The conjunctiva of the eye is a thin mucous membrane located in the anterior surface of the eye. Its main function is to protect the cornea from foreign particles, bacteria and viruses. This article will discuss conjunctivitis: causes, symptoms and treatment of this disease. Its essence lies in the development of an inflammatory reaction in the conjunctiva under the influence of various factors.
Types of conjunctivitis
Conjunctivitis, the causes (treatment will be discussed later) of which are most often caused by a lesion of a viral and bacterial nature, is the most common type of eye pathology. According to medical statistics, more than 67% of patients turn to ophthalmologists with this diagnosis.
Classification of pathology is made according to 2 main criteria - according to the course and causes of the disease with conjunctivitis:
- bacterial conjunctivitis (pneumococcal, streptococcal, diphtheria, gonococcal, chlamydial);
- viral caused by contagiousshellfish, herpes, rubella, chickenpox, measles and other pathogens;
- fungal, when affected by fungi Sporotrichium, Rhinosporidium, Penicillium, Candida, actinomycetes, coccidia, aspergillus;
- allergic (medicinal, spring keratoconjunctivitis, hay fever and other types).
Viral and bacterial forms often occur against the background of concomitant diseases of the nasopharynx, inflammation of the ear, the edges of the eyelids or paranasal sinuses, as well as dry eye syndrome.
In young children, this disease is acute, while in middle-aged and older people it can become chronic.
Symptoms
Common signs of the disease are as follows:
- feeling of pain, itching in the eyes;
- mucous or purulent discharge;
- heightened sensitivity to light;
- edema of the conjunctiva of the eyelids;
- pronounced network of blood vessels in the eyeball;
- rapid eye fatigue;
- film formation.
The damage to the right and left eyes can have varying degrees of severity.
Bacterial conjunctivitis
The prevalence of bacterial conjunctivitis is explained by the fact that in the eye of each person there are a large number of microbial forms (more than 60). The specific features of the most common ones are shown in the table below.
| Form of conjunctivitis | Characteristics | Features of the flow |
|
Staphylococcal or streptococcal |
Profuse discharge from the eyes, gluing eyelashes. The severity of redness decreases towards the pupil. Mucus loses transparency |
Inflammation may spread to the cornea leading to keratitis |
| Pneumococcal |
Severe reddening of the conjunctiva. Small hemorrhages, grayish films appear on the mucous membrane of the eyelids |
Infection occurs through contact. Possible development of keratitis |
| Diphtheria |
Diphtheritic form: first develops severe swelling and thickening of the eyelids; purulent discharge occurs; dark gray films are formed, the separation of which leaves bleeding wounds, scars. Crupaceous form: less inflammation, films are soft and easy to remove, the cornea is not affected. Catarrhal form: only redness and swelling of varying intensity |
Transmission of infection - airborne. The disease is most common in children aged 2-10 years. Often there is a combination with catarrh of the upper respiratory tract. Complications develop: fusion of the eyelid membrane with the conjunctiva of the eye, corneal ulceration, inversion of the eyelids, eyelash growth towards the cornea |
| Gonococcal | Severe swelling of the eyelids, discharge is purulent and profuse, the conjunctiva is bright red and folds, in newborns itbleeds when pressed | The cause of conjunctivitis in adults is a sexually transmitted disease. Newborns become infected while passing through the maternal birth canal. Complications are possible - swelling and ulceration of the cornea, which quickly leads to its perforation |
| Chlamydia | Edematous conjunctiva develops multiple follicles that contain cloudy fluid. Subsequently, scars form, visual acuity decreases | The incubation period is 1-2 weeks. Possible complications: degeneration of the lacrimal glands, inversion of the eyelids, corneal ulceration |
Diagnosis is based on external examination and biomicroscopic examination of the smear.
Antibacterial drugs
Bacterial conjunctivitis, the causes and symptoms of which are listed above, is treated with the following remedies:
- antibacterial eye ointments: Ciprofloxacin, Ofloxacin, Lomefloxacin, 1% erythromycin or tetracycline ointment;
- eye drops containing solutions of antibiotics and antiseptics: "Sulfacetamide", "Sulfamethoxypyridazine", "Miramistin", "Ophthalmo-septonex", "Tobrex";
- in the diagnosis of staphylococcal lesions: eye drops "Gentamicin", "Tobramycin", "Fucitalmic", "Futuron";
- with streptococc althe nature of the disease: drops "Chloramphenicol", "Levomycetin".
Antibacterial ointments are applied at night, and in the absence of abundant purulent discharge - during the daytime.
There are also combined drugs that contain corticosteroids and antibiotics:
- "Maxitrol";
- "Dexa-Gentamicin";
- "Tobrazon" and others.
In case of diphtheria conjunctivitis, the patient is hospitalized in the infectious diseases hospital. Treatment is carried out systemically, using antidiphtheria serum and intramuscular or intravenous antibiotics. With the chlamydial and gonococcal nature of the disease, systemic antibiotic therapy is also prescribed.
Viral conjunctivitis: causes and treatment
All viruses that cause various human diseases (and there are about 500 of them) can also affect the eyes. The most common causes of conjunctivitis in adults and children are listed in the table below.
| Pathogen | Transmission route | Characteristic symptoms | Features of the course of the disease |
| Adenoviruses 3, 5, 7 serotypes | Airborne, contact | In the inner region of the lower eyelid, small follicles, hemorrhages, gray films appear. Parotid lymph nodes are enlarged | The incubation period is 1 week. Mostchildren of preschool age and primary school children suffer from the disease. Before the onset of conjunctivitis, there is inflammation of the pharynx, trachea, runny nose, bronchitis or otitis with high fever. The illness lasts about 2 weeks |
| Adenovirus serotype 8 | Contact, airborne |
At the initial stage - symptoms of general malaise. Regional lymph nodes enlarge and become painful. Small follicles and hemorrhages, pinpoint infiltrates are formed, visual acuity decreases |
More than 70% of patients are infected in medical facilities. The infectious period is 14 days, the total duration of the disease is up to 2 months |
| Enterovirus type 70 | Airborne | Severe pain in the eyes and photophobia, the formation of follicles, hemorrhages of various sizes and shapes. Small white or yellow spots that clog the excretory ducts of the lacrimal glands. Inflammation of the anterior lymph nodes | Duration of illness is on average 1-2 weeks |
| Herpes simplex viruses | Direct contact | The pathological process involves the skin, the edges of the eyelids, the cornea. Eruption of herpetic vesicles on the conjunctiva and along the edges of the eyelids, in place of which erosion or ulcers subsequently form | The disease is more typical for childhood. Tendency to relapse and long course |
| Molluscum contagiosum viruses | Contact household | Dense nodules ranging in size from 2 to 5 mm appear on the skin. They are painless and have a depression in the center. When pressed, a white mass is released | In many cases, the edges of the eyelids become inflamed |
Inflammation of the conjunctiva in chickenpox, measles and rubella
The causes of conjunctivitis in children are often associated with "childhood" viral infections:
- Chickenpox. First, the body temperature rises sharply, a rash occurs. Of the ophthalmic signs, the following are distinguished: photophobia, redness of the conjunctiva, profuse lacrimation, the formation of vesicles on the eyelids, which ulcerate and scar. The discharge from the eyes is first mucous, and then purulent.
- Measles. The temperature rises, white spots with a red rim appear on the mucous membrane of the cheeks and eyelids, after which the rash becomes in the form of small nodules. The child develops photophobia, eyelid twitching and swelling, the cornea becomes inflamed and eroded.
- Rubella. First, symptoms of SARS occur, lymph nodes increase, the temperature rises, a rash appears in the form of pink spots. Inflammation of the conjunctiva is usually mild.
Antivirals
Treatment of viral conjunctivitis is carried out using the following means:
- antiviral eye drops "Ophthalmoferon", "Idoxuridin", "Keretsid", "Okoferon", "Tobradex","Aktipol";
- eye gels and drops that promote the regeneration of the cornea and mucous membrane - "Korneregel", "Solcoseryl", "Glekomen", "Taufon";
- antiviral ointments placed behind the eyelid - Acyclovir, Bonafton, oxolinic, tebrofen;
- for the prevention of secondary bacterial infection - antibacterial agents described above;
- anti-inflammatory drugs containing glucocorticosteroids.
If the cause of conjunctivitis in a child is measles, rubella or chickenpox, then similar therapy is carried out:
- instillation of antiseptics into the eye - eye drops "Furacilin", "Sulfacetamide";
- use of interferon or interferonogen solutions;
- administration of anti-measles gamma globulin in injections and drops.
In case of molluscum contagiosum, scraping or diathermocoagulation of skin formations on the eyelids is performed, after which the treatment of these areas with brilliant green is shown.
Fungal conjunctivitis
Inflammation of the organs of vision in humans can cause about 50 species of pathogenic fungi. The most common causes of conjunctivitis in adults and children are 3 types:
- yeast-like mushrooms;
- mold micromycetes;
- dermatophytes that affect the skin.
Fungi get into the eyes from the environment or foci of infection on the skin, in more rare cases - through the bloodstream. The determining factor in the development of the disease aredamage to the cornea and eyelid tissues, as well as reduced immunity.
Signs of fungal conjunctivitis are as follows:
- edema, redness of the conjunctiva and the formation of dense small yellow grains on its surface;
- formation of blisters filled with serous fluid;
- when affected by fungi of the genus Penicillium - ulcers with a greenish surface;
- with candidiasis - plaque on the conjunctiva.
If the fungal disease has a different localization on the body, the patient may develop allergic conjunctivitis.
Treatment of the fungal form of the disease
Therapy of fungal infection of the conjunctiva is carried out using the following means:
- solution "Amphotericin B" or "Nystatin";
- eye drops "Okomistin", "Miramistin";
- systemic drugs taken orally - Fluconazole, Itraconazole.
For extensive eye damage, Amphotericin B is administered intravenously.
Allergic Conjunctivitis (ARC)
Allergic conjunctivitis is the second most common after infectious conjunctivitis. In recent years, there has been a tendency to increase the incidence, which in children is approaching 40%.
There are several forms of this pathology:
- seasonal (hay fever);
- year-round (permanent inflammation of the conjunctiva; exacerbations are not associated with seasonality);
- professional;
- episodic (less than 4 days per week or less than 4 weeks per year);
- persistent chronic;
- mild - minor symptoms leading to disruption of sleep or daytime activities, the patient can do without treatment;
- moderate, in which the quality of life significantly deteriorates;
- severe - the patient cannot work, study, sleep normally without treatment.
The highest prevalence of hay fever is recorded in the Volga region, the Urals and Siberia (up to 80% of all allergic pathologies).
Causes of pollinous conjunctivitis
This disease can be caused by a large number of allergens. They are divided into 3 main groups:
- household allergens (mold spores, cockroaches, pets and plants, dust mites);
- professional, medicinal, food allergens;
- allergens coming from outside (plant pollen).
The last factor is the most common. Pollen from wind pollinated plants is very light and can be transported over long distances.
The causes of pollinous (hay) conjunctivitis in the central part of Russia are due to three flowering peaks:
- March-May - alder, poplar, ash, hazel, aspen and other trees.
- June-July - cereals (wheatgrass, fescue, rye, timothy grass and others).
- July-August - weeds (wormwood, quinoa, hemp) and Compositae (sunflower and others) plants.
Most numbercalls for pollinosis falls on the third peak. Some non-flowering houseplants also release allergens into the air in the form of sap. An allergic reaction can also be caused by dust accumulating on their leaves.
ARC symptoms
The main signs of allergic conjunctivitis are:
- rhinitis symptoms - clear discharge, sneezing, itching, burning in the nose, impaired sense of smell;
- lacrimation;
- itchy eyes;
- cough, scratchy or burning throat;
- redness and swelling of the conjunctiva;
- due to deterioration in breathing, a headache occurs, the voice changes;
- stuffiness and heaviness in the ears, hearing loss;
- during the off-season, mucous pulling discharge from the eyes is possible.
These signs are associated with the cause of pollinous conjunctivitis - direct contact with the allergen. The best conditions for the distribution of pollen are in dry windy weather. In children, in many cases, cross-food allergies are observed. With the fungal nature of the disease, patients develop intolerance to foods containing yeast (kvass, fermented milk products, and others), and the condition worsens in humid weather or when in damp rooms.
ARC risk factors
The main cause of pollinous (hay) conjunctivitis is an immunopathological process, which is based on an inflammatory IgE-mediated reaction. It occurs when allergens enter the mucous membranes.surfaces in the nose and eyes.
Risk factors for triggering an allergic reaction are as follows:
- past infectious diseases leading to an increase in the sensitivity of the body;
- genetic predisposition;
- poor living conditions, malnutrition;
- unfavorable environmental situation (air pollution);
- hypothermia;
- stress.
In young children, the increased likelihood of ARC is associated with the following factors:
- young age of mother;
- smoking during pregnancy;
- preterm birth;
- artificial feeding;
- lack of oxygen in a newborn during childbirth;
- Maternal use of allergenic foods during pregnancy.
ARC treatment
The following types of drugs are used to treat allergic conjunctivitis:
- antihistamines (orally) - Desloratadine, Loratadine, Levocetirizine, Rupatadine, Fexofenadine, Cetirizine, Ebastin;
- Glucocorticosteroids for topical use (sprays and eye drops) - Beclomethasone, Budesonide, Mometasone, Fluticasone propionate or furoate, Dexamethasone, Hydrocortisone eye ointment;
- means for the prevention of exacerbation - "Ketotifen" (inside), "Kromoglikatsodium" (eye drops and nasal spray);
- artificial tear preparations for dry eyes - "Lacrisifi", "Slezin", "Defislez", "Vizmed", "Okutiarz", "Avizor" and others.
Measures to limit exposure to allergens are also recommended:
- spend more time indoors when plants are in peak bloom;
- close windows during the day and open them at night (at this time of day the concentration of allergens in the air decreases);
- use a medical mask and goggles;
- when driving in a car, close the windows and turn on the air conditioner;
- move to a different climate zone for flowering time.
General Therapy
For all forms of the disease, the following general recommendations should be followed:
- Maintain personal hygiene - wash hands frequently with soap and water, use individual towels and disposable wipes, separate pipettes for each eye.
- Remove discharge from the eyes by washing with a sterile swab soaked in "Furacilin" (ready-made solution is available in pharmacies) or a weak solution of potassium permanganate.
- To improve the discharge of secretions containing a large number of microbes, do not cover the eyes.
- To reduce the inflammatory process, use solutions of glucocorticosteroid drugs (GCS) - eye drops "Dexamethasone", "Desonide", "Prenacid" or a solution of NSAIDs (0.1% diclofenac sodium).
