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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
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| | {| class="infobox" style="float:right;" |
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| | | [[File:Siren.gif|30px|link=Conjunctivitis resident survival guide]]|| <br> || <br> |
| | | [[Conjunctivitis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
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| {{DiseaseDisorder infobox | | | {{DiseaseDisorder infobox | |
| Name = Conjunctivitis | | | Name = Conjunctivitis | |
| ICD10 = {{ICD10|H|10||h|10}} |
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| ICD9 = {{ICD9|372.0}}-{{ICD9|372.3}} |
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| ICDO = |
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| Image = Pink_eye.jpg | | | Image = Pink_eye.jpg | |
| Caption = An eye with viral conjunctivitis | | | Caption = An eye with viral conjunctivitis | |
| OMIM = |
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| MedlinePlus = 001010 |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| DiseasesDB = 3067 |
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| }} | | }} |
| {{CMG}}
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| {{Conjunctivitis}} | | {{Conjunctivitis}} |
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| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| | {{CMG}} {{AE}} {{SaraM}} |
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| | {{SK}} Madras eye; Pink eye; Pinkeye; Inflammation of conjunctiva; Conjunctiva inflamed; Infective conjunctivitis; Acute Hemorrhagic Conjunctivitis; Hyperacute Bacterial Conjunctivitis (HBC); Koch-Weeks conjunctivitis |
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| ==[[Conjunctivitis overview|Overview]]== | | ==[[Conjunctivitis overview|Overview]]== |
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| ==[[Conjunctivitis historical perspective|Historical Perspective]]== | | ==[[Conjunctivitis historical perspective|Historical Perspective]]== |
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| | ==[[Conjunctivitis classification|Classification]]== |
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| ==[[Conjunctivitis pathophysiology|Pathophysiology]]== | | ==[[Conjunctivitis pathophysiology|Pathophysiology]]== |
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| ==[[Conjunctivitis epidemiology and demographics|Epidemiology & Demographics]]== | | ==[[Conjunctivitis causes|Causes]]== |
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| | ==[[Conjunctivitis differential diagnosis|Differentiating Conjunctivitis from other Diseases]]== |
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| | ==[[Conjunctivitis epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==[[Conjunctivitis risk factors|Risk Factors]]== | | ==[[Conjunctivitis risk factors|Risk Factors]]== |
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| ==[[Conjunctivitis screening|Screening]]== | | ==[[Conjunctivitis screening|Screening]]== |
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| ==[[Conjunctivitis causes|Causes]]==
| | ==[[Conjunctivitis natural history|Natural History, Complications and Prognosis]]== |
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| ==[[Conjunctivitis differential diagnosis|Differentiating Conjunctivitis]]==
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| ==[[Conjunctivitis natural history|Complications & Prognosis]]== | |
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| ==Diagnosis== | | ==Diagnosis== |
| [[Conjunctivitis history and symptoms|History and Symptoms]] | [[Conjunctivitis physical examination|Physical Examination]] | [[Conjunctivitis staging|Staging]] | [[Conjunctivitis laboratory tests|Laboratory tests]] | [[Conjunctivitis electrocardiogram|Electrocardiogram]] | [[Conjunctivitis x ray|X Rays]] | [[Conjunctivitis CT|CT]] | [[Conjunctivitis MRI|MRI]] [[Conjunctivitis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Conjunctivitis other imaging findings|Other images]] | [[Conjunctivitis other diagnostic studies|Alternative diagnostics]] | | [[Conjunctivitis history and symptoms|History and Symptoms]] | [[Conjunctivitis physical examination|Physical Examination]] | [[Conjunctivitis laboratory tests|Laboratory Findings]] | [[Conjunctivitis chest x ray|Chest X Ray]] | [[Conjunctivitis CT|CT]] | [[Conjunctivitis MRI|MRI]] | [[Conjunctivitis other imaging findings|Other Imaging Findings]] | [[Conjunctivitis other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| [[Conjunctivitis medical therapy|Medical therapy]] | [[Conjunctivitis surgery|Surgical options]] | [[Conjunctivitis primary prevention|Primary prevention]] | [[Conjunctivitis secondary prevention|Secondary prevention]] | [[Conjunctivitis cost-effectiveness of therapy|Financial costs]] | [[Conjunctivitis future or investigational therapies|Future therapies]] | | [[Conjunctivitis medical therapy|Medical Therapy]] | [[Conjunctivitis surgery|Surgery]] | [[Conjunctivitis primary prevention|Primary Prevention]] | [[Conjunctivitis secondary prevention|Secondary Prevention]] | [[Conjunctivitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] |
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| ==Diagnosis==
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| ===Symptoms===
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| [[Image:Pinkeye_twoangles.jpg|thumb|right|225px|Eyes with conjunctivitis.]]
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| Redness, irritation and watering of the eyes are symptoms common to all forms of conjunctivitis. Itch and the closing of the throat is variable.
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| 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]].
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| <!-- Image with unknown copyright status removed: [[Image:Grosseye.jpg|thumb|right|225px|]] -->
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| ''Viral conjunctivitis'' is often associated with an infection of the upper [[respiratory tract]], a common cold, 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.
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| ''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", ''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.
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| ''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.
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| === Physical Examination ===
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| ==== Eyes ====
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Conjunctivitis-giardiacorp-xs.jpg|One eye with conjunctivitis.
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| Image:Bacterial_Conjunctivitis.jpg|Bacterial Conjunctivitis<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages/</ref>
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| Image:chemical conjunctivits (day1-2).jpg|Chemical Conjunctivits<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages/</ref>
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| </gallery>
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| </div>
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| (Images shown below are courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:eyes_conjunctivitis.jpg|Conjunctivitis: Note inflamed conjunctiva of sclera and reflection onto underside of eyelid.
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| Image:eyes_conjunctivitis2.jpg|Conjunctivitis: Marked bilateral inflammation involving conjunctiva that covers sclera and under surface of eyelid. Thick exudate can also be seen.
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| Image:eyes_conjunctivitis3.jpg|Conjunctivitis: Inflammation of conjunctiva covering sclera and under surface of eyelid.
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| </gallery>
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| </div>
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| ===Pathology===
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| [[Image:chlamydial conjunctivitis.jpg|thumb|left|Chlamydial conjunctivitis (Day 5-14)<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages</ref>]]
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| {{clr}}
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| ===Signs===
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| 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.
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| ''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.
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| ''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 follicle12:02, 22 January 2008 (EST)12:02, 22 January 2008 (EST)~~s on the tarsal conjunctiva, and sometimes a punctate keratitis.
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| Pyogenic ''bacterial conjunctivitis'' shows an opaque purulent discharge, a very red eye, and on biomicroscopy there are numerous white cells and desquamated [[epithelial cell]]s 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.
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| ''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 [[iritis|anterior uveitis]].
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| ==Differential diagnosis==
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| Conjunctivitis symptoms and signs are relatively non-specific. Even after biomicrosopy, laboratory tests are often necessary if proof of aetiology is needed.
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| 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.
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| 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.
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| 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.
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| Clinical tests for lagophthalmos, dry eye (Schirmer test) and unstable tear film may help distinguish the various types of dry eye.
| | ==Case Studies== |
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| 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.
| | [[Conjunctivitis case study one|Case #1]] |
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| ===Investigations===
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| 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.
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| Swabs for bacterial culture are necessary if the history & signs suggest bacterial conjunctivitis, but there is no response to topical [[antibiotic]]s. 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.
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| ==Treatment and management==
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| 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, [[NSAID|non-steroidal anti-inflammatory medications]] and [[antihistamine]]s may be prescribed. Some patients with persistent allergic conjunctivitis may also require topical steroid drops.
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| 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.<ref>{{cite journal | author=Hazel A Everitt, Paul S Little, Peter W F Smith | title=A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice | journal=BMJ | month=July 16 | year=2006 |id= {{doi|:10.1136/bmj.38891.551088.7C}} | url=http://bmj.bmjjournals.com/cgi/content/short/bmj.38891.551088.7Cv1?etoc}}</ref>
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| Although there is no cure for viral conjunctivitis, symptomatic relief may be achieved with cool compresses 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.
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| Conjunctivitis due to burns, toxic and chemical require careful wash-out with [[saline (medicine)|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.
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| ==Footnotes==
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| {{reflist|2}}
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| ==External links==
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| * [http://www.nei.nih.gov/health/cornealdisease/index.asp Facts About the Cornea and Corneal Disease] The National Eye Institute (NEI).
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| * [http://www.statuseyecare.com/category/conjunctivitis/ All About Conjunctivitis]
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| {{Eye pathology}} | | {{Eye pathology}} |
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| [[de:Konjunktivitis]]
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| [[es:Conjuntivitis]] | | [[es:Conjuntivitis]] |
| [[eo:Konjunktivito]]
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| [[fr:Conjonctivite]] | | [[fr:Conjonctivite]] |
| [[hr:Konjunktivitis]]
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| [[id:Konjungtivitis]]
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| [[it:Congiuntivite]]
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| [[nl:Bindvliesontsteking]]
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| [[ja:結膜炎]] | | [[ja:結膜炎]] |
| [[no:Konjunktivitt]]
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| [[pl:Zapalenie spojówek]] | | [[pl:Zapalenie spojówek]] |
| [[pt:Conjuntivite]] | | [[pt:Conjuntivite]] |
| [[qu:Ñawi huñuna unquy]]
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| [[simple:Conjunctivitis]]
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| [[fi:Sidekalvontulehdus]]
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| [[zh:结膜炎]] | | [[zh:结膜炎]] |
| [[Category:Inflammations]]
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| [[Category:Ophthalmology]]
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| [[Category:Overview complete]]
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| {{eye pathology}}
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