Conjunctivitis

Conjunctivitis (commonly called " pinkeye " in the USA and " Madras Eye " in India ) is an inflammation of the conjunctiva (the outermost layer of the eye and the inner surface of the eyelids), often due to infection. The three most common types of conjunctivitis are: viral , allergic , and bacterial . Each requires different treatments. With the exception of the allergic type, conjunctivitis is typically contagious. Most causes of conjunctivitis are benign, and the role of the emergency physician is to separate those few conditions requiring more vigorous treatment from the majority that can be handled satisfactorily in the ED. When you wake up in the morning, your eyes may seem to be pasted shut from the discharge coming from your eyes. As with any mucous membrane, infectious agents may adhere to the conjunctiva, thus overwhelming normal defense mechanisms and producing clinical symptoms of redness, discharge, irritation, and possibly photophobia. Bacterial conjunctivitis is most often caused by pyogenic bacteria such as Staphylococcus or Streptococcus from the patient's own skin or respiratory flora. Allergic conjunctivitis may also be caused by intolerance to substances such as cosmetics, perfume, or drugs. Pink eye caused by bacteria, viruses, and STDs can spread easily from person to person, but is not a serious health risk if diagnosed promptly.

Conjunctivitis is an inflammation of the conjunctiva, the thin, clear tissue that lies over the white part of the eye and lines the inside of the eyelid. The accessory lacrimal glands (Krause and Wolfring), along with goblet cells, are contained within the conjunctiva and are responsible for keeping the eye lubricated. The viral type is often associated with an upper respiratory tract infection, cold, or sore throat. Inflammation causes small blood vessels in the conjunctiva to become more prominent, resulting in a pink or red cast to the whites of your eyes. Conjunctivitis can be caused by a virus, bacteria, irritating substances (shampoos, dirt, smoke, and especially pool chlorine), allergens (substances that cause allergies) or transmitted diseases (STDs . Other forms of dry eye are associated with aging, poor lid closure, scarring from previous injury, or autoimmune diseases such as rheumatoid arthritis , and these can all cause chronic conjunctivitis. Bacteria line the surface of the eyelids (all the way down into the shaft of the eyelashes), which makes the conjunctiva predisposed to germs and conjunctivitis . The severity of the infection depends on the type of bacteria involved.

Causes of Conjunctivitis

The common causes of Conjunctivitis :

• Vernal conjunctivitis is a bilateral recurrent hypersensitivity that occurs during the warm months of the year, particularly in hot climates.
• Gram-negative for the following cocci - Neisseria meningitidis and Moraxella lacunata
• Virus infection may also occur.
• Allergic reactions, eg hayfever , may cause conjunctivitis, but do not usually cause a sticky discharge.
• Allergies, like dust, pollen, or a special type of allergy that affects some contact lens wearers
• Bacteria (such as gonorrhea or chlamydia)
• Air pollution or chemical irritants may lead to conjunctivitis.
• Cervical infections (chlamydia, genital herpes or gonorrhea) in a pregnant woman may result in potentially blinding conjunctivitis in her baby.
• Radiation, especially the ultraviolet in sunlight 
• Occasionally, irritation from eye make-up.

Symptoms of Conjunctivitis

Some common symptoms of Conjunctivitis :

• The eye is sticky, with a discharge, which is worse when you wake up.
• The eye is itchy or painful.
• Infection usually begins with one eye, but may spread easily to the fellow eye
• Usually affects only one eye, but may spread easily to the fellow eye
• Burning eyes (especially in conjunctivitis caused by chemicals and irritants)
• Thick yellow discharge that crusts over the eyelashes, especially after sleep (in conjunctivitis caused by bacteria)
• Gritty feeling in the eyes
• Itching and a gritty sensation in the eye
• A discharge in one or both eyes that forms a crust during the night
• Green or white discharge from the eye.

Treatment of Conjunctivitis

• Artificial tears help the discomfort of keratitis and photophobia.
• If the problem is a virus infection, then it will not respond to antibiotics, and your body will have to fight off the infection.
• Physicians and other medical personnel must be careful not to transmit this infection.
• Bacterial conjunctivitis is usually treated with antibiotic eye drops or ointments that cover a broad range of bacteria.
• The discomfort with viral or bacterial conjunctivitis can be soothed by applying warm compresses (a clean cloth soaked in warm water) to closed eyes.
• your child's tolerance for specific medications, procedures, or therapies
• Your child's physician may order antibiotic drops for the eyes to help decrease the chance of a secondary infection.
• extent of the condition
• Reserve topical corticosteroids for use by an ophthalmologist when substantial inflammation is present and herpes simplex is excluded.

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