View source for Conjunctivitis (patient information)

'''For the WikiDoc page for this topic, click [[Conjunctivitis|here]]'''
{{DiseaseDisorder infobox |
  Name        = Conjunctivitis |
  ICD10          = {{ICD10|H|10||h|10}} |
  ICD9           = {{ICD9|372.0}}-{{ICD9|372.3}} |
  ICDO           = |
  Image          = Pink_eye.jpg |
  Caption        = An eye with viral conjunctivitis |
  OMIM           = |
  MedlinePlus    = 001010 |
  eMedicineSubj  =  |
  eMedicineTopic =  |
  DiseasesDB     = 3067 |
}}
{{SI}}

{{CMG}}; '''Assistant Editor(s)-In-Chief:''' Erin E. Lord; [[User:Amanda Chirlin|Amanda Chirlin]]

==Overview==
'''Conjunctivitis''' (commonly called "'''pink eye'''" or "'''Madras eye'''"<ref>{{cite news
|title=Beware, `Madras eye' is here!
|date=2001-10-12
|work=The Hindu
|url=http://www.hinduonnet.com/2001/10/12/stories/0412402c.htm
|accessdate=2008-10-30
}}</ref>) is an [[acute]] [[inflammation]] of the [[conjunctiva]] (the outermost layer of the [[eye]] and the inner surface of the [[eyelid]]s), most commonly due to an [[allergic reaction]] or an [[infection]] (usually [[viral]], but sometimes [[bacterial]]<ref>Langley JM. Adenoviruses. Pediatr Rev. 2005;26:238-242.</ref>).  Conjunctivitis is an irritating and fairly common condition, but rarely causes long term [[eye]] or [[vision]] damage.

==What are the symptoms of conjunctivitis?==
[[Image:Pinkeye twoangles.jpg|thumb|left|[[Eye]]s with conjunctivitis]]
[[Image:ConjunctivitisRedEye.jpg|thumb|left|An eye, red due to acute conjunctivitis.]]
[[Image:Swollen eye with conjunctivitis.jpg|thumb|left|An eye with bacterial conjunctivitis.]]

Redness ([[hyperaemia]]), irritation ([[chemosis]]) and watering ([[epiphora (medical)|epiphora]]) of the eyes are symptoms common to all forms of conjunctivitis. 

Additionally, symptoms vary based on the specific type of conjunctivitis: 

'''Allergic conjunctivitis'''

{{main|Allergic conjunctivitis}}Allergic conjunctivitis is typically [[itch|itchy]], sometimes distressingly so, and often involves some [[Periorbital edema|eye swelling]].  [[Chronic]] [[allergy]] often causes just [[itch|itching]] or [[irritation]].  Allergic conjunctivitis often causes pale watery swelling of the [[conjunctiva]] and sometimes the whole [[eyelid]].  There is frequently a sticky [[mucus]] discharge, and there is variable redness.

'''Viral conjunctivitis'''

''Viral conjunctivitis'' is often associated with an [[infection]] of the upper [[respiratory tract]], a [[common cold]], and/or a [[sore throat]]. Its symptoms include watery discharge and variable [[itch]]. The [[infection]] usually begins with one [[eye]], but may spread easily to the other.  ''Viral conjunctivitis'' is commonly known as "pink eye."

'''Bacterial conjunctivitis'''

''Bacterial conjunctivitis'' due to the common [[pyogenic]] (pus-producing) bacteria causes marked grittiness/irritation and a stringy, opaque, grey or yellowish [[mucopurulent discharge]] (''[[mucus]]'', ''gowl'', ''goop'', ''gunk'', ''[[eye crust]]'',  or other regional names, officially known as '[[gound]]') that may cause the [[eyelid|lids]] to stick together (''matting''), especially after [[sleep|sleeping]]. Another symptom that could be caused by bacterial conjunctivitis is severe crusting of the infected [[eye]] and the surrounding [[skin]]. However, discharge is not essential to the diagnosis, contrary to popular belief.  Bacteria such as ''[[Chlamydia trachomatis]]'' or ''[[Moraxella]]'' can cause a non-exudative but persistent conjunctivitis without much redness. The gritty and/or scratchy feeling is sometimes localized enough for patients to insist they must have a [[foreign body]] in the [[eye]].  The more [[acute]] [[pyogenic]] [[infections]] can be painful. Like viral conjunctivitis, it usually affects only one [[eye]] but may spread easily to the other [[eye]]. However, it is dormant in the [[eye]] for three days before the patient shows signs of symptoms.

'''Chemical conjunctivitis'''

''Irritant'' or ''toxic conjunctivitis'' is [[irritable]] or painful when the infected [[eye]] is pointed far down or far up. Discharge and [[itch]] are usually absent. It show primarily marked redness.  This is the only group in which severe [[pain]] may occur.

==What are the causes of conjunctivitis?==
Conjunctivitis is most commonly caused by [[viruses]], often [[adenovirus]], but many other factors can lead to its occurrence.  Other causes include:
* [[Allergies]] ([[allergic conjunctivitis]])
* [[Bacteria]]
* Certain diseases
* Chemical exposure
* [[Chlamydia]]
* [[Fungi]]
* [[Parasites]] (rarely)
* Use of [[contact lenses]] (especially extended-wear lenses)

Conjunctivitis is spread from person-to-person by:

* Direct contact with the infected person’s [[eye]] drainage or drainage from the person’s [[cough]], [[sneeze]], or [[runny nose]].
* Indirect contact with objects that may have the infected person’s drainage on them (e.g. eye makeup applicators, towels, shared eye medications).
* Contact with the infected person’s [[fingers]] or [[hands]] which may contain the [[virus]] or [[bacteria]].

[[Newborns]] can be infected by [[bacteria]] in the [[birth canal]]. This condition is called [[ophthalmia neonatorum]], and it must be treated immediately to preserve [[eyesight]].  Additionally, [[neonatal]] conjunctivitis is a red eye in a [[newborn]] caused by [[irritation]], a blocked [[tear duct]], or [[infection]].

==Who is at highest risk?==
People who are exposed to someone infected with the [[viral]] or [[bacterial]] form of conjunctivitis are at risk for developing conjunctivitis.  [[Children]] and [[adults]] can develop both [[bacterial]] and [[viral]] conjunctivitis, however bacterial conjunctivitis is more common in young [[children]].  

Additionally, [[babies]] born to [[mothers]] infected with either [[Neisseria gonorrhoeae]] or [[Chlamydia trachomatis]] are at an increased risk for conjunctivitis.  During [[delivery]], these babies can contract [[ophthalmia neonatorum]], a form of bacterial conjunctivitis when their [[eyes]] are exposed to the [[bacteria]] in the [[birth canal]].  It must be treated immediately to prevent [[blindness]].

==How to know you have conjunctivitis?==
Conjunctivitis may make you feel like you have something in your [[eye|eye(s)]] that you cannot get out.  Your eyes may feel crusted over or pasted shut when you wake up in the morning and there may be a discharge coming from the [[eyes]].  If the discharge has a yellow-greenish color, the cause of [[infection]] is more likely to be [[bacterial]].  The whites of the [[eyes]] usually have a pink or reddish cast to them.  Other symptoms include:

* Eye [[pain]]
* Increased [[tear|tearing]]
* Itching of the [[eye]]
* Sensitivity to light

Except in obvious [[pyogenic]] (pus-producing) or toxic/chemical conjunctivitis, a [[slit lamp]] (biomicroscope) is needed to have any confidence in the [[diagnosis]].  Even after [[Slit lamp|biomicroscopy]], laboratory tests are often necessary if proof of [[etiology]] is needed.

==When to seek urgent medical care?==
Urgent medical care is not usually necessary for conjunctivitis.  However, newborns with [[ophthalmia neonatorum]] must be treated immediately to prevent blindness. 

Call for an appointment with your health care provider if your symptoms last longer than 3 or 4 days.

==Treatment options==
Treatment varies by the type of conjunctivitis under consideration:

'''Allergic'''

For the allergic type, cool water poured over the face with the head inclined downward constricts [[capillaries]], and [[artificial tears]] sometimes relieve discomfort in mild cases. In more severe cases, [[NSAID|non-steroidal anti-inflammatory medications]] and [[antihistamine]]s may be prescribed. Persistent [[allergic conjunctivitis]] may also require topical [[steroid]] drops.

'''Bacterial'''

Bacterial conjunctivitis usually resolves without [[treatment]].  [[Antibiotics]] eye drops or [[ointment]] are thus only needed if no improvement is observed after 3 days.<ref>{{cite web |url=http://www.cfp.ca/cgi/content/abstract/55/11/1071?etoc |title=Evidence-based treatment of acute infective conjunctivitis: Breaking the cycle of antibiotic prescribing -- Visscher et al. 55 (11): 1071 -- Canadian Family Physician |format= |work= |accessdate=}}</ref>  Even though [[antibiotics]] speed recovery time ( from 4.6 days to 3.3 days) no serious effects were noted either with or without [[]treatment]].<ref>{{cite journal |author=Sheikh A, Hurwitz B |title=Antibiotics versus placebo for acute bacterial conjunctivitis |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD001211 |year=2006 |pmid=16625540 |doi=10.1002/14651858.CD001211.pub2 |url=}}</ref><ref>{{cite journal | author=Hazel A Everitt, Paul S Little, Peter W F Smith | title=A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice | journal=BMJ | month=July 16 | year=2006 |doi= 10.1136/bmj.38891.551088.7C | url=http://bmj.bmjjournals.com/cgi/content/short/bmj.38891.551088.7Cv1?etoc | pmid=16847013 | volume=333 | pages=321 | issue=7563 | pmc=1539078}}</ref>

'''Viral'''

Although there is no specific [[treatment]] for [[viral]] conjunctivitis, symptomatic relief may be achieved with cold compresses<ref>http://emedicine.medscape.com/article/1191370-treatment, Retrieved 17 December 2009</ref> and artificial tears. People are often advised to avoid touching their [[eyes]] or sharing towels and washcloths.

'''Chemical'''

Conjunctivitis due to [[chemicals]] is treated via [[irrigation]] with [[Ringer's lactate]] or [[saline (medicine)|saline solution]]. Chemical injuries (particularly [[alkali]] burns) are medical emergencies as they can lead to severe [[scarring]], and intraocular damage.

==Diseases with similar symptoms==
Diseases with symptoms similar to conjunctivitis include:

* [[Keratoconjunctivitis sicca]]
* [[Trachoma]]

==Where to find medical care for conjunctivitis==
[http://maps.google.com/maps?f=q&amp;hl=en&amp;geocode=&amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|conjunctivitis}}}}&amp;sll=37.0625,-95.677068&amp;sspn=65.008093,112.148438&amp;ie=UTF8&amp;ll=37.0625,-95.677068&amp;spn=91.690419,149.414063&amp;z=2&amp;source=embed Directions to Hospitals Treating conjunctivitis]

==Prevention of conjunctivitis==
Good [[hygiene]] can help prevent the spread of conjunctivitis:

* Change pillowcases frequently.
* Change towels and wash cloths daily.
* Do not share personal articles that come in contact with the [[eyes]] (e.g. eye make-up applicators, towels, wash cloths, eye droppers)
* Handle and clean [[contact lenses]] properly.
* Keep hands away from the [[eye]].
* Replace [[eye]] cosmetics regularly.
* Wash your [[hands]] often.
* Always wash [[hands]] with soap and water or an alcohol based hand sanitizer prior to and following contact with a person who has conjunctivitis.

==What to expect (Outlook/Prognosis)?==
The outcome is usually good with [[treatment]].  Conjunctivitis resolves, in 65% of cases, within 2 – 5 days.<ref>{{cite journal |author=Rose P |title=Management strategies for acute infective conjunctivitis in primary care: a systematic review |journal=Expert Opin Pharmacother |volume=8 |issue=12 |pages=1903–21 |year=2007 |month=August |pmid=17696792 |doi=10.1517/14656566.8.12.1903 |url=}}</ref>

==Additional links==
http://www.nlm.nih.gov/medlineplus/ency/article/001010.htm

http://www.in.gov/isdh/21205.htm

==Sources==
{{reflist|2}}

[[Category:Patient information]]
[[Category:Opthalmology]]
[[Category:Opthalmology patient information]]
[[Category:Pediatrics]]
[[Category:Pediatrics patient information]]
[[Category:Disease state]]
[[Category:Mature chapter]]

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