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Conjunctivitis- is an inflammation or infection of the conjunctiva, the thin transparent layer of tissue that lines the inner surface

of the eyelid and covers the white part of the eye. Conjunctivitis, often called pink eye, is a common eye disease, especially in children. It may affect one or both eyes. S/S A gritty feeling in one or both eyes Itching or burning sensation in one or both eyes Excessive tearing Discharge coming from one or both eyes Swollen eyelids Pink discoloration to the whites of one or both eyes Increased sensitivity to light

How is conjunctivitis diagnosed?

Conjunctivitis can be diagnosed through a comprehensive eye examination.

Conjunctivitis can be diagnosed through a comprehensive eye examination. Testing, with special emphasis on evaluation of the conjunctiva and surrounding tissues, may include:

Patient history to determine the symptoms the patient is experiencing, when the symptoms began, and the presence of any general health or environmental conditions that may be contributing to the problem. Visual acuity measurements to determine the extent to which vision may be affected. Evaluation of the conjunctiva and external eye tissue using bright light and magnification. Evaluation of the inner structures of the eye to ensure that no other tissues are affected by the condition. Supplemental testing may include taking cultures or smears of conjunctival tissue, particularly in cases of chronic conjunctivitis or when the condition is not responding to treatment.

Using the information obtained from these tests, your optometrist can determine if you have conjunctivitis and advise you on treatment options.
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How is conjunctivitis treated?


Treatment of conjunctivitis is directed at three main goals: 1. To increase patient comfort. 2. To reduce or lessen the course of the infection or inflammation. 3. To prevent the spread of the infection in contagious forms of conjunctivitis. The appropriate treatment for conjunctivitis depends on its cause:

Allergic conjunctivitis The first step should be to remove or avoid the irritant, if possible. Cool compresses and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, non-steroidal anti-inflammatory medications and antihistamines may be prescribed. Cases of persistent allergic conjunctivitis may also require topical steroid eye drops. Bacterial conjunctivitis This type of conjunctivitis is usually treated with antibiotic eye drops or ointments. Improvement can occur after three or four days of treatment, but the entire course of antibiotics needs to be used to prevent recurrence. Viral Conjunctivitis There are no available drops or ointments to eradicate the virus for this type of conjunctivitis. Antibiotics will not cure a viral infection. Like a common cold, the virus just has to run its course, which may take up to two or three weeks in some cases. The symptoms can often be relieved with cool compresses and artificial tear solutions. For the worst cases, topical steroid drops may be prescribed to reduce the discomfort from inflammation, but do not shorten the course of the infection. Some doctors may perform an ophthalmic iodine eye wash in the office in hopes of shortening the course of the infection. This newer treatment has not been well studied yet, therefore no conclusive evidence of the success exists. Chemical Conjunctivitis Treatment for chemical conjunctivitis requires careful flushing of the eyes with saline and may require topical steroids. The more acute chemical injuries are medical emergencies, particularly alkali burns, which can lead to severe scarring, intraocular damage or even loss of the eye.

Contact Lens Wearers

Contact lens wearers may need to discontinue wearing their lenses while the conjunctivitis is active.

Contact lens wearers may need to discontinue wearing their lenses while the condition is active. Your doctor can advise you on the need for temporary restrictions on contact lens wear. If the conjunctivitis developed due to wearing contact lenses, your eye doctor may recommend that you switch to a different type of contact lens or disinfection solution. Your optometrist might need to alter your contact lense prescription to a type of lens that you replace more frequently to prevent the conjunctivitis from recurring.

Self-care
Practicing good hygiene is the best way to control the spread of conjunctivitis. Once an infection has been diagnosed, follow these steps:

Don't touch your eyes with your hands. Wash your hands thoroughly and frequently. Change your towel and washcloth daily, and don't share them with others. Discard eye cosmetics, particularly mascara.

Don't use anyone else's eye cosmetics or personal eye-care items. Follow your eye doctor's instructions on proper contact lens care.

You can soothe the discomfort of viral or bacterial conjunctivitis by applying warm compresses to your affected eye or eyes. To make a compress, soak a clean cloth in warm water and wring it out before applying it gently to your closed eyelids. For allergic conjunctivitis, avoid rubbing your eyes. Instead of warm compresses, use cool compresses to soothe your eyes. Over the counter eye drops are available. Antihistamine eye drops should help to alleviate the symptoms, and lubricating eye drops help to rinse the allergen off of the surface of the eye. See your doctor of optometry when you experience conjunctivitis to help diagnose the cause and the proper course of action.

Conjunctivitis (also called pink eye[1] or madras eye[2]) is inflammation of theconjunctiva (the outermost layer of the eye and the inner surface of the eyelids).[1] It is most commonly due to an infection (usually viral, but sometimes bacterial[3]) or an allergic reaction.

Classification
Classification can be either by cause or by extent of the inflamed area. [edit]By

cause

Allergic conjunctivitis Bacterial conjunctivitis Viral conjunctivitis Chemical conjunctivitis

Neonatal conjunctivitis is often defined separately due to different organisms

[edit]By

extent of involvement

Blepharoconjunctivitis is the dual combination of conjunctivitis with blepharitis (inflammation of the eyelids). Keratoconjunctivitis is the combination of conjunctivitis and keratitis (corneal inflammation). [edit]Signs

and symptoms

Red eye (hyperaemia), swelling of conjunctiva (chemosis) and watering (epiphora) of the eyes are symptoms common to all forms of conjunctivitis. However, the pupils should be normally reactive and the visual acuity normal. [edit]Viral Viral conjunctivitis is often associated with an infection of the upper respiratory tract, acommon cold, and/or a sore throat. Its symptoms include excessive watering and itching. The infection usually begins with one eye, but may spread easily to the other. Viral conjunctivitis, commonly known as pink eye, shows a fine, diffuse pinkness of the conjunctiva, which is easily mistaken for the ciliary injection of iritis, but there are usually corroborative signs on microscopy, particularly numerous lymphoid follicles on the tarsal conjunctiva, and sometimes a punctate keratitis. [edit]Bacterial Bacterial conjunctivitis causes the rapid onset of conjunctival redness, swelling of the eyelid, and mucopurulent discharge. Typically, symptoms develop first in one eye, but may spread to the other eye within 2-5 days. Bacterial conjunctivitis due to common pyogenic (pus-producing)

bacteria causes marked grittiness/irritation and a stringy, opaque, greyish or yellowish mucopurulent discharge that may cause the lids to stick together, especially after sleep. Severe crusting of the infected eye and the surrounding skin may also occur, but, contrary to popular belief, discharge is not essential to the diagnosis. The gritty and/or scratchy feeling is sometimes localized enough for patients to insist they must have a foreign body in the eye. The more acute pyogenic infections can be painful.[citation needed] Bacteria such as Chlamydia trachomatis or Moraxella 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 of inflammatory cells and exudates, and are loosely adherent 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 with Neisseria gonorrhoeae, hemolytic streptococci, and C. diphtheriae. Corynebacterium diphtheriae causes membrane formation in conjunctiva of non immunized children.[citation needed] [edit]Chemical Chemical eye injury is due to either an acidic or alkali substance getting in the eye.[4] Alkalis are typically worse than acidic burns.[5]Mild burns will produce conjunctivitis while more severe burns may cause the cornea to turn white.[5] Litmus paper is an easy way to rule out the diagnosis by verifying that the pH is within the normal range of 7.07.2.[4] Large volumes of irrigation is the treatment of choice and should continue until the pH is 68.[5] Local anaesthetic eye drops can be used to decrease the pain.[5]

Irritant or toxic conjunctivitis show primarily marked redness. If due to splash injury, it is often present only in the lower conjunctival sac. With some chemicals, above all with caustic alkalis such as sodium hydroxide, there may be necrosis of the conjunctiva with a deceptively white eye due to vascular closure, followed by sloughing of the dead epithelium. This is likely to be associated with slit-lamp evidence of anterior uveitis. [edit]Other Inclusion conjunctivitis of the newborn (ICN) is a conjunctivitis that may be caused by the bacteria Chlamydia trachomatis, and may lead to acute, purulent conjunctivitis.[6] However, it is usually self-healing.[6] Conjunctivitis is identified by irritation and redness of the conjunctiva. Except in obvious pyogenic or toxic/chemical conjunctivitis, a slit lamp (biomicroscope) is needed to have any confidence in the diagnosis. Examination of the tarsal conjunctiva is usually more diagnostic than the bulbar conjunctiva. [edit]Causes Conjunctivitis is most commonly caused by viral infection, but bacterial infections, allergies, other irritants and dryness are also common etiologies for its occurrence. 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. The most common cause of viral conjunctivitis is adenoviruses.[7] Herpetic keratoconjunctivitis (caused by herpes simplex viruses) can be serious and requires treatment with acyclovir. Acute hemorrhagic conjunctivitis is a highly contagious disease caused by one of twoenteroviruses, Enterovirus 70 and Coxsackievirus A24.

These were first identified in an outbreak in Ghana in 1969, and have spread worldwide since then, causing several epidemics.[8] The most common causes of acute bacterial conjunctivitis are Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae.[7] Though very rare, hyperacute cases are usually caused by Neisseria gonorrhoeae or N. meningitidis. Chronic cases of bacterial conjunctivitis are those lasting longer than 3 weeks, and are typically caused by Staphylococcus aureus, Moraxella lacunata, or gram negative enteric flora. [edit]Diagnosis Cultures are done infrequently because most cases of conjunctivitis are treated empirically and (eventually) successfully, but often only after running the gamut of the common possibilities. Swabs for bacterial culture are necessary if the history and signs suggest bacterial conjunctivitis, but there is no response to topicalantibiotics. Viral culture may be appropriate in epidemic case clusters. Conjunctival scrapes for cytology can be useful in detectingchlamydial and fungal infections, allergy and dysplasia, but are rarely done because of the cost and the general lack of laboratory staff experienced in handling ocular specimens. Conjunctival incisional biopsy is occasionally done when granulomatous diseases (e.g.,sarcoidosis) or dysplasia are suspected. [edit]Differential

diagnosis

Conjunctivitis causes relatively nonspecific symptoms.[1] Even after biomicroscopy, laboratory tests are often necessary if proof of etiology is needed. A purulent discharge (a whitish-yellow, yellow or yellow-brown substance, more commonly known as pus) suggests a bacterial

infection. It can also be caused by bacteria from feces, pet hair, or by smoke or other fumes. Infection with Neisseria gonorrhoeaeshould be suspected if the discharge is particularly thick and copious. Itching (rubbing eyes) is the hallmark symptom of allergic conjunctivitis. Other symptoms include history of eczema, or asthma. A diffuse, less "injected" conjunctivitis (looking pink rather than red) suggests a viral cause, especially if numerous follicles are present on the lower tarsal conjunctiva on biomicroscopy. Scarring of the tarsal conjunctiva suggests trachoma, especially if seen in endemic areas, if the scarring is linear (von Arlt's line), or if there is also corneal vascularization. Clinical tests for lagophthalmos, dry eye (Schirmer test) and unstable tear film may help distinguish the various types of conjunctivitis. Other symptoms, including pain, blurring of vision and photophobia, should not be prominent in conjunctivitis. Fluctuating blurring is common, due to tearing and mucoid discharge. Mild photophobia is common. However, if any of these symptoms are prominent, it is important to exclude other diseases such as glaucoma, uveitis, keratitis and even meningitis or caroticocavernous fistula. Many people with conjunctivitis have trouble opening their eyes in the morning because of the dried mucus on their eyelids. There is often excess mucus over the eye after sleeping for an extended period. Episcleritis is an inflammatory condition that produces a similar appearance to conjunctivitis, but without discharge or tearing. [edit]Prevention

The best effective prevention is hygiene and not rubbing the eyes by infected hands. Vaccination against adenovirus, haemophilus influenzae, and neisseria meningiditis is also effective.[citation needed] [edit]Management Conjunctivitis resolves in 65% of cases without treatment, within two to five days. The prescription of antibiotics is not necessary in most cases.[9] [edit]Allergic For the allergic type, cool water poured over the face with the head inclined downward constricts capillaries, and artificial tearssometimes relieve discomfort in mild cases. In more severe cases, nonsteroidal antiinflammatory medications and antihistamines may be prescribed. Persistent allergic conjunctivitis may also require topical steroid drops. [edit]Bacterial Bacterial conjunctivitis usually resolves without treatment. Antibiotics, eye drops, or ointment may only be needed if no improvement is observed after three days.[10] In people receiving no antibiotics, recovery was in 4.8 days, with immediate antibiotics it was 3.3 days, and with delayed antibiotics 3.9 days. No serious effects were noted either with or without treatment.[11] As they do speed healing in bacterial conjunctivitis, their use is also reasonable.[12] When appropriate, the choice of antibiotic varies, differing based on the cause (if known) or the likely cause of the conjunctivitis. For acute cases, 3rd or 4th generation fluoroquinolones, sodium sulfacetamide, or trimethoprim/polymyxin may be used, typically for 710 days.[7] Cases of meningococcal conjunctivitis can be treated with systemic penicillin, as long as the strain is sensitive to penicillin.

The number of bacterial eye infections related to sexually transmitted disease is steadily rising. Chlamydial eye infections are the world's leading cause of blindness, and these cases will not resolve without antibiotics. If the conjunctivitis is known to be caused bygonorrhea, then it may be treated with a one-time injection of ceftriaxone, followed by 2-3 weeks of oral tetracycline orerythromycin.[citation needed] [edit]Viral In 2001, a stir was created when an ophthalmologist published anecdotal evidence that a brief povidone iodine eye wash in patients known to be suffering from viral conjunctivitis successfully helped to resolve the malady far faster than observation and supportive therapy alone. [13] Since that time, investigators have been evaluating the agent to officially validate its use in this regard as well as potentially expand its role in the management of ocular disease. In the Review of Optometry 2002 Clinical Guide to Ophthalmic Drugs, Melton and Thomas present an off-label use of Betadine 5% solution to treat viral conjunctivitis. [14] However, in one study, though povidone iodine 1.25% ophthalmic solution was as effective as neomycin-polymyxin B-gramicidin for treating bacterial conjunctivitis and was somewhat more effective against Chlamydia, it was judged ineffective against viral conjunctivitis.[15] In 2011, Derek Cunningham, O.D., of Dell Laser Consultants Austin, noted that almost all published studies on povidone-iodine to that date have been from animal models or conjunctival isolates from normal eyes, and that there is a lack of well-controlled studies on the clinical effects of povidone-iodine mono-treatment on infected eyes. [16] The new treatment for viral eye infection involves a single treatment of Iodine solution (Betadine 2.5% - 5% concentration). After ocular anaesthetization, made necessary by the Iodine solution's irritating nature to the eye, a series of drops are instilled in the patient's

eye.[17][unreliable medical source?] It is generally advisable to avoid touching the eyes or sharing towels and washcloths in the case of viral Conjunctivitis infection. Because a topical anesthetic must be used, this should be an in-office procedure only, says Dr. Cunningham. Using Betadine as an at-home remedy could be dangerous for several reasons, especially because Betadine is a trade name for different solutions containing povidoneiodine, Many commercially available [non-ophthalmic] preparations can contain detergents that are disruptive to tissue and can cause considerable cornea and conjunctiva damage, he says. Time of exposure and possible adverse reactions need to be monitored [in office]. [edit]Chemical Conjunctivitis due to chemicals is treated via irrigation with Ringer's lactate or saline 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, regardless of whether or not their hands are clean, as they run the risk of spreading the condition to another eye.

Conjunctivitis is redness and inflammation of the thin layer of tissue that covers the front of the eye (conjunctiva). It is very common. People often refer to conjunctivitis as red eye. Other symptoms of conjunctivitis include itchiness and watering of the eyes, and sometimes a sticky coating on the eyelashes (if it's caused by an allergy). Read more about the symptoms of conjunctivitis. Conjunctivitis can affect one or both eyes.

What causes conjunctivitis?


The conjunctiva can become inflamed as as result of:

a bacterial or viral infection this is known asinfective conjunctivitis an allergic reaction to a substance such as pollen or dust mites this is known as allergic conjunctivitis the eye coming into contact with substances that can irritate the conjunctiva, such as chlorinated water or shampoo, or a loose eyelash rubbing against the eye this is known as irritant conjunctivitis

Read more about the causes of conjunctivitis.

Treating conjunctivitis
Conjunctivitis often doesn't require treatment as the symptoms usually clear up within a couple of weeks. If treatment is thought necessary, the type of treatment will depend on the cause but in most cases antibiotic eye drops can be used to clear the infection. Irritant conjunctivitis will clear up as soon as whatever is causing it is removed. Allergic conjunctivitis can usually be treated with anti-allergy medications such as antihistamines. If possible, avoid the substance that triggered the allergy. It's best not to wear contact lenses until the symptoms have cleared up. Any sticky or crusty coating on the eylids or lashes can be cleansed with cotton wool and water. Infective conjunctivitis is easily spread, although it isn't necessary to stay away from work or keep your child away from school. Washing your hands regularly and avoiding sharing pillows or towels will help prevent it spreading. Read more about treating conjunctivitis. See your GP immediately if you have:

eye pain sensitivity to light (photophobia) disturbed vision intense redness in one or both of your eyes

a newborn baby with conjunctivitis

Complications
Conjunctivitis can be a frustrating condition especially allergic conjunctivitis but in most cases it doesn't pose a serious threat to health. Complications of conjunctivitis are very rare but when they do occur they can be serious, such as:

a severe case of allergic conjunctivitis can lead to scarring in the eye in cases of infective conjunctivitis the infection can spread to other areas of the body, triggering more serious secondary infections such as meningitis (an infection of the outer layer of the brain)

About Pinkeye
Conjunctivitis, commonly known as pinkeye, is an inflammation of the conjunctiva, the clear membrane that covers the white part of the eye and the inner surface of the eyelids. Pinkeye can be alarming because it may make the eyes extremely red and can spread rapidly. But it's a fairly common condition and usually causes no long-term eye or vision damage. Still, if your child shows symptoms of pinkeye, it's important to see a doctor. Some kinds of pinkeye go away on their own, but others require treatment.

Causes
Pinkeye can be caused by many of the bacteria and viruses responsible for colds and other infections, including ear infections, sinus infections, and sore throats and by the same types of bacteria that cause chlamydia and gonorrhea, two sexually transmitted diseases (STDs, also called sexually transmitted infections, or STIs).

Pinkeye also can be caused by allergies. These cases tend to happen more frequently among kids who also have other allergic conditions, such as hay fever. Triggers of allergic conjunctivitis include grass, ragweed pollen, animal dander, and dust mites. Sometimes a substance in the environment can irritate the eyes and cause pinkeye, such as chemicals (chlorine, soaps, etc.) or air pollutants (smoke and fumes).

Pinkeye in Newborns
Newborns are particularly susceptible to pinkeye and can be more prone to serious health complications if it goes untreated. If a baby is born to a mother who has an STD/STI, during delivery the bacteria or virus can pass from the birth canal into the baby's eyes, causing pinkeye. To prevent this, doctors give antibiotic ointment or eye drops to all babies immediately after birth. Occasionally, this preventive treatment causes a mild chemical conjunctivitis, which typically clears up on its own. Doctors also can screen pregnant women for STDs/STIs and treat them during pregnancy to prevent transmission of the infection to the baby. Many babies are born with a narrow or blocked tear duct (called lacrimal duct stenosis), which usually clears up on its own. Sometimes, though, it can lead to conjunctivitis.

Symptoms
The different types of pinkeye can have different symptoms. And symptoms can vary from child to child. One of the most common symptoms is discomfort in the eye. A child may say that it feels like there's sand in the eye. Many kids have redness of the eye and inner eyelid, which is why conjunctivitis is often called pinkeye. It can also cause discharge from the eyes, which may cause the eyelids to stick together when the child

awakens in the morning. Some kids have swollen eyelids or sensitivity to bright light. In cases of allergic conjunctivitis, itchiness and tearing are common symptoms.

Contagiousness
Cases of pinkeye that are caused by bacteria and viruses are contagious; cases caused by allergies or environmental irritants are not. A child can get pinkeye by touching an infected person or something an infected person has touched, such as a used tissue. In the summertime, pinkeye can spread when kids swim in contaminated water or share contaminated towels. It also can be spread through coughing and sneezing. Doctors usually recommend keeping kids diagnosed with contagious conjunctivitis out of school, childcare, or summer camp for a short time. Also, someone who has pinkeye in one eye can inadvertently spread it to the other eye by touching the infected eye, then touching the other eye.

Preventing Pinkeye
To prevent pinkeye caused by infections, teach kids to wash their hands often with warm water and soap. They also should not share eye drops, tissues, eye makeup, washcloths, towels, or pillowcases with other people. Be sure to wash your own hands thoroughly after touching an infected child's eyes, and throw away items like gauze or cotton balls after they've been used. Wash towels and other linens that the child has used in hot water separately from the rest of the family's laundry to avoid contamination. If you know your child is prone to allergic conjunctivitis, keep windows and doors closed on days when the pollen is heavy, and dust and vacuum frequently to limit allergy triggers in the home. Irritant conjunctivitis can only be prevented by avoiding the irritating causes. Many cases of pinkeye in newborns can be prevented by screening and treating pregnant women for STDs/STIs. A pregnant woman may have bacteria in her birth canal even if she shows no symptoms, which is why prenatal screening is important.

Treatment
Pinkeye caused by a virus usually goes away on its own without any treatment. If a doctor suspects that the pinkeye has been caused by a bacterial infection, antibiotic eye drops or ointment will be prescribed. Sometimes it can be a challenge to get kids to tolerate eye drops several times a day. If you're having trouble, put the drops on the inner corner of your child's closed eye when the child opens the eye, the medicine will flow into it. If you continue to have trouble with drops, ask the doctor about antibiotic ointment. It can be applied in a thin layer where the eyelids meet, and will melt and enter the eye.

If your child has allergic conjunctivitis, your doctor may prescribe anti-allergy medication, which comes in the form of pills, liquid, or eye drops. Cool or warm compresses and acetaminophen or ibuprofen may make a child with pinkeye feel more comfortable. You can clean the edges of the infected eye carefully with warm water and gauze or cotton balls. This can also remove the crusts of dried discharge that may cause the eyelids to stick together first thing in the morning. If your child wears contact lenses and has conjunctivitis, your doctor or eye doctor may recommend that the contact lenses not be worn until the infection is gone. After the infection is gone, clean the lenses carefully. Be sure to disinfect the lenses and case at least twice before letting your child wear them again. If your child wears disposable contact lenses, throw away the current pair and use a new pair.

When to Call the Doctor


If you think your child has pinkeye, it's important to contact your doctor to learn what's causing it and how to treat it. Other serious eye conditions can mimic conjunctivitis, so a child who complains of severe pain, changes in eyesight, swelling around the eyes, or sensitivity to light should be examined. If the pinkeye does not improve after 2 to 3 days of treatment, or after a week when left untreated, call your doctor. If your child has pinkeye and starts to develop increased swelling, redness, and tenderness in the eyelids and around the eye, along with a fever, call your doctor. Those symptoms may mean the infection has started to spread beyond the conjunctiva and will require additional treatment.