Conjunctivitis natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [3]
Overview
If left untreated, viral conjunctivitis will generally clear without any complications. Bacterial conjunctivitis is often self-limited. If left untreated, bacterial conjunctivitis will clear within 1 or 2 weeks without any complications, and it is generally associated with a favorable long-term prognosis.[1] Allergic conjunctivitis improves by eliminating or significantly reducing contact with the allergen. If left untreated, most cases of allergic conjunctivitis may resolve without any long-term consequences. Keratoconjunctivitis sicca associated with Sjögren's syndrome is associated with a particularly poor prognosis and requiring a longer course of treatment.[2][3][4] Prognosis for conjunctivitis is generally good with treatment.
Natural History
Viral conjunctivitis is often caused by adenovirus. It presents with watery discharge, hyperemia, chemosis, and lymphadenopathy. If left untreated, most cases of viral conjunctivitis are mild and will clear in 7 to 14 days without any long-term consequences. if complications arise, viral conjunctivitis can take two or more weeks to resolve. Some cases of viral conjunctivitis may develop stromal or subepithelial abnormalities. In such cases, if subepithelial infiltrates are in the pupillary axis, they may lead to decreased vision. Usually stromal abnormalities may persist for months to years, long after the epithelial changes have resolved.[1][2][5]
Acute hemorrhagic conjunctivitis is often caused by picornavirus. It presents with a severe red, swollen eyes as well as subconjuntival hemorrhaging, and will clear up in 5 to 7 days. If left untreated, acute hemorrhagic conjunctivitis almost always resolves without sequelae.[6]
Bacterial conjunctivitis presents with red eye, mucopurulent discharge, and chemosis. The incubation period for bacterial conjunctivitis is estimated to be 1 to 7 days. If left untreated, most cases of bacterial conjunctivitis will clear in 7 to 10 days without any long-term consequences. If left untreated, In patients who have purulent or mucopurulent discharge (suspected chlamydial and gonococcal conjunctivitis), who wear contact lenses, and who are immunocompromised, conjunctivitis may cause corneal damage (such as corneal ulcer, scar, and perforation), sepsis, and meningitis. This may lead to permanent blindness and death.[1][2][7]
Hyperacute bacterial conjunctivitis (HBC) is often caused by Neisseria gonorrhoeae in sexually active adults. It presents with a severe copious purulent discharge, eyelid swelling, eye pain on palpation, preauricular adenopathy, and decreased vision. If left untreated, hyperacute bacterial conjunctivitis may cause corneal involvement, and ultimately corneal perforation.[8]
Neonatal conjunctivitis is one of the most common infections occurring in the first month of life. Chemical conjunctivitis secondary to silver nitrate solution application usually occurs in the first day of life, and disappears spontaneously within 2- 4 days. In the absence of adequate prophylaxis, 30% to 42% of infants born by vaginal delivery to infected mothers will develop gonococcal conjunctivitis. Gonococcal conjunctivitis tends to occur 2-7 days after birth, and tends to be more severe than other causes of ophthalmia neonatorum. It presents with severe bilateral purulent conjunctivitis, tearing, and eyelids swelling. If left untreated, gonococcal conjunctivitis may cause corneal involvement such as corneal ulceration, diffuse opacification, and corneal perforation. This may lead to blindness, sepsis, or death. The onset of chlamydial conjunctivitis is usually later than gonococcal conjunctivitis. In the absence of adequate prophylaxis, 30%-50% of infants born by vaginal delivery to infected mothers will develop chlamydial conjunctivitis. The incubation period is 5-14 days. Chlamydial conjunctivitis presents with mild hyperemia, watery discharge, eyelid swelling, papillary reaction, and pseudomembrane formation. If left untreated, chlamydial conjunctivitis can progress to copious and purulent discharge. This may lead to central corneal opacification and blindness. Herpetic conjunctivitis is a rare cause of neonatal conjunctivitis. Herpetic conjunctivitis usually occurs within the first 2 weeks after birth and has an incubation period of approximately 6-14 days. If left untreated, HSV conjunctivitis can cause corneal scarring and ulceration. Additionally, disseminated HSV infection can cause central nervous system (CNS) involvement. Ophthalmia neonatorum caused by pseudomonas is rare but can present with eyelid edema, erythema, and purulent discharge. If left untreated, ophthalmia neonatorum can progress to corneal perforation, endophthalmitis, blindness, and possibly death.[9][10][11]
Allergic conjunctivitis usually presents with itching of the eyes and eyelid swelling. Seasonal allergic conjunctivitis is the most common form of the condition, and symptoms are related to season-specific aeroallergens. If left untreated, most cases of allergic conjunctivitis improve by eliminating or significantly reducing contact with the allergen (pollen or animal dander) without any long-term consequences.[12][13][14]
Keratoconjunctivitis sicca (dry eye syndrome) presents with a foreign body sensation, mucoid discharge, ocular dryness, excessive tearing (reflex secretion), photophobia, itching, and blurry vision. Symptoms tend to be worse toward the end of the day with prolonged use of the eyes. If left untreated, it can progress to corneal ulceration, corneal perforation, and ultimately permanent blindness.[3][15][16]
Superior limbic keratoconjunctivitis (SLK) symptoms develop around the sixth decade of life, and include a foreign body sensation, burning sensation, pruritus, and dry eye sensation. Superior limbic keratoconjunctivitis is typically associated with remission as the natural history and eventual total resolution, although symptoms may last for years.[4][17]
Complications
Viral Conjunctivitis
Complications to viral conjunctivitis include:[5][18]
- Bacterial superinfection
- Keratitis
- Subepithelial infiltrates
- Corneal ulceration with keratoconjunctivitis
- Chronic infection
Bacterial Conjunctivitis
Complications to bacterial conjunctivitis include:[19][20]
- Corneal perforation
- Keratitis
- Corneal epithelial defects
Neonatal Conjunctivitis
Complications to neonatal conjunctivitis include:[11][21]
- Ocular complications
- Pseudomembrane formation
- Corneal edema
- Thickened palpebral conjunctiva
- Peripheral pannus formation
- Corneal opacification
- Staphyloma
- Corneal perforation
- Endophthalmitis
- Loss of eye and blindness
- Systemic complications of chlamydia conjunctivitis
- Systemic complications of gonococcal conjunctivitis
- Arthritis
- Meningitis
- Anorectal infection
- Septicemia
Allergic Conjunctivitis
Complications to allergic conjunctivitis include:[13][14]
- Conjunctivochalasis (chronic recurrences)
- Corneal ulceration
- Corneal opacification
- Visual loss
- Steroid induced intraocular pressure elevations
- Cataract
Keratoconjunctivitis Sicca
Complications to Keratoconjunctivitis sicca (dry eye syndrome) include:[15][16]
- Corneal ulceration
- Corneal erosions
- Corneal neovascularization
- Corneal scarring
- Corneal thinning
- Corneal perforation
Prognosis
- Viral conjunctivitis is often associated with a favorable long-term prognosis. However, viral conjunctivitis associated with subepithelial infiltrates may last for several months and cause decreased vision.[5][18]
- Acute hemorrhagic conjunctivitis almost always resolves without sequelae, and has a good visual prognosis.[6]
- Bacterial conjunctivitis is often associated with a favorable long-term prognosis.
Early detection and early treatment of extremely pathogenic bacteria, such as Chlamydia trachomatis or Neisseria gonorrhoeae, is associated with a good prognosis.[19][20]
- Early detection and early treatment of hyperacute bacterial conjunctivitis (HBC) is associated with a good prognosis.[22]
- Early detection and early treatment of neonatal conjunctivitis is associated with a good prognosis.[11][21]
- Allergic conjunctivitis is associated with a favorable long-term prognosis. However, atopic keratovonjunctivitis and vernal keratoconjunctivitis (allergic conjunctivitis subtypes) are associated with poor outcomes.[23]
- The prognosis of Keratoconjunctivitis sicca (dry eye syndrome) associated with Sjögren's syndrome is poor. These patients require a longer course of treatment.[16]
- Superior limbic keratoconjunctivitis (SLK) is associated with excellent prognosis.[4][17]
References
- ↑ 1.0 1.1 1.2 Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
- ↑ 2.0 2.1 2.2 Rose P (2007). "Management strategies for acute infective conjunctivitis in primary care: a systematic review". Expert Opin Pharmacother. 8 (12): 1903–21. doi:10.1517/14656566.8.12.1903. PMID 17696792.
- ↑ 3.0 3.1 Schaumberg DA, Dana R, Buring JE, Sullivan DA (2009). "Prevalence of dry eye disease among US men: estimates from the Physicians' Health Studies". Arch Ophthalmol. 127 (6): 763–8. doi:10.1001/archophthalmol.2009.103. PMC 2836718. PMID 19506195.
- ↑ 4.0 4.1 4.2 Watson S, Tullo AB, Carley F (2002). "Treatment of superior limbic keratoconjunctivitis with a unilateral bandage contact lens". Br J Ophthalmol. 86 (4): 485–6. PMC 1771108. PMID 11914237.
- ↑ 5.0 5.1 5.2 Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB (2015). "Adenoviral keratoconjunctivitis". Surv Ophthalmol. 60 (5): 435–43. doi:10.1016/j.survophthal.2015.04.001. PMID 26077630.
- ↑ 6.0 6.1 Yin-Murphy M (1976). "Simple tests for the diagnosis of picornavirus epidemic conjunctivitis (acute haemorrhagic conjunctivitis)". Bull World Health Organ. 54 (6): 675–9. PMC 2366581. PMID 1088513.
- ↑ Azari AA, Barney NP (2013). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.
- ↑ Høvding G (2008). "Acute bacterial conjunctivitis". Acta Ophthalmol. 86 (1): 5–17. doi:10.1111/j.1600-0420.2007.01006.x. PMID 17970823.
- ↑ Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G (2008). "Neonatal conjunctivitis - a review". Malays Fam Physician. 3 (2): 77–81. PMC 4170304. PMID 25606121.
- ↑ Matejcek A, Goldman RD (2013). "Treatment and prevention of ophthalmia neonatorum". Can Fam Physician. 59 (11): 1187–90. PMC 3828094. PMID 24235191.
- ↑ 11.0 11.1 11.2 Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC; et al. (1986). "Ophthalmia neonatorum in Nairobi, Kenya: the roles of [[Neisseria gonorrhoeae]] and [[Chlamydia trachomatis]]". J Infect Dis. 153 (5): 862–9. PMID 3084664. URL–wikilink conflict (help)
- ↑ La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S; et al. (2013). "Allergic conjunctivitis: a comprehensive review of the literature". Ital J Pediatr. 39: 18. doi:10.1186/1824-7288-39-18. PMC 3640929. PMID 23497516.
- ↑ 13.0 13.1 Jun J, Bielory L, Raizman MB (2008). "Vernal conjunctivitis". Immunol Allergy Clin North Am. 28 (1): 59–82, vi. doi:10.1016/j.iac.2007.12.007. PMID 18282546.
- ↑ 14.0 14.1 Bonini S (2004). "Atopic keratoconjunctivitis". Allergy. 59 Suppl 78: 71–3. doi:10.1111/j.1398-9995.2004.00570.x. PMID 15245362.
- ↑ 15.0 15.1 Zoukhri D (2006). "Effect of inflammation on lacrimal gland function". Exp Eye Res. 82 (5): 885–98. doi:10.1016/j.exer.2005.10.018. PMC 1361268. PMID 16309672.
- ↑ 16.0 16.1 16.2 Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC (1998). "The pathology of dry eye: the interaction between the ocular surface and lacrimal glands". Cornea. 17 (6): 584–9. PMID 9820935.
- ↑ 17.0 17.1 Nelson JD (1989). "Superior limbic keratoconjunctivitis (SLK)". Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.
- ↑ 18.0 18.1 Drug and Therapeutics Bulletin (2011). "Management of acute infective conjunctivitis". Drug Ther Bull. 49 (7): 78–81. doi:10.1136/dtb.2011.02.0043. PMID 21733975.
- ↑ 19.0 19.1 Høvding G (2004). "[Acute bacterial conjunctivitis]". Tidsskr Nor Laegeforen. 124 (11): 1518–20. PMID 15195156.
- ↑ 20.0 20.1 "Bacterial conjunctivitis in children: antibiotic eye drops only if eye washing is ineffective". Prescrire Int. 16 (89): 120–1. 2007. PMID 17585426.
- ↑ 21.0 21.1 Centers for Disease Control and Prevention (2015)[1] Accessed on June 30, 2016
- ↑ Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC) (2010). "Sexually transmitted diseases treatment guidelines, 2010". MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459.
- ↑ Kumar S (2009). "Vernal keratoconjunctivitis: a major review". Acta Ophthalmol. 87 (2): 133–47. doi:10.1111/j.1755-3768.2008.01347.x. PMID 18786127.