Conjunctivitis - how to treat, symptoms and signs, causes and types. Acute conjunctivitis of the eye: treatment of adults and children Acute conjunctivitis of the eye

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Conjunctivitis is an inflammation of the mucous membrane of the eye, provoked by various pathogenic factors. In general, the correct name for the disease is conjunctivitis however, it is often known only to doctors and nurses. In everyday life, the term "conjunctivitis" is used most often to refer to the inflammatory process on the mucous membrane of the eye. In the text of the article, we will use exactly the wrong, but familiar term for people far from medical science.

Classification

In general, the term "conjunctivitis" is not the name of the disease, but reflects only the localization of the inflammatory process - the mucous membrane of the eye. In order to get the full name of the disease, it is necessary to add the designation of the causative factor to the term "conjunctivitis" or indicate the nature of the inflammatory process, for example, "bacterial conjunctivitis" or "chronic conjunctivitis", etc. The full name of the disease, which includes the designation of the cause of the inflammation or its nature, is used by doctors in medical records. The nature and cause of inflammation of the conjunctiva should always be clarified, since the correct and effective treatment depends on it.

Currently, there are a number of classifications of conjunctivitis, each of which reflects some significant factor regarding the cause or nature of inflammation of the mucous membrane of the eye.

Depending on the cause that provoked inflammation of the mucous membrane of the eye, conjunctivitis is divided into the following types:

  • Bacterial conjunctivitis is provoked by various pathogenic or opportunistic bacteria, such as streptococci, pneumococci, staphylococci, gonococci, diphtheria bacillus, Pseudomonas aeruginosa, etc .;

  • Chlamydial conjunctivitis (trachoma) is provoked by the ingress of chlamydia into the eyes;

  • Angular conjunctivitis (angular) is provoked by the Morax-Axenfeld diplobacillus and is characterized by a chronic course;

  • Viral conjunctivitis, provoked by various viruses, such as adenoviruses, herpes viruses, etc .;

  • Fungal conjunctivitis is provoked by various pathogenic fungi and is a particular manifestation of systemic infections, such as actinomycosis, aspergillosis, candidomycosis, spirotrichelosis;

  • Allergic conjunctivitis develops under the influence of any allergen or factor that irritates the mucous membrane of the eye (for example, dust, wool, varnishes, paints, etc.);

  • Dystrophic conjunctivitis develops under the influence of various substances that cause damage to the mucous membrane of the eye (for example, reagents, paints, industrial vapors and gases, etc.).

Chlamydial and angular (angular) conjunctivitis are special cases of bacterial conjunctivitis, however, based on certain features of the clinical course and signs, they are isolated into separate varieties.

Depending on the type of inflammatory process on the mucous membrane of the eye, conjunctivitis is divided into:

  • Acute conjunctivitis;

  • Chronic conjunctivitis.

A special case of acute conjunctivitis is an epidemic, provoked by the Koch-Weeks bacillus.

Depending on the nature of inflammation and morphological changes in the mucous membrane of the eye, conjunctivitis is divided into the following types:

  • Purulent conjunctivitis, proceeding with the formation of pus;

  • Catarrhal conjunctivitis, flowing without the formation of pus, but with copious mucous discharge;

  • Papillary conjunctivitis develops against the background of an allergic reaction to ophthalmic drugs and is the formation of small grains and seals on the mucous membrane of the eye in the upper eyelid;

  • Follicular conjunctivitis develops according to the first type of allergic reaction and is the formation of follicles on the mucous membrane of the eye;

  • Hemorrhagic conjunctivitis is characterized by numerous hemorrhages in the mucous membrane of the eye;

  • Filmy conjunctivitis develops in children against the background of acute viral respiratory diseases.
Despite the rather large number of varieties of conjunctivitis, any form of the disease is manifested by a set of typical symptoms, as well as a number of specific signs.

Causes

The causes of conjunctivitis are the following groups of factors that can cause inflammation on the mucous membrane of the eye:
  1. Infectious causes:

    • Pathogenic and opportunistic bacteria (staphylococci, streptococci, gonococci, meningococci, Pseudomonas aeruginosa, etc.);


    • Viruses (adenoviruses and herpes viruses);

    • Pathogenic fungi (actinomycetes, aspergillus, candida, spirothrihella);

  2. Allergic reasons (wearing contact lenses, atopic, medicinal, or seasonal conjunctivitis);

  3. Other reasons (occupational hazards, dust, gases, etc.).
All of the listed causes of conjunctivitis cause disease only if they manage to get on the mucous membrane of the eye. As a rule, infection occurs through dirty hands, with which a person rubs or touches the eyes, as well as airborne droplets in the case of viruses, allergens or occupational hazards. In addition, infection with pathogenic microorganisms can occur ascending from the ENT organs (nasal, oral, ear, throat, etc.).

Symptoms of different types of conjunctivitis

With any type of conjunctivitis, a person develops certain non-specific symptoms, such as:
  • Swelling of the eyelids;

  • Swelling of the mucous membrane of the eye;

  • Redness of the conjunctiva and eyelids;

  • Photophobia;

  • Lachrymation;


  • Feeling of a foreign body in the eye;

  • Discharge of a mucous, purulent or mucopurulent character.
The above symptoms develop with any type of conjunctivitis and are therefore called nonspecific. Quite often, the symptoms of conjunctivitis are combined with the phenomena of catarrh of the upper respiratory tract with various respiratory infections, as well as a rise in temperature, headache and other signs of intoxication (muscle pain, weakness, fatigue, etc.).

However, in addition to nonspecific symptoms, various types of conjunctivitis are characterized by the appearance of specific signs that are due to the properties of the factor that causes the inflammatory process. It is the specific symptoms that make it possible to differentiate different types of conjunctivitis on the basis of the clinical picture without special laboratory tests. Let us consider in detail what nonspecific and specific symptoms manifest various types of conjunctivitis.

Acute (epidemic) conjunctivitis

Currently, the term "acute conjunctivitis" refers to a disease, the full name of which is "acute epidemic Koch-Weeks conjunctivitis." However, for the convenience of using the term, only a part of it is taken to make it possible to understand what it is about.

Acute conjunctivitis refers to bacterial, since it is provoked by a pathogenic bacterium - Koch-Weeks bacillus. However, since acute epidemic conjunctivitis has features of the course associated, first of all, with the defeat of a large number of people and the rapid spread in the population, this type of bacterial inflammation of the mucous membrane of the eye is isolated in a separate form.

Acute Koch-Wicks conjunctivitis is widespread in Asia and the Caucasus; in more northern latitudes, it practically does not occur. The infection occurs in the form of seasonal, epidemic outbreaks, mainly in the autumn and summer periods of the year. Infection with Koch-Weeks conjunctivitis occurs by contact and airborne droplets. This means that the causative agent of conjunctivitis is transmitted from a sick person to a healthy person through close household contacts, as well as through common household items, dirty hands, dishes, fruits, vegetables, water, etc. Epidemic conjunctivitis is contagious.

Koch-Weeks conjunctivitis begins acutely and suddenly, after a short incubation period of 1 to 2 days. Typically, both eyes are affected at the same time. Conjunctivitis begins with redness of the lining of the eyelids, which quickly invades the surface of the eyeball and transitional folds. The most severe redness and swelling develops in the area of ​​the lower eyelid, which takes the form of a roller. Within 1 - 2 days, mucopurulent or purulent discharge appears in the eyes, and brownish thin films are formed, which are easily rejected and removed without damaging the mucous membrane of the eye. In addition, numerous hemorrhages in the form of dots are visible in the mucous membrane of the eye. A person is worried about photophobia, a feeling of cramps or a foreign body in the eyes, lacrimation, swelling of the eyelids and redness of the entire surface of the eyeball.

In addition to Koch-Weeks epidemic conjunctivitis, the term "acute conjunctivitis" doctors often denote any acute inflammation of the mucous membrane of the eye, regardless of what pathogen or cause it provoked. Acute conjunctivitis always comes on suddenly and usually occurs in both eyes.
Any acute conjunctivitis, with proper treatment, ends with recovery within 5 to 20 days.

Bacterial

It always proceeds acutely and is provoked by contact with the mucous membrane of the eye of various pathogenic or opportunistic bacteria, such as staphylococci, streptococci, Pseudomonas aeruginosa, gonococci, pneumococci, etc. Regardless of what kind of microbe caused bacterial conjunctivitis, the inflammatory process begins suddenly with the appearance of a cloudy, viscous, grayish-yellowish discharge on the surface of the mucous membrane of the eye. The discharge leads to sticking of the eyelids, especially after a night's sleep. In addition, a person develops dryness of the mucous membrane and skin around the sore eye. You may also feel pain and pain in the eye. With bacterial conjunctivitis, as a rule, only one eye is affected, but if untreated, inflammation can also affect the other. The most common bacterial ones are gonococcal, staphylococcal, pneumococcal, Pseudomonas aeruginosa and diphtheria conjunctivitis. Let's consider the features of their course.

Staphylococcal conjunctivitis is characterized by pronounced redness and swelling of the eyelids, as well as profuse mucopurulent discharge, which makes it difficult to open the eyes after sleep. Swelling of the eyelids is combined with severe itching and burning. Photophobia and the sensation of a foreign body under the eyelid are noted. Usually, both eyes are involved alternately in the inflammatory process. With timely treatment with local antibiotics (ointments, drops, etc.), conjunctivitis disappears within 3 to 5 days.

Gonococcal conjunctivitis (gonoblennorrhea) usually develops in newborn babies due to infection during the passage through the birth canal of a mother infected with gonorrhea (gonorrhea). With gonococcal conjunctivitis, rapid and very dense swelling of the eyelids and mucous membranes of the eye develops. There is an abundant mucopurulent discharge, which has a characteristic look of "meat slops". When the closed eyelids are opened, the discharge literally spills out in a stream. As you recover, the amount of discharge decreases, it becomes thick, and films form on the surface of the mucous membrane of the eye, which are easily removed without damaging the underlying tissues. After 2 - 3 weeks, the discharge again acquires a liquid consistency and a greenish color, completely disappearing by the end of the 2nd month of the disease. Together with the disappearance of the discharge, the swelling and redness of the conjunctiva also pass. Gonoblennorrhea requires local treatment with antibiotics until complete recovery.

Pneumococcal conjunctivitis occurs in children. The inflammation begins acutely, with one eye being affected first, and then the other is involved. First, a profuse purulent discharge appears, combined with edema of the eyelids, punctate hemorrhages in the mucous membrane of the eye and photophobia. Films are formed on the conjunctiva, which are easily removed and do not damage the underlying tissues.

Pseudomonas aeruginosa is characterized by profuse purulent discharge, pronounced redness of the mucous membrane of the eye, edema of the eyelids, cuts, photophobia and lacrimation.
Diphtheria conjunctivitis develops against the background of diphtheria. First, the eyelids swell a lot, redden and thicken. The skin is so dense that the eyes cannot be opened. Then a cloudy discharge appears, which is replaced by a bloody one. Films of a dirty gray color are formed on the mucous membrane of the eyelids, which cannot be removed. When the films are forcibly removed, bleeding surfaces are formed.

At about the 2nd week of the disease, the films are rejected, the edema disappears, and the amount of discharge increases. After 2 weeks, diphtheria conjunctivitis ends or becomes chronic. After inflammation, complications may develop, such as scars on the conjunctiva, volvulus, etc.

Chlamydial

The disease begins with a sudden onset of photophobia, which is accompanied by rapid swelling of the eyelids and redness of the mucous membrane of the eye. A scanty mucopurulent discharge appears, which sticks the eyelids together in the morning. The most pronounced inflammatory process is localized in the lower eyelid region. First, one eye is affected, but with inadequate hygiene, the inflammation goes to the second.

Chlamydial conjunctivitis often appears in the form of epidemic outbreaks during mass swimming pool visits. Therefore, chlamydial conjunctivitis is also called pool or bath.

Viral

Conjunctivitis can be caused by adenoviruses, herpes viruses, atypical trachoma virus, measles, smallpox viruses, etc. The most common are herpetic and adenoviral conjunctivitis, which are very contagious. Therefore, patients with viral conjunctivitis should be isolated from others until complete recovery.

Herpetic conjunctivitis is characterized by sharp redness, infiltration, and the formation of follicles on the mucous membrane of the eye. Thin films are often formed, which can be easily removed without damaging the underlying tissues. Inflammation of the conjunctiva is accompanied by photophobia, blepharospasm, and lacrimation.

Adenoviral conjunctivitis can take three forms:

  1. The catarrhal form is characterized by mild inflammation. The redness of the eye is slight, and the discharge is very scarce;

  2. The membranous form is characterized by the formation of thin films on the surface of the mucous membrane of the eye. Films are easily removed with a cotton swab, but sometimes they are tightly attached to the underlying surface. In the thickness of the conjunctiva, hemorrhages and seals can form, which completely disappear after recovery;

  3. The follicular form is characterized by the formation of small bubbles on the conjunctiva.
Adenoviral conjunctivitis is very often combined with sore throat and fever, as a result of which the disease is called adenopharyngoconjunctival fever.

Allergic

Allergic conjunctivitis, depending on the factor that provokes them, is divided into the following clinical forms:
  • Pollinosis conjunctivitis, provoked by allergy to pollen, flowering plants, etc.;

  • Spring keratoconjunctivitis;

  • Drug allergy to eye drugs, manifested in the form of conjunctivitis;

  • Chronic allergic conjunctivitis;

  • Allergic conjunctivitis associated with contact lens wear.
Establishment of the clinical form of allergic conjunctivitis is carried out on the basis of an analysis of the history data. Knowledge of the form of conjunctivitis is necessary to select the optimal therapy.

Symptoms of any form of allergic conjunctivitis are unbearable itching and burning on the mucous membrane and skin of the eyelids, as well as photophobia, lacrimation, severe edema and redness of the eye.

Chronic

This type of inflammatory process in the conjunctiva of the eye lasts for a long time, and a person presents numerous subjective complaints, the severity of which does not correlate with the degree of objective changes in the mucous membrane. A person is worried about the feeling of heaviness of the eyelids, "sand" or "debris" in the eyes, pain, fatigue when reading, itching and a feeling of heat. During an objective examination, the doctor records a slight reddening of the conjunctiva, the presence of irregularities in it due to an increase in the papillae. Detachable is very scarce.

Chronic conjunctivitis is triggered by physical or chemical factors that irritate the mucous membrane of the eye, such as dust, gases, smoke, etc. The most common chronic conjunctivitis affects people who work in flour mills, chemical, textile, cement, brick and sawmills and factories. In addition, chronic conjunctivitis can develop in people against the background of diseases of the digestive system, nasopharynx and sinuses, as well as anemias, vitamin deficiencies, helminthic invasions, etc. Treatment of chronic conjunctivitis consists in eliminating the causative factor and restoring the normal functioning of the eye.

Angular

Also called corner. The disease is caused by the bacillus Morax-Axenfeld and is most often chronic. The person is worried about pain and severe itching in the corners of the eye, which intensifies in the evening. The skin at the corners of the eyes is red and may crack. The mucous membrane of the eye is moderately reddish. The discharge is scanty, viscous, of a mucous nature. During the night, the discharge accumulates in the corner of the eye and freezes in the form of a small dense lump. Correct treatment allows you to completely eliminate angular conjunctivitis, and the lack of therapy leads to the fact that the inflammatory process continues for years.

Purulent

It is always bacterial. With this type of conjunctivitis, an abundant discharge of a purulent character is formed in the affected eye in a person. Purulent is gonococcal, Pseudomonas aeruginosa, pneumococcal and staphylococcal conjunctivitis. With the development of purulent conjunctivitis, it is necessary to use topical antibiotics in the form of ointments, drops, etc.

Catarrhal

It can be viral, allergic or chronic, depending on the causative factor that provoked the inflammatory process on the mucous membrane of the eye. With catarrhal conjunctivitis, a person develops moderate swelling and redness of the eyelids and mucous membrane of the eye, and the discharge is mucous or mucopurulent. Photophobia is moderate. With catarrhal conjunctivitis, there are no hemorrhages in the mucous membrane of the eye, papillae do not increase, follicles and films do not form. This type of conjunctivitis usually resolves within 10 days without causing serious complications.

Papillary

It is a clinical form of allergic conjunctivitis, and therefore usually lasts a long time. With papillary conjunctivitis, the existing papillae increase in the mucous membrane of the eye, forming irregularities and roughness on its surface. A person is usually worried about itching, burning, pain in the eye in the area of ​​the eyelid and scanty mucous membrane. Most often, papillary conjunctivitis develops due to the constant wearing of contact lenses, the use of eye prostheses, or prolonged contact of the surface of the eye with a foreign object.

Follicular

It is characterized by the appearance on the mucous membrane of the eye of grayish-pink follicles and papillae, which are infiltrates. Swelling of the eyelids and conjunctiva is mild, but the redness is pronounced. Infiltrates in the mucous membrane of the eye cause severe lacrimation and pronounced blepharospasm (closing of the eyelids).

Follicular conjunctivitis, depending on the type of pathogen, can be viral (adenoviral) or bacterial (for example, staphylococcal). Follicular conjunctivitis actively proceeds for 2 to 3 weeks, after which the inflammation gradually decreases, completely disappearing also within 1 to 3 weeks. The total duration of follicular conjunctivitis is 2 to 3 months.

Conjunctivitis temperature

Conjunctivitis almost never causes fever. However, if conjunctivitis occurs against the background of any infectious and inflammatory disease (for example, bronchitis, sinusitis, pharyngitis, acute respiratory infections, acute respiratory viral infections, etc.), then the person may have a fever. In this case, the temperature is not a sign of conjunctivitis, but an infectious disease.

Conjunctivitis - photo

The photograph shows catarrhal conjunctivitis with moderate redness and swelling, and scanty mucous discharge.


The photograph shows purulent conjunctivitis with pronounced edema, severe redness and purulent discharge.

What studies can a doctor prescribe for conjunctivitis?

With conjunctivitis, doctors rarely prescribe any studies and tests, since a routine examination and questioning about the nature of the discharge and the symptoms present is usually sufficient to determine the type of disease and, accordingly, prescribe the necessary treatment. After all, each type of conjunctivitis has its own characteristics that allow it to be distinguished from other types of the disease with sufficient accuracy.

However, in some cases, when it is not possible to accurately determine the type of conjunctivitis on the basis of examination and survey, or it proceeds in an erased form, an ophthalmologist may prescribe the following studies:

  • Sowing secretions from the eye on the aerobic microflora and determining the sensitivity of microorganisms to antibiotics;
  • Sowing of the discharge from the eye to the anaerobic microflora and determination of sensitivity to antibiotics;
  • Sowing of eye discharge for gonococcus (N. gonorrhoeae) and determination of sensitivity to antibiotics;
  • Determination of the presence of IgA antibodies to adenovirus in the blood;
  • Determination of the presence of IgE antibodies in the blood.
Sowing secretions from the eye on the aerobic and anaerobic microflora, as well as on the gonococcus, is used to identify bacterial conjunctivitis, which is difficult or not at all amenable to treatment. Also, these cultures are used for chronic bacterial conjunctivitis to determine which antibiotic will be most effective in this particular case. In addition, culture for gonococcus is used for bacterial conjunctivitis in children in order to confirm or refute the diagnosis of gonoblenorrhea.

An analysis for the determination of antibodies to adenovirus in the blood is used in cases of suspected viral conjunctivitis.

A blood IgE antibody test is used to confirm suspected allergic conjunctivitis.

Which doctor should I contact for conjunctivitis?

If signs of conjunctivitis appear, you should contact an ophthalmologist (ophthalmologist) or a pediatric ophthalmologist (), when it comes to a child. If for some reason it is impossible to get an appointment with an ophthalmologist, then adults should contact therapist (), and children - to pediatrician ().

General principles for the treatment of all types of conjunctivitis

Regardless of the type of conjunctivitis, its treatment consists in eliminating the causative factor and using drugs that relieve the painful symptoms of an inflammatory disease.

Symptomatic treatment aimed at eliminating the manifestations of an inflammatory disease consists in the use of topical preparations that are injected directly into the eye.

With the development of the first signs of conjunctivitis, it is first of all necessary to relieve pain by introducing drops containing local anesthetics into the eye sac, such as, for example, Pyromecaine, Trimecaine or Lidocaine. After relieving pain, it is necessary to conduct a toilet of the ciliary edge of the eyelids and the mucous membrane of the eye, washing its surface with antiseptic solutions, such as potassium permanganate, brilliant green, Furacilin (dilution 1: 1000), Dimexide, Oxycyanate.

After relieving pain and sanitizing the conjunctiva, medications containing antibiotics, sulfonamides, antiviral or antihistamines are injected into the eye. In this case, the choice of the drug depends on the causative factor of the inflammation. If there is bacterial inflammation, then antibiotic drugs are used. sulfonamides (for example, tetracycline ointment, Albucid, etc.).

For viral conjunctivitis, local agents with antiviral components are used (for example, Kerecid, Florenal, etc.).

With allergic conjunctivitis, it is necessary to use antihistamines, for example, drops with Diphenhydramine, Dibazol, etc.

Treatment of conjunctivitis should be carried out until the clinical symptoms disappear completely. In the process of treating conjunctivitis, it is strictly forbidden to put any dressings on the eyes, since this will create favorable conditions for the multiplication of various microorganisms, which will lead to complications or aggravate the course of the process.

Home Treatment Principles

Viral

With adenoviral conjunctivitis, interferon preparations, such as Interferon or Laferon, are used to destroy the virus. Interferons are used in the form of instillations of a freshly prepared solution into the eye. In the first 2 - 3 days, interferons are injected into the eyes 6 - 8 times a day, then 4 - 5 times a day until the symptoms disappear completely. In addition, ointments with antiviral action, such as Tebrofenovaya, Florenalevaya or Bonaftonovaya, are laid 2 to 4 times a day. In case of severe inflammation of the eye, it is recommended to inject Diclofenac into the eye 3-4 times a day. In order to prevent dry eye syndrome, artificial tear substitutes are used throughout the course of treatment, for example, Oftagel, Sistain, Vidisik, etc.

Herpes viral
In order to destroy the virus, interferon solutions are also used, which are prepared from a lyophilized powder immediately before injection into the eye. The first 2 - 3 days, interferon solutions are administered 6 - 8 times a day, then 4 - 5 times a day until the symptoms disappear completely. To reduce inflammation, relieve pain, itching and burning, Diclofenac is injected into the eye. For the prevention of bacterial complications in herpetic conjunctivitis, Pikloxidine or a solution of silver nitrate is injected into the eyes 3-4 times a day.

Bacterial

It is imperative that during the entire course of treatment, Diclofenac should be instilled into the eyes 2 to 4 times a day to reduce the severity of the inflammatory process. The discharge must be removed by flushing the eye with antiseptic solutions, for example, Furacilin in a dilution of 1: 1000 or 2% boric acid. To destroy the pathogenic microbe-pathogen, ointments or drops with antibiotics or sulfonamides are used, such as Tetracycline, Gentamicin, Erythromycin, Lomefloxacin, Ciprofloxacin, Ofloxacin, Albucid, etc. Ointment or drops with antibiotics should be administered in the first 2 - 3 days in 4 - 6 times a day, then 2 - 3 times a day until the clinical symptoms disappear completely. Simultaneously with antibacterial ointments and drops, Pikloxidin can be instilled into the eyes 3 times a day.

Chlamydial

Since chlamydiae are intracellular microorganisms, the treatment of the infectious and inflammatory process provoked by them requires the use of systemic drugs. Therefore, with chlamydial conjunctivitis, it is necessary to take Levofloxacin 1 tablet per day for a week.

At the same time, local preparations with antibiotics, such as Erythromycin ointment or Lomefloxacin drops, should be injected into the affected eye 4 - 5 times a day. Ointment and drops must be applied continuously from 3 weeks to 3 months, until the clinical symptoms completely disappear. To reduce the inflammatory reaction, Diclofenac is administered into the eye 2 times a day, also for 1 to 3 months. If Diclofenac does not help to stop inflammation, then it is replaced with Dexamethasone, which is also administered 2 times a day. For the prevention of dry eye syndrome, it is necessary to use artificial tear preparations, such as Oksial, Oftagel, etc., on a daily basis.

Purulent

With purulent conjunctivitis, be sure to flush the eye with antiseptic solutions (2% boric acid, Furacilin, potassium permanganate, etc.) in order to remove abundant discharge. Rinsing the eye is performed as needed. Treatment of conjunctivitis consists in the introduction of Erythromycin, Tetracycline or Gentamicin ointment or Lomefloxacin into the eye 2 to 3 times a day until the clinical symptoms disappear completely. With pronounced edema, Diclofenac is injected into the eye to stop it.

Allergic

For the treatment of allergic conjunctivitis, local antihistamines are used (Spersallerg, Allergophthal) and agents that reduce mast cell degranulation (Lekrolin 2%, Kuzikrom 4%, Alomid 1%). These drugs are injected into the eyes 2 times a day for a long time. If these drugs do not completely stop the symptoms of conjunctivitis, then anti-inflammatory drops Diclofenac, Dexalox, Maxidex, etc. are added to them. In severe allergic conjunctivitis, eye drops containing corticosteroids and antibiotics are used, for example, Maxitrol, Tobradex, etc.

Chronic

For successful treatment of chronic conjunctivitis, the cause of the inflammation must be eliminated. To stop the inflammatory process, a 0.25 - 0.5% solution of zinc sulfate with a 1% solution of resorcinol is instilled into the eyes. In addition, Protargol and Collargol solutions can be injected into the eyes 2 - 3 times a day. Before going to bed, yellow mercury ointment is applied to the eyes.

Drugs (medicine) for the treatment of conjunctivitis

For the treatment of conjunctivitis, drugs are used for topical use in two main forms - drops and ointments, recommended by the Ministry of Health of the Russian Federation. Also for the treatment of conjunctivitis, drops and ointments are presented in the table.
Ointments for the treatment of conjunctivitis Drops for the treatment of conjunctivitis
Erythromycin (antibiotic)Picloxidine (antiseptic)
Tetracycline ointment (antibiotic)Albucid 20% (antiseptic)
Gentamicin (antibiotic)Levomycetin drops (antibiotic)
Yellow mercury ointment (antiseptic)Diclofenac (non-steroidal anti-inflammatory drug)
Dexamethasone (anti-inflammatory agent)
Olopatodin (anti-inflammatory agent)
Suprastin
Fenistil (antiallergic agent)
Oxial (artificial tear)
Tobradex (anti-inflammatory and antibacterial agent)

Folk remedies

Folk remedies can be used in the complex treatment of conjunctivitis as solutions for washing and treating the eyes. Currently, the most effective folk remedies used for conjunctivitis are as follows:
  • Pass the dill greens through a meat grinder, collect the resulting gruel in cheesecloth and squeeze thoroughly to obtain pure juice. Moisten a clean, soft cotton cloth in dill juice and put it on the eyes for 15 - 20 minutes when the initial signs of conjunctivitis appear;

  • Dilute honey with boiled water in a ratio of 1: 2 and bury the eyes with the resulting solution as needed;

  • Grind two teaspoons of rose hips and pour a glass of boiling water over them. Boil the berries and leave for half an hour. Strain the ready-made infusion, moisten a clean cloth in it and apply lotions to the eyes when pus is released;

  • Crush 10 g of plantain seeds in a mortar and pour them with a glass of boiling water, then leave for half an hour and strain. In the finished infusion, moisten a clean cloth and apply lotions to the eyes. You can also wash your eyes with infusion as needed;

  • Collect fresh datura leaves and grind them. Then pour 30 g of chopped leaves with a glass of boiling water, leave for half an hour, then strain. Use the ready-made infusion for making lotions.

What is the recovery treatment after conjunctivitis

Conjunctivitis can provoke various visual impairments associated with damage to the mucous membrane of the eye. Therefore, after complete recovery, a person may be disturbed by periodic discomfort, which are quite amenable to treatment. Currently, ophthalmologists recommend immediately after stopping inflammation in conjunctivitis to start using local drugs that accelerate healing and complete restoration of tissue structure (reparants).

Solcoseryl eye gel, made from the blood of dairy calves, is one of the most effective and commonly used reparants.

This drug activates metabolism at the cellular level, as a result of which tissue restoration occurs in a short time. In addition, there is a complete restoration of the damaged structure, which, accordingly, creates conditions for the normalization of the functions of the damaged organ, in this case the eye. Solcoseryl ensures the formation of a normal and uniform mucous membrane of the eye, which will perfectly perform its functions and will not create any subjective discomfort. Thus, rehabilitation treatment after conjunctivitis consists in the use of Solcoseryl eye gel for 1 to 3 weeks.

Before use, you must consult a specialist.

According to medical statistics, a third of all clinical cases with eye disease occur in various forms.

This inflammatory process, as a rule, is formed in an acute form, only with the development of which it is able to flow into a chronic pathology of the visual organs.

In fact, acute conjunctivitis is not particularly dangerous, however, in order to neutralize all sorts of risks of complications, it is advisable to treat this ailment in a timely manner and in full. In more detail about the causes of inflammation, its danger, symptoms and treatment will be discussed below.

Acute conjunctivitis: redness of the eye

Acute conjunctivitis is one of the forms of the inflammatory process of the conjunctiva (mucous membrane of the eyes), which is characterized by rapid and pronounced development.

Depending on how long the inflammation in the structure of the visual organs lasts, it also determines which category conjunctivitis belongs to in a particular case.

Note that any form of pathology is considered an acute form that lasts less than 4-5 weeks. Above this period, the disease will already refer to a chronic formation.

According to the pathogenesis of development, various types of acute conjunctivitis are distinguished. The most common of them are:

  1. bacterial;
  2. viral;
  3. allergic;
  4. chemical;
  5. traumatic.

Perhaps, the essence of various types of ailments does not need to be described, since it is fully reflected in their name. The reason for the development of acute conjunctivitis is also determined from the pathogenesis of its development. Naturally, it is worth highlighting as typical causes of pathology:

  • damage to the mucous membrane of the eyes with viruses, adenoviruses or bacteria;
  • contact with an allergen;
  • injury to the visual organs;
  • chemical burns of the membranes of the eyes (exposure to vapors is enough).

Factors significantly predisposing to the development of mucosal inflammation include:

  1. overheating or hypothermia of the body;
  2. weak immunity;
  3. the presence of chronic diseases of a general nature;
  4. avitaminosis;
  5. work in chemically or dusty and dirty places;
  6. having problems with refraction of the eyes (myopia and similar visual impairments).

As noted at the very beginning of the article, acute conjunctivitis does not pose a particular danger, however, in the absence of proper and timely therapy, the occurrence of complications should not be ruled out.

Typical problems caused by inflammation of the mucous membrane of the eyes include inflammatory ailments of the eyelids, the appearance of conjunctival defects and scarring. Of course, the list of possible complications of acute conjunctivitis is quite wide and largely depends on the characteristics of a particular clinical case. The presented ailments are most common.

Symptoms of pathology


Acute conjunctivitis is one of the few diseases that can be qualitatively diagnosed solely by the symptoms manifested.

This is due to the fact that the signs of the disease have a pronounced and original character, which takes place only during the inflammatory process in the conjunctiva.

Typical symptoms of acute conjunctivitis are:

  • redness of the white of the eyes;
  • swelling of the upper region of the organs and eyelids;
  • increased lacrimation;
  • photophobia;
  • the appearance of eye tissue irritation.

Depending on the pathogenesis, pathologies can also develop:

  1. drying out of the mucous membrane of the visual organs;
  2. the appearance of secretions on their surface;
  3. temperature increase;
  4. the appearance of films and follicles;
  5. severe eye irritation.

Having noticed the cumulative manifestation of at least 2-3 of the presented signs, any person needs to visit an ophthalmologist for a more detailed examination. Do not forget that with incorrect or delayed therapy, acute conjunctivitis is usually complicated and provokes the appearance of extremely unpleasant diseases.

The video will acquaint you with the symptoms of conjunctivitis:

Diagnostic procedures

Due to the specificity and severity of conjunctivitis, they are not particularly difficult for diagnosis. Naturally, the diagnosis can only be carried out by a professional ophthalmologist, but the diagnostic procedures are always extremely simple.

The basic set of examinations for detecting acute conjunctivitis and its pathogenesis includes:

  1. Detailed and conversation with him. It is in the case of conjunctivitis of any form that this stage of diagnosis is almost the main one, since it helps to obtain the maximum amount of information about the patient's pathology.
  2. Microscopic examination of the eyes. It is aimed at identifying the pathogenesis of the disease and the presence of its complications.
  3. Conjunctival smear examination. This stage is also of tremendous importance, as it allows you to identify the cause of the development of inflammation as accurately as possible. This aspect plays an important role in the organization of therapy for acute conjunctivitis.

Depending on the individual characteristics of each individual patient and the ailment manifested in him, ophthalmoscopy, biomicroscopy and instillation tests of different formations can be added to the main list of diagnostic methods.

Such studies are necessary to identify complications of inflammation, if there are suspicions of such, and a more accurate pathogenesis of the disease. In addition to the presented types of diagnostics, in the overwhelming majority of cases, no examinations are used to detect acute conjunctivitis.

Acute conjunctivitis treatment


Acute conjunctivitis is treated with drops

Therapy of the acute form of conjunctivitis is a relatively simple procedure, consisting of consistent and competent implementation of some simple measures. However, even taking into account the general simplicity of treating the ailment, in no case should it be carried out on its own.

The participation of an ophthalmologist in this process is mandatory. This is due to the fact that competent therapy can be organized only after determining the cause and general pathogenesis of the pathology. At home, without the participation of a doctor, it will not be possible to organize the appropriate diagnostic procedures.

Based on the foregoing, it is worth making a simple conclusion - for the treatment of acute conjunctivitis, it is enough to identify its first manifestations of the disease and consult a doctor. Before contacting a specialist, it is important:

  • Do not touch your eyes with your hands and do not let others do it.
  • Wash hands and face thoroughly at all times to avoid getting infection on affected eyes.
  • Use individual dishes and a towel so as not to infect loved ones with an infectious etiology of the disease.
  • Do not take any measures to organize self-medication.

After a quality and competent consultation with a doctor, any patient suffering from inflammation of conjunctivitis is determined the optimal course of treatment. The latter is always based on medicines. The specific groups of drugs used are determined taking into account the cause of the inflammatory process. So:

  1. with allergic inflammation of the conjunctiva, antihistamines are used;
  2. for bacterial and viral conjunctivitis - eye drops of the appropriate specification;
  3. for injuries - eye wash solutions, eye ointments, immunostimulants and vitamin complexes.

Medicines can be taken both for oral administration (tablets) and for external application to the affected area of ​​the eye (drops, ointments, solutions). Everything here directly depends on the recommendations and exact prescriptions of the attending physician.

Note that for high-quality treatment of acute conjunctivitis, it is sufficient to timely identify the ailment, contact an ophthalmologist and fully follow his advice during treatment. We assure you that this approach guarantees a favorable prognosis for the therapy of inflammation and getting rid of it in a short time (1-2 weeks).

Disease prevention


Acute conjunctivitis: cramps in the eyes

After complete recovery from acute conjunctivitis or, if desired, to prevent the development of pathology of this kind, no complicated measures are required. To prevent inflammation, it is enough to adhere to basic prevention.

The latter fully applies:

  • Full observance of personal hygiene, organized through the use of only clean clothes, towels, blankets and constant washing of hands and face with clean water (preferably with soap).
  • Limiting manual eye contact.
  • Refusal from reusable handkerchiefs - it is better to give preference to disposable napkins.
  • Fencing from dusty, chemically unclean and allergenic-contaminated places.
  • Prophylactic use of immunostimulating eye drops.
  • Periodic examination in the ophthalmologist's office.
  • Complete and timely treatment of all pathologies of the visual organs.

Perhaps, on this note, the narration on the topic of today's article can be ended. We hope the presented material was useful for you and provided answers to your questions. Health to you!

Acute conjunctivitis is an inflammatory process in the conjunctival membrane of the visual analyzer, which appears when an infection, allergens penetrates, or under the influence of unfavorable environmental conditions.

The average statistical data report that 40% of all requests for an ophthalmologist consultation result in the specified diagnosis. Certain forms of pathological deviation have increased virulence, causing epidemics.

Classification of pathology

Experts say that conjunctivitis has a different etiology and level of infection:

  • - registered in 73%;
  • allergic nature - occur in 25%;
  • viral or other form - no more than 2%.

Acute conjunctivitis is divided into two main forms - infectious or non-infectious. The first are formed under the influence of:

  • bacterial;
  • fungal;
  • viral infection.

The non-infectious form is the result of external influences.

The process of inflammation can affect not only the mucous membranes, but also the cornea with the skin of the eyelids. In this case, acute conjunctivitis becomes or.

Secondary subdivision implies:

  • an acute form of the process - with pronounced symptomatic manifestations and a duration of 1 to 3 weeks;
  • subacute - with blurred symptoms.

The disease often affects children in preschool conditions and becomes the reason for the announcement of quarantine in an educational institution.

Division by type of pathogen

Acute conjunctivitis of a bacterial type

The process begins from the moment pathogenic microorganisms enter the conjunctiva. Harmful bacteria are carried in with dust particles, contaminated water and poorly washed hands. The degree of damage and the duration of the disease directly depends on the subspecies of the pathogen, its ability to attack the body and the time of seeking professional help.

The sources of the acute form of purulent conjunctivitis are:

  • streptococcal;
  • staphylococcal;
  • pneumococcal;
  • gonococcal infection;
  • diphtheria corynebacterium, etc.

The most dangerous is diphtheria conjunctivitis. Patients infected with this type of infection must be admitted to an infectious diseases hospital. The pathology formed as a result of infection with the Koch-Weeks bacterium forms whole epidemics. The disease spreads in preschool and school groups, in the family.

Viral origin

A feature of this feat is a high level of contagiousness. Transmission originates from any carrier or patient and is transmitted in work teams, families or crowded places (hospitals, shops, markets, gyms).

The introduction of a pathogen occurs when passing an ophthalmological examination (violation of the rules of asepsis and antiseptics in relation to a medical instrument), when using eye drops (from a sick person) or when hygiene rules are not followed (dirty hands).

Patients are diagnosed with various types of the disease:

Herpesvirus

Herpesvirus form - occurs when the herpes simplex virus enters. It is more common in childhood and affects one organ of vision. It is characterized by a subacute or acute course, it can be combined with damage to the corneal surfaces - keratitis. With pathology, it is noted:

  • catarrhal;
  • follicular;
  • vesicular-ulcerative inflammatory process.

Adenoviral

Adenoviral - the source of the disease is adenoviruses of certain subtypes - 3, 5, 7. The pathogen penetrates by contact or airborne droplets. After infection, the patient may develop:

  • pharyngoconjunctival fever;
  • keratoconjunctivitis.

The latter form often becomes the cause of epidemic outbreaks in the conditions of adults and children.

Hemorrhagic

Hemorrhagic - formed under the influence of enterovirus infection. A symptomatic feature of the lesion is the formation of massive hemorrhages on the surface of the conjunctiva. From the outside, the affected organ seems completely swollen with blood.

Allergic etiology

Formed as a result of increased sensitivity of the body to pet hair, pollen and drugs. Additional manifestations of pathology are rhinitis, cough and skin rashes.

The disease is further subdivided into:

  • on the dosage form - certain types of antibacterial, anesthetics and sulfonamides cause a negative effect on the body;
  • hay fever - formed as a response to the irritating effect of plant pollen;
  • atopic - of unknown origin, with a predominance in certain seasons - spring or summer.

Under the influence of irritants

Inflammation processes on the surface of the conjunctiva can occur under the influence of:

  • sand particles;
  • dust;
  • burning;
  • soap;
  • synthetic detergents;
  • bleaches containing chlorine or other active substances.

The process can occur after walking in windy weather. Patients who violate the rules for wearing and handling contact lenses often suffer from papillary pathology.

Symptoms

Acute conjunctivitis develops at an increased rate - it may take several hours from the moment of subinfection to the appearance of the first negative symptoms. In some cases, the disease manifests itself after a few days.

Acute conjunctivitis is characterized by a sharp deterioration in the patient's condition. The causative agent of the inflammatory lesion does not matter in this case. Symptoms of general malaise include manifestations of:

  • increased body temperature indicators;
  • painful sensation in the area of ​​the face and head;
  • disturbances in nighttime sleep - intermittent insomnia and drowsiness during the daytime.

All other symptomatic manifestations depend on the specific form of the pathological process.

Symptoms of the acute bacterial form

The acute bacterial form of the disease is characterized by:

  • the process of inflammation with damage to one visual analyzer;
  • the transition to a healthy organ of vision;
  • increased swelling of the mucous eyeballs;
  • redness of the conjunctiva;
  • the appearance of soreness, cramps and a feeling of persistent burning;
  • discharge of purulent contents;
  • infringement of the conjunctiva when trying to close the eyes.

The affected eye becomes covered with a hard crust consisting of dried purulent discharge. There are problems with free opening - the eyelids stick together from pus.

Symptoms of the viral form

The viral form manifests itself:

  • damage to one eyeball - in rare exceptions, the process affects both eyes;
  • a mucous secretion is released from the diseased eye;
  • lymphoid follicles form on the mucous surface of the affected area;
  • there is a process of infiltration of the mucous membranes;
  • the surface of the organ of vision is covered with the thinnest films that can be easily removed with a cotton pad;
  • hyperemia of protein membranes;
  • painful and uncomfortable sensations;
  • fear of light hitting the area of ​​the diseased organ - photophobia.

Chlamydial form

It is characterized by an asymptomatic course of the process. In exceptional cases, it may be accompanied by manifestations:

  • signs of inflammation on one of the organs of vision - in a third of cases, the process also affects the second eye;
  • slight hyperemia of the conjunctiva;
  • moderate tearing;
  • slight photophobia.

The disease can be accompanied by inflammation of the lymph nodes in the ears.

Fungal form

Differs in a mild clinical picture, with certain symptomatic signs:

  • minimal secretion of a secret;
  • the duration of the course is more than 10 days;
  • deformational changes in the structure of the eyelids;
  • lack of response to antibiotic therapy.

Allergic and non-infectious form

It differs in a process that is insignificant in strength, with certain symptoms:

  • discharge of watery secretions from the nasal passages;
  • periodic sneezing;
  • discharge from the organs of vision of transparent, slightly viscous mucus;
  • increased dryness of the mucous membranes of the eyes;
  • fear of light;
  • violation of the process of formation of lacrimal fluid - tears appear in significant volumes or their number is significantly reduced;
  • increased fatigue of visual analyzers.

In childhood, this form of pathology is characterized by the addition of a secondary infection. Babies, to reduce discomfort, begin to rub their eyes vigorously. Along with this, infectious agents enter the surface of the eyes. A sign of a secondary infection is the accumulation of purulent secretions in the corners of the eyes.

Therapies

Each of the variants of the pathological process requires a separate approach to treatment. Appointments occur after a full diagnostic study to determine the type of pathogen that has penetrated. The types of drugs and the duration of therapy are selected on an individual basis.

Purulent form

Requires the constant use of antiseptic medications for daily cleansing of the surface of the affected eye (due to the constant sticking of the eyelids from purulent discharge):

  • a slightly colored solution of potassium permanganate;
  • "Furacilina";
  • decoction of chamomile pharmacy;
  • other specialized antiseptic preparations sold in pharmacy chains.

The basis of therapeutic treatment is made up of drops, gels and antibacterial ointments. Each of their medications affects a certain type of pathogen - the appointment occurs after diagnosis.

Atopic form

Therapy for conjunctivitis of unknown origin is similar to the treatment of the allergic form. In both options, eye drops are prescribed to suppress signs of inflammation, relieve irritation and itching:

  • "Allergodil";
  • Visin Allergy;
  • "Declofenac";
  • "Zaditen";
  • "Indocollir";
  • "Cromohexal";
  • Opatanol;
  • "Tobradex".

As additional means of complex therapy, the patient is prescribed immunostimulants in order to increase the functionality of the autoimmune system. Antibiotic therapy is used to suppress the symptoms of a secondary infection. Antibacterial drugs are used in extreme cases.

Bacterial form

Requires the use of ophthalmic drugs in the form of local forms - drops, ointments or gels. For successful therapy, drugs of the fluoroquinolone subgroup are often recommended:

  • Levofloxacin;
  • Santen;
  • Oftaquix;
  • "Vigamox".

Catarrhal form

Refers to problematic subspecies, poorly amenable to therapeutic treatment. This form of pathology is eliminated with the help of a set of medications:

  • Rivanola;
  • "Boric acid";
  • "Sulfapyridazine";
  • emulsion "Syntamycin";
  • "Furacilina";
  • potassium permanganate solution;
  • "Erythromycin";
  • "Gentamicin";
  • "Oleandomycin" ointment.

Infectious form

Treatment of this type of pathology includes a set of individual therapeutic measures:

  • tear replacement therapy;
  • daily washing of the affected organ of vision with antiseptic drugs;
  • laying "Tetracycline" ointment under the eyelids;
  • the use of anti-inflammatory drops;
  • specific therapy - includes certain types of antibacterial medicines (subject to diagnosing a subspecies of pathogenic microflora);
  • the use of antihistamines drugs - in some cases.

Any form of pathological process requires constant compliance with personal hygiene requirements. When performing medical manipulations, patients are prohibited from contacting the conjunctival surfaces - hands, pipette tip, drug dispenser.

The limitations are due to the prevention of the attachment of a secondary infection - if it is accidentally introduced, the process will begin to develop at maximum speed.

Complications

Frequent and prolonged inflammatory processes on the organs of vision can cause various complications. Deviations are observed in persons who refuse professional medical care or who applied at the last stages of the disease.

The main types of complications include:

  • the development of myopia - the patient stops clearly seeing objects in the distance;
  • the formation of farsightedness - characterized by "blurring" in front of the eyes of nearby objects;
  • the appearance of astigmatism - a defective curvature of the cornea, after which a combination of different types of myopia can be observed;
  • development of strabismus.

Certain pathologies formed as a complication of acute conjunctivitis have additional symptoms.

Increased dryness of the mucous membranes of the eyes:

  • constant burning sensation;
  • pinching sensation;
  • feeling of a trapped foreign body;
  • hyperemia of the protein membranes;
  • swelling of the skin of the eyelids;
  • visual acuity disorders;
  • spontaneous lacrimation;
  • increased sensitivity to light.

Cataract:

  • photophobia of direct and scattered sunlight;
  • periodic burning;
  • painful sensations;
  • violation of color vision - fading of colors;
  • a cloudy veil before the eyes;
  • bifurcation or multiplicity of objects in the field of view.

Glaucoma:

  • persistent burning sensation;
  • painful sensations;
  • impaired visual acuity;
  • sudden headaches;
  • hyperemic protein membranes;
  • darkening or clouding is observed at the edges of the field of view;
  • distortion of peripheral vision.

In order to avoid the development of complications, it is necessary to contact the deputy medical help in a timely manner and strictly follow all the prescriptions of the attending physician.

Forecast

The chances of recovery depend on the type of defeat:

  • bacterial forms of uncomplicated etiology - are cured within a week;
  • with a high degree of infection and increased aggressiveness of pathogens - treatment can last for several weeks;
  • viral forms - the average duration is up to three weeks;
  • allergic options - from several days to years - with constant contact with allergens.

Dangerous processes are considered gonococcal, diphtheria and chlamydial lesions - their treatment is delayed for several months. These forms are often complicated and prone to chronic infections. In the case of damage to the corneal surfaces, the prognosis is unfavorable - the development of partial or absolute blindness is possible.

Prophylaxis

To prevent infection, experts recommend adhering to certain rules:

  • constant adherence to the requirements of personal hygiene - frequent hand washing, refusal to use common items (towels, handkerchiefs, etc.);
  • when wearing contact lenses, you must strictly follow the manufacturer's recommendations - change in a timely manner, remove at the specified time, properly handle and store;
  • avoid direct contact with carriers of pathogenic microflora - especially during sexual intercourse;
  • periodically attend consultations of ophthalmologists;
  • in public places, do not touch the face and eyes;
  • do not take other people's contact lenses, medications (eye drops with dispensers) and do not purchase them in questionable places.

Seasonal vitamin therapy will increase the level of functionality of the autoimmune system. The human body is able to independently fight pathogens - provided that the protective barrier is working properly.

Conjunctivitis in children

In the childhood age period, the following forms of the disease are more often recorded:

  • adenoviral;
  • bacterial;
  • measles;
  • allergic.

Newborns are exposed to damage to the organs of vision from gonococcal and chlamydial infections. The source of the infection is a sick woman in labor. These variants of ailments are characterized by a complex course and often end in partial or absolute loss of vision.

The primary symptomatic manifestations of the disease in babies require an immediate appeal to a pediatric ophthalmologist. Inflammatory processes on the conjunctival integument can have serious consequences and result in blindness. Timely therapy will allow you to suppress negative manifestations within a week.

In children's groups, conjunctivitis epidemics often break out. This is due to certain types of the disease - the viral form or the Koch-Winks bacteria. In the event of collective epidemics, preschool and school institutions switch to a quarantine regime.

Self-medication at the age of children is unacceptable - folk methods will aggravate the child's condition, accelerate the development of the pathological process, with its transition to the chronic type.

- polyetiological inflammatory lesion of the conjunctiva - the mucous membrane covering the inner surface of the eyelids and sclera. Various forms of conjunctivitis occur with hyperemia and edema of the transitional folds and eyelids, mucous or purulent discharge from the eyes, lacrimation, burning and itching in the eyes, etc. bacteriological examination of a smear from the conjunctiva, cytological, immunofluorescent, enzyme-linked immunosorbent assay of scraping from the conjunctiva, additional consultations (infectious disease specialist, dermatovenerologist, ENT, phthisiatrician, allergist) according to indications. Treatment of conjunctivitis is mainly local medication with the use of eye drops and ointments, washing of the conjunctival sac, subconjunctival injections.

ICD-10

H10

General information

Conjunctivitis is the most common eye disease, accounting for about 30% of all eye pathology. The frequency of inflammatory lesions of the conjunctiva is associated with its high reactivity to various kinds of exogenous and endogenous factors, as well as the availability of the conjunctival cavity to adverse external influences. The term "conjunctivitis" in ophthalmology combines etiologically heterogeneous diseases that occur with inflammatory changes in the mucous membrane of the eyes. The course of conjunctivitis can be complicated by blepharitis, keratitis, dry eye syndrome, entropion, scarring of the eyelids and cornea, corneal perforation, hypopyon, decreased visual acuity, etc.

The conjunctiva performs a protective function and, due to its anatomical position, is constantly in contact with many external stimuli - dust particles, air, microbial agents, chemical and temperature influences, bright light, etc. Normally, the conjunctiva has a smooth, moist surface, pink in color; it is transparent, vessels and meibomian glands are visible through it; conjunctival secretion resembles a tear. With conjunctivitis, the mucous membrane acquires turbidity, roughness, and scars can form on it.

Classification

All conjunctivitis is divided into exogenous and endogenous. Endogenous lesions of the conjunctiva are secondary, arising against the background of other diseases (natural and chickenpox, rubella, measles, hemorrhagic fever, tuberculosis, etc.). Exogenous conjunctivitis occurs as an independent pathology with direct contact of the conjunctiva with an etiological agent.

Depending on the course, there are chronic, subacute and acute conjunctivitis. In clinical form, conjunctivitis can be catarrhal, purulent, fibrinous (filmy), follicular.

Due to inflammation, the following are isolated:

  • conjunctivitis of bacterial etiology (pneumococcal, diphtheria, diplobacillary, gonococcal (gonoblenorrhea), etc.)
  • conjunctivitis of chlamydial etiology (paratrachoma, trachoma)
  • conjunctivitis of viral etiology (adenoviral, herpetic, with viral infections, molluscum contagiosum, etc.)
  • conjunctivitis of fungal etiology (with actinomycosis, sporotrichosis, rhinosporodiosis, coccidiosis, aspergillosis, candidiasis, etc.)
  • conjunctivitis of allergic and autoimmune etiology (with hay fever, spring catarrh, pemphigus of the conjunctiva, atopic eczema, demodicosis, gout, sarcoidosis, psoriasis, Reiter's syndrome)
  • conjunctivitis of traumatic etiology (thermal, chemical)
  • metastatic conjunctivitis in general diseases.

Causes

  • Bacterial conjunctivitis, as a rule, occur during infection by contact-household way. At the same time, bacteria begin to multiply on the mucous membrane, which are normally few in number or not at all part of the normal conjunctival microflora. The toxins released by the bacteria cause a pronounced inflammatory response. The most common causative agents of bacterial conjunctivitis are staphylococci, pneumococci, streptococci, Pseudomonas aeruginosa, Escherichia coli, Klebsiella, Proteus, Mycobacterium tuberculosis. In some cases, it is possible to infect the eyes with pathogens of gonorrhea, syphilis, diphtheria.
  • Viral conjunctivitis can be transmitted by contact-household or airborne droplets and are acutely infectious diseases. Acute pharyngoconjunctival fever is caused by adenoviruses 3, 4, 7 types; epidemic keratoconjunctivitis - adenoviruses of 8 and 19 types. Viral conjunctivitis can be etiologically associated with herpes simplex viruses, herpes zoster, chickenpox, measles, enteroviruses, etc.
  • Viral and bacterial conjunctivitis in children is often associated with diseases of the nasopharynx, otitis media, sinusitis. In adults, conjunctivitis can develop against the background of chronic blepharitis, dacryocystitis, dry eye syndrome.
  • Development of chlamydial conjunctivitis newborns is associated with infection of the child in the process of passing through the birth canal of the mother. In sexually active women and men, chlamydial eye damage is often combined with diseases of the genitourinary system (in men - with urethritis, prostatitis, epididymitis, in women - with cervicitis, vaginitis).
  • Fungal conjunctivitis can be caused by actinomycetes, molds, yeast-like and other types of fungi.
  • Allergic conjunctivitis is caused by the body's hypersensitivity to any antigen and in most cases serves as a local manifestation of a systemic allergic reaction. The causes of allergic manifestations can be drugs, alimentary (food) factors, helminths, household chemicals, plant pollen, demodex mite, etc.
  • Non-infectious conjunctivitis can occur when the eyes are irritated by chemical and physical factors, smoke (including tobacco), dust, ultraviolet light; metabolic disorders, vitamin deficiencies, ametropia (hyperopia, myopia), etc.

Conjunctivitis symptoms

Specific manifestations of conjunctivitis depend on the etiological form of the disease. Nevertheless, the course of conjunctivitis of various origins is characterized by a number of common features. These include: swelling and hyperemia of the mucous membrane of the eyelids and transitional folds; discharge of mucous or purulent secretions from the eyes; itching, burning, lacrimation; a feeling of "grit" or a foreign body in the eye; photophobia, blepharospasm. Often the main symptom of conjunctivitis is the inability to open the eyelids in the morning due to their sticking together with dried discharge. With the development of adenoviral or ulcerative keratitis, a decrease in visual acuity is possible. With conjunctivitis, as a rule, both eyes are affected: sometimes inflammation occurs in them alternately and proceeds with varying degrees of severity.

Acute conjunctivitis manifests suddenly with pain and cramps in the eyes. Against the background of conjunctival hyperemia, hemorrhages are often noted. Conjunctival injection of the eyeballs, mucosal edema; an abundant mucous, mucopurulent or purulent secretion is secreted from the eyes. In acute conjunctivitis, general health is often disturbed: malaise, headache, body temperature rises. Acute conjunctivitis can last from one to two to three weeks.

Subacute conjunctivitis is characterized by less severe symptoms than the acute form of the disease. The development of chronic conjunctivitis occurs gradually, and the course is persistent and prolonged. Discomfort and sensations of a foreign body in the eyes, rapid eye fatigue, moderate hyperemia and looseness of the conjunctiva, which takes on a velvety appearance, are noted. Against the background of chronic conjunctivitis, keratitis often develops.

A specific manifestation of conjunctivitis of bacterial etiology is a purulent opaque viscous discharge of a yellowish or greenish color. Pain syndrome, dry eyes and skin of the periorbital region are noted.

Viral conjunctivitis often occurs against a background of upper respiratory tract infections and is accompanied by moderate lacrimation, photophobia and blepharospasm, scanty mucous discharge, submandibular or parotid lymphadenitis. In some types of viral lesions of the eyes, follicles (follicular conjunctivitis) or pseudomembranes (membranous conjunctivitis) are formed on the mucous membrane of the eyes.

Allergic conjunctivitis, as a rule, proceeds with severe itching, pain in the eyes, lacrimation, eyelid edema, sometimes allergic rhinitis and cough, atopic eczema.

Features of the clinic of fungal conjunctivitis are determined by the type of fungus. With actinomycosis, catarrhal or purulent conjunctivitis develops; with blastomycosis - membranous with grayish or yellowish easily removable films. Candidamycosis is characterized by the formation of nodules consisting of an accumulation of epithelioid and lymphoid cells; aspergillosis proceeds with conjunctival hyperemia and corneal lesions.

With conjunctivitis caused by toxic effects of chemicals, severe pain occurs when moving the gaze, blinking, trying to open or close the eyes.

Diagnostics

Conjunctivitis is diagnosed by an ophthalmologist based on complaints and clinical manifestations. To clarify the etiology of conjunctivitis, anamnesis data are important: contact with patients, allergens, existing diseases, connection with the change of season, exposure to sunlight, etc. External examination reveals hyperemia and edema of the conjunctiva, injection of the eyeball, the presence of discharge.

To establish the etiology of conjunctivitis, laboratory tests are carried out: cytological examination of scraping or smear-imprint, bacteriological examination of a smear from the conjunctiva, determination of the titer of antibodies (IgA and IgG) to the alleged pathogen in the lacrimal fluid or blood serum, a study for demodex. With allergic conjunctivitis, they resort to skin-allergic, nasal, conjunctival, sublingual tests.

If conjunctivitis of a specific etiology is detected, it may be necessary to flush the conjunctival cavity with medicinal solutions, instillation of drugs, lay eye ointments, and perform subconjunctival injections.

With conjunctivitis, it is forbidden to apply bandages to the eyes, since they impair the evacuation of the discharge and can contribute to the development of keratitis. To exclude autoinfection, it is recommended to wash your hands more often, use disposable towels and napkins, separate pipettes and eye sticks for each eye.

Before the introduction of drugs into the conjunctival cavity, local anesthesia of the eyeball is carried out with solutions of novocaine (lidocaine, trimecaine), then the toilet of the ciliary edges of the eyelids, conjunctiva and eyeball with antiseptics (solution of furacilin, manganese-sour potassium). Before receiving information about the etiology of conjunctivitis, eye drops of 30% solution of sulfacetamide are instilled into the eyes, eye ointment is applied at night.

When the bacterial etiology of conjunctivitis is detected, gentamicin sulfate is used locally in the form of drops and eye ointment, erythromycin eye ointment. For the treatment of viral conjunctivitis, virostatic and virucidal agents are used: trifluridine, idoxuridine, leukocyte interferon in the form of instillations and acyclovir - topically, in the form of an ointment, and orally. Antimicrobial drugs may be prescribed to prevent the addition of a bacterial infection.

When chlamydial conjunctivitis is detected, in addition to local treatment, systemic administration of doxycycline, tetracycline or erythromycin is indicated. Therapy for allergic conjunctivitis includes the appointment of vasoconstrictor and antihistamine drops, corticosteroids, tear substitutes, and the use of desensitizing drugs. With conjunctivitis of fungal etiology, antimycotic ointments and instillations are prescribed (levorin, nystatin, amphotericin B, etc.).

Prophylaxis

Timely and adequate therapy for conjunctivitis allows you to achieve recovery without consequences for visual function. In the case of secondary damage to the cornea, vision may decrease. The main prevention of conjunctivitis is the fulfillment of sanitary and hygienic requirements in medical and educational institutions, compliance with personal hygiene standards, timely isolation of patients with viral lesions, and anti-epidemic measures.

Prevention of chlamydial and gonococcal conjunctivitis in newborns provides for the treatment of chlamydial infection and gonorrhea in pregnant women. With a tendency to allergic conjunctivitis, preventive local and general desensitizing therapy is necessary on the eve of the expected exacerbation.

It is forbidden to apply a patch on the eye, as this interferes with the blinking movements of the eyes, due to which the conjunctiva is cleared of pus.

The main treatment for acute bacterial conjunctivitis is topical antibiotics. Drops are usually applied at intervals of 1 to 4 hours, ointments - 4 times a day. Treatment should continue until the clinical symptoms disappear completely, usually 10-14 days. Currently, fluoroquinolones have replaced aminoglycosides, which have been used for many years for the local treatment of bacterial conjunctivitis (except for streptococcal and pneumococcal). However, an increase in resistance to fluoroquinolones has been noted, and therefore their use in ophthalmic practice should be limited only to severe destructive bacterial lesions. Currently, the most justified is the use of a combination of polymyxin-B with trimethoprim in the form of drops and a combination of polymyxin-B with bacitracin in the form of an ophthalmic ointment. Systemic antimicrobial therapy is rarely used for acute uncomplicated bacterial conjunctivitis, with the exception of hemophilic conjunctivitis in children and infection in all age groups Haemophilus influenzae biogroups aegiptius, which is often accompanied by the development of severe complications.

First aid for pneumococcal conjunctivitis consists primarily in acidifying the environment of the conjunctival sac, since pneumococcus develops well in an alkaline environment, and dies in an acidic environment. For this purpose, every 1.5-2 hours, the conjunctival sac is washed with 2% boric acid solution. In addition, solutions of antibiotics are buried, to which this flora is sensitive.

Zinc sulfate, applied as instillation of 0.25 - 0.5% and less often 1% solution, 4 - 6 times a day, specifically affects the Morax-Axenfeld diplobacillus.

The clinical picture of viral conjunctivitis

Viral conjunctivitis caused by adenoviruses types 3 and 7a, less often - adenoviruses of types 6 and 10, 11, 17, 21, 22, is the most common form of conjunctivitis. It is transmitted by contact and airborne droplets.

The incubation period lasts 4 to 8 days. Often, the development of conjunctivitis is preceded by the phenomenon of inflammatory diseases of the upper respiratory tract, an increase in body temperature. The process is usually one-sided, although the second eye may be affected. Are noted severe hyperemia and edema conjunctiva (catarrhal form), folliculosis lower transitional fold (follicular form); detachable mucous membrane. Corneal damage (coin-shaped infiltrates) is possible, leading to a temporary decrease in visual acuity.

Enteroviral, or epidemic hemorrhagic conjunctivitis is caused by a virus from the picornavirus family (enterovirus-70, coxsackie A-24).

The virus of epidemic hemorrhagic conjunctivitis is transmitted mainly by contact through infected solutions of ophthalmic drugs, devices and instruments, as well as common items. The disease is highly contagious, acute.

It spreads quickly, the incubation period is very short (8-48 hours). Epidemics are "explosive", causing outbreaks in organized collectives, can quickly spread across entire continents, taking on the character of a pandemic.

Severe eye pain, conjunctival hyperemia, lacrimation, photophobia, a feeling of a foreign body in the eye appear. Swelling and hyperemia of the eyelids rapidly increase, which leads to a sharp narrowing of the palpebral fissure. The discharge (usually mucopurulent) is insignificant. Acute pronounced conjunctivitis is accompanied by subconjunctival hemorrhages from barely noticeable punctate to extensive, covering the entire eyeball. Corneal sensitivity is reduced, there are multiple point subepithelial infiltrates. At the same time, general symptoms of the disease can be observed: headache, fever, tracheobronchitis. Pronounced manifestations of conjunctivitis usually last for a week, then gradually decrease and disappear after 2-3 weeks. However, subepithelial corneal infiltrates, despite the treatment, very slowly give in to reverse development (within several months).

Chlamydial conjunctivitis (paratrachoma, adult conjunctivitis with inclusions, bath conjunctivitis, pool conjunctivitis) develops when the mucous membrane of the eye infected with chlamydia is separated from the affected eyes or genitourinary system. There are also epidemic outbreaks of diseases when swimming in polluted water bodies. The incubation period is 5-14 days. Usually one eye is affected, which is a characteristic difference from trachoma.

Acute paratrachoma is characterized by a sharp hyperemia of the conjunctiva of the eyelids and transitional folds, its edema and infiltration. The appearance of large, loose follicles, arranged in rows in the lower fornix, is typical; in the future, the follicles can merge, forming horizontally located rollers. Complete resorption of conjunctival follicles without scarring is characteristic.

At the beginning of the disease, there is a slight mucopurulent discharge, later, with the development of the process, the discharge becomes abundant, often purulent. There is also a hypertrophy of the papillae of the conjunctiva, mainly of the upper eyelid, rarely pseudomembranes are formed on the conjunctiva. In the acute phase of the disease, pronounced edema of the eyelids and narrowing of the palpebral fissure, unilateral pseudoptosis due to subtarsal edema of the eyelid conjunctiva and folliculosis can be observed.

With the help of a slit lamp during biomicroscopy, it is often possible to detect the involvement of the upper limbus in the form of the appearance of micropannus, as well as multiple small, punctate epithelial infiltrates in the cornea, similar to those in adenovirus infection.

A characteristic feature of paratrachoma is the onset from the 3-5th day of the disease regional preauricular adenopathy on the side of the affected eye, which does not happen with trachoma. An enlarged lymph gland is usually painless on palpation, which is one of the criteria for the differential diagnosis with adenoviral conjunctivitis.

The diagnosis of paratrachoma is made on the basis of anamnesis and a characteristic clinical picture, as well as laboratory data. One of the main signs, characteristic and typical only for chlamydial infections, is the detection of intracellular inclusions in the scraping of the epithelium of the conjunctiva - the bodies of Provachek-Halberstedter (cytological method).

Methods such as the study of fluorescent antibodies, immunofluorescence analysis, and methods of serological diagnosis are more informative.

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