Sunday, September 12, 2010

Conjunctivitis (Madras eye, Pink eye, Sore eyes)

Conjunctivitis is an inflammation or infection of the lining of the white part of the eye and the underside of the eyelid (conjunctiva). Inflammation causes small blood vessels in the conjunctiva to become more prominent making the eye looks pink or red. Conjunctivitis is most commonly caused by viral infection, but it can be caused by bacterial infections, allergies, other irritants and dryness. Both bacterial and viral infections are contagious. Commonly, conjunctival infections are passed from person-to-person, but can also spread through contaminated objects or water.
Blepharoconjunctivitis: is conjunctivitis along with blepharitis (inflammation of the eyelids).
Keratoconjunctivitis: is conjunctivitis along with keratitis (inflammation of cornea).
Episcleritis: is an inflammatory condition of sclera without discharge or tearing.
Causes of Conjunctivitis: Acute conjunctivitis is typically caused by an allergy, virus or bacteria. Typically, it is associated with a red eye (hyperemia), irritation (chemosis) and discharge (epiphora).
1. Allergic conjunctivitis: Itching (sometimes severe) is a primary symptom to make diagnosis of allergic conjunctivitis. There is often some eye swelling. There is pale watery swelling of conjunctiva. There is variable redness. Chronic allergy often causes just itching or irritation without swelling.
2. Bacterial conjunctivitis: It is due to the common pyogenic (pus-producing) bacteria. There is marked grittiness/irritation, a very red eye and a stringy, opaque, grey or yellowish mucopurulent discharge (known as 'gound') that may cause the lids to stick together, especially after sleeping. There is severe crusting of the infected eye and the surrounding skin. Some bacteria such as Chlamydia trachomatis or Moraxella can cause persistent conjunctivitis with minimal redness and no discharge.
3. Viral conjunctivitis: The most common cause of viral conjunctivitis is adenoviruses. There may be a recent exposure to an individual with red eye at home; school, work or they may have a history of recent symptoms of cold or an upper respiratory tract infection. Its symptoms include watery discharge, itching, foreign body sensation and photophobia (if cornea involve as in keratoconjunctivitis). The infection usually begins with one eye, but may spread easily to the other. Viral conjunctivitis shows a fine diffuse pinkness of the conjunctiva.
4. Acute Hemorrhagic Conjunctivitis: It is a highly contagious disease caused by two enteroviruses, Enterovirus 70 and Coxsackievirus A24. AHC is characterized by a prominent hemorrhagic conjunctival congestion, vascular dilatation and edema. Later it is associated with a painful, rapidly progressive follicular conjunctivitis. The lids often become swollen and indurated. The infection usually resolves within 5-7 days without treatment.
5. Chemical conjunctivitis: Irritant or toxic conjunctivitis is irritable or painful on eye movement. There is marked redness. Discharge and itch are usually absent. If due to splash injury, it is often present only in the lower conjunctival sac. There may be necrosis of the conjunctiva, followed by sloughing of the dead epithelium depending upon the type of chemical exposure.
6. Neonatal conjunctivitis: It is a conjunctivitis that is usually caused by the bacteria Chlamydia trachomatis and may lead to acute, purulent conjunctivitis. However, it is usually self-healing.
Symptoms of Conjunctivitis: The symptoms of conjunctivitis are:
1. Redness in the eyes: More marked in Acute Hemorrhagic conjunctivitis.
2. Discharge: Either yellow, green or watery. The discharge is watery in viral conjunctivitis and thick purulent in bacterial conjunctivitis which collects overnight and crusts over the eye. Excessive watering of the eye is seen in Allergic Conjunctivitis.
3. A gritty feeling in the eye.
4. Itching of the eye: Intense Itching is the symptom of allergic conjunctivitis.
5. Eye pain: More prominent in Irritant or toxic conjunctivitis.
6. Swelling of the eyes: More prominent in AHC.
7. Sneezing and runny nose is common in allergic and viral conjunctivitis.
8. An enlarged lymph gland in front of the ear
9. In chemical conjunctivitis there may be burning, red eyes and blurred vision.
Diagnosis: Generally, a diagnosis of conjunctivitis is made on the clinical features along with slit lamp bio-microscopy. Most cases of conjunctivitis are managed successfully on empirical treatment. Conventional laboratory identification can be expensive and time-consuming but may be helpful in certain circumstances.
1. Swabs for bacterial culture: If suggestive of bacterial conjunctivitis but having no response to topical antibiotics.
2. Viral culture may be appropriate in epidemic case clusters.
3. Conjunctival scrapes for cytology can be useful in detecting chlamydial and fungal infections, allergy and dysplasia.
4. Giemsa stain is helpful to screen for intracellular inclusion bodies of Chlamydia.
5. Direct immunofluorescence monoclonal antibody staining and enzyme-linked immunosorbent assay (ELISA) are rapid and widely available detection techniques.
6. More specifically, PCR can be used to diagnose AHC.
7. Serologic tests are available but generally require 2 serum samples at least 2 weeks apart, which can delay treatment.
Prevention: Conjunctivitis is highly contagious and it can easily be spread to other eye, other people and to you again once the initial infection has cleared. Although pink eye symptoms may resolve in three or four days, children with viral conjunctivitis may be contagious for a week or more.
• Don't touch or rub eyes with hands. If eyes itch or burn, use a tissue to wipe drainage; put the used tissue in the trash, and clean your hands.
• Clean hands frequently with soap and water.
• Use a clean towel and washcloth daily.
• Don't share towels, handkerchiefs or washcloths.
• Change your pillowcases frequently.
• Don't share eye cosmetics or personal eye-care items.
• Do not wear contact lenses if eyes are red or draining.
• Do not share eye drops or any medications.
• Stay home from school, childcare or work until the eye drainage has resolved.
• Wear sunglasses if light bothers (photophobia) eyes.
• Avoid swimming in a pool if having eye drainage.
Treatment of Conjunctivitis:
Conjunctivitis resolves in 65% of cases without treatment, within 2 – 5 days. Treatment often is supportive.
1. Artificial tears (Trade name-Aurosol): These help the discomfort of keratitis and photophobia.
2. Cold compresses: These improve the swelling and discomfort of the lids.
3. Antibiotic drops: These prevent a secondary bacterial infection. Ciprofloxacin (Ciloxan) or Ofloxacin (Ocuflox) are good choices. Sulfacetamide is also acceptable. Aminoglycoside is toxic to epithelia and retards healing. Trimethoprim/sulfamethoxazole (Polytrim) is a choice in children.
4. Topical corticosteroids: These for use by an ophthalmologist when substantial inflammation is present and herpes simplex is excluded.
Specific Treatment:
Treatment of Allergic Conjunctivitis:

1. Pour cool water over the face with the head inclined downward.
2. Artificial tears relieve discomfort in mild cases.
3. Non-steroidal anti-inflammatory medications and antihistamines are indicated for severe cases.
4. Persistent allergic conjunctivitis may also require topical steroid drops.

Treatment of Bacterial Conjunctivitis:
1. It usually resolves without treatment.
2. Topical antibiotic is the mainstay of treatment. Systemic antibiotics are indicated for N gonorrhoeae and chlamydial infections. Sodium sulfacetamide, gentamicin (Genoptic, Gentasia®), tobramycin, neomycin, trimethoprim and polymyxin B combination, ciprofloxacin, Ofloxacin, Gatifloxacin, and erythromycin are first-line agents. Eye drops have the advantage of not interfering with vision while ointments provide prolonged contact and soothing effect.
3. The neonate may be treated with erythromycin orally in liquid form 50 mg/kg/day in 4 divided doses for 2 weeks. The mother and at-risk contacts may be treated with doxycycline 100 mg orally twice daily for 7 days.
Treatment of Viral Conjunctivitis:
1. Treatment is supportive.
2. Cold compresses give symptomatic relief.
3. Artificial tears also give symptomatic relief.
4. Topical vasoconstrictors and antihistamines may be used only for severe itching.
5. Povidone-iodine at a concentration of 1:10 (0.8%) is highly effective against free adenovirus.
Treatment of acute hemorrhagic conjunctivitis: Treatment is supportive.
1. Bed rest,
2. Cold compresses,
3. Topical artificial tears, 4-8 times per day
4. Analgesics.
5. Topical vasoconstrictor/antihistamine, 4 times per day, for severe itching.
6. Antibiotics is indicated only when bacterial superinfection is present.
Treatment of Chemical Conjunctivitis:
1. Irrigation with Ringer's lactate or saline solution.
2. Artificial tear provide a barrier function
3. Nonsteroidal anti-inflammatory agents (NSAIDs): They are used primarily for anti-inflammatory but also relieve pain and itching. Ketorolac 0.4% has also been shown as effective in treating allergic conjunctivitis.
4. Systemic and/or topical antihistamines may be given to relieve acute symptoms.
5. Corticosteroids remain most effective agents in the treatment of ocular allergy. Loteprednol etabonate (Lotemax 0.05% and Alrex 0.02%), is rapidly metabolized once it enters the anterior chamber of the eye. It is extremely useful in treating ocular surface and superficial corneal inflammations.
6. Other agents that may be useful are: Vasoconstrictors, Mast cell stabilizers like cromolyn sodium and lodoxamide (Alomide).
Diet and Conjunctivitis:
1. Adopt an exclusive fresh fruit diet for a week: 3 meals a day of fresh, juicy seasonal fruits. Avoid banana.
2. Restrict chapatis, nuts etc.
3. Avoid strong tea and coffee.
4. Avoid starchy and sugary foods like white bread, refined cereals, potatoes, puddings, sugar, jams, confectionery, meats, fatty foods, too much salt, condiments, and sauces.
5. Constipation worsens the case of conjunctivitis.
6. Smoking and alcohol is highly restricted.
Vitamins/Minerals and conjunctivitis:
1. Vitamins A and B12 in liberal quantities have proved useful in conjunctivitis. Foods rich in vitamin A are whole milk, yoghurt, butter, carrots, pumpkin, green leafy vegetables, tomatoes, mangoes, and papaya. Foods rich in vitamin B2 are green leafy vegetables, milk, almonds, citrus fruits, bananas, and tomatoes.
2. Vitamin C deficiency makes swollen or injured eyes more difficult to recover. Citrus fruits (oranges, lemons, grapefruits, limes, tangerines, etc.) are very rich.
3. Vitamin E: A lack of Vitamin E produces degenerative changes in the cells of some tissues. Plants having vitamin E are vegetable fats: Wheat germ oil, sunflower seeds, hazelnuts, sunflower oil, toasted almonds and olive oil. Other foods with vitamin E are mangoes and avocados.
4. Calcium deficiency may be responsible for some inflammatory diseases including conjunctivitis. Legumes contain plenty of calcium. The main animal source of calcium is milk and dairy products (mainly cheese and yogurt).
5. Zinc is necessary for good vision, since it helps the absorption of vitamin A. Milk derivatives, such as cheese or yogurt, are very rich in this mineral. It is also available in red meats, celery, asparagus, borage, figs, potatoes, eggplant, etc.
6. Selenium helps the absorption of other components need for the eyes, such as vitamin E. Seafood provides a great deal of selenium. Among the plant foods we have rice, wheat, oats or their derivatives, such as bread or pasta. Other food rich in this mineral are: squash, barley, grapes, garlic, peaches, corn, soybean, pistachios, Brazil nuts, asparagus or spinach.

Home Remedies for Conjunctivitis:

1. Raw combined juice of carrots (300 ml) mixed with spinach (200 m) is very effective in conjunctivitis.
2. Raw combined juice of parsley (prajmoda) (200 ml) mixed with carrot (300 ml) has also been found beneficial.
3. A cup juice of the Indian gooseberry mixed with two teaspoons honey is useful in treating conjunctivitis.
4. Make a cold infusion by putting some leaves of the marigold plant into water and use it as eyewash. This provides fast relief to the inflamed.
5. Coriander: A decoction prepared with a handful of dried coriander in 60 ml of water. It relieves burning and reduces pain and swelling.
6. Apply clean cloth soaked in solution of aloe vera juice with water over the eyes. This reduces the itchiness, pain of the sore eyes.
7. Ayurveda believes the fasting will help wonderfully in the case of conjunctivitis.
Myths and Facts:
Myth: You can only get pink eye if someone else already has it.
Fact: Conjunctivitis has three main causes: bacterial, viral, and allergic. Bacterial can be contract from ear infection. Viral can also occur from colds and the flu. Allergic is caused by allergies.
Myth: Pink eye is not contagious if the infected person is using antibiotic eye drops.
Fact: Conjunctivitis remains contagious with or without medicated drops.
Myth: Only children can contract pink eye.
Fact: People of any age can get pink eye.
Myth: Reading in dim light is harmful to your eyes.
Fact: Although reading in dim light can make your eyes feel tired, it is not harmful.
Myth: Using a computer screen is harmful to the eyes.
Fact: Although using a computer screen is associated with eyestrain or fatigue, it is not harmful to the eyes.
Myth: Wearing poorly fitting eyeglasses damages your eyes.
Fact: Although a good fit is required for good vision, a poor fit does not damage your eyes.
Myth: It is okay to swim while wearing soft contact lenses.
Fact: Swimming with contact lenses on can result serious eye infections.
Warning: The reader of this article should exercise all precautions before following any of the method mentioned in this article and the site. To avoid any problems, it is advised that you consult a doctor. The responsibility lies solely with the reader and not with the site or the writer.

2 comments:

  1. Thanks.... Suggestions are always welcome for improvement.
    Dr. Akshay

    ReplyDelete

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