Conjunctivitis: Symptoms and Treatment
- Little about conjunctiva
- Types of conjunctivitis
- Causes of conjunctivitis
- Conjunctivitis symptoms
- Diagnosis of conjunctivitis
- Conjunctivitis treatment
Conjunctivitis is an inflammation of the mucous membrane of the eye. This is a disease that many people experience throughout their lives. Some patients are worried about this pathology throughout their lives several times a year, which greatly reduces the patient's quality of life and imposes certain limitations.
Little about conjunctiva
A conjunctiva is a thin, transparent membrane that covers the outside of the eye. It performs quite important functions that ensure the normal functioning of the organ of vision.
- Secretion in a sufficient amount of mucous and liquid component of the tear fluid. It constantly moistens the eye and prevents the surface from drying out. Otherwise, the eyes could not remain so tender and sensitive to the light.
- The resulting liquid helps to nourish the eye, since a number of its transparent structures are deprived of their own blood vessels and cannot otherwise receive nutrients.
- Natural antiseptics with which the tear fluid is rich constantly protect human eyes from the effects of harmful microorganisms. They are safe for the body's own cells, but ruthlessly destroy most pathogens that enter the eye.
On the edge of the eyelid, the conjunctiva is bordered by the skin, and behind it passes into the non-keratinizing epithelium of the cornea. Its thickness does not exceed 1 millimeter, and the area of the water eye is 15 cm square.
The part of the conjunctiva that covers the back of the eyelid is called the conjunctiva of the eyelid. During blinking, the eyelids of the patient close and all the tear fluid that is contained in the cavity of the orbit, is evenly distributed over the entire surface of the cornea, abundantly wetting every square millimeter.
It is also on the conjunctiva that the tear points are located, along which excess tear fluid flows into the nasal cavity. This saves the patient from the constant transfusion of tears beyond the edge of the lower eyelid. If there is a constant tearing, then doctors will always suspect a violation of the nasal duct patency.
Also, some vessels of the conjunctiva (their final branches) are involved in the blood supply to the cornea. Under unfavorable conditions (inflammation of the cornea), these capillaries can grow into it and become a reason for reducing the transparency of this structure.
The clinical significance of the conjunctiva
Doctors actively examine the conjunctiva during the examination for many diseases that are not related to the organ of vision. It is very thin and the vessels in it are clearly visible, which allows the naked eye to detect changes in the blood. For example, with an increase in the content of bilirubin (it happens with many liver diseases), the conjunctiva stains yellow in the blood. If the conjunctiva is pale, it may be suspected that the patient has insufficient hemoglobin in the blood (anemia).
Types of conjunctivitis
There are several classifications of this disease, which are based on different symptoms.
Depending on the presence or absence of damage to other structures of the eye, the following forms are distinguished:
- blepharoconjunctivitis - inflammation simultaneously and conjunctiva and eyelid;
- keratoconjunctivitis - a combination of inflammation of the conjunctiva with inflammation of the cornea;
- episcleritis is a condition in which there is almost the same damage to the tissues as in conjunctivitis, but tearing and discharge from the eyes is not observed.
Depending on how severe the symptoms of the disease are and how quickly they develop, they release:
- acute conjunctivitis - the disease is pronounced and gives the patient a lot of inconvenience, reducing the quality of life;
- chronic conjunctivitis - the symptoms of the disease are somewhat erased, but they bother the patient for a long time;
- subacute conjunctivitis - a form that occupies a transitional position in the clinic between the two indicated above;
- recurrent - the disease periodically affects the patient's eyes, often at about the same time of year.
The disease during its course may cause changes of a different nature. Based on what can be observed in the affected eye, there are several morphological forms of the disease.
- Catarrhal - the main symptom of the disease is tearing due to increased secretion of the lacrimal fluid from the glands of the conjunctiva. The body thus tries to cope with the disease and eliminate its cause by cleansing the conjunctival sac by washing.
- Follicular conjunctivitis is a form of the disease in which there is some loosening of the conjunctiva. It produces small rounded elevations, with a diameter of about 1-2 millimeters. Follicles are a collection of lymphocytes - one of the leukocyte fractions that the body sends to the inflammatory focus to fight the pathogen. Regardless of which pathogen caused the disease (except for trachoma), the follicles subsequently disappear without a trace when the pathology resolves.
- Papillary conjunctivitis - in most cases, occurs in response to irritation of the delicate conjunctiva by contact lenses when they are worn incorrectly or if the patient is allergic to the material from which the lens is made. Appearing nipples adversely affect the surface of the eyeball, rubbing and irritating the cornea, which can cause the development of keratitis and aggravate the patient's condition.
- Membranous conjunctivitis - most often occurs in young children 3-4 years with the defeat of the eyes by bacteria that can provoke purulent processes. Often this form of the disease is confused with diphtheria of the eye, although the causative agent of diphtheria is not detected there. All this is due to the peculiarity of the clinical picture - the appearance of dense films on the conjunctiva and the surface of the eyeball, which significantly impair vision and bring additional inconvenience to the patient.
- Hemorrhagic conjunctivitis is almost always triggered by viruses and is epidemic in nature. The disease develops rapidly, its main manifestation is subconjunctival hemorrhage. In most cases, the disease passes as quickly as it begins, which distinguishes epidemic conjunctivitis from other forms of the disease.
- A mixed form of the disease is characterized by the presence of features from several types of disease (hemorrhage and follicles, for example). If you carefully consider the affected tissue, then almost always you can find a few morphological elements.
About this form of the disease should be written separately, because the causes and pathogenesis of the main clinical manifestations. In case of allergies, an infectious agent that can irritate the mucous membrane does not enter the patient's eyes. Everything is in the presence of hypersensitivity to individual substances (they are individual for each patient).
Most often allergic conjunctivitis is caused by allergens in the air — pollen of plants during their flowering period, various aerosols, smoke, etc. Often, conjunctival inflammation can be triggered by food allergens (eggs, cow's milk, cereals, and many other products).
After the allergen enters the body, the immune response is launched, designed to protect the person from the pest (this is how the allergen is perceived). Special inflammatory mediators (predominantly histamine) are released, which rush to the site of localization and cause a local tissue response there. The blood vessels dilate, and the permeability of their walls increases. Due to this, it is possible to observe reddening of the tissues and edema caused by the release of the liquid component of blood from the vascular bed.
Causes of conjunctivitis
All the causes of conjunctivitis can be divided into several groups: infectious pathogens, allergic agents and a consequence of exposure to adverse environmental factors.
Causative agents of infectious nature
1. Bacterial conjunctivitis:
- Koch-Weeks bacterium - the cause of the development of epidemic conjunctivitis.
- Chlamydia (trachomatous conjunctivitis is caused by one of these types of bacteria).
- Causative agent of diphtheria.
- Other bacteria.
2. Viral conjunctivitis:
- Herpetic conjunctivitis.
- Adenoviral, etc.
Bacterial conjunctivitis causes the most severe forms of the disease. Fortunately, now they account for a small number of all cases of the disease. However, until now they are regularly found in clinical practice. Trachoma, a very common disease at one time, is still one of the main causes of blindness in countries where, so far, it has not been possible to overcome the epidemic.
Causes of allergic conjunctivitis
- Pollen and plant seeds contained in large quantities in the air during flowering.
- Cosmetics are increasingly becoming a cause provoking conjunctivitis due to the fact that they have not been used so actively before. Now, companies use a lot of chemicals, and cosmetics are becoming less natural.
- Food allergens, as well as substances that are currently added to products in order to increase their shelf life (preservatives), attractiveness (colors and flavors).
- Drugs with long-term use (sometimes after the first contact) may cause allergies.
- Household chemicals (detergents, powders, air conditioners, air fresheners).
- Bacteria that infect other areas in the body may not directly infect the conjunctiva, but produce substances that are allergic to humans. An example is tuberculosis-allergic conjunctivitis.
- Contact lenses - due to the peculiarities of wearing and frequency of use of the population often cause conjunctivitis. Recently, however, firms are developing ever more inert substances from which lenses are made. They are less likely to cause allergies in patients.
Allergic conjunctivitis in recent times are among the leaders in the overall structure of the incidence. This can be explained by the fact that people have to deal with an increasing number of chemicals in the course of their life. On top of all this, the body's sensitivity to allergens is steadily increasing due to poor environmental conditions in which the body develops and grows.
Other causes of conjunctivitis
- The impact of harmful physical factors in enterprises (milling industry, textile industry, production of building materials).
- Exposure to ionizing radiation.
- Excessive effects of light energy on the human organ.
- Accidental contact with eyes of dust, soot, small chemical particles, etc.
Symptoms of the disease can vary, depending on what caused the inflammation. Of course, many common features can be distinguished for some forms, but it would be more expedient to consider their clinical manifestations separately. This will highlight the features of each form and pay attention to them.
Most often, this variant of the development of the disease is noted in case of defeat by an infectious agent. Patients do not notice any precursors, since the main symptoms increase almost immediately. Basically, in acute conjunctivitis, both eyes are affected at once. Symptoms are quite pronounced.
- Tearing due to the production of an excess amount of tear fluid.
- The cut in the eyes is a consequence of irritation of the nerve endings, which both the conjunctiva and the eyeball are rich in.
- Burning sensation.
- Photophobia appears as a result of increased sensitivity to sunlight.
- Eyelids swollen due to edema.
- The conjunctiva is red, swollen.
- If the bacteria that caused acute conjunctivitis are suppurative, then pus is released, the eyelids stick together.
- Runny nose and general symptoms (fever, weakness, fatigue, loss of appetite).
Symptoms of chronic conjunctivitis
This form of the disease is characterized by a gradual and unhurried increase of manifestations, which are relatively weak in themselves.
- Tingling in eyes.
- Slight tearing, slightly worse in the evening.
- A feeling of heaviness in the eyelids.
- The feeling that there is sand or other small particles over the centuries.
- With artificial and insufficient light, almost all manifestations of the disease increase.
- Redness of the conjunctiva, if it happens, is insignificant.
- Corneal opacity due to prolonged inflammation of surrounding tissues.
So the disease can occur for months, periodically exacerbated for a short time.
Clinical manifestations of viral conjunctivitis
These forms of the disease are relatively common. Often, the infection first affects the respiratory tract, and only after it switches to the conjunctiva of the eye. Viruses in large quantities stand out from the eyes of a sick person and have a good ability to penetrate the mucous membranes into the body of another person. Due to this, viral conjunctivitis can occur in the form of outbreaks in certain groups of people. The largest number of cases of viral conjunctivitis accounts for three types of diseases:
- adenoviral conjunctivitis;
- herpetic conjunctivitis;
- epidemic keratoconjunctivitis.
This form of the disease is highly contagious and is caused by several types of adenoviruses (3, 4, 7a, 10 and 11). Children's groups are most at risk due to the large crowding of patients and the frequent occurrence of adenoviral respiratory infections among them. The disease can be transmitted through the airborne route with normal breathing and coughing. It is also possible contamination by direct contact with the pathogen on the mucous membrane, and this is quite likely in the process of outdoor games in the children's team.
The initial symptoms of the disease are:
- runny nose;
- general weakness;
- sore throat;
After the disease, under certain conditions, it can affect the mucous membrane of the eyes and cause conjunctivitis. Fortunately, children are much easier to handle this disease than adults. The cornea is extremely rarely involved in the inflammatory process, as a result of which the visual impairment in patients, after suffering adenoviral conjunctivitis, is almost never the case. There are three forms of this disease.
- Catarral form - all inflammatory changes are expressed slightly. The discharge expires from the eyes in a small amount. Also insignificant is redness of the mucous membrane of the eye. If there is no complication, the disease disappears in about one week.
- Filmy form of the disease - a thin film is formed on the conjunctiva, which is quite easily eliminated. In some cases, the films can be heavily soldered to the underlying tissues, which creates the impression that the patient has eye diphtheria . Therefore, it is important to conduct a survey for the presence of the causative agent of diphtheria. In the overwhelming majority of cases, the films disappear without a trace, but occasionally minor scars remain on the conjunctiva.
- Follicular form - small bubbles cover the mucous membrane and deliver the patient some discomfort due to the impact on the eyeball.
If you do not eliminate adenoviral conjunctivitis in a timely manner, the production of tear fluid may be disrupted. The consequence of which is dry eye syndrome in the future.
Symptoms of herpetic conjunctivitis
Herpes simplex virus is very common among the human population. Under certain conditions, it can affect the patient's eyes. Most often, children are affected, and one eye is affected. Unlike other forms of the disease, herpetic conjunctivitis occurs for a long time and is characterized by the following symptoms:
- redness of the eyelids;
- eyelid edema;
- the presence of herpetic vesicles on the eyelid skin - this symptom is the main distinguishing feature of the course of the herpetic form of the disease.
The disease can flow in the form of catarrhal and follicular forms.
This form of the disease is also characterized by strong contagion, but is most often found in the adult population. Often get sick with whole families or work collectives. The disease is transmitted through contact (household items, unwashed hands, underwear, clothes, towels - especially important). The main symptoms of the disease:
- insomnia or poor sleep;
- слабость, утомляемость, сниженная работоспособность;
- глаза поражаются не одномоментно, а один за другим;
- ощущение «засоренности» глаз;
- слезотечение и другие выделения из глаз;
- отечность и покраснение век;
- гиперемия слизистой оболочки;
- на конъюнктиве появляются легкоустранимые пленки – отмечается только в некоторых случаях;
- увеличение лимфатических узлов около уха и под нижней челюстью – также в отдельных случаях;
- снижение резкости зрения вследствие воспаления.
Заболевание не отступает на протяжении примерно 2-х месяцев. Если человек однажды переболел данным заболеванием, то у него на всю жизнь вырабатывается стойкий иммунитет.
Эта форма заболевания часто развивается при травме глаз и других повреждениях, в результате которых несколько нарушается целостность тканей конъюнктивы. Это дает бактериям возможность проникать внутрь и размножаться там. Также бактерии могут попадать в глаза из полостей носа или уха при условии, что иммунитет несколько ослаблен, а адекватная терапия не проводится. Бактериальный конъюнктивит обладает некоторыми особыми чертами, помимо основных клинических признаков:
- покраснение и отечность век (иногда пациентам трудно открыть глаза);
- обильные выделения гноя из глаз;
- пенистые выделения, обладающие достаточной вязкостью – характерны для отдельных возбудителей;
- в области глазного яблока возможны небольшого размера;
- утром пациентам особо трудно открыть веки за счет того, что веки склеиваются гнойным содержимым;
- глаза пациента очень быстро утомляются, возникает головная боль;
- пациенты ощущают жжение и резь в глазах, иногда складывается ощущение наличия инородного тела за веком;
- и веки, и глазное яблоко приобретают красную окраску вследствие расширения сосудов.
Симптомы аллергического конъюнктивита
Данная форма заболевания проявляет себя практически сразу после того, как в организм пациента попадает аллерген. Симптомы у детей и у взрослых во многом схожи, поскольку механизм их появления один и тот же. В целом же проявления заболевания практически не отличаются от таковых при других формах:
- отек век вследствие выхода жидкой части крови в межклеточную жидкость;
- покраснение конъюнктивы и век;
- зуд в области глаз;
- сильное жжение и резь в глазах;
- слезотечение и выделение слизистой жидкости.
Хламидии – это одни из самых частых возбудителей заболеваний, передающихся половым путем. Однако они могут поражать не только половые органы и нередко вызывают конъюнктивит. В подавляющем большинстве случаев болезнь поражает взрослое население, но возможно также попадание бактерии в глаза ребенка при прохождении его по родовым путям больной матери.
Есть несколько форм хламидиозного конъюнктивита:
- бассейновый конъюнктивит;
- хламидийный увеит;
- хламидийный эписклерит.
- Хламидийный мейболит.
В большинстве случаев заболевание протекает бессимптомно, да и после его проявления не особо сильно выражен. Возникают светобоязнь, слезотечение, ощущение жжения и резь, покраснение, как слизистой, так и самого глазного яблока.
Непосредственно диагноз «конъюнктивит» поставить несложно. Врач невооруженным взглядом видит все изменения, происходящие в глазах пациента. Основным в диагностике является определение причины заболевания, без которой невозможно провести эффективное специфическое лечение.
- Микроскопия отделяемого из глаза – может помочь обнаружить непосредственно возбудителя.
- Посев на питательные среды – метод, благодаря которому можно вырастить колонию микробов и определить их чувствительность к различным лекарствам.
- Биомикроскопия – рассмотрение глаза под микроскопом в щелевой лампе. Так можно очень хорошо рассмотреть многие структуры и увидеть изменения на конъюнктиве и роговице.
- Общий анализ крови.
The treatment of a disease can vary significantly depending on what caused its development. Therefore, it is important for doctors to know the cause of the disease. It is important to give doctors a chance to cope with the disease as soon as possible, promptly asking for help. You also need to remember that the disease is contagious and long-term self-treatment can lead to infection of other people.
- Artificial tears and compresses on the eye area will relieve inflammation.
- Actively and successfully used drops containing interferon.
- Acyclovir is used in cases where the cause of conjunctivitis is herpes simplex virus.
- Drops with antibiotics are used when, against the background of inflammation, a patient develops bacterial complications.
Drops and ointments containing antibiotics in their composition significantly accelerate the convalescence process, without affecting the entire patient's body, as is the case with drinking pills and injections. If the symptoms are not very developed, and the patient's body is strong, then the disease with a large proportion will pass on its own, without the help of medications.
Antihistamines are excellent for a patient with this form of the disease. They block the action of the inflammatory mediator and do not allow the allergen to cause a cascade of inflammatory reactions in the conjunctiva. They can be used in the form of drops for the eyes and in the form of tablets. Artificial tear drops can reduce all unpleasant symptoms and improve the patient's well-being.
In severe cases it is possible to use local preparations containing hormones, diphenhydramine and interferon.
For patients with any form of the disease, it is important to remember that it is extremely undesirable to touch the eyes, as this can either ensure the entry of bacteria or spread the pathogen. It is important to especially carefully follow the rules of personal hygiene, use only your towel to protect loved ones from the pathogen.
- Conjunctivitis in children: symptoms, treatment of conjunctivitis in children
- Conjunctivitis eye drops