Conjunctivitis pathophysiology: Difference between revisions

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==Overview==
==Overview==
[[Conjunctivitis]] is defined as [[inflammation]] of [[bulbar]] and/or palpebral [[conjunctiva]]. Conjunctivitis has many [[etiologies]], but the majority of cases can be caused by [[allergies]] or infection. '''Infective conjunctivitis''' is an infection of the [[conjunctiva]] either caused by [[viruses]] or [[bacteria]]. Airborne [[antigens]] may be involved in the [[pathogenesis]] of '''[[allergic conjunctivitis]]'''. Common airborne antigens include [[pollen]], grass, and weeds '''[[Allergic conjunctivitis]]''' is a common occurrence in people who have other signs of allergic disease. '''[[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]]''' is a multifactorial disease and associated with different [[medical conditions]].<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment.| journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468  }} </ref><ref name="pmid26681960">{{cite journal| author=Kyei S, Koffuor GA, Ramkissoon P, Abokyi S, Owusu-Afriyie O, Wiredu EA| title=Possible Mechanism of Action of the Antiallergic Effect of an Aqueous Extract of Heliotropium indicum L. in Ovalbumin-Induced Allergic Conjunctivitis. | journal=J Allergy (Cairo) | year= 2015 | volume= 2015 | issue=  | pages= 245370 | pmid=26681960 | doi=10.1155/2015/245370 | pmc=4657065 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26681960  }} </ref>
[[Conjunctivitis]] is defined as [[inflammation]] of [[bulbar]] and/or palpebral [[conjunctiva]]. Conjunctivitis has many etiologies, but the majority of cases can be caused by [[allergies]] or infection. Infective conjunctivitis is an infection of the [[conjunctiva]] either caused by [[viruses]] or [[bacteria]]. Airborne [[antigens]] may be involved in the pathogenesis of [[allergic conjunctivitis]]. Common airborne antigens include [[pollen]], grass, and weeds. [[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]] is a multifactorial disease and associated with different [[medical conditions]].<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment.| journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468  }} </ref><ref name="pmid26681960">{{cite journal| author=Kyei S, Koffuor GA, Ramkissoon P, Abokyi S, Owusu-Afriyie O, Wiredu EA| title=Possible Mechanism of Action of the Antiallergic Effect of an Aqueous Extract of Heliotropium indicum L. in Ovalbumin-Induced Allergic Conjunctivitis. | journal=J Allergy (Cairo) | year= 2015 | volume= 2015 | issue=  | pages= 245370 | pmid=26681960 | doi=10.1155/2015/245370 | pmc=4657065 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26681960  }} </ref>


==Pathophysiology==
==Pathophysiology==
===Pathogenesis===
===Pathogenesis===
====Infective Conjunctivitis====
====Infective Conjunctivitis====
Infective conjunctivitis is an infection of the [[conjunctiva]] either caused by [[viruses]] or [[bacteria]]. Ocular [[conjunctival]] surfaces are usually colonized by [[normal flora]] or external organism (such as ''[[Staphylococcus aureus]], [[Haemophilus influenzae]], [[Streptococcus pneumoniae]]).
Infective conjunctivitis is an infection of the [[conjunctiva]] either caused by [[viruses]] or [[bacteria]], such as [[adenovirus]], ''[[Staphylococcus aureus]]'', ''[[Streptococcus pneumoniae]]'', and ''[[Haemophilus influenzae]]''.
Any change in the host defense, or in the [[species]] of [[normal flora]] of the eye can lead to clinical infection and conjunctivitis.
Any change in the host defense, or in the [[species]] of [[normal flora]] of the eye, can lead to clinical infection and conjunctivitis.
Change in the [[normal flora]] can be occurred by:<ref name="pmid12564275">{{cite journal| author=Everitt H, Kumar S, Little P| title=A qualitative study of patients' perceptions of acute infective conjunctivitis. | journal=Br J Gen Pract | year= 2003 | volume= 53 | issue= 486 | pages= 36-41 | pmid=12564275 | doi= | pmc=1314490 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12564275  }} </ref>
 
Change in the [[normal flora]] may occur by:<ref name="pmid12564275">{{cite journal| author=Everitt H, Kumar S, Little P| title=A qualitative study of patients' perceptions of acute infective conjunctivitis. | journal=Br J Gen Pract | year= 2003 | volume= 53 | issue= 486 | pages= 36-41 | pmid=12564275 | doi= | pmc=1314490 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12564275  }} </ref>
* External contamination
* External contamination
* [[Contact lens]] wear  
* [[Contact lens]] wear  
* Swimming  
* Swimming  
Infective conjunctivitis is usually spread by:<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468  }} </ref><ref name="pmid26681960">{{cite journal| author=Kyei S, Koffuor GA, Ramkissoon P, Abokyi S, Owusu-Afriyie O, Wiredu EA| title=Possible Mechanism of Action of the Antiallergic Effect of an Aqueous Extract of Heliotropium indicum L. in Ovalbumin-Induced Allergic Conjunctivitis. | journal=J Allergy (Cairo) | year= 2015 | volume= 2015 | issue=  | pages= 245370 | pmid=26681960 | doi=10.1155/2015/245370 | pmc=4657065 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26681960  }} </ref>
Infective conjunctivitis is usually spread by:<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468  }} </ref><ref name="pmid26681960">{{cite journal| author=Kyei S, Koffuor GA, Ramkissoon P, Abokyi S, Owusu-Afriyie O, Wiredu EA| title=Possible Mechanism of Action of the Antiallergic Effect of an Aqueous Extract of Heliotropium indicum L. in Ovalbumin-Induced Allergic Conjunctivitis. | journal=J Allergy (Cairo) | year= 2015 | volume= 2015 | issue=  | pages= 245370 | pmid=26681960 | doi=10.1155/2015/245370 | pmc=4657065 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26681960  }} </ref>
* Direct contact with the infected person’s eye drainage or drainage from the person’s [[cough]], [[sneeze]], or [[runny nose]]
* Direct contact with the infected person’s eye drainage or drainage from the person’s [[cough]], [[sneeze]], or [[runny nose]]
* Contact with the infected person’s [[fingers]], [[hands]] or objects (eye makeup applicators, towels, shared eye medications)  
* Contact with the infected person’s [[fingers]], [[hands]], or objects (eye makeup applicators, towels, shared eye medications)  
* Adjacent infectious sites (rubbing of the eyes)
* Adjacent infectious sites (rubbing of the eyes)
'''Viral conjunctivitis''' is often caused by [[adenovirus]]. Viral conjunctivitis is highly contagious, and patients should avoid direct or indirect contact with other healthy individuals.
'''Acute hemorrhagic conjunctivitis''' may be caused by [[picornaviruses]] that are clinically similar to adenovirus conjunctivitis, but are more severe and [[hemorrhagic]].<ref name="pmid1088513">{{cite journal| author=Yin-Murphy M| title=Simple tests for the diagnosis of picornavirus epidemic conjunctivitis (acute hemorrhagic conjunctivitis). | journal=Bull World Health Organ | year= 1976 | volume= 54 | issue= 6 | pages= 675-9 | pmid=1088513 | doi= | pmc=2366581 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1088513  }} </ref><ref name=conjunctivitis> Centers for Disease Control and Prevention (2004) https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5328a2.htm Accessed on June 24, 2016</ref>
====Neonatal Conjunctivitis====
====Neonatal Conjunctivitis====
Neonatal conjunctivitis is occurring in a [[newborn]] during the first month of life, and often known as [[ophthalmia neonatorum]].  
Neonatal conjunctivitis is occurring in a [[newborn]] during the first month of life, and often known as [[ophthalmia neonatorum]].  
Neonatal conjunctivitis is mainly caused by [[sexually transmitted diseases]] agents such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', and [[Herpes simplex virus|Herpes simplex virus (HSV)]].  
Neonatal conjunctivitis is mainly caused by [[sexually transmitted diseases]] agents such as ''[[Chlamydia trachomatis]]'', ''[[Neisseria gonorrhoeae]]'', and [[herpes simplex virus|herpes simplex virus (HSV)]].  
''Chlamydia trachomatis'' is the most common cause of ophthalmia neonatorum in the developed countries because of higher [[prevalence]] of chlamydia as a [[sexually transmitted disease]].
''Chlamydia trachomatis'' is the most common cause of ophthalmia neonatorum in the developed countries because of higher prevalence of chlamydia as a [[sexually transmitted disease]].
 
The recognized routes of transmission of the organisms to the newborns include:<ref name="pmid7848819">{{cite journal| author=Treadwell P| title=Sexually transmitted diseases in neonates and infants. | journal=Semin Dermatol | year= 1994 | volume= 13 | issue= 4 | pages= 256-61 | pmid=7848819 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7848819  }} </ref>
The recognized routes of transmission of the organisms to the newborns include:<ref name="pmid7848819">{{cite journal| author=Treadwell P| title=Sexually transmitted diseases in neonates and infants. | journal=Semin Dermatol | year= 1994 | volume= 13 | issue= 4 | pages= 256-61 | pmid=7848819 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7848819  }} </ref>
*Infected [[birth canal]] during vaginal birth  
*Infected [[birth canal]] during vaginal birth  
*Transmembrane transmission of the infection
*Transmembrane transmission of the infection
*[[Transplacental]] transmission of the infection
*[[Transplacental]] transmission of the infection
On [[gross pathology]], It is characterized by eyelids edema, [[erythema]] of the palpebral conjunctiva, and [[purulent]] eye discharge. On a gram stained of [[conjunctival]] smear, one or more polymorph nuclear per oil immersion field may be detected.
Additionally, [[silver nitrate]] drops (ocular prophylaxis) can cause ocular irritation and result in chemical conjunctivitis in newborn.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
Additionally, neonatal conjunctivitis may caused by [[irritation]]. it is generally secondary to the instillation of silver nitrate drops for ocular prophylaxis.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref>
 
====Allergic Conjunctivitis====
====Allergic Conjunctivitis====
Airborne [[antigens]] may be involved in the [[pathogenesis]] of [[allergic conjunctivitis]]. Common airborne antigens include [[pollen]], grass, and weeds.<ref name="pmid19134019">{{cite journal| author=Malling HJ, Montagut A, Melac M, Patriarca G, Panzner P, Seberova E et al.| title=Efficacy and safety of 5-grass pollen sublingual immunotherapy tablets in patients with different clinical profiles of allergic rhinoconjunctivitis. | journal=Clin Exp Allergy | year= 2009 | volume= 39 | issue= 3 | pages= 387-93 | pmid=19134019 | doi=10.1111/j.1365-2222.2008.03152.x | pmc=4233960 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19134019  }} </ref><ref name="pmid17967188">{{cite journal| author=Kämpe M, Stålenheim G, Janson C, Stolt I, Carlson M| title=Systemic and local eosinophil inflammation during the birch pollen season in allergic patients with predominant rhinitis or asthma. | journal=Clin Mol Allergy | year= 2007 | volume= 5 | issue=  | pages= 4 | pmid=17967188 | doi=10.1186/1476-7961-5-4 | pmc=2174506 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17967188  }} </ref>
Development of allergic conjunctivitis is the result of [[type 1 hypersensitivity]] reaction in the [[conjunctiva]].
Allergic conjunctivitis is caused by the [[IgE|immunoglobulin E (IgE)]] mediated reaction to environmental [[allergens]].
Following exposure to environmental [[allergens]] in sensitized individual, the cross-linking of [[IgE]] at the [[mast cell]] membrane level results in subsequent cell [[degranulation]] and secretion of [[histamine]], [[leukotriene]], and [[prostaglandin]]. The principal effects of these products are [[vasodilation]] and smooth-muscle contraction.
Common airborne antigens involve in the [[pathogenesis]] of [[allergic conjunctivitis]] include [[pollen]], grass, and weeds.<ref name="pmid19134019">{{cite journal| author=Malling HJ, Montagut A, Melac M, Patriarca G, Panzner P, Seberova E et al.| title=Efficacy and safety of 5-grass pollen sublingual immunotherapy tablets in patients with different clinical profiles of allergic rhinoconjunctivitis. | journal=Clin Exp Allergy | year= 2009 | volume= 39 | issue= 3 | pages= 387-93 | pmid=19134019 | doi=10.1111/j.1365-2222.2008.03152.x | pmc=4233960 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19134019  }} </ref><ref name="pmid17967188">{{cite journal| author=Kämpe M, Stålenheim G, Janson C, Stolt I, Carlson M| title=Systemic and local eosinophil inflammation during the birch pollen season in allergic patients with predominant rhinitis or asthma. | journal=Clin Mol Allergy | year= 2007 | volume= 5 | issue=  | pages= 4 | pmid=17967188 | doi=10.1186/1476-7961-5-4 | pmc=2174506 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17967188  }} </ref>


Allergic conjunctivitis is often associated with [[atopic diseases]], such as [[allergic rhinitis]] (most common), [[eczema]], and [[asthma]].
Combination of type 1 and type 4 hypersensitivity reactions may be responsible for '''giant papillary conjunctivitis'''. Also, prolonged mechanical irritation to the [[superior tarsal muscle|superior tarsal]] conjunctiva of the upper lid from [[foreign bodies]] may also be a contributing factor in giant papillary conjunctivitis.<ref name="pmid7886881">{{cite journal| author=Donshik PC| title=Giant papillary conjunctivitis. | journal=Trans Am Ophthalmol Soc | year= 1994 | volume= 92 | issue=  | pages= 687-744 | pmid=7886881 | doi= | pmc=1298525 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7886881  }} </ref><ref name="pmid10703125">{{cite journal| author=Donshik PC, Porazinski AD| title=Giant papillary conjunctivitis in frequent-replacement contact lens wearers: a retrospective study. | journal=Trans Am Ophthalmol Soc | year= 1999 | volume= 97 | issue=  | pages= 205-16; discussion 216-20 | pmid=10703125 | doi= | pmc=1298261 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10703125  }} </ref>
Development of allergic conjunctivitis is the result of [[type 1 hypersensitivity]] (immediate hypersensitivity) reactions involving the [[conjunctiva]].
Type I hypersensitivity is an allergic reaction provoked by reexposure to a specific type of [[antigen]] or [[allergens]].
[[IgE]] and [[mast cells]] play an important role in these allergic inflammations. IgE mediated release of [[histamine]] and other mediators from [[mast cells]] and [[basophils]]


Combination of type 1 and type 4 hypersensitivity reactions may be responsible for '''giant papillary conjunctivitis'''. Also, prolonged mechanical irritation to the [[superior tarsal muscle|superior tarsal]] conjunctiva of the upper lid from [[foreign bodies]] may also be a contributing factor in giant papillary conjunctivitis.<ref name="pmid7886881">{{cite journal| author=Donshik PC| title=Giant papillary conjunctivitis. | journal=Trans Am Ophthalmol Soc | year= 1994 | volume= 92 | issue=  | pages= 687-744 | pmid=7886881 | doi= | pmc=1298525 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7886881  }} </ref><ref name="pmid10703125">{{cite journal| author=Donshik PC, Porazinski AD| title=Giant papillary conjunctivitis in frequent-replacement contact lens wearers: a retrospective study. | journal=Trans Am Ophthalmol Soc | year= 1999 | volume= 97 | issue=  | pages= 205-16; discussion 216-20 | pmid=10703125 | doi= | pmc=1298261 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10703125  }} </ref>
====Keratoconjunctivitis Sicca====
====Keratoconjunctivitis Sicca====
[[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]] is a multifactorial disease and associated with different [[medical conditions]] such as:<ref name="pmid27179980">{{cite journal| author=Sivaraman KR, Jivrajka RV, Soin K, Bouchard CS, Movahedan A, Shorter E et al.| title=Superior Limbic Keratoconjunctivitis-like Inflammation in Patients with Chronic Graft-Versus-Host Disease. | journal=Ocul Surf | year= 2016 | volume=  | issue=  | pages=  | pmid=27179980 | doi=10.1016/j.jtos.2016.04.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27179980  }} </ref><ref name="pmid25686388">{{cite journal| author=Messmer EM| title=The pathophysiology, diagnosis, and treatment of dry eye disease. | journal=Dtsch Arztebl Int | year= 2015 | volume= 112 | issue= 5 | pages= 71-81; quiz 82 | pmid=25686388 | doi=10.3238/arztebl.2015.0071 | pmc=4335585 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25686388  }} </ref>
[[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]] is a multifactorial disease and associated with different [[medical conditions]] such as:<ref name="pmid27179980">{{cite journal| author=Sivaraman KR, Jivrajka RV, Soin K, Bouchard CS, Movahedan A, Shorter E et al.| title=Superior Limbic Keratoconjunctivitis-like Inflammation in Patients with Chronic Graft-Versus-Host Disease. | journal=Ocul Surf | year= 2016 | volume=  | issue=  | pages=  | pmid=27179980 | doi=10.1016/j.jtos.2016.04.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27179980  }} </ref><ref name="pmid25686388">{{cite journal| author=Messmer EM| title=The pathophysiology, diagnosis, and treatment of dry eye disease. | journal=Dtsch Arztebl Int | year= 2015 | volume= 112 | issue= 5 | pages= 71-81; quiz 82 | pmid=25686388 | doi=10.3238/arztebl.2015.0071 | pmc=4335585 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25686388  }} </ref>
Line 49: Line 47:
* [[Anxiety disorder]]
* [[Anxiety disorder]]
* [[Depression]]
* [[Depression]]
Keratoconjunctivitis sicca associated [[Sjögren's syndrome]] may caused by focal infiltration of the [[lacrimal gland]] and [[conjunctiva]] with [[CD4+ T cells]] and [[B cells]]. Focal infiltration can induce [[apoptosis]], and this results in dysfunction of the [[lacrimal gland]] with reduced [[tear]] production.
The exact pathogenesis of the keratoconjunctivitis sicca associated [[Sjögren's syndrome]] is not fully understood. It is thought that keratoconjunctivitis sicca associated [[Sjögren's syndrome]] is the result of lymphocytic infiltration and malfunction of the [[lacrimal glands]].
Additionally, keratoconjunctivitis sicca associated [[Sjögren's syndrome]] can lead to chronic [[inflammatory state]] with production of [[autoantibodies]] such as:<ref name="pmid9820935">{{cite journal| author=Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC| title=The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. | journal=Cornea | year= 1998 | volume= 17 | issue= 6 | pages= 584-9 | pmid=9820935 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9820935  }} </ref>
This lymphasitic infiltration ([[CD4+ T cells]] and [[B cells]]) may result in [[lacrimal gland]] dysfunction and reduced [[tear]] production (mediated by [[apoptosis]]).
*[[Antinuclear antibody|Antinuclear antibody (ANA)]]
 
*[[Rheumatoid factor|Rheumatoid factor (RF)]]
*Fodrin (a cytoskeletal protein)
*[[Muscarinic receptor|Muscarinic M3 receptor]]
*[[Sjögren's syndrome]]-specific antibodies (anti-RO and anti-LA)
====Superior Limbic Keratoconjunctivitis====
====Superior Limbic Keratoconjunctivitis====
[[Superior limbic keratoconjunctivitis|Superior limbic keratoconjunctivitis (SLK)]] is disease characterized by [[inflammation]] of the upper palpebral and superior [[bulbar conjunctiva]]. On microscopic [[histopathological]] analysis, it is charactrized by [[keratinization]] of the superior limbus, corneal filaments, and conjunctival filaments.
[[Superior limbic keratoconjunctivitis|Superior limbic keratoconjunctivitis (SLK)]] is disease characterized by [[inflammation]] of the upper palpebral and superior [[bulbar conjunctiva]].
The exact pathogenesis of superior limbic keratoconjunctivitis is not fully understood, a mechanical [[hypothesis]] seems most attractive. It is thought that mechanical trauma from tight upper lids or loose redundant conjunctiva could lead to the disruption of normal [[epithelium]]. Also association between [[thyroid]] abnormalities ([[Graves ophthalmopathy]]) and superior limbic keratoconjunctivitis has been reported.<ref name="pmid2695351">{{cite journal| author=Nelson JD| title=Superior limbic keratoconjunctivitis (SLK). | journal=Eye (Lond) | year= 1989 | volume= 3 ( Pt 2) | issue=  | pages= 180-9 | pmid=2695351 | doi=10.1038/eye.1989.26 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2695351  }} </ref><ref name="pmid25792798">{{cite journal| author=Chelala E, El Rami H, Dirani A, Fakhoury H, Fadlallah A| title=Extensive superior limbic keratoconjunctivitis in Graves' disease: case report and mini-review of the literature. | journal=Clin Ophthalmol | year= 2015 | volume= 9 | issue=  | pages= 467-8 | pmid=25792798 | doi=10.2147/OPTH.S79561 | pmc=4362972 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25792798  }} </ref><ref name=Superior_limbic_keratoconjunctivitis >  American Academy of Ophthalmology (2015) http://eyewiki.aao.org/Superior_limbic_keratoconjunctivitis Accessed on June 27, 2016 </ref>
The exact pathogenesis of superior limbic keratoconjunctivitis is not fully understood, a mechanical [[hypothesis]] seems most attractive. It is thought that mechanical trauma from tight upper lids or loose redundant conjunctiva can lead to the disruption of normal [[epithelium]]. Also, the association between [[thyroid]] abnormalities ([[graves ophthalmopathy]]) and superior limbic keratoconjunctivitis has been reported.<ref name="pmid2695351">{{cite journal| author=Nelson JD| title=Superior limbic keratoconjunctivitis (SLK). | journal=Eye (Lond) | year= 1989 | volume= 3 ( Pt 2) | issue=  | pages= 180-9 | pmid=2695351 | doi=10.1038/eye.1989.26 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2695351  }} </ref><ref name="pmid25792798">{{cite journal| author=Chelala E, El Rami H, Dirani A, Fakhoury H, Fadlallah A| title=Extensive superior limbic keratoconjunctivitis in Graves' disease: case report and mini-review of the literature. | journal=Clin Ophthalmol | year= 2015 | volume= 9 | issue=  | pages= 467-8 | pmid=25792798 | doi=10.2147/OPTH.S79561 | pmc=4362972 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25792798  }} </ref><ref name=Superior_limbic_keratoconjunctivitis >  American Academy of Ophthalmology (2015) http://eyewiki.aao.org/Superior_limbic_keratoconjunctivitis Accessed on June 27, 2016 </ref>


===Gross Pathology===
===Gross Pathology===
Line 66: Line 60:
*Pseudomembrane formation
*Pseudomembrane formation
*[[Chemosis]]
*[[Chemosis]]
*Eyelid swelling
*Eyelid edema
*[[Conjunctival hemorrhage]] (specific for Acute hemorrhagic conjunctivitis)
*[[Conjunctival hemorrhage]] (specific for acute hemorrhagic conjunctivitis)


===Microscopic histopathological analysis===
===Microscopic Histopathological Analysis===
On microscopic histopathological analysis, the following are characteristic findings of conjunctivitis:<ref name=Conjunctivitis > DermNet NZ (2015)[http://www.dermnetnz.org/pathology/conjunctivitis-path.html] Accessed on June 26, 2016 </ref>
On microscopic histopathological analysis, the following are characteristic findings of conjunctivitis:<ref name=Conjunctivitis > DermNet NZ (2015)[http://www.dermnetnz.org/pathology/conjunctivitis-path.html] Accessed on June 26, 2016 </ref>
*Mild spongiotic reaction pattern (low power view of the histology)
*Mild spongiotic reaction pattern (low power view of the histology)
*Stromal infiltration by polymorphonuclear, [[leukocytes]], [[plasma cells]], [[mastocytes]], and [[lymphocyte]]
*Stromal infiltration by [[polymorphonuclear cells]], [[leukocytes]], [[plasma cells]], [[mastocytes]], and [[lymphocyte]]
*[[Eosinophils]] ([[allergic conjunctivitis]])
*[[Eosinophils]] ([[allergic conjunctivitis]])
*Numerous [[neutrophils]] (bacterial conjunctivitis)
*Numerous [[neutrophils]] (bacterial conjunctivitis)
*[[Hyperplastic]] with increase numbers of [[plasma cell]] (chronic conjunctivitis)
*[[Hyperplastic]] with increase numbers of [[plasma cell]] (chronic conjunctivitis)
*epithelial cells [[Keratinization]] of the superior limbus ([[Superior limbic keratoconjunctivitis|Superior limbic keratoconjunctivitis (SLK)]])
*[[Keratinization]] of the superior limbus ([[Superior limbic keratoconjunctivitis|superior limbic keratoconjunctivitis (SLK)]])
*Dyskeratosis ([[Superior limbic keratoconjunctivitis|Superior limbic keratoconjunctivitis (SLK)]])
*Dyskeratosis ([[Superior limbic keratoconjunctivitis|superior limbic keratoconjunctivitis (SLK)]])


===Images===
===Images===
The following are gross and microscopic images associated with [[conjunctivitis]].
The following are gross and microscopic images associated with conjunctivitis:


<gallery>
<gallery>
Image:An eye with viral conjunctivitis.jpg|Viral conjunctivitis<ref> Image Courtesy of Joyhil09 [https://commons.wikimedia.org/wiki/File:An_eye_with_viral_conjunctivitis.jpg]</ref>
Image:An eye with viral conjunctivitis.jpg|Viral conjunctivitis - By Joyhill09 - I took this photo with a Nikon D40 of my eye infected with conjunctivitis, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18954730


Image:220px-Acute_hemorrhagic_conjunctivitis.jpg|Acute hemorrhagic conjunctivitis<ref> Image Courtesy of James Heilman [https://en.wikipedia.org/wiki/Acute_hemorrhagic_conjunctivitis#/media/File:Acute_hemorrhagic_conjunctivitis.jpg]</ref>
Image:220px-Acute_hemorrhagic_conjunctivitis.jpg|Acute hemorrhagic conjunctivitis - By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=27401136


Image:220px-Gonococcal_ophthalmia_neonatorum.jpg|Neonatal conjunctivitis<ref> Centers for Disease Control and Prevention's Public Health Image
Image:220px-Gonococcal_ophthalmia_neonatorum.jpg|Neonatal conjunctivitis - Source: https://www.cdc.gov/
Library[https://en.wikipedia.org/wiki/Neonatal_conjunctivitis#/media/File:Gonococcal_ophthalmia_neonatorum.jpg]</ref>


Image:chlamydial conjunctivitis.jpg|Chlamydial conjunctivitis (Day 5-14)<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages</ref>
</gallery>
</gallery>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 21:07, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [4]

Overview

Conjunctivitis is defined as inflammation of bulbar and/or palpebral conjunctiva. Conjunctivitis has many etiologies, but the majority of cases can be caused by allergies or infection. Infective conjunctivitis is an infection of the conjunctiva either caused by viruses or bacteria. Airborne antigens may be involved in the pathogenesis of allergic conjunctivitis. Common airborne antigens include pollen, grass, and weeds. Keratoconjunctivitis sicca (dry eye syndrome) is a multifactorial disease and associated with different medical conditions.[1][2]

Pathophysiology

Pathogenesis

Infective Conjunctivitis

Infective conjunctivitis is an infection of the conjunctiva either caused by viruses or bacteria, such as adenovirus, Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae. Any change in the host defense, or in the species of normal flora of the eye, can lead to clinical infection and conjunctivitis.

Change in the normal flora may occur by:[3]

Infective conjunctivitis is usually spread by:[1][2]

  • Direct contact with the infected person’s eye drainage or drainage from the person’s cough, sneeze, or runny nose
  • Contact with the infected person’s fingers, hands, or objects (eye makeup applicators, towels, shared eye medications)
  • Adjacent infectious sites (rubbing of the eyes)

Neonatal Conjunctivitis

Neonatal conjunctivitis is occurring in a newborn during the first month of life, and often known as ophthalmia neonatorum. Neonatal conjunctivitis is mainly caused by sexually transmitted diseases agents such as Chlamydia trachomatis, Neisseria gonorrhoeae, and herpes simplex virus (HSV). Chlamydia trachomatis is the most common cause of ophthalmia neonatorum in the developed countries because of higher prevalence of chlamydia as a sexually transmitted disease.

The recognized routes of transmission of the organisms to the newborns include:[4]

  • Infected birth canal during vaginal birth
  • Transmembrane transmission of the infection
  • Transplacental transmission of the infection

Additionally, silver nitrate drops (ocular prophylaxis) can cause ocular irritation and result in chemical conjunctivitis in newborn.[5]

Allergic Conjunctivitis

Development of allergic conjunctivitis is the result of type 1 hypersensitivity reaction in the conjunctiva. Allergic conjunctivitis is caused by the immunoglobulin E (IgE) mediated reaction to environmental allergens. Following exposure to environmental allergens in sensitized individual, the cross-linking of IgE at the mast cell membrane level results in subsequent cell degranulation and secretion of histamine, leukotriene, and prostaglandin. The principal effects of these products are vasodilation and smooth-muscle contraction. Common airborne antigens involve in the pathogenesis of allergic conjunctivitis include pollen, grass, and weeds.[6][7]

Combination of type 1 and type 4 hypersensitivity reactions may be responsible for giant papillary conjunctivitis. Also, prolonged mechanical irritation to the superior tarsal conjunctiva of the upper lid from foreign bodies may also be a contributing factor in giant papillary conjunctivitis.[8][9]

Keratoconjunctivitis Sicca

Keratoconjunctivitis sicca (dry eye syndrome) is a multifactorial disease and associated with different medical conditions such as:[10][11]

The exact pathogenesis of the keratoconjunctivitis sicca associated Sjögren's syndrome is not fully understood. It is thought that keratoconjunctivitis sicca associated Sjögren's syndrome is the result of lymphocytic infiltration and malfunction of the lacrimal glands. This lymphasitic infiltration (CD4+ T cells and B cells) may result in lacrimal gland dysfunction and reduced tear production (mediated by apoptosis).

Superior Limbic Keratoconjunctivitis

Superior limbic keratoconjunctivitis (SLK) is disease characterized by inflammation of the upper palpebral and superior bulbar conjunctiva. The exact pathogenesis of superior limbic keratoconjunctivitis is not fully understood, a mechanical hypothesis seems most attractive. It is thought that mechanical trauma from tight upper lids or loose redundant conjunctiva can lead to the disruption of normal epithelium. Also, the association between thyroid abnormalities (graves ophthalmopathy) and superior limbic keratoconjunctivitis has been reported.[12][13][14]

Gross Pathology

On gross pathology, the following are characteristic findings of conjunctivitis:[15]

Microscopic Histopathological Analysis

On microscopic histopathological analysis, the following are characteristic findings of conjunctivitis:[16]

Images

The following are gross and microscopic images associated with conjunctivitis:

References

  1. ↑ 1.0 1.1 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.
  2. ↑ 2.0 2.1 Kyei S, Koffuor GA, Ramkissoon P, Abokyi S, Owusu-Afriyie O, Wiredu EA (2015). "Possible Mechanism of Action of the Antiallergic Effect of an Aqueous Extract of Heliotropium indicum L. in Ovalbumin-Induced Allergic Conjunctivitis". J Allergy (Cairo). 2015: 245370. doi:10.1155/2015/245370. PMC 4657065. PMID 26681960.
  3. ↑ Everitt H, Kumar S, Little P (2003). "A qualitative study of patients' perceptions of acute infective conjunctivitis". Br J Gen Pract. 53 (486): 36–41. PMC 1314490. PMID 12564275.
  4. ↑ Treadwell P (1994). "Sexually transmitted diseases in neonates and infants". Semin Dermatol. 13 (4): 256–61. PMID 7848819.
  5. ↑ 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.
  6. ↑ Malling HJ, Montagut A, Melac M, Patriarca G, Panzner P, Seberova E; et al. (2009). "Efficacy and safety of 5-grass pollen sublingual immunotherapy tablets in patients with different clinical profiles of allergic rhinoconjunctivitis". Clin Exp Allergy. 39 (3): 387–93. doi:10.1111/j.1365-2222.2008.03152.x. PMC 4233960. PMID 19134019.
  7. ↑ Kämpe M, Stålenheim G, Janson C, Stolt I, Carlson M (2007). "Systemic and local eosinophil inflammation during the birch pollen season in allergic patients with predominant rhinitis or asthma". Clin Mol Allergy. 5: 4. doi:10.1186/1476-7961-5-4. PMC 2174506. PMID 17967188.
  8. ↑ Donshik PC (1994). "Giant papillary conjunctivitis". Trans Am Ophthalmol Soc. 92: 687–744. PMC 1298525. PMID 7886881.
  9. ↑ Donshik PC, Porazinski AD (1999). "Giant papillary conjunctivitis in frequent-replacement contact lens wearers: a retrospective study". Trans Am Ophthalmol Soc. 97: 205–16, discussion 216-20. PMC 1298261. PMID 10703125.
  10. ↑ Sivaraman KR, Jivrajka RV, Soin K, Bouchard CS, Movahedan A, Shorter E; et al. (2016). "Superior Limbic Keratoconjunctivitis-like Inflammation in Patients with Chronic Graft-Versus-Host Disease". Ocul Surf. doi:10.1016/j.jtos.2016.04.003. PMID 27179980.
  11. ↑ Messmer EM (2015). "The pathophysiology, diagnosis, and treatment of dry eye disease". Dtsch Arztebl Int. 112 (5): 71–81, quiz 82. doi:10.3238/arztebl.2015.0071. PMC 4335585. PMID 25686388.
  12. ↑ Nelson JD (1989). "Superior limbic keratoconjunctivitis (SLK)". Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.
  13. ↑ Chelala E, El Rami H, Dirani A, Fakhoury H, Fadlallah A (2015). "Extensive superior limbic keratoconjunctivitis in Graves' disease: case report and mini-review of the literature". Clin Ophthalmol. 9: 467–8. doi:10.2147/OPTH.S79561. PMC 4362972. PMID 25792798.
  14. ↑ American Academy of Ophthalmology (2015) http://eyewiki.aao.org/Superior_limbic_keratoconjunctivitis Accessed on June 27, 2016
  15. ↑ National Eye Institute (2015) [1] Accessed on June 24, 2016
  16. ↑ DermNet NZ (2015)[2] Accessed on June 26, 2016

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