References:
- Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition, ISBN 978-197-51-6103-3, by Janice L. Hinkle, Kerry H. Cheever, and Kristen J. Overbaugh (Ch. 58, [ebook] pp. 5116–5122)
An inflammation of the conjunctiva. It is a common ocular disorder worldwide, characterized by a pink appearance (hence its name “pink eye”) because of subconjunctival blood vessel congestion.
Clinical Manifestations
General symptoms include foreign-body sensation, scratching or burning sensation, itching, and photophobia. It may be unilateral or bilateral, but the infection usually starts in one eye then spreads to the other eye through hand contact.
Diagnostic Examination
Diagnosis is based on the distinctive characteristics of ocular signs, acute or chronic presentation, and identification of any precipitating events. Positive results of swab smear preparations and cultures confirm the diagnosis. The four main clinical features important to evaluate are:
- Discharge: determine if the discharge is watery, mucoid, purulent, or mucopurulent.
- Conjunctival Reaction: determine if the reaction is follicular or papillary.
- Follicles are multiple, slightly elevated lesions encircled by tiny blood vessels. They appear like grains of rice.
- Papillae are hyperplastic conjunctival epithelium in numerous projections that are usually seen as a fine mosaic pattern under slit-lamp examination.
- Pseudomembranes or True Membranes: pseudomembranes consist of coagulated exudate that adheres to the surface of the inflamed conjunctiva. True membranes form when the exudate adhered to the superficial layer of the conjunctiva, and removal results in bleeding.
- Lymphadenopathy: enlargement of the periauricular and submandibular lymph nodes where the eyelids drain.
Types of Conjunctivitis
- Bacterial Conjunctivitis: acute or chronic; acute may become chronic.
- Signs and symptoms vary from mild to severe: acute onset of redness, burning, and discharge. There is pupillary formation, conjunctival irritation, and injection in the fornices. Exudates are variable but are commonly present in the morning.
- Exudates may cause adhesion, producing difficulty in opening the eyes. Mucopurulent discharge is seen in mild cases, while purulent discharge appear in severe acute bacterial infections.
- Chronic form is often seen in patients with lacrimal duct obstruction, chronic dacryocystitis, and chronic blepharitis.
- In gonococcal conjunctivitis, the symptoms appear more acute, exudate is profuse and purulent, and lymphadenopathy occurs. Pseudomembranes may be present.
- Trachoma from Chlamydia trachomatis is the leading cause of preventable blindness, spread by direct contact or by carriers (insects).
- Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus
- Viral Conjunctivitis: acute or chronic.
- Signs and symptoms vary from mild to severe: tearing, redness, foreign-body sensation, lid edema, ptosis, and conjunctival hyperemia (red eyes caused by dilation of blood vessels).
- Symptoms of upper respiratory tract infection often precede the condition.
- Discharge is watery, and follicles are prominent. Severe cases include pseudomembranes.
- Corneal involvement produces photophobia
- Adenovirus (highly contagious) and Herpes Simplex Virus (HSV).
- Vital conjunctivitis is self-limiting but lasts longer than bacterial conjunctivitis.
- Epidemic Keratoconjunctivitis is a seasonal outbreak of epidemics, especially during summer as people use swimming pools. This is often accompanied by periauricular lymphadenopathy and occasionally periorbital pain. There are marked follicular and papillary formations. This may lead to keratopathy.
- Allergic Conjunctivitis: a hypersensitivity reaction as a part of allergic rhinitis, or independent. A history is often present (pollens, other environmental allergens). Extreme pruritus, epiphora (excessive secretion of tears), injection, and usually severe photophobia. A string-like mucoid discharge is usually associated with rubbing the eyes because of severe pruritus.
- Vernal conjunctivitis is also known as seasonal conjunctivitis because it appears mostly during warm weather, and in children and young adults. Most affect people have a history of asthma or eczema. There may be large formations of papillae that have a cobblestone appearance.
- Toxic Conjunctivitis: potentially as a result of medications; chlorine from swimming pools; exposure to toxic fumes among industrial workers; or exposure to other irritants such as smoke, hair sprays, acids, and alkalis.
Medical Management
- Bacterial Conjunctivitis: acute forms are almost always self-limiting, lasting two weeks if left untreated. If treated with antibiotic agents, it may last a few days (except for gonococcal and staphylococcal conjunctivitis).
- Trachoma is treated with broad-spectrum oral and systemic antibiotics. Surgical management includes correction of trichiasis to prevent conjunctival scarring.
- Adult inclusion conjunctivitis requires 1 week of antibiotics. Prevention of reinfection is important. Affected people and their sexual partners should seek treatment for STIs if indicated.
- Viral Conjunctivitis: not responsive to any treatment. Patients should be made aware of the contagious nature of the disease (esp. for highly contagious forms like epidemic keratoconjunctivitis).
- Cold compress may alleviate some symptoms.
- Health care-associated infections should be prevented. Frequent hand hygiene and procedures for environmental cleaning and disinfection of equipment used for eye examination must be strictly followed at all times. Patients suspected of conjunctivitis caused by adenovirus should have their own specific areas for treatment during an adenovirus conjunctivitis outbreak.
- Isolation for 3 to 7 days (until symptoms resolve) is prescribed for employees who are infection.
- Allergic Conjunctivitis: corticosteroids in ophthalmic preparations are given. Depending on severity, they may be oral. The use of vasoconstrictors, such as topical epinephrine solution, cold compresses, ice packs, and cool ventilation usually provide comfort by decreasing swelling.
- Toxic Conjunctivitis: profuse irrigation with saline or sterile water.