insist that they have a foreign body in the eye.[citation needed]

Typical membranous conjunctivitis

Bacteria such asChlamydia trachomatisorMoraxellaspp. can cause a nonexudative but persistent conjunctivitis without much redness. Bacterial conjunctivitis may cause the production of membranes or pseudomembranes that cover the conjunctiva. Pseudomembranes consist of a combination ofinflammatory cellsand exudates and adhere loosely to the conjunctiva, while true membranes are more tightly adherent and cannot be easily peeled away. Cases of bacterial conjunctivitis that involve the production of membranes or pseudomembranes are associated withNeisseria gonorrhoeae,β-hemolytic streptococci, andCorynebacterium diphtheriae.C. diphtheriaecauses membrane formation in conjunctiva of unimmunized children.[13]

Chemical

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Chemical eye injury may result when anacidicoralkalinesubstance gets in the eye.[14]Alkali burns are typically worse than acidic burns.[15]Mild burns produce conjunctivitis, while more severe burns may cause thecorneato turn white.[15]Litmus papermay be used to test for chemical causes.[14]When a chemical cause has been confirmed, the eye or eyes should be flushed until thepHis in the range 6–8.[15]Anaesthetic eye drops can be used to decrease the pain.[15]

Irritant or toxic conjunctivitis is primarily marked by redness. If due to a chemical splash, it is often present in only the lower conjunctival sac. With some chemicals, above all with caustic alkalis such assodium hydroxide,necrosisof the conjunctiva marked by a deceptively white eye due to vascular closure may occur, followed by sloughing off of the deadepithelium.A slit lamp examination is likely to show evidence ofanterior uveitis.[citation needed]

Biomarkers

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Omics technologies have been used to identify biomarkers that inform on the emergence and progression of conjunctivitis. For example, in chronic inflammatory cicatrizing conjunctivitis, activeoxylipins,lysophospholipids,fatty acids,andendocannabinoidsalterations, from which potential biomarkers linked to inflammatory processes were identified.[16]

Other

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An eye with chlamydial conjunctivitis

Inclusion conjunctivitis of the newborn is a conjunctivitis that may be caused by the bacteriumChlamydia trachomatis,and may lead to acute,purulentconjunctivitis.[17]However, it is usually self-healing.[17]

Causes

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Infective conjunctivitis is most commonly caused by a virus.[3]Bacterial infections, allergies, other irritants, and dryness are also common causes. Both bacterial and viral infections are contagious, passing from person to person or spread through contaminated objects or water. Contact with contaminated fingers is a common cause of conjunctivitis. Bacteria may also reach the conjunctiva from the edges of the eyelids and the surrounding skin, from the nasopharynx, from infected eye drops or contact lenses, from the genitals or the bloodstream.[18]Infection by human adenovirus accounts for 65% to 90% of cases of viral conjunctivitis.[19]

Viral

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Adenovirusesare the most common cause of viral conjunctivitis (adenoviral keratoconjunctivitis).[20]Herpetic keratoconjunctivitis,caused byherpes simplexviruses, can be serious and requires treatment withaciclovir.Acute hemorrhagic conjunctivitis is a highly contagious disease caused by one of twoenteroviruses,enterovirus 70 andcoxsackievirusA24. These were first identified in an outbreak in Ghana in 1969, and have spread worldwide since then, causing several epidemics.[21]

Bacterial

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The most common causes of acute bacterial conjunctivitis areStaphylococcus aureus,Streptococcus pneumoniae,andHaemophilus influenzae.[20][22]Though very rare, hyperacute cases are usually caused byNeisseria gonorrhoeaeorNeisseria meningitidis.Chronic cases of bacterial conjunctivitis are those lasting longer than 3 weeks, and are typically caused byS. aureus,Moraxella lacunata,or Gram-negative enteric flora.[citation needed]

Allergic

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Conjunctivitis may also be caused by allergens such as pollen, perfumes, cosmetics, smoke,[23][unreliable medical source?]dust mites,Balsam of Peru,[24]or eye drops.[25]The most frequent cause of conjunctivitis is allergic conjunctivitis and it affects 15% to 40% of the population.[26]Allergic conjunctivitis accounts for 15% of eye related primary care consultations; most including seasonal exposures in the spring and summer or perpetual conditions.[27]

Other

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Diagnosis

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The procedure of conjunctival swabs

Cultures are not often taken or needed as most cases resolve either with time or typical antibiotics. If bacterial conjunctivitis is suspected, but no response to topical antibiotics is seen, swabs for bacterial culture should be taken and tested. Viral culture may be appropriate in epidemic case clusters.[30]

Apatch testis used to identify the causative allergen in allergic conjunctivitis.[31]

Although conjunctival scrapes forcytologycan be useful in detecting chlamydial andfungalinfections, allergies, anddysplasia,they are rarely done because of the cost and the general dearth of laboratory staff experienced in handling ocular specimens. Conjunctival incisional biopsy is occasionally done whengranulomatousdiseases (e.g.,sarcoidosis)[32]or dysplasia are suspected.[33]

Classification

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Conjunctivitis may be classified either by cause or by extent of the inflamed area.[citation needed]

Causes

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  • Allergy
  • Bacteria
  • Viruses
  • Chemicals
  • Autoimmune

Neonatal conjunctivitis is often grouped separately from bacterial conjunctivitis because it is caused by different bacteria than the more common cases of bacterial conjunctivitis.[citation needed]

By extent of involvement

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Blepharoconjunctivitis is the dual combination of conjunctivitis withblepharitis(inflammation of the eyelids).[citation needed]

Keratoconjunctivitisis the combination of conjunctivitis andkeratitis(cornealinflammation).[citation needed]

Blepharokeratoconjunctivitis is the combination of conjunctivitis with blepharitis and keratitis. It is clinically defined by changes of the lid margin, meibomian gland dysfunction, redness of the eye, conjunctival chemosis and inflammation of the cornea.[34]

Differential diagnosis

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Some more serious conditions can present with a red eye, such as infectious keratitis, angle-closure glaucoma, or iritis. These conditions require the urgent attention of an ophthalmologist. Signs of such conditions include decreased vision, significantly increased sensitivity to light, inability to keep the eye open, a pupil that does not respond to light, or a severe headache with nausea.[35]Fluctuating blurring is common, due to tearing and mucoid discharge. Mild photophobia is common. However, if any of these symptoms is prominent, considering other diseases such asglaucoma,uveitis,keratitis,and evenmeningitisorcarotico-cavernous fistulais important.[citation needed]

A more comprehensive differential diagnosis for the red or painful eye includes:[35]

Prevention

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The most effective prevention is good hygiene, especially avoiding rubbing the eyes with infected hands. Vaccination against some of the causative pathogens such asHaemophilus influenzae,pneumococcus, andNeisseria meningitidisis also effective.[36]

Povidone-iodineeye solution has been found to prevent neonatal conjunctivitis.[37]It is becoming more commonly used globally because of its low cost.[37]

Management

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Conjunctivitis resolves in 65% of cases without treatment, within 2–5 days. The prescription of antibiotics is not necessary in most cases.[38]

Viral

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Viral conjunctivitis usually resolves on its own and does not require any specific treatment.[3]Antihistamines (e.g.,diphenhydramine) or mast cell stabilizers (e.g.,cromolyn) may be used to help with the symptoms.[3]Povidone-iodine has been suggested as a treatment, but as of 2008, evidence to support it was poor.[39]

Allergic

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For allergic conjunctivitis, cool water poured over the face with the head inclined downward constricts capillaries, andartificial tearssometimes relieve discomfort in mild cases. In more severe cases,nonsteroidal anti-inflammatory medicationsandantihistaminesmay be prescribed. Persistent allergic conjunctivitis may also require topical steroid drops.[40]

Bacterial

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Bacterial conjunctivitis usually resolves without treatment.[3]Topical antibiotics may be needed only if no improvement is observed after 3 days.[41]No serious effects were noted either with or without treatment.[42]Because antibiotics do speed healing in bacterial conjunctivitis, their use may be considered.[42]Antibiotics are also recommended for those who wear contact lenses, areimmunocompromised,have disease which is thought to be due to chlamydia or gonorrhea, have a fair bit of pain, or have copious discharge.[3]Gonorrheal or chlamydial infections require both oral and topical antibiotics.[3]

The choice of antibiotic varies based on the strain or suspected strain of bacteria causing the infection.Fluoroquinolones,sodium sulfacetamide,ortrimethoprim/polymyxinmay be used, typically for 7–10 days.[20]Cases of meningococcal conjunctivitis can also be treated with systemic penicillin, as long as the strain is sensitive to penicillin.[citation needed]

When investigated as a treatment, povidone-iodine ophthalmic solution has also been observed to have some effectiveness against bacterial and chlamydial conjunctivitis, with a possible role suggested in locations where topical antibiotics are unavailable or costly.[43]

Chemical

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Conjunctivitis due to chemicals is treated viairrigationwithRinger's lactateorsaline solution.Chemical injuries, particularly alkali burns, are medical emergencies, as they can lead to severe scarring and intraocular damage. People with chemically induced conjunctivitis should not touch their eyes to avoid spreading the chemical.[44]

Epidemiology

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Conjunctivitis is the most common eye disease.[45]Rates of disease is related to the underlying cause which varies by the age as well as the time of year. Acute conjunctivitis is most frequently found in infants, school-age children and the elderly.[18]The most common cause of infectious conjunctivitis is viral conjunctivitis.[26]

It is estimated that acute conjunctivitis affects 6 million people annually in the United States.[3]

Some seasonal trends have been observed for the occurrence of different forms of conjunctivitis. In the northern hemisphere, the occurrence of bacterial conjunctivitis peaks from December to April, viral conjunctivitis peaks in the summer months and allergic conjunctivitis is more prevalent throughout the spring and summer.[18]

History

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An adenovirus was first isolated by Rowe et al. in 1953. Two years later, Jawetz et al. published on epidemic keratoconjunctivitis.[46]: 437 "Madras eye" is a colloquial term that has been used inIndiafor the disease.

Outbreak in Pakistan

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Main article:Pink eye outbreak in Pakistan

In September 2023, a significant outbreak of conjunctivitis occurred inPakistan.The outbreak began inKarachiand quickly spread toLahore,Rawalpindi,andIslamabad.By the end of the month, over 86,133 cases had been reported inPunjabalone. The rapid spread of the disease led to the temporary closure of schools in the region. This event marked one of the largest outbreaks of Pink Eye in the country's recent history.[47][48][49][50]

Society and culture

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Conjunctivitis imposes economic and social burdens. The cost of treating bacterial conjunctivitis in the United States was estimated to be $377 million to $857 million per year.[3]Approximately 1% of all primary care office visits in the United States are related to conjunctivitis. Approximately 70% of all people with acute conjunctivitis present to primary care and urgent care.[3]

See also

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References

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