Conjunctivitis (Essay Sample)

LUCABEN, ANGELICA R.
TOPIC: CONJUNCTIVITIS
PINK EYE
Pink eye is an inflammation of the conjunctiva, which is in a form of any disturbance or mild abnormality causing small blood vessels to become inflamed as well causing it to be more visible giving the eye it’s pink color. It may be caused by:
1 VIRAL CONJUNCTIVITIS
Various viruses can cause conjunctivitis; however, the most common etiologic agent is adenovirus. In this report, only two subtypes will be discussed, namely, the adenoviral conjunctivitis, and the COVID-19 Conjunctivitis, as we are in the time of pandemic, to raise awareness to us all.
* Adenoviral Conjunctivitis
About 90% of viral conjunctivitis cases are caused by adenoviruses. It can cause in children pharyngoconjunctival fever that results in acute follicular conjunctivitis that usually presents with fever, pharyngitis, as well as periauricular lymphadenopathy. The more severe ocular infection caused by this virus is called the Epidemic keratoconjunctivitis (EK) wherein the cornea is affected by the viral replication in the epithelium and the anterior stroma leading to superficial punctate keratopathy and subepithelial infiltrates.
Patients with viral conjunctivitis usually present with a history of itching, swelling and watering of the eyes. Symptoms usually include watery eyes, also blurring of vision because of the watery eyes, a discomfort or foreign body sensation is also felt, and in cases of EK, there may be a photophobia or increased sensitivity to light.
The mode of transfer since it is viral is highly contagious. It easily spreads in the school settings. Sharing of make-up and contact lenses are the most common causes of spread. Rubbing of the eyes should be avoided and frequent hand washing should be practiced to avoid the spread of the infection.
Viral infections are usually self-limiting and require supportive therapy such as resting and increasing fluid intake as well as taking in vitamins to strengthen the immune system. In severe cases such as EK, monotherapy with povidone-iodine 2% can demonstrate resolution of symptoms. Visual symptoms caused by subepithelial infiltrates can be debilitating to patients, and the use of tacrolimus, 1% and 2% cyclosporine A have been shown effective.
* COVID-19 Conjunctivitis
There are isolated coronavirus strains that were reported to cause conjunctivitis along with fever, cough, respiratory distress and even death in the recent studies. Both retrospective and prospective studies have shown that patients that display COVID-19 related conjunctivitis, also present with positive conjunctival swabs. Because of these findings, ophthalmologists are at higher risk for COVID-19 infection due to the close proximity to patients, the use of clinical equipment that also are in contact with the patient’s conjunctival mucosal surfaces. It is therefore recommended that additional protective measures should be practiced in clinics as well, and thorough disinfection and sterilization of instruments every after patient used is also a must to prevent or reduce transmission risk.
2 ALLERGIC CONJUNCTIVITIS
Ocular allergy represents one of the most common ocular conditions encountered in clinical practice. It can cause conjunctival congestion, excessive tearing and excessive mucous production. Allergic conjunctivitis is an inclusive term that encompasses seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC). However, this paper will discuss the presence or absence of corneal involvement in allergic conjunctivitis.
Allergic conjunctivitis is caused by an allergen-induced inflammatory response in which allergens interact with IgE bound to sensitized mast cells resulting in the clinical ocular allergic expression. The pathogenesis is predominantly an IgE-mediated hypersensitivity reaction. Activation of mast cells induces enhanced tear levels of histamine, tryptase, prostaglandins and leukotrienes, and this response lasts for 20-30 minutes.
Seasonal and perennial allergic conjunctivitis are those that do not affect the cornea. Other types such as keratoconjunctivitis, involves the cornea, and may present with extreme papillary hypertrophy of the tarsal conjunctiva and a Type I hypersensitivity reaction. Vernal keratoconjunctivitis may present with ocular itching, redness, swelling and discharge. Itching may be quite severe and even incapacitating and some patients may also complain of photophobia. Atopic keratoconjunctivitis on the other hand is considered to be an ocular counterpart of atopic dermatitis. It presents with eczematous lesions on the eyelids, that are also present on other parts of the body.
Treatment of this condition is usually the avoidance of the offending antigen however, the eye is a large surface area and is impossible to avoid ocular exposure especially to airborne allergens, therefore, artificial tear substitutes may provide a barrier function to improve the first line defense of the conjunctival mucosa. The mainstay management would be the use of antihistamines such as H1 topical levocabastine hydrochloride that helps in relieving ocular inflammation and applied 4x a day. With prolonged use, antihistamines may irritate the eyes, therefore combination treatments using decongestants with antihistamines may have been shown to be more effective and applied as eye drops, 4x a day.
0165290RED EYE CAUSES
When there is an anterior segment inflammation, it involves the anterior branches of the ciliary arteries, thereby indicating an inflammation of the cornea, iris as well as the ciliary body and this presents with ciliary injection which causes redness of the eyes. Conjunctival hyperemia as well is a manifestation of conjunctival inflammation which is the main cause of red eye. It can be caused by the following:
1 ACUTE CONJUNCTIVITIS
Streptococcal Conjunctivitis
Patients with streptococcal conjunctivitis usually present with an acute onset history of red eye, usually 3-5 days with an accompanying discharge on the eye, burning sensation and irritation. They usually complain that their eyelids are matted together upon waking up. Upon examination, bulbar and tarsal conjunctival hyperemia is noted. There is also a pseudomembrane formation This is commonly caused by Streptococcal pneumoniae.
A well-known complication of this is bacterial keratitis wherein there is corneal epithelial defect.
Although acute bacterial conjunctivi