Conjunctivitis: Symptoms and Treatment
- A little bit about the conjunctiva
- Types of conjunctivitis
- Causes of conjunctivitis
- Symptoms of conjunctivitis
- Diagnosis of conjunctivitis
- Treatment of conjunctivitis
Conjunctivitis is called inflammation of the mucous membrane of the eye. This is a disease that many people face throughout their lives. In some patients, this pathology worries throughout life several times a year, which greatly reduces the patient's quality of life and imposes certain limitations.
A little bit about the conjunctiva
Conjunctiva is a thin transparent shell that covers the eye from the outside. It performs quite important functions that ensure the normal functioning of the organ of vision.
- Secretion in sufficient quantity of mucous and liquid component of 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 light.
- The resulting liquid contributes to the nourishment of the eye, since a number of its transparent structures are deprived of their own blood vessels and can not receive nutrients in any other way.
- Natural antiseptics, which are rich in tear fluid, constantly protect human eyes from harmful microorganisms. They are safe for their own cells of the body, but mercilessly destroy most of the pathogens that enter the eye.
At the edge of the eyelids, the conjunctiva borders on the skin, and at the back passes into the non-coronary epithelium of the cornea. Its thickness does not exceed 1 millimeter, and the area of the aquatic eye is 15 centimeters.
That part of the conjunctiva that covers the eyelid behind is called the conjunctiva of the eyelid. During blinking, the patient's eyelids are closed and all the tear fluid that is contained in the orbital cavity is evenly distributed throughout the entire surface of the cornea, abundantly moistening every square millimeter.
Also on the conjunctiva are tear points, in which excess tear fluid flows into the nasal cavity. This relieves the patient from the constant transfusion of tears beyond the edge of the lower eyelid. If there is a constant lacrimation, doctors will always suspect a violation of the patency of the nasolacrimal canal.
Also, some vessels of the conjunctiva (their terminal branches) are involved in the blood supply of the cornea. Under unfavorable conditions (inflammation of the cornea), these capillaries can grow into it and cause a decrease in the transparency of this structure.
Clinical significance of conjunctiva
Doctors are actively examining the conjunctiva in conducting a survey of many diseases that do not involve the organ of vision. It is very thin and the vessels in it are well visible, which allows the naked eye to detect changes in blood. For example, with an increase in the bilirubin content (it happens with many liver diseases) in the blood, the conjunctiva turns yellow. If the conjunctiva is pale, you may suspect that the patient has insufficient hemoglobin in the blood (anemia).
It is convenient for physicians to examine the conjunctiva and conjunctival sac with an unaided eye, without resorting to the help of complicated devices and without causing any damage to the patient.
Types of conjunctivitis
There are several classifications of this disease, which take as a basis different symptoms.
Depending on the presence or absence of damage to other structures of the eye, the following forms are distinguished:
- Blepharoconjunctivitis - inflammation of one-stage and conjunctiva, and eyelids;
- keratoconjunctivitis - a combination of inflammation of the conjunctiva with inflammation of the cornea;
- episcleritis is a condition in which almost the same tissue damage occurs as with conjunctivitis, but no tearing and discharge from the eyes is noted.
Depending on how pronounced the symptoms of the disease and how quickly they develop, they distinguish:
- acute conjunctivitis - the disease is pronounced and delivers a lot of inconvenience to the patient, reducing the quality of life;
- chronic conjunctivitis - the symptoms of the disease are somewhat erased, but worried about the patient for a long time;
- subacute conjunctivitis - a form occupying a transitional position in the clinic between the two above;
- recurrent - the disease periodically affects the patient's eyes, often at about the same time of year.
Disease during its course can cause changes of a different nature. Based on what can be observed in the affected eye, several morphological forms of the disease are distinguished.
- Catarrhal - the main symptom of the disease is lacrimation due to increased secretion from the glands of the conjunctiva tear fluid. The body, thus, tries to cope with the disease and eliminate its cause, cleaning the conjunctival sac by washing.
- Follicular conjunctivitis is a form of the disease, in which there is some loosening of the conjunctiva. It forms small elevations of round shape, with a diameter of about 1-2 millimeters. Follicles are a collection of lymphocytes - one of the leukocyte fractions, which the body sends to the inflammatory focus to fight the causative agent of the disease. Regardless of which causative agent caused the disease (with the exception of trachoma), follicles subsequently disappear without a trace in the resolution of pathology.
- Papillary conjunctivitis - in most cases occurs in response to irritation of the tender conjunctiva with contact lenses if they are not properly worn or if the patient has an allergy to the material from which the lens is made. Emerging papillae adversely affect the surface of the eyeball, rubbing and irritating the cornea, which can lead to the development of keratitis and aggravation of the patient's condition.
- Membrane conjunctivitis - most often occurs in small children 3-4 years old when the eyes are affected 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 found there. All this is due to the peculiarity of the clinical picture - the appearance on the conjunctiva and the surface of the eyeball of dense films that significantly impair vision and cause additional inconvenience to the patient.
- Hemorrhagic conjunctivitis is almost always provoked by viruses and is epidemic in nature. The disease develops rapidly, the main manifestation of it is subconjunctival hemorrhage. The disease passes in most cases as quickly as it begins, which distinguishes epidemic conjunctivitis from other forms of the disease.
- 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 several morphological elements.
About this form of the disease should be written separately, as the causes and pathogenesis of the development of major clinical manifestations. In the case of allergy, the infectious agent that can irritate the mucosa does not enter the patient's eyes. Everything consists in the presence of hypersensitivity to individual substances (they are individual for each patient).
Most often allergic conjunctivitis causes allergens that are in the air - pollen of plants during their flowering period, various aerosols, smoke, etc. Often inflammation of the conjunctiva can be triggered by food allergens (eggs, cow's milk, cereals, many other foods).
After the allergen enters the body, an immune response is triggered to protect the person from the pest (this is how the allergen is perceived). Special mediators of inflammation (mainly histamine) are thrown out, which rush to the site of localization and cause a local tissue response there. 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 reasons for the development of conjunctivitis can be divided into several groups: infectious agents, allergic agents and consequence of adverse environmental factors.
Pathogens of infectious nature
1. Bacterial conjunctivitis:
- The Koch-Weeks bacterium is the cause of the development of epidemic conjunctivitis.
- Chlamydia (trachomatous conjunctivitis is caused by one of the types of these bacteria).
- The causative agent of diphtheria.
- Other bacteria.
2. Viral conjunctivitis:
- Herpetic conjunctivitis.
- Adenovirus, etc.
Bacterial conjunctivitis causes the most severe forms of the disease. Fortunately, at present 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 in its time is still one of the main causes of blindness in countries where until now it has not been possible to defeat the epidemic.
The causes of allergic conjunctivitis
- Pollen and plant seeds, in large quantities contained in the air during flowering.
- Cosmetic means are increasingly the cause of conjunctivitis due to the fact that previously they were not so actively used. Now companies use a lot of chemicals, and cosmetics is becoming less natural.
- Food allergens, as well as substances that are currently added to the products in order to increase their shelf life (preservatives), attractiveness (dyes and flavors).
- Medicinal preparations with long-term use (sometimes after the first contact) have every chance to cause allergies.
- Means of household chemicals (detergents, powders, conditioners, air fresheners).
- Bacteria that affect other areas in the body can not directly affect the conjunctiva, but produce substances that are an allergen to humans. An example is tuberculosis-allergic conjunctivitis.
- Contact lenses - due to the peculiarity of wearing and frequency of application by the population, often cause conjunctivitis. However, in recent years, companies are developing ever more inert substances, of which lenses are made. They are less likely to cause allergies in patients.
Allergic conjunctivitis has recently become one of the leaders in the overall pattern of morbidity. This can be explained by the fact that people have to face more and more chemicals in the process of their life. In addition to all this, the sensitivity of the organism to allergens is steadily rising due to unsatisfactory environmental conditions in which the body develops and grows.
Other causes of conjunctivitis
- The impact of harmful physical factors in enterprises (flour milling industry, textile industry, production of building materials).
- Exposure to ionizing radiation.
- Excess exposure to light energy on the human body.
- Accidental exposure to the eyes of dust, soot, fine chemical particles, etc.
Symptoms of conjunctivitis
Symptoms of the disease may vary, depending on what caused the inflammation. Of course, we can identify many common features for some forms, but it will be more appropriate to consider their clinical manifestations separately. This will highlight the features of each form and draw attention to them.
Most often, this variant of the development of the disease is noted in case of infection by an infectious agent. Patients do not notice any precursors, because the main symptoms increase almost immediately. Basically, with acute conjunctivitis, both eyes are immediately affected. Symptoms are quite pronounced.
- Lachrymation due to the production of excess tear fluid.
- Cutting in the eyes - a consequence of irritation of nerve endings, which is rich in both the conjunctiva and the eyeball itself.
- A burning sensation.
- Photophobia appears as a result of increased sensitivity to sunlight.
- Eyelids swollen due to swelling.
- Conjunctiva is red, very swollen.
- If the bacteria that caused acute conjunctivitis refer to pyogenic, then pus is released, the eyelids are glued together.
- Runny nose and general symptoms (fever, weakness, fatigue, decreased appetite).
Symptoms of chronic conjunctivitis
This form of the disease is characterized by a gradual and unhurried increase in manifestations, which in themselves are relatively weakly expressed.
- Feeling tingling in the eyes.
- Slight lachrymation, slightly worse in the evening.
- Feeling of heaviness in the eyelids.
- Feeling that sand or other small particles are behind the ages.
- With artificial and insufficiently intensive lighting, almost all manifestations of the disease are intensified.
- Redness of the conjunctiva, if it happens, is insignificant.
- Corneal turbidity due to prolonged inflammation of surrounding tissues.
So the disease can take months, periodically exacerbating 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, but only then turns to conjunctiva eyes. Viruses in large numbers are allocated 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 as flares in separate groups of people. The greatest number of cases of viral conjunctivitis occurs in three types of disease:
- adenoviral conjunctivitis;
- herpetic conjunctivitis;
- epidemic keratoconjunctivitis.
This form of the disease is very 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 adenovirus infections of the respiratory tract among them. The disease can be transmitted through the airborne pathway with normal breathing and coughing. It is also possible to infect by direct contact of the pathogen on the mucous membrane, and this is quite likely in the process of moving games in the children's team.
The initial symptoms of the disease are:
- general weakness;
- a sore throat;
After the disease, under certain conditions, it can affect the mucous eyes and cause conjunctivitis. Fortunately, the children carry this disease much easier than adults. The cornea is rarely involved in the inflammatory process, so that visual impairment in patients after an adenoviral conjunctivitis has almost never happened. There are three forms of this disease.
- Catarrhal form - all inflammatory changes are not very pronounced. The separated leaves out of the eyes in small amounts. Also minor is the redness of the mucous eye. If there is no complication, the disease lasts approximately one week.
- Femoral form of the disease - on the conjunctiva formed a thin film, which is easily eliminated. In some cases, the films can be strongly soldered to the underlying tissues, which creates the impression that the patient has diphtheria eyes. Therefore, it is important to conduct a test for the presence of a pathogen diphtheria. In the overwhelming majority of cases, the films disappear without a trace, but occasionally on the conjunctiva there are minor scars.
- The follicular form - small vesicles cover the mucous membrane and cause the patient some discomfort due to exposure to the eyeball.
If adenoviral conjunctivitis is not eliminated in a timely manner, the production of tear fluid may be impaired. The consequence of this 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. Children are most often affected by the disease, 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;
- swelling of the eyelids;
- the presence on the skin of the eyelids of herpetic vesicles - this particular symptom is the main distinguishing feature of the course of the herpetic form of the disease.
The disease can occur in the form of catarrhal and follicular forms.
This form of the disease is also characterized by severe infectiousness, but most often occurs among the adult population. They are often infected by whole families or labor collectives. The disease is transmitted through contact (household items, unwashed hands, underwear, clothes, towels - especially relevant). The main symptoms of the disease:
- insomnia or poor sleep;
- weakness, fatigue, reduced working capacity;
- eyes are not amazed at the same time, but one by one;
- feeling of "clogged" eyes;
- lacrimation and other discharge from the eyes;
- swelling and redness of the eyelids;
- hyperemia of the mucosa;
- on the conjunctiva appear easily removable films - it is noted only in some cases;
- enlargement of lymph nodes near the ear and under the lower jaw - also in some cases;
- reduction of visual acuity due to inflammation.
The disease does not recede for about 2 months. If a person once had a disease, then he has a permanent immunity for life.
This form of the disease often develops with eye trauma and other injuries, as a result of which the integrity of the conjunctival tissues is somewhat disturbed. This allows bacteria to penetrate and multiply there. Also, bacteria can get into the eyes from the nasal or ear cavities, provided that the immunity is somewhat weakened, and adequate therapy is not performed. Bacterial conjunctivitis has some special features, in addition to the main clinical signs:
- redness and swelling of the eyelids (sometimes it is difficult for patients to open their eyes);
- abundant discharge of pus from the eyes;
- Foamy discharge with a sufficient viscosity is characteristic of individual pathogens;
- in the field of the eyeball a small size is possible;
- in the morning it is especially difficult for patients to open their eyelids due to the fact that the eyelids are stuck together with purulent contents;
- the patient's eyes very quickly become tired, there is a headache;
- patients feel burning and stinging in the eyes, sometimes there is a sense of the presence of a foreign body after the eyelid;
- and eyelids, and the eyeball acquire a red color due to the expansion of blood vessels.
Symptoms of allergic conjunctivitis
This form of the disease manifests itself almost immediately after the allergen enters the patient's body. Symptoms in children and adults are similar in many respects, since the mechanism of their appearance is the same. In general, the manifestations of the disease practically do not differ from those in other forms:
- edema of the eyelids due to the release of the liquid part of the blood into the intercellular fluid;
- redness of the conjunctiva and eyelids;
- itching in the eye area;
- severe burning and aching in the eyes;
- lacrimation and discharge of mucous fluid.
Chlamydia are one of the most frequent causative agents of sexually transmitted diseases. However, they can affect not only the genitals and often cause conjunctivitis. In most cases, the disease affects the adult population, but it is also possible to get the bacteria into the eyes of the child when passing through the birth canal of the sick mother.
There are several forms of chlamydia conjunctivitis:
- basin conjunctivitis;
- chlamydial uveitis;
- chlamydial episcleritis.
- Chlamydial meybolit.
In most cases, the disease is asymptomatic, and even after its manifestation is not particularly pronounced. There is photophobia, lacrimation, a burning sensation and pain, redness, both mucous and the eyeball itself.
Diagnosis of conjunctivitis
Immediately diagnose "conjunctivitis" is easy to put. The doctor sees with an unaided eye all the changes that occur in the eyes of the patient. The main thing in diagnosis is the definition of the cause of the disease, without which it is impossible to conduct effective specific treatment.
- The microscopy of the discharge from the eye can help to detect the pathogen directly.
- Sowing on nutrient media is a method by which one can grow a colony of microbes and determine their sensitivity to various medicines.
- Biomicroscopy - examination of the eye under a microscope in a slit lamp. So you can very well consider many structures and see changes in the conjunctiva and the cornea.
- General blood analysis.
Treatment of conjunctivitis
Treatment of the 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 in the shortest possible time, in a timely turn for help. It must also be remembered that the disease is contagious and long-term self-treatment can lead to infection of other people.
- Artificial tear and compresses on the eye area will remove inflammation.
- Active and successful use of drops containing interferon.
- Acyclovir is used in cases where the cause of the development of conjunctivitis is the herpes simplex virus.
- Drops with antibiotics are used when against a background of inflammation the patient develops bacterial complications.
Drops and ointments containing antibiotics in their composition greatly accelerate the process of recovery, without affecting the entire body of the patient, as happens when drinking tablets and injections. If the symptoms are not developed strongly, and the patient's body is strong, then the disease will go away on its own without medication.
Antihistamines are great for a patient with this form of disease. They block the action of the mediator of inflammation 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. Drops of artificial tears can reduce all unpleasant symptoms and improve the patient's well-being.
In particularly severe cases, it is possible to use local drugs containing hormones, diphenhydramine and interferon.
Patients with any form of the disease are important to remember that it is extremely undesirable to touch the eyes with hands, as this can either ensure the entry of bacteria there, or spread the pathogen. It is important to carefully observe the rules of personal hygiene, use only your towel to protect loved ones from the pathogen.
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