Conjunctivitis Classification and external resources
An eye with viral conjunctivitis.
ICD-10	H10.
ICD-9	372.0
DiseasesDB	3067
MedlinePlus	001010
eMedicine	emerg/110

Conjunctivitis (IPA: /condʒʌnktɪvˌаɪtis/), commonly called "Pink Eye" and "Red Eye" in the UK, and "Madras Eye" in India^{[citation needed]} is an 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 bacterial, or viral). Image File history File links Metadata Size of this preview: 800 × 492 pixelsFull resolution (1256 × 773 pixel, file size: 695 KB, MIME type: image/jpeg) I, the copyright holder of this work, hereby release it into the public domain. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // H00-H59 - Diseases of the eye and adnexa (H00-H06) Disorders of eyelid, lacrimal system and orbit (H00) Hordeolum and chalazion (H000) Hordeolum and other deep inflammation of eyelid (H001) Chalazion (H01) Other inflammation of eyelid (H010) Blepharitis (H011) Noninfectious dermatoses of eyelid (H02) Other disorders of eyelid (H020) Entropion... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Image of a human eye clearly showing the blood vessels of the conjuntiva. ... For other uses, see Eye (disambiguation). ... An eyelid is a thin fold of skin that covers and protects an eye. ... Pancreatitus can be caused by an Allergic Reaction to a food. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Phyla/Divisions Actinobacteria Aquificae Bacteroidetes/Chlorobi Chlamydiae/Verrucomicrobia Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Nitrospirae Omnibacteria Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Bacteria is also the fictional name of a warring nation under Benzino Napaloni as dictator, in the 1940 film The Great Dictator... vaghhyyyyyyyyyyyyyyyyyyyyyyyyyyyy viral vaghela (shrewsbury, massachusetts) also know as vagh is the hot sexy lover of kinjal shah (houston, texas) ...

Variants

Blepharoconjunctivitis is the combination of conjunctivitis with blepharitis (inflammation of the eyelids). Blepharitis is inflammation of the eyelids. ... An eyelid is a thin fold of skin that covers and protects an eye. ...

Keratoconjunctivitis is the combination of conjunctivitis and keratitis (corneal inflammation). Keratoconjunctivitis sicca or KCS is an eye disease caused by decreased tear production or increased tear film evaporation commonly found in people and small animals. ... The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber, providing most of an eyes optical power [1]. Together with the lens, the cornea refracts light and, as a result, helps the eye to focus. ...

Episcleritis is an inflammatory condition that produces a similar appearance to conjunctivitis, but without discharge or tearing. This article or section does not cite its references or sources. ... Inflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. ...

Causes

Some forms of conjunctivitis are extremely contagious while others are not. It all depends on the etiology. This article is about the medical term. ...

Diagnosis

Symptoms

Eyes with conjunctivitis

Redness, irritation and watering of the eyes are symptoms common to all forms of conjunctivitis. Itch and the closing of the throat is variable. Image File history File links Pinkeye_twoangles. ... Image File history File links Pinkeye_twoangles. ...

Acute allergic conjunctivitis is typically itchy. Sometimes distressingly so, and the patient often complains of some lid swelling. Chronic allergy often causes just itch or irritation, and often much frustration because the absence of redness or discharge can lead to accusations of hypochondria. For the anatomical term, see hypochondrium. ...

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 fellow eye. In humans the respiratory tract is the part of the anatomy that has to do with the process of respiration or breathing. ... Acute viral nasopharyngitis, or acute coryza, usually known as the common cold, is a highly contagious, viral infectious disease of the upper respiratory system, primarily caused by picornaviruses or coronaviruses. ... Sore Throat were a British noisegrind band, credited with contributing to the creation of that genre. ...

Bacterial conjunctivitis due to the common pyogenic (pus-producing) bacteria causes marked grittiness/irritation and a stringy, opaque, grey or yellowish mucopurulent discharge (gowl, goop, "gunk", "eye crust", sleep, or other regional names) 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. Many other bacteria (e.g., Chlamydia, Moraxella) can cause a non-exudative but very persistent conjunctivitis without much redness. The gritty and/or scratchy feeling is sometimes localised 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 until patient shows signs of symptoms. Pyogenic refers to bacterial infections that make pus. ... Mucopurulent discharge is the emission or secretion of fluid containing mucus and pus from the eye, nose, cervix, vagina, or other part of the body due to infection and inflammation. ... Chlamydia is a common term for Chlamydiae. ... Species M. catarrhalis Moraxella is a genus of Gram negative bacteria in the Moraxellaceae family. ... Pyogenic refers to bacterial infections that make pus. ...

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. This is the only group in which severe pain may occur.

Signs

An eye with bacterial conjunctivitis.

Infection (redness) of the conjunctiva on one or both eyes should be apparent, but may be quite mild. Except in obvious pyogenic or toxic/chemical conjunctivitis, a slit lamp (biomicroscope) is needed to have any confidence in the diagnosis. Examination of the tarsal conjunctiva is usually more diagnostic than the bulbar conjunctiva. The slit-lamp examination looks at structures that are at the front of the eye (the anterior segment): The eyelid, the sclera (white outer structure of the eye), conjunctiva (membranes lining the eyelid and sclera surface), iris (colored part of the eye), natural crystalline lens, and the cornea (thin transparent...

Allergic conjunctivitis shows pale watery swelling or edema of the conjunctiva and sometimes the whole eyelid, often with a ropy, non-purulent mucoid discharge. There is variable redness. This page is about the condition called edema. ...

Viral conjunctivitis, commonly known as "pink eye", shows a fine diffuse pinkness of the conjunctiva which is easily mistaken for the 'ciliary infection' of iritis, but there are usually corroborative signs on biomicroscopy, particularly numerous lymphoid follicles on the tarsal conjunctiva, and sometimes a punctate keratitis. Iritis is a form of anterior uveitis and refers to the inflammation of the iris of the eye. ... Lymph nodes are components of the lymphatic system. ...

Pyogenic bacterial conjunctivitis shows an opaque purulent discharge, a very red eye, and on biomicroscopy there are numerous white cells and desquamated epithelial cells seen in the 'tear gutter' along the lid margin. The tarsal conjunctiva is a velvety red and not particularly follicular. Non-pyogenic infections can show just mild injection and be difficult to diagnose. Scarring of the tarsal conjunctiva is occasionally seen in chronic infections, especially in trachoma. In zootomy, epithelium is a tissue composed of a layer of cells. ...

Irritant or toxic conjunctivitis show primarily marked redness. If due to splash injury, it is often present only in the lower conjunctival sac. With some chemicals—above all with caustic alkalis such as sodium hydroxide—there may be necrosis of the conjunctiva with a deceptively white eye due to vascular closure, followed by sloughing of the dead epithelium. This is likely to be associated with slit-lamp evidence of anterior uveitis. Sodium hydroxide (NaOH), also known as lye, caustic soda and (incorrectly, according to IUPAC nomenclature)[1] sodium hydrate, is a caustic metallic base. ... Iritis is a form of anterior uveitis and refers to the inflammation of the iris of the eye. ...

Differential diagnosis

Conjunctivitis symptoms and signs are relatively non-specific. Even after biomicroscopy, laboratory tests are often necessary if proof of aetiology is needed.

A purulent discharge strongly suggests bacterial cause, unless there is known exposure to toxins. Infection with Neisseria gonorrhoeae should be suspected if the discharge is particularly thick and copious. Pus is a whitish-yellow or yellow substance that can be found in regions of bacterial infection, including superficial infections, such as pimples. ... Binomial name Neisseria gonorrhoeae Zopf, 1885 Neisseria gonorrhoeae is a species of Gram-negative bacteria responsible for the disease gonorrhoea. ...

A diffuse, less "injected" conjunctivitis (looking pink rather than red) suggests a viral cause, especially if numerous follicles are present on the lower tarsal conjunctiva on biomicroscopy.

Scarring of the tarsal conjunctiva suggests trachoma, especially if seen in endemic areas, if the scarring is linear (von Arlt's line), or if there is also corneal vascularisation.

Clinical tests for lagophthalmos, dry eye (Schirmer test) and unstable tear film may help distinguish the various types of dry eye. Schirmers test determines whether the eye produces enough tears to keep it moist. ...

Other symptoms including pain, blurring of vision and photophobia should not be prominent in conjunctivitis. Fluctuating blurring is common, due to tearing and mucoid discharge. Mild photophobia is common. However, if any of these symptoms are prominent, it is important to exclude other diseases such as glaucoma, uveitis, keratitis and even meningitis or caroticocavernous fistula. Photophobia (also light sensitivity) or fear of light, is a symptom of excessive sensitivity to light and the aversion to sunlight or well-lit places. ... Uveitis specifically refers to inflammation of the middle layer of the eye, termed the uvea but in common usage may refer to any inflammatory process involving the interior of the eye. ... Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ... A carotid-cavernous fistula (CCF) is an abnormal communication between the carotid artery and the cavernous sinus. ...

Many people who have conjunctivitis have trouble opening their eyes in the morning because of the dried mucus on their eyelids. There is often excess mucus over the eye after sleeping for a long period of time.

Investigations

These are done infrequently because most cases of conjunctivitis are treated empirically and (eventually) successfully, but often only after running the gamut of the common possibilities.

Swabs for bacterial culture are necessary if the history & signs suggest bacterial conjunctivitis, but there is no response to topical antibiotics. Research studies indicate that many bacteria implicated in low-grade conjunctivitis are not detected by the usual culture methods of medical microbiology labs, so negative results are common. Viral culture may be appropriate in epidemic case clusters. Conjunctival scrapes for cytology can be useful in detecting chlamydial and fungal infections, allergy and dysplasia, but are rarely done because of the cost and the general lack of laboratory staff experienced in handling ocular specimens. Conjunctival incisional biopsy is occasionally done when granulomatous diseases (e.g., sarcoidosis) or dysplasia are suspected. Staphylococcus aureus - Antibiotics test plate. ... Cytology (also known as Cell biology) is the scientific study of cells. ... Chlamydia is a common term for infection with any bacteria belonging to the phylum Chlamydiae. ... Divisions Chytridiomycota Zygomycota Ascomycota Basidiomycota The Fungi (singular: fungus) are a large group of organisms ranked as a kingdom within the Domain Eukaryota. ... Allergy is an abnormal reaction to a substance foreign to the body that is acquired, predictable and rapid. ... Dysplasia (from Greek, roughly: bad form) is a term used in pathology to refer to an abnormality in maturation of cells within a tissue. ... Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... In medicine (anatomical pathology), a granuloma is a group of epithelioid macrophages surrounded by a lymphocyte cuff. ... Dysplasia (from Greek, roughly: bad form) is a term used in pathology to refer to an abnormality in maturation of cells within a tissue. ...

Treatment and management

Conjunctivitis sometimes requires medical attention. The appropriate treatment depends on the cause of the problem. For the allergic type, cool water 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. Some patients with persistent allergic conjunctivitis may also require topical steroid drops. Artificial tears are lubricant eye drops used to treat the dryness and irritation associated with deficient tear production in keratoconjunctivitis sicca (dry eyes). ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ... An H1 antihistamine is a histamine antagonist which serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions, through action at the H1 receptor. ...

Bacterial conjunctivitis is usually treated with antibiotic eye drops or ointments that cover a broad range of bacteria (chloramphenicol or fusidic acid used in UK). However evidence suggests that this does not affect symptom severity and gains only modest reduction in duration from an average of 4.8 days (untreated controls) to 3.3 days for those given immediate antibiotics. Deferring antibiotics yields almost the same duration as those immediately starting treatment with 3.9 days duration, but with half the two-week clinic reattendance rate.^[1] Staphylococcus aureus - Antibiotics test plate. ... An ointment is a viscous semisolid preparation used topically on a variety of body surfaces. ... Chloramphenicol is a bacteriostatic antibiotic originally derived from the bacterium Streptomyces venezuelae, isolated by David Gottlieb, and introduced into clinical practice in 1949. ... Fusidic acid is an antibacterial antibiotic used particularly for eye and skin infections. ...

Although there is no cure for viral conjunctivitis, symptomatic relief may be achieved with warm compresses^[2] and artificial tears. For the worst cases, topical corticosteroid drops may be prescribed to reduce the discomfort from inflammation. However prolonged usage of corticosteroid drops increases the risk of side effects. Antibiotic drops may also be used for treatment of complementary infections. Patients are often advised to avoid touching their eyes or sharing towels and washcloths. Viral conjunctivitis usually resolves within 3 weeks. However in worst cases it may take over a month.

Conjunctivitis due to burns, toxic and chemical require careful wash-out with saline, especially beneath the lids, and may require topical steroids. The more acute chemical injuries are medical emergencies, particularly alkali burns, which can lead to severe scarring, and intraocular damage. Fortunately, such injuries are uncommon. In medicine, saline is a solution of sodium chloride (a substance also commonly known as table salt) in sterile water, used frequently for intravenous infusion, rinsing contact lenses, and nasal irrigation (or the yogic practice called jala neti). ...

References

1. ^ Hazel A Everitt, Paul S Little, Peter W F Smith (July 16 2006). "A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice". BMJ. doi::10.1136/bmj.38891.551088.7C. 
2. ^ Medline Plus Medical Encyclopedia, http://www.nlm.nih.gov/medlineplus/ency/article/001010.htm#Treatment, Retrieved 7 April 2008

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

• Facts About the Cornea and Corneal Disease The National Eye Institute (NEI).