Conjunctivitis

CONJUNCTIVITIS

The conjunctiva can be inflammed being the  thin, transparent mucous membrane that lines  the front part of the eyeball over the white sclera as well as the inner aspect of the eyelids, forming a continuous layer that physically prevents debris such as fallen eyelashes from migrating to the back of the eye socket. 
The  conjunctiva  secretes mucus and tears,contains immune cells to prevent infection. It is  about 30 microns thick (roughly half the thickness of a human hair) and its  supply of blood vessels dilate in response to inflammation. 
Pain, sensitivity to light and visual disturbances are not the predominant features of conjunctivitis. 

The bulbar  tissue stops at the junction between the sclera and cornea.The palpebral or tarsal conjunctiva covers the inner surface of both the upper and lower eyelids
When the small blood vessels in the conjunctiva are inflamed, they swell and become more visible, which causes the eyes to appear in a red eye or pink eye state.
Infective causes  can be very contagious eg coughing or sneezing in the viral form which may last for up to two weeks. Children with bacterial pink eye may return to school or day care 24 hours after starting eye drops or ointment. The conjunctivitis treatment depends upon the symptoms and cause.
Associations with trachoma,allergic rhinitis,red eye,gonococcal causes,irritant causes,nenoatal,giant papillary forms,degree of sticky eye,discarge,eye redness all have to be considered to avoid recontamination.


Treatments depend upon cause but to limit spreading

  • Good hygiene is essential 
  • Keep your hands away from your eyes.
  • Ensure towels,sheets,clothes,cosmetics etc are fresh.
  • Wash hands frequently.
  • Handle and clean contact lenses properly

Signs and symptoms:

  • Redness
  • Itchiness
  • A gritty, uncomfortable feeling
  • A discharge, which can form a crust during the night and make it difficult to open the eye in the morning especially if bacterial
  • Excessive tears especially if viral
  • Swelling of the eyelid
  • Sensitivity to light

Types of conjunctivitis

Sign
Bacterial
Viral
Allergic
Bilaterality
most cases
normally one eye
most cases
Discharge
mucus/pussy
watery
Little
Redness
not so much in infants
Usually
Usually
Ear inflammation
40%
10%
No
Itchiness
No
No
Yes

Viral conjunctivitis is the most common form of infectious cause. A virus called adenovirus (which also causes respiratory infections and diarrhoea) is responsible for up to 90 % of cases. Other viruses, such as herpes simplex virus (also responsible for cold sores) and varicella zoster virus (also responsible for chicken pox), can be causations.  The disease usually self-resolves in two to three weeks.
Conjunctivitis is an inflammation of the eyeball’s protective coat called the conjunctiva that secretes mucus and tears,contains immune cells to prevent infection.It is a thin, transparent mucous membrane that is about 30 microns thick (roughly half the thickness of a human hair)and its  supply of blood vessels dilate in response to inflammation. The viral measles infection (that can be vaccinated against by the MMR- measles,mumps and rubella- vaccine) through  often presents as dry cough,running nose,rash,fever and conjunctivitis that may not resolve as quickly as the bacterial form of conjunctivitis.

Bacterial conjuncitivitis or post eye operation or foreign body removal chlorsig drops and ointment are used and not the high-dose oral form.  

If contact lenses are involved extra caution is required for correct diagnosis and treatment
Bacterial conjunctivitis is less common than viral conjunctivitis. It is caused by bacteria such as Streptococcus pneumoniae, Staphylococcus aureus, Moraxella catarrhalis and Haemophilus influenzae.
These bacteria are members of the normal colonies living on healthy eyes and usually do not cause disease. However, they can proliferate and cause conjunctivitis in certain conditions, such as dry eye, after damage to the eye, or in a weakened immune system. More commonly, though, these bacteria simply cause conjunctivitis when transmitted from an infected person to a non-infected person.
Broad-spectrum antibiotic eye drops, such as chloramphenicol are effective but not in cases of STIs such as Neisseria gonorrhoeae (gonorrhoea) and Chlamydia trachomatis (chlamydia)
Both viral and bacterial forms ( very contagious and  be associated with sore throats and colds )  can  cause a watery discharge but the  bacterial form usually has  thicker, yellow-green discharge. 

In newborns, infectious causes can be very serious and necessitating treatment. 

Allergic conjunctivitis
Allergic conjunctivitis is triggered by exposure to allergens such as pollen, dust mites and animal dander (microscopic flecks of skin). 
 These may be accompanied by an itchy nose, itchy throat and sneezing.
Identifying and avoiding the offending allergen(s) is important for treatment. This may require an allergy test.
Symptom relief can be achieved through lubricating eye drops, cold compresses and OTC  antihistamine eye drops and tablets. 
However, eye drops containing the active ingredients antazoline and naphazoline (vasoconstrictors) should not be used for long periods as these may cause a rebound red eye when they are stopped.
Allergies can affect both eyes and is often a IgE response  inflammatory cascade including histamine release
Artificial eye lashes or eyelash extensions sometimes can cause allergic or microbial reactions in the eye so care is required.

Redness, itchiness and watering of both eyes are the prominent features. 

Traumatic conjunctivitis
A chemical injury or foreign object in the eye can result  in red, watery eyes and a mucous discharge.

Giant Papillary Conjunctivits

Often manifesting in some contact lens wearers as raised lumps diagnosed as Follicular  or Papillary Conjunctivitis.

Management GPC

Cease Contact lens wear or monitor wearing times with daily lenses,if relevant. Often tear supplements are useds for flushing away of allergens and other debris. Topical mast cell stabilizers,and topical corticosteroids are needed under supervision.

Treatment of conjunctivitis and precautions with conjunctivitis

Causes of Eye Swelling on Both Sides.

  • Oedema (serious). Edema is retained fluid within body tissues. Edema fluid first appears as swelling of the feet due to gravity. Edema fluid also occurs around both eyes after lying down. It’s caused by kidney, heart or liver failure.
  • Anaphylaxis (very serious). A severe life-threatening allergic reaction. Triggered by foods, drugs and bee stings. Serious symptoms such as trouble breathing or swallowing occur. Hives are almost always present.

Most forms are  due to allergy, dryness or viral eye infections. 
To avoid cross infection

  • Keep your hands away from your eyes
  • Wash hands frequently (and make sure children wash their hands properly)
  • Handle and clean contact lenses properly
  • Don’t share towels, tissues, handkerchiefs or cosmetics


Inflammation is normally  from autoimmune causes,allergic reactions, (sometimes requiring a diagnostic allergy test), dry eyes,mechanical irritation  and not the bacterial form especially in adults.  

stye is a red and painful lump on the eyelid that occurs when a small gland on the edge of the eyelid becomes infected or inflamed.​​​

red-eye-frog

Allergic causes 

  • antihistamines and mast-cell stabilisers, anti inflammatories and avoidance of allergens

Bacterial causes  

  •  Chlorsig contains chloramphenicol, a synthetic antibiotic, ( needs to be used judiciously especially as is OTC )  as the active ingredient and is available  as eyedrops and eye ointment, for external use only.

It is used to treat a bacterial infection involving the mucous membrane of the surface of the eye  and  should ease after several days.
Viral causes 

  • no treatment may last for 2 or 3 weeks unless  herpes simplex virus which can be treated with  antiviral medications such as aciclovir or valaciclovir. 
early mucopurulent eye discharge
Is discharge watery (viral) or mucopurulent (bacterial subject to swab confirmation)l

How to get rid of conjunctivitis

Chlorsig OTC antibiotic drops and ointment

As an OTC product precaution is still required as conjunctivitis can easily be misdiagnosed without slit lamp examination. 

In cases of corneal foreign bodies depth and size can be scanned by anterior OCT of the cornea

Iritis

Corneal foreign body

Iritis requires instead an intense course of steroid eye drops (prednisolone acetate — Pred Forte) and a  pupil dilation eye drop (eg. atropine) to  prevent the inflammed iris from sticking to the front of the eye’s natural lens. 

Anterior uveitis is a eye condition that has a strong association with other systemic inflammatory or autoimmune disorders. 
corneal foreign body

For cases of diagnosed bacterial conjunctivitis

Chlorsig eye drops dosage:

For adults and children (2 years and over): 
​Instil 1 or 2 eye drops in the affected eye(s) every two to six hours for up to 5 days 

For adults and children (2 years and over): Apply 1.5 cm of eye ointment every three hours for up to 5 days

If ointment is used together with drops for day and night coverage, eye ointment should be applied before bedtime while using the drops during the day.

If the condition does not get better after 2 days, seek  advice.

Chlorsig eye drops:
​Chlorsig eye drops is in a plastic dropper bottle with tamper seals. It is a clear to slightly hazy, slightly viscous, colourless, odourless liquid

Active ingredient: 
chloramphenicol 5 mg/mL (0.5%)

Other ingredients:

boric acid
borax
hypromellose
sodium hydroxide
water-purified
phenylmercuric acetate.
Chlorsig eye drops contain the preservative phenylmercuric acetate (0.002% w/v).

Chlorsig eye ointment:
is a white opaque ointment in a 4 g tube with an ophthalmic cap.


Active ingredient:
chloramphenicol 10 mg/g (1%)

Other ingredients:

paraffin – liquid
paraffin – soft white
wool fat.

Chlorsig eye ointment is preservative free 
Store in a cool dry place, protected from light, where the temperature stays below 25°C. Discard 4 weeks after opening.

chlorsig
Punctal occlusion recommended to avoid metallic taste and systemic absorption

Allergic  reaction to Chlorsig may include irritation, pain and swelling in the eye. Skin rashes, blisters and fever may also occur,
CHLORSIG EYE DROPS have Phenylmercuric acetate (0.002% w/v) as as a preservative which can cause stinging.
CHLORSIG EYE OINTMENT contains no preservatives.
Chlorsig is overused and caution applies​ in cases

  • children under 2 years of age 
  • blurred vision or sensitivity to light
  • limited eye movement
  • abnormal pupil
  • if your eye looks cloudy
  • there is copious yellow-green purulent discharge that accumulates after being wiped away
  • ​you have been welding without eye protection immediately before your eye symptoms appeared
  • you have glaucoma
  • you have dry eye syndrome
  • you have had similar symptoms in the past
  • you have had eye surgery or laser treatment in the past six months
  • you have recently travelled overseas
  • you are allergic to any other medicines or any foods, dyes or preservatives
  • you have surgery (including dental surgery) using a general anaesthetic
  • you feel unwell​​
Chlorsig  is the generic name of an antibiotic drug used to treat eye infections. It was  added to the PBS (pharmaceutical benefits scheme) in 2017 after being removed in 2016 with the restriction that it is only available to patients who identify as Aboriginal or Torres Strait Islander (ATSI).
The rate of eye infections, like trachoma (which leads to blindness), is three times higher for ATSI patients than for other Australians. The lower price for ATSI patients is because of extra funding under the government’s Closing the Gap PBS co-payment program.
Maximum cost to Aboriginal and Torres Strait Islanders: A$0-6.10
Maximum cost to other patients: A$20.11

Allergic Conjunctvitis hayfever

Allergic rhinitis (commonly known as hay fever) affects around 18% of people (children and adults) in Australia
​A referral to a clinical immunology/allergy specialist may be required for further assessment including allergy testing. ​eg particular season allergies to grass, weed or tree pollens or all year round (usually house dust mites, moulds or animal hairs).

Complications of allergic rhinitis may include:

• Sleep disturbance
• Daytime tiredness
• Headaches

hayfever

Poor concentration
• Recurrent ear infections in children
• Recurrent sinus infections in adults
• Asthma which is more difficult to control

Active substances that can cause allergic conjunctivitis include

  • Animal fur
  • spores
  • Mould
  • Dust mites
  • Makeup
  • Eye drops.
  • Pollen carried by wind from plants and grass  

Conjunctitis is an inflammation of the eyeball’s protective coat called the conjunctiva that secretes mucus and tears,contains immune cells to prevent infection.It is a thin, transparent mucous membrane that is about 30 microns thick (roughly half the thickness of a human hair)and its supply of blood vessels dilate in response to inflammation.

Viral conjunctivitis is the most common form of infectious conjunctivitis. A virus called adenovirus (which also causes respiratory infections and diarrhoea) is responsible for 65-90% of all cases of viral conjunctivitis. Other viruses, such as herpes simplex virus (also responsible for cold sores) and varicella zoster virus (also responsible for chicken pox), can also cause conjunctivitis.

The disease usually self-resolves in two to three weeks.

Bacterial conjunctivitis is less common than viral conjunctivitis. It is caused by bacteria such as Streptococcus pneumoniae, Staphylococcus aureus, Moraxella catarrhalis and Haemophilus influenzae.

These bacteria are members of the normal colonies living on healthy eyes and usually do not cause disease. However, they can proliferate and cause conjunctivitis in certain conditions, such as dry eye, after damage to the eye, or in a weakened immune system. More commonly, though, these bacteria simply cause conjunctivitis when transmitted from an infected person to a non-infected person.

Broad-spectrum antibiotic eye drops, such as chloramphenicol are effective but not in cases of STIs such as Neisseria gonorrhoeae (gonorrhoea) and Chlamydia trachomatis (chlamydia)

Allergic conjunctivitis
Allergic conjunctivitis is triggered by exposure to allergens. These include pollen, dust mites and animal dander (microscopic flecks of skin). Because it is not caused by micro-organisms, this condition is not contagious and avoiding school or work is not required.

Redness, itchiness and watering of both eyes are the prominent features. These may be accompanied by an itchy nose, itchy throat and sneezing.

Identifying and avoiding the offending allergen(s) is important for treatment. This may require an allergy test.

Symptom relief can be achieved through lubricating eye drops, cold compresses and antihistamine eye drops and tablets. These are available over the counter at pharmacies.

However, eye drops containing the active ingredients antazoline and naphazoline (vasoconstrictors*, which reduce redness) should not be used for long periods as these may cause a rebound red eye when they are stopped.

It is important to note that pain, sensitivity to light and visual disturbances are not features of conjunctivitis.
Sneezing,itchy mouth,sinus pressure,runny or blocked nose,headaches,red, sore and itchy eyes around springtime is classic of hay fever and allergies.
Inflammation can be moderated with antihistamine tablets, syrups, intranasal sprays and eye drops (non-sedating)
Cold compresses help soothe red, inflamed eyes. Avoid eye rubbing ss it releases histamine increasing the inflammation.

Severe hay fever or chronic allergies can be treated with mast cell stabilisers or steroid eye drops.
​• Intranasal corticosteroid nasal sprays (INCS)
• Decongestant sprays for no more than a few days.
• Decongestant tablets used with caution as they can have ‘stimulant’ side effects eg tremors, anxiety or blood pressure issues.

Trachoma

​The bacterial eye infection trachoma (known as ‘sandy blight’) has long been the leading infectious cause of blindness in the impoverished world.

Repeated infections by contact with an infected person’s hands or clothing can over years eventually lead to scarring that causes the margin of the eyelid to turn inwards damaging the cornea, painfully scratching it and causing damage.

​ Australia is the only developed country in the world where trachoma is endemic.

ECZEMA and EYES
External irritant or allergen conditions can cause eczema which affect the eye area. These occur more commonly in people with eczema elsewhere on the body – usually those with atopic eczema and related conditions (asthma and hay fever)
Eczema of the eyelid skin
Seborrhoeic eczema of the eyelids tends to affect just the eyelid margins and is seen more frequently in adults.

The itchy, red, dry, scaling skin found in eyelid eczema in all ages. Eyelid eczema is treated by emollients or topical steroids.
(0.5–1% hydrocortisone) for eyelid eczema
Topical calcineurin inhibitors (TCI’s) are treatments that alter the immune system and have been developed for controlling eczema.
Tacrolimus ointment (Protopic) for moderate to severe eczema and Pimecrolimus cream (Elidel) for mild to moderate eczema.
Use bland emollient to wash and moisturise with.
CONTACT DERMATITIS
Contact dermatitis of the eyelids may be either allergic or irritant in origin such as make-up, detergents or solvents eg
When manufacturers change the formulation of a product and you are sensitive to the new ingredient(s).
Allergy to nail varnish (or varnish remover).
Hair dye,perfume sprays.
Allergic dermatitis
An allergic skin reaction can be sudden and dramatic, and/or sometimes occur hours or days after contact with the allergen eg medications such as atropine , neomycin drops, or preservatives in contact lens systems.
Blepharitis
​Blepharitis refers to inflammation of the eyelid skin, and is a very common problem found with sebhorrhoeic dermatitis that affects the face, scalp, ears and eyebrows as well as the eyelids.

Small yellowish skin scales (dandruff scalp) collect around the eyelashes, making the eyes look tired, puffy and wrinkled. ​

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