Conjunctivitis (patient information)

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Overview
Conjunctivitis (commonly called "pink eye" or "Madras eye" ) is an acute inflammation of the conjunctiva (the outermost layer of the eye and the inner surface of the eyelids), most commonly due to an allergic reaction or an infection (usually viral, but sometimes bacterial ). Conjunctivitis is an irritating and fairly common condition, but rarely causes long term eye or vision damage.

What are the symptoms of Conjunctivitis?
Redness (hyperaemia), irritation (chemosis) and watering (epiphora) of the eyes are symptoms common to all forms of conjunctivitis. Additionally, symptoms vary based on the specific type of conjunctivitis:
 * Allergic conjunctivitis: Allergic conjunctivitis is typically itchy, sometimes distressingly so, and often involves some eye swelling. Chronic allergy often causes just itching or irritation.  Allergic conjunctivitis often causes pale watery swelling of the conjunctiva and sometimes the whole eyelid.  There is frequently a sticky mucus discharge, and there is variable redness.
 * Viral conjunctivitis: Viral conjunctivitis is often associated with an infection of the upper respiratory tract, a common cold, and/or a sore throat. Its symptoms include watery discharge and variable itch. The infection usually begins with one eye, but may spread easily to the other. Viral conjunctivitis is commonly known as "pink eye."
 * Bacterial conjunctivitis: Bacterial conjunctivitis due to the common pyogenic (pus-producing) bacteria causes marked grittiness/irritation and a stringy, opaque, grey or yellowish mucopurulent discharge (mucus, gowl, goop, gunk, eye crust, or other regional names, officially known as 'gound') that may cause the lids to stick together (matting), especially after sleeping. Another symptom that could be caused by bacterial conjunctivitis is severe crusting of the infected eye and the surrounding skin. However, discharge is not essential to the diagnosis, contrary to popular belief.  Bacteria such as Chlamydia trachomatis or Moraxella can cause a non-exudative but persistent conjunctivitis without much redness. 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. Like viral conjunctivitis, it usually affects only one eye but may spread easily to the other eye. However, it is dormant in the eye for three days before the patient shows signs of symptoms.
 * Chemical conjunctivitis:Irritant or toxic conjunctivitis is irritable or painful when the infected eye is pointed far down or far up. Discharge and itch are usually absent. It show primarily marked redness.  This is the only group in which severe pain may occur.

What causes Conjunctivitis?
Conjunctivitis is most commonly caused by viruses, often adenovirus, but many other factors can lead to its occurrence. Other causes include: Conjunctivitis is spread from person-to-person by: Newborns can be infected by bacteria in the birth canal. This condition is called ophthalmia neonatorum, and it must be treated immediately to preserve eyesight. Additionally, neonatal conjunctivitis is a red eye in a newborn caused by irritation, a blocked tear duct, or infection.
 * Allergies (allergic conjunctivitis)
 * Bacteria
 * Certain diseases
 * Chemical exposure
 * Chlamydia
 * Fungi
 * Parasites (rarely)
 * Use of contact lenses (especially extended-wear lenses)
 * Direct contact with the infected person’s eye drainage or drainage from the person’s cough, sneeze, or runny nose.
 * Indirect contact with objects that may have the infected person’s drainage on them (e.g. eye makeup applicators, towels, shared eye medications).
 * Contact with the infected person’s fingers or hands which may contain the virus or bacteria.

Who is at highest risk?
People who are exposed to someone infected with the viral or bacterial form of conjunctivitis are at risk for developing conjunctivitis. Children and adults can develop both bacterial and viral conjunctivitis, however bacterial conjunctivitis is more common in young children. Additionally, babies born to mothers infected with either Neisseria gonorrhoeae or Chlamydia trachomatis are at an increased risk for conjunctivitis. During delivery, these babies can contract ophthalmia neonatorum, a form of bacterial conjunctivitis when their eyes are exposed to the bacteria in the birth canal. It must be treated immediately to prevent blindness.

When to seek urgent medical care?
Urgent medical care is not usually necessary for conjunctivitis. However, newborns with ophthalmia neonatorum must be treated immediately to prevent blindness.

Diagnosis
Conjunctivitis may make you feel like you have something in your eye(s) that you cannot get out. Your eyes may feel crusted over or pasted shut when you wake up in the morning and there may be a discharge coming from the eyes. If the discharge has a yellow-greenish color, the cause of infection is more likely to be bacterial. The whites of the eyes usually have a pink or reddish cast to them. Other symptoms include: Except in obvious pyogenic (pus-producing) or toxic/chemical conjunctivitis, a slit lamp (biomicroscope) is needed to have any confidence in the diagnosis. Even after biomicroscopy, laboratory tests are often necessary if proof of etiology is needed. Call for an appointment with your health care provider if your symptoms last longer than 3 or 4 days.
 * Eye pain
 * Increased tearing
 * Itching of the eye
 * Sensitivity to light

Treatment options
Treatment varies by the type of conjunctivitis under consideration:
 * Allergic: For the allergic type, cool water poured over the face with the head inclined downward constricts capillaries, and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, non-steroidal anti-inflammatory medications and antihistamines may be prescribed. Persistent allergic conjunctivitis may also require topical steroid drops.
 * Bacterial: Bacterial conjunctivitis usually resolves without treatment. Antibiotics eye drops or ointment are thus only needed if no improvement is observed after 3 days.  Even though antibiotics speed recovery time ( from 4.6 days to 3.3 days) no serious effects were noted either with or without ]treatment.
 * Viral: Although there is no specific treatment for viral conjunctivitis, symptomatic relief may be achieved with cold compresses and artificial tears. People are often advised to avoid touching their eyes or sharing towels and washcloths.
 * 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.

Where to find medical care for (Conjunctivitis)?
Directions to Hospitals Treating Conjunctivitis

What to expect (Outlook/Prognosis)?
The outcome is usually good with treatment. Conjunctivitis resolves, in 65% of cases, within 2 – 5 days.

Possible complications
Reinfection within a household or school may occur if you don't follow preventive measures.

Diseases with similar symptoms
Diseases with symptoms similar to conjunctivitis include:
 * Keratoconjunctivitis sicca
 * Trachoma

Prevention of conjunctivitis
Good hygiene can help prevent the spread of conjunctivitis:
 * Change pillowcases frequently.
 * Change towels and wash cloths daily.
 * Do not share personal articles that come in contact with the eyes (e.g. eye make-up applicators, towels, wash cloths, eye droppers)
 * Handle and clean contact lenses properly.
 * Keep hands away from the eye.
 * Replace eye cosmetics regularly.
 * Wash your hands often.
 * Always wash hands with soap and water or an alcohol based hand sanitizer prior to and following contact with a person who has conjunctivitis.

Additional links
http://www.nlm.nih.gov/medlineplus/ency/article/001010.htm http://www.in.gov/isdh/21205.htm