Conjunctivitis: causes, symptoms and treatment

The conjunctiva of the eye is a thin mucous membrane located in the front surface of the eye. Its main function is to protect the cornea from foreign particles, bacteria and viruses. This article will discuss conjunctivitis: the 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 of which (treatment will be discussed later) which is most often caused by a lesion of a viral and bacterial nature, is the most common type of ocular pathology. According to medical statistics, more than 67% of patients turn to ophthalmologists with just such a diagnosis.

The pathology is classified according to 2 main criteria - according to the course and causes of conjunctivitis:

• bacterial conjunctivitis (pneumococcal, streptococcal, diphtheria, gonococcal, chlamydial);
• viral, caused by molluscum contagiosum, herpes viruses, rubella, chickenpox, measles and other pathogens;
• fungal, with the defeat of fungi Sporotrichium, Rhinosporidium, Penicillium, Candida, actinomycetes, coccidia, aspergillus;
• allergic (drug, spring keratoconjunctivitis, hay fever and other types).

The viral and bacterial form often occurs against the background of concomitant diseases of the nasopharynx, inflammation of the ear, the edges of the eyelids or paranasal sinuses, as well as with dry eye syndrome.

In young children, this disease proceeds in an acute form, and 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;
• hypersensitivity to light;
• conjunctival edema of the eyelids;
• pronounced mesh of blood vessels in the eyeball;
• rapid eye fatigue;
• film formation.

Damage to the right and left eye can have a different degree of severity.

Bacterial conjunctivitis

The prevalence of conjunctivitis of a bacterial nature is explained by the fact that in the eye of each person there are a large number of microbial forms (over 60). The specific features that are characteristic of the most common of them are indicated in the table below.

The diagnosis is established on the basis of external examination and biomicroscopic examination of the smear.

Antibacterial drugs

Bacterial conjunctivitis, the causes and symptoms of which are listed above, are eliminated using the following means:

• 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", "Futsitalmik", "Futuron";
• with streptococcal nature of the disease: drops of "Chloramphenicol", "Levomycetin."

Antibacterial ointments are laid at night, and in the absence of copious purulent secretions - in the daytime.

There are also combined preparations, which include GCS and antibiotics:

• "Maxitrol";
• Dex-Gentamicin;
• "Tobrazon" and others.

With diphtheria conjunctivitis, the patient is hospitalized in an infectious diseases hospital. Treatment is carried out systemically, with the help of anti-diphtheria 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 ones that cause conjunctivitis in adults and children are listed in the table below.

Conjunctival inflammation in chickenpox, measles and rubella

The causes of conjunctivitis in children are often associated with "children's" viral infections:

• Chickenpox. First, the body temperature rises sharply, a rash occurs. Of the ophthalmic signs, the following are distinguished: photophobia, conjunctival redness, profuse lacrimation, the formation of vesicles on the eyelids, which ulcerate and scar. 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 has photophobia, twitching and swelling of the eyelids, the cornea of ​​the eye becomes inflamed, and erosion forms on it.
• Rubella. First, symptoms of SARS arise, lymph nodes increase, temperature rises, a rash in the form of pink spots occurs. Inflammation of the conjunctiva proceeds, as a rule, in a mild form.

Antiviral drugs

The treatment of viral conjunctivitis is carried out using the following means:

• antiviral eye drops Ophthalmoferon, Idoxuridine, Keretsid, Okoferon, Toradex, Aktipol;
• eye gels and drops that contribute to the regeneration of the cornea and mucous membrane - Korneregel, Solkoseril, Glekomen, Taufon;
• antiviral ointments, laid over the eyelid - "Acyclovir", "Bonaphton", oxolinic, tebrofenovoy;
• 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 chicken pox, then similar therapy is performed:

• instillation of antiseptics in the eye - eye drops "Furacilin", "Sulfacetamide";
• the use of solutions of interferons or interferonogens;
• the introduction of measles gamma globulin in injections and drops.

With molluscum contagiosum, curettage or diathermocoagulation of skin lesions on the eyelids is performed, after which treatment of these areas with green leaf is indicated.

Fungal conjunctivitis

About 50 species of pathogenic fungi can cause inflammation of the organs of vision in humans. Most often, the cause of conjunctivitis in adults and children are 3 types:

• yeast-like mushrooms;
• mold micromycetes;
• dermatophytes affecting 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 is damage to the cornea and tissues of the eyelids, as well as reduced immunity.

Symptoms of fungal conjunctivitis are as follows:

• swelling, redness of the conjunctiva and the formation on its surface of dense small yellow grains;
• the formation of blisters filled with serous fluid;
• with the defeat of penicillium fungi - ulcers with a greenish surface;
• with candidiasis - conjunctival plaque.

If the fungal disease has a different localization on the body, the patient may develop allergic conjunctivitis.

Treatment of a fungal form of the disease

Therapy of fungal lesions of the conjunctiva is carried out using the following means:

• Amphotericin B or Nystatin solution;
• eye drops "Okomistin", "Miramistin";
• systemic drugs taken orally - "Fluconazole", "Itraconazole".

With extensive eye damage, Amphotericin B is administered intravenously.

Allergic Conjunctivitis (ARC)

Allergic conjunctivitis in prevalence is in second place after the infectious. In recent years, there has been a trend towards an increase in incidence, which in children is approaching 40%.

There are several forms of this pathology:

• seasonal (hay fever);
• year-round (persistent inflammation of the conjunctiva; exacerbations are not associated with seasonality);
• professional;
• occasional (less than 4 days a week or less than 4 weeks per year);
• persistent chronic;
• mild - minor symptoms leading to impaired sleep or daytime activity, the patient can do without treatment;
• moderate, in which the quality of life is significantly impaired;
• severe - the patient cannot work normally, study, sleep without treatment.

The highest prevalence of hay fever is recorded in the Volga region, in the Urals and in Siberia (up to 80% of all allergic pathologies).

Causes of pollinosis conjunctivitis

This disease can be caused by a large number of allergens. They are divided into 3 main groups:

• home allergens (mold spores, cockroaches, pets and plants, dust mites);
• professional, medicinal, food allergens;
• allergens from outside (plant pollen).

The latter factor is the most common. The pollen of wind-pollinated plants is very light and can be transported over long distances.

The causes of hay fever (hay) conjunctivitis in the central part of Russia are due to three peaks of flowering:

1. March-May - alder, poplar, ash, hazel, aspen and other trees.
2. June-July - cereals (wheat grass, fescue, rye, timothy and others).
3. July-August - weeds (wormwood, quinoa, hemp) and Asteraceae (sunflower and others) plants.

The largest number of complaints about hay fever falls on the third peak. Some non-flowering house plants also release allergens into the air in the form of juice. An allergic reaction can also cause dust accumulating on their leaves.

Symptoms of the ARC

The main signs of conjunctivitis of an allergic nature are:

• symptoms of rhinitis - clear discharge, sneezing, itching, burning in the nose, worsening of smell;
• lacrimation
• itching in the eyes;
• coughing, tickling, or burning in the throat;
• conjunctival redness and swelling;
• due to impaired breathing, a headache occurs, the voice changes;
• congestion and heaviness in the ears, hearing impairment;
• in the offseason, mucous pulling discharge from the eyes is possible.

These symptoms are associated with the cause of pollinous conjunctivitis - direct contact with the allergen. The best conditions for the spread of pollen are created in dry windy weather. In many cases, children have a cross-food allergy. With the fungal nature of the disease, patients have intolerance to food containing yeast (kvass, dairy products, and others), and deterioration occurs in wet weather or when in damp rooms.

ARC Risk Factors

The main cause of hay fever (conjunctivitis) is the immunopathological process, which is based on an inflammatory IgE-mediated reaction. It occurs when allergens get on the mucous surfaces in the nose and eyes.

Risk factors for triggering an allergic reaction are as follows:

• transferred infectious diseases leading to an increase in the sensitivity of the body;
• genetic predisposition;
• poor living conditions, malnutrition;
• adverse environmental conditions (gas contamination);
• hypothermia;
• stress.

In young children, an increased likelihood of ARC is associated with the following factors:

• young age of mother;
• smoking during pregnancy;
• premature birth;
• artificial feeding;
• lack of oxygen in the newborn during childbirth;
• mother consuming allergenic products during pregnancy.

ARC treatment

The following types of drugs are used to treat allergic conjunctivitis:

• antihistamines (inside) - "Desloratadine", "Loratadin", "Levocetirizine", "Rupatadin", "Fexofenadine", "Cetirizine", "Ebastin";
• glucocorticosteroids for topical use (sprays and eye drops) - Beclomethasone, Budesonide, Mometasone, fluticasone propionate or furoate, Dexamethasone, hydrocortisone eye ointment;
• funds for the prevention of exacerbation - "Ketotifen" (inside), "Cromoglycate sodium" (eye drops and nasal spray);
• preparations of artificial tears with a feeling of dryness in the eyes - Lacrisifi, Slezin, Defislez, Vizmed, Okutiarz, Avizor and others.

Measures to limit contact with allergens are also recommended:

• spend more time indoors when the peak of flowering plants sets in;
• 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 glasses;
• when driving in a car, close windows and turn on air conditioning;
• relocation during flowering to another climatic zone.

General therapy

For all forms of the disease, the following general recommendations must be followed:

• Follow personal hygiene - wash your hands with soap more often, use individual towels and disposable napkins, separate pipettes for each eye.
• Remove eye discharge by washing with a sterile swab soaked with Furacilin (a 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 put a blindfold on the eyes.
• To reduce the inflammatory process, apply solutions of glucocorticosteroid drugs (GCS) - eye drops "Dexamethasone", "Desonide", "Prenatsid" or NSAID solution (0.1% diclofenac sodium).