What Is Conjunctivitis?

Conjunctival inflammatory diseases can be divided into acute, subacute, and chronic categories according to the disease condition and course; according to the etiology, they can be divided into bacterial, viral, chlamydial, fungal, and allergic diseases; according to the characteristics of conjunctival lesions, Can be divided into acute follicular conjunctivitis, chronic follicular conjunctivitis, membranous and pseudoconjunctivitis.

Basic Information

English name: conjunctivitis

Visiting department: Ophthalmology
Common symptoms: Suffering from foreign body sensation, burning sensation, heavy eyelid, increased secretion

Causes of conjunctivitis

The etiology of conjunctivitis can be divided into two categories, infectious and non-infectious, according to their different properties. Infectivity Conjunctival inflammation caused by pathogenic microorganism infection. Non-infectious Allergic inflammation caused by local or systemic allergies is the most common. External physical and chemical factors, such as light and various chemicals, can also become pathogenic factors.

Clinical manifestations of conjunctivitis

Conjunctival congestion and increased secretion are common characteristics of various conjunctivitis. Inflammation can occur simultaneously or sequentially in one or both eyes.

Symptoms

The affected eye has a foreign body sensation, burning sensation, heavy eyelids, and increased secretions. When the lesion involves the cornea, photophobia, tearing, and varying degrees of vision loss can occur.

2. Signs

The signs of conjunctivitis are an important basis for the correct diagnosis of various conjunctivitis.

(1) Conjunctival congestion The conjunctival vascular congestion is characterized by the more obvious congestion near the fornix, the blood vessels are reticularly distributed, and the color is bright red, which can extend into the periphery of the cornea to form a corneal vascular crest.

(2) Secretory purulent secretions are more common in gonococcal conjunctivitis; mucosal purulent or catarrhal secretions are more common in bacterial or chlamydial conjunctivitis, which can often be firmly adhered to the eyelashes and open the eyelids in the morning Difficult; watery secretions are usually found in viral conjunctivitis.

(3) Conjunctival edema Conjunctival inflammation causes conjunctival blood vessels to dilate and exudate, resulting in tissue edema. The bulbar conjunctiva and fornix conjunctival tissue are loosened, and the swelling is obvious when the edema occurs.

(4) Subconjunctival hemorrhage is mostly punctate or small pieces. Epidemic hemorrhagic conjunctivitis caused by the virus can often be accompanied by subconjunctival hemorrhage.

(5) The nipple is a non-specific sign of conjunctival inflammation, which can be located on the eyelid conjunctiva or the limbus, showing a raised polygonal mosaic-like appearance, and the congested area is separated by pale grooves.

(6) Follicles Follicles are yellowish white, smooth, rounded bulges, 0.5-2.0mm in diameter, but in some cases, such as chlamydial conjunctivitis, larger follicles can also appear; viral conjunctivitis and chlamydia Conjunctivitis is often referred to as acute follicular conjunctivitis or chronic follicular conjunctivitis due to the formation of significant follicles.

(7) Membrane and pseudomembrane are exuding cellulose attached to the surface of the conjunctiva. The pseudomembrane is easy to peel off, but the real membrane is not easy to separate. The wound is bleeding after forcible peeling. The essential difference between the two is the difference in the degree of inflammation. The inflammatory response is more severe, and diphtheria bacterium causes severe membranous conjunctivitis; -hemolytic streptococcus, pneumococcus, gonococcus, adenovirus, inclusion bodies, etc. can cause membranous or pseudoconjunctivitis.

(8) Scar The damage of stromal tissue is the histological basis of conjunctival scar formation. The early manifestations of conjunctival scarring include narrowing of the conjunctival dome and fibrosis of the conjunctiva.

(9) Preauricular lymphadenopathy Viral conjunctivitis is often accompanied by an auricular lymphadenopathy.

(10) Pseudo upper eyelid ptosis Due to cell infiltration or scar formation, the upper eyelid tissue is thickened, causing mild upper eyelid ptosis, which is more common in the late stage of trachoma.

(11) Conjunctival granuloma is rare and can be seen in chronic inflammation caused by tuberculosis, leprosy, syphilis, and rickettsia.

Conjunctivitis examination

Conjunctival scraper

Gram staining and Giemsa staining initially determine the types of pathogenic bacteria and the characteristics of the inflammatory response of the conjunctiva. If the infiltration of neutrophils is the main factor, it usually indicates the infection of bacteria or chlamydia; It is a viral infection; if there are inclusion bodies in the cytoplasm of the epithelial cells, and there are lymphocytes and plasma cells, it indicates a Chlamydia infection.

2. Bacterial examination of conjunctiva, bacterial culture of secretions and drug sensitivity test

These tests help to diagnose and guide the treatment of pathogens. If you consider chlamydia or virus infection, you can do laboratory pathogen isolation or use PCR technology to help diagnosis.

Diagnosis of conjunctivitis

First of all, a preliminary judgment can be made based on the patient's pathogenesis and clinical manifestations. For example, infectious conjunctivitis usually develops in both eyes and can affect the family; most acute viral conjunctivitis first develops in one eye and then in the other eye; Eyelid-based; viral-induced acute follicular conjunctivitis is dominated by the lower eyelid; bacterial conjunctivitis is more pronounced with catarrhal inflammation; gonococcal inflammation is accompanied by a large number of purulent secretions; these The characteristics of the lesions are helpful for diagnosis.

Conjunctivitis treatment

Local treatment

(1) Rinse the conjunctival sac. Its role is mainly to clean. Commonly used are normal saline, 2% to 3% shed acid solution or 1: 5000 to 1: 10000 liters of mercury (or potassium permanganate) solution.

(2) Don't cover the affected eye. Because the secretion is large during conjunctivitis, if the affected eye is covered, the secretion is not easy to be discharged, but accumulated in the conjunctival sac; and the temperature of the conjunctival sac will increase after covering, which is more conducive to bacteria. Breeding, exacerbates conjunctivitis.

(3) Topical application Antibacterial or antiviral eye drops. According to the etiological diagnosis, select the appropriate treatment. Can use 0.5% to 1% silver nitrate, when the eye drops, flip the eyelid, drop eye drops on the eyelid conjunctiva, stop for a moment after the eye drops, that is, rinse with saline. Or use a cotton swab dipped in a small amount of liquid medicine, apply it on the surface of the eyelid conjunctiva, and then rinse with saline.

2. Systemic treatment

Severe conjunctivitis, such as gonococcal conjunctivitis, needs to be treated with systemic medication.

Conjunctivitis prevention

Conjunctivitis is mostly contagious. Wash your hands frequently to avoid rubbing your eyes. It is recommended to wash your face under running water. Towels, handkerchiefs, and other items should be separated from others, and often washed and disinfected. Patients with infectious conjunctivitis should take certain isolation measures, and they are not allowed to swim in public swimming areas. If conjunctivitis develops in one eye, the patient must be told to protect healthy eyes from infection. If the working environment is windy, dusty, or other irritants, the environment should be improved and protective glasses should be worn to prevent conjunctivitis.