Conjunctivitis, or inflammation of the conjunctiva (the thin tissue covering the white part of the eye), is a general term that refers to a diverse group of diseases/disorders that primarily affect the conjunctiva1. Conjunctivitis is generally characterized by irritation, itching, foreign body sensation, and tearing or discharge2.
There are two main types of conjunctivitis – infectious and non-infectious. Viruses and bacteria are the most common infectious causes of conjunctivitis. Non-infectious conjunctivitis includes allergic, toxic, and cicatricial conjunctivitis, as well as inflammation secondary to immune-mediated diseases and neoplastic processes3.
Most types of conjunctivitis are self-limiting, but some progress and may cause serious ocular and extra-ocular complications. The economic impact of the disease in terms of lost work time, cost of medical visits, diagnostic testing, and medication is considerable1. Benefits of antibiotic treatment for conjunctivitis include quicker recovery, decrease in transmissibility, and early return to school3.
Conjunctivitis is common in men, women and children of all ages. In primary care in the UK, an estimated 1% of all consultations is due to conjunctivitis14. In England, there are 13 to 14 cases per 1000 people per year8.
Allergies are the most frequent cause of conjunctivitis, affecting 15% to 40% of the population and are observed more frequently in spring and summer. About 40% of the general population experiences allergic conjunctivitis3.
Infectious conjunctivitis is most common in children and elderly. Bacterial conjunctivitis is more common in children and viral conjunctivitis is more common in adults.
Of cases of infectious conjunctivitis15:
• 42% to 80% is bacterial
• 13% to 70% is viral
• 3% is chlamydial
In Europe, bacterial conjunctivitis represents a significant health problem and accounts for an estimated 1–1.5% of primary-care consultations9.
Symptoms will depend on the cause of the condition, however the two main ones are usually10:
Other common symptoms include12:
There are two main types of conjunctivitis, infectious and non-infectious, which can have many causes. The disease can also be classified into acute, hyperacute, and chronic according to the mode of onset and the severity of the clinical response3.
Viral conjunctivitis is most commonly caused by adenovirus. The most common strains cause a mild conjunctivitis with pharyngitis and fever, while more virulent strains may cause a severe conjunctivitis with corneal involvement causing keratitis.
Other viruses are herpes simplex virus, varicella zoster virus, Epstein-Barr virus, coxsackie and enteroviruses.
Bacterial conjunctivitis is most commonly caused by Staphylococcus species, Streptococcus pneumonia, Haemophilus influenza and Moraxella catarrhalis. Poor hygiene, using contaminated cosmetics or physical contact with other people with the infection6 is often responsible.
This occurs in newborn babies within the first 28 days of life, with the majority due to bacteria. The bacterial causes include sexually transmitted diseases agents (Chlamydia trachomatis and Neisseria gonorrhoea), microorganisms from the skin (Staphylococcus aureus) and the mother’s gastrointestinal tract, or toxic response to topical treatments applied to the eye.
This occurs more commonly among people who already have seasonal allergies.
Giant papillary conjunctivitis is a type of allergic conjunctivitis caused by the chronic presence of a foreign body in the eye. People who wear hard or rigid contact lenses, wear soft contact lenses that are not replaced frequently, or have an exposed suture on the surface of the eye, are more likely to develop this form of Conjunctivitis7.
This can be caused by irritants like air pollution, chlorine in swimming pools, exposure to noxious chemicals, and overuse of topical medications or cosmetics, or both7.
Cicatricial conjunctivitis is chronic conjunctivitis that leads to scarring of the conjunctiva8.
The most important reason for early detection of conjunctivitis is that prompt and appropriate treatment is available for most types of conjunctivitis. Early treatment speeds resolution of the disease, minimizing both the sequelae of untreated conjunctivitis and time away from work or school. Early detection of conjunctivitis is also important because conjunctivitis can herald serious systemic disease1.
Treatment of conjunctivitis is ideally directed at the root cause. Indiscriminate use of topical antibiotics or corticosteroids should be avoided, because antibiotics can induce toxicity and corticosteroids can potentially prolong adenoviral infections and worsen HSV infections. Treatment methods are described below for the most common types of conjunctivitis and for those types that are particularly important to treat16.
The antibiotic eye drops commonly used to treat bacterial conjunctivitis differ according to mechanism of action, delivery and administration and who they can be prescribed for according to the individual licenses and approvals. Several classes of antibiotic eye drops are effective against bacterial conjunctivitis13:
Most viral conjunctivitis is related to adenoviral infection. Supportive therapy includes time honored treatment options: cold compresses, lubricants, and ocular decongestants.
Topical antibiotics are not routinely used to treat viral conjunctivitis, unless there is evidence of secondary bacterial infection. The risk of toxic and allergic reactions may outweigh the potential benefit of antibiotic use.
Topical steroids are specifically contraindicated for treating herpes simplex conjunctivitis .
The primary treatment for adults is systemic antibiotics as topical therapy alone is inadequate.
Patients' sexual partners should also be evaluated for the presence of infection and their treatment initiated as indicated. In cases of chlamydial infection affecting pre-adolescent children, the clinician should consider the possibility that sexual abuse has occurred .
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