Disease Index Eyes and Vision

Conjunctivitis

Inflammation of the conjunctiva (conjunctivitis) is a common external eye problem.Typical symptoms exhibited by all patients include reddened eyes and sticky eyelids in the morning due to increased secretion. If the patient has not experienced pain or blurred vision, conjunctivitis is a likely diagnosis.Treatment for conjunctivitis varies with the cause.


Inflammation of the conjunctiva (conjunctivitis) is a common external eye problem. Its symptoms are a diffusely reddened eye with a purulent or serous discharge accompanied by itching, stinging, or a scratching, “Foreign body” sensation. If the patient has not experienced pain or blurred vision, conjunctivitis is a likely diagnosis.

Conjunctivitis may be caused by foreign bodies, contusions or lacerations, or parasitic infestations. Most foreign bodies may be removed easily with irrigation or cotton-tipped applicator provided no damage has occurred to deeper structures. If removal is difficult, the patients should consult a physician; the eye may have been irritated by rubbing, causing corneal epithelial abrasions which may lead to infection.

Patients with contusions or lacerations of the conjunctiva should consult an ophthalmologist for assessment of possible trauma to the globe or conjunctiva. Conjunctival irritation due to foreign bodies, chemical irritants, or allergies generally is treated by removing the cause and administering non-prescription decongestants.

A clue to chemical conjunctivitis, caused by airborne irritants such as smoke, smog, or garden sprays, is that both eyes are involved. Allergic conjunctivitis usually occurs on warm, windy days in the spring and during hay fever season. Typical symptoms, such as wheeling, congestion, stinging, watering, and itching, affect both eyes.

Bacterial conjunctivitis usually is self limiting and does not impair vision. If the patient awakens with the eyelids stuck together by dried exudates or if there is discharge or signs of swelling or the local lymph nodes, the cause is probably bacterial.

Consultation of a physician is needed, since recovery may be hastened with appropriate medicines.

Without treatment, most bacterial conjunctivitis lasts 10-14 days, although Staphylococcus and Moraxella species infections may become chronic.

Corneal infections may exhibit symptoms similar to those of bacterial conjunctivitis. These infections are more serious and may obliterate vision rapidly. An accurate diagnosis is important.

Viral conjunctivitis may resemble chemically induced conjunctivitis; symptoms may include red, perhaps swollen, watery, itching eyes and swollen lymph nodes. Unlike chemical irritations, however, viral conjunctivitis often is accompanied by systemic symptoms.

Etiology of conjunctivitis

The causes of conjunctivitis fall into two broad categories:

Infectious

  • Bacterial
  • Viral
  • Parasitic
  • Mycotic

Noninfectious

  • From a persistent irritation (such as lack of tear fluid or uncorrected refractive error)
  • Allergic
  • Toxic (due to irritants such as smoke, dust, etc.)
  • As a result of another disorder (such as Stevens -Johnson syndrome)

Symptoms of conjunctivitis

Typical symptoms exhibited by all patients include reddened eyes and sticky eyelids in the morning due to increased secretion. Any conjunctivitis also causes swelling of the eyelid, which will appear partially closed (pseudoptosis). Foreign- body sensation, a sensation of pressure, and burning sensation are usually present, although these symptoms may vary between individual patients. Intense itching always suggests an allergic reaction. Photophobia and lachrymation may also be present but can vary considerably. Simultaneous presence of blepharospasm suggests corneal involvement (keratoconjunctivitis).


Diagnosis of conjunctivitis

Physical examination reveals peripheral injection of the bulbar Conjunctival vessels. In children, possible systemic symptoms include sore throat or fever, if the conjunctivitis is suspected of being of adenoviral origin.

Lymphocytes are predominant in stained smears of Conjunctival scrapings if conjunctivitis is caused by a virus. Polymorphonuclear cells (neutrophils) predominate if conjunctivitis is due to bacteria; eosinophils, if it’s allergy related. Culture and sensitivity tests indentify the causative bacterial organisms and indicate appropriate antibiotic therapy in conventional medicine.

Treatment of conjunctivitis

Treatment for conjunctivitis varies with the cause. In conventional medicine, bacterial conjunctivitis requires topical applications of the appropriate broad-spectrum antibiotic. Although viral conjunctivitis resists treatment, a sulfonamide or broad spectrum antibiotic eye-drops may prevent a secondary infection. Patients may be contagious for several weeks after onset. The most important aspect of treatment is preventing transmission. Treatment for vernal (allergic) conjunctivitis includes administration of corticosteroid drops followed by cromolyn sodium, cold compresses to relieve itching and occasionally, oral antihistamines.

Special considerations

  • Apply compresses and therapeutic ointment or drops, as ordered. Don’t irrigate the eye, as this will spread the infection. Have the patient wash his hands before he uses the medications. Tell him to use clean washcloths or towels frequently so he doesn’t infect his other eye.
  • Teach the patient to instill eye-drops and ointment correctly -without touching the bottle tip to his eye or lashes.
  • Remind the patient that the ointment will blur his vision.
  • Stress the importance of safety glasses for the patient who works near chemical irritants.
  • Notify public health authorities if cultures show N. Gonorrhoeae.

Prevention of conjunctivitis

To prevent conjunctivitis from occurring or recurring, teach your patient to practice good hygiene. Encourage the following prevention tips.

Practice good hygiene

To encourage good eye hygiene, teach proper hand washing technique because bacterial and viral conjunctivitis are highly contagious. Stress the risk of spreading infection to family members by sharing washcloths, towels, and pillows. Suggest the use of tissues or disposable wipes to reduce the risk of transmission from contaminated linens. Caution the patient against rubbing his infected eye, which could spread infection to his other eye.

Use cosmetics carefully

If the patient uses eye cosmetics, instruct her not to share them. Also, encourage her to replace eye cosmetics regularly.

Keep contact lenses clean

If the patient wears contact lenses, teach him to handle and clean contact lenses properly. Also, while his eyes are infected, he should stop wearing the lenses until the infections clears.

Avoid contact with contagious people

Because conjunctivitis is highly contagious, particularly among children, infected children should avoid close contact with other children. Warn the patient with “cold sores” to avoid kissing others on the eyelids to prevent the spread of the disease.

Homeopathic treatment of conjunctivitis – Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat conjunctivitis but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to cure conjunctivitis symptoms that can be selected on the basis of cause, sensations and modalities of the complaints.  For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of conjunctivitis.

Aconite Nap – From cold, injury, dust, surgical operations; scrofulous inflammation with enlarged glands

Belladonna: – When eyes are blood-shot and very red. Much inflamed and painful

Euphrasia- With watering from the eyes which is acrid

Argentum Nit. – Profuse, purulent discharge; cornea opaque, lids sore, thick, swollen and uncreated; agglutinated in morning. The canthi are red as blood. Mucus obstructs the vision unless frequently wiped off. Catarrhal, ulcerative; opacities of cornea. Better by cold application

Kreosote- Inflamed and red eyes bleed easily.

Apis M. – Swelling of the lids with stinging, shooting pain and photophobia

Rhus Tox. – Thick purulent discharge. Profuse hot lachrymation, Restlessness, Worse about midnight

Alumina Silicate- Pain in the eyes; burning in the evening as from smoke, Inflammation in the open air with itching, Burning in the lids and in the canthi, Pain in the eyes as from sand

Hepar Sul. – Inflammation of the eyes with offensive thick, purulent discharge. Ulcers of the cornea with bloody, offensive discharge

Other important medicines for conjunctivitis are:

Kali bi, calendula, Calcarea Carb, Sulphur, Petroleum, Sepia, Chamomilla, Bryonia and many other medicines.

References:

Johannes P. Schade- The complete Encyclopedia of Medicine & Health; 2006; 364-65

Gerhard, K. Lang- Ophthalmology: a pocket textbook atlas; 74-75

By: Lippincott Williams & Wilkins – Professional guide to diseases; 2008; 665-66

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Ashish Sharma

Ashish Sharma

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