CONJUNCTIVITIS

Conjunctivitis

The conjunctiva is the thin, transparent mucous membrane that lines the front part of the eyeball over the white sclera and the inner aspect of the eyelids, forming a continuous layer that physically prevents debris such as fallen eyelashes migrating to the back of the eye socket. 
Conjunctivitis is an inflammation of that protective coat that is about 30 microns thick (roughly half the thickness of a human hair). Its supply of blood vessels dilate in response to inflammation and secrete mucus and tears, which contain immune cells to prevent infection.
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.
Conjunctivitis needs to be differentiated from Corneal ulcer, Acute iritis, Acute glaucoma and then what form it is.

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

SignBacterialViralAllergic
BilateralityMost casesNormally one eyeMost cases
DischargeMucus/pussyWateryLittle
RednessNot so much in infantsUsuallyUsually
Ear inflammation40%10%No
ItchinessNoNoNo

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 (severe). 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.
  • Conjunctivitis can present in severe cases in later stages of the COVID 19 virus, rather than an initial presentation of the covid-19 infection.

red-eye-frog

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

discharge variation
Is discharge watery (viral) or mucopurulent (bacterial subject to swab confirmation)

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.  Allergic dermatitis can be sudden and dramatic, after hours or days after contact with the allergen, e.g. medications such as atropine, neomycin drops, or preservatives in contact lens systems. Blepharitis refers to inflammation of the eyelid skin. It is a widespread problem found with seborrhoeic dermatitis that affects the face, scalp, ears and eyebrows, and eyelids. Small yellowish skin scales (dandruff scalp) collect around the eyelashes, making the eyes look tired, puffy and wrinkled.

How to get rid of conjunctivitis

Chlorsig OTC antibiotic drops and ointment

Iritis

floaters and flare magnified

The eye has two chambers separated by the lens that contains fluid that is normally homogenous and clear. The green lines indicate the anterior and posterior chamber showing microscopic particles that sometimes present there. Most commonly, vitreous floaters in the rear chamber are microscopic collagen fibres within the vitreous that tend to clump and cast shadows on the retina. 

When the epithelial barrier between the blood vessel walls that supply the eye breaks down due to inflammation, proteins and white blood cells can enter the anterior and posterior chamber.
Uveitis is inflammation of one or all parts of the iris, the ciliary body, and the choroid. Iritis is uveitis but confined to the iris.
In iritis, the conjunctiva is most red at the border of the iris compared to conjunctivitis, which reddens the whites of the eyes.
Adhesions or synechiae between the iris can occur, which can be seen under the magnification of the slit lamp.
Also, floaters in the anterior chamber give rise to flare and circulate by convection currents and precipitate to the back of the cornea. There has been some concern over uveitis and Covid 19 regarding the suspected adverse drug reaction of AZD1222 vaccination. 
Flare can be graded between nil to intense depending upon the number and density of cells seen under special magnification and illumination.
The “grainy” or Granulomatous form of inflammation may be due to infections like syphilis, tuberculosis, herpes infections or Lyme disease. Still, most commonly, it is associated with autoimmune disease or systemic illnesses.
Nongranulomatous inflammation is usually of unknown origin and more acute. It shows finer precipitates known as keratitis precipitates (KP’s).
Iritis requires instead an intense course of steroid eye drops (prednisolone acetate — Pred Forte) and a  pupil dilation eye drop (e.g. atropine) to prevent the inflamed iris from sticking to the front of the eye’s natural lens. Anterior uveitis is an eye condition that has a strong association with other systemic inflammatory or autoimmune disorders. 

Corneal foreign body

chlorsig

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

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

corneal foreign body

Corneal foreign bodies, floaters, macula conditions can all be differentially diagnosed by slit lamp and Optical Coherence Tomography (OCT) examination.

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

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.It is used to treat a bacterial infection involving the mucous membrane of the eye’s surface and should ease after several days.Chlorsig eye drops are not associated with the rare Grey Baby Syndrome when injected chloramphenicol to the mother cannot be metabolised sometimes by the baby

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

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.

PUNCTAL OCCLUSION TECHNIQUE TO REDUCE TEAR DUCT DRAINAGE

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Punctal occlusion slows the drainage of the tears for better wetting times with poor tear volume. Punctal plugs are tiny biocompatible devices that are inserted into the lacrimal punctum.
This means penetration of any drops inserted into the eye and less systemic release and side effects. This involves pressing your finger near the inside drainage corner of your eye for 2 minutes after instilling the eye drop.The drop size of a commercial eyedropper bottle can be as large as 50-75 microlitres and the conjunctival sac is capable of holding only 25-30 microlitres so some are lost within 30 seconds but the total amount instilled disappearing within 10-20 min.

Allergic Conjunctvitis hayfever

hayfever

Allergic rhinitis (commonly known as hay fever) affects around 18% of people (children and adults) in Australia.
A clinical immunology/allergy specialist referral may be required for further assessment, including allergy testing. e.g. particular season allergies to grass, weed or tree pollens, or year-round (usually house dust mites, moulds or animal hairs). 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 can have ‘stimulant’ side effects, e.g. 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 the 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 THE EYES

eczema cream

The itchy, red, dry, scaly seborrhoeic eczema of the eyelids affects just the eyelid margins and is seen more frequently in adults but occurs in all ages. ​
Emollients or topical steroids can treat eyelid eczema.
(0.5–1% hydrocortisone)  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.
A  bland emollient to wash and moisturise can help. Contact dermatitis of the eyelids can occur as can be allergic or irritant in origins such as makeup, detergents, or solvents.

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