Conjunctivitis natural history: Difference between revisions
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'''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, disappearing spontaneously within 2-4 days. ''[[Gonococcal]]'' conjunctivitis tends to occur 2-7 days after birth but can present later. The onset of ''[[chlamydial]]'' conjunctivitis is usually later than gonococcal conjunctivitis, the [[incubation period]] is 5-14 days. ''[[Herpetic]]'' conjunctivitis usually occurs within the first 2 weeks after birth and has an incubation period of approximately 6-14 days.''[[Gonococcal]]'' conjunctivitis tends to be more severe than other causes of [[ophthalmia neonatorum]]. It presents with severe [[bilateral]] [[purulent]] conjunctivitis, tearing, [[eyelid]] [[swelling]]. If left untreated, may cause [[corneal]] involvement such as [[diffuse]] [[epithelial]] [[edema]], [[ulceration]] and [[diffuse]] opacification. This may lead to[[Sepsis]], ultimately [[blindness]] and death. | '''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, disappearing spontaneously within 2-4 days. ''[[Gonococcal]]'' conjunctivitis tends to occur 2-7 days after birth but can present later. The onset of ''[[chlamydial]]'' conjunctivitis is usually later than gonococcal conjunctivitis, the [[incubation period]] is 5-14 days. ''[[Herpetic]]'' conjunctivitis usually occurs within the first 2 weeks after birth and has an incubation period of approximately 6-14 days.''[[Gonococcal]]'' conjunctivitis tends to be more severe than other causes of [[ophthalmia neonatorum]]. It presents with severe [[bilateral]] [[purulent]] conjunctivitis, tearing, [[eyelid]] [[swelling]]. If left untreated, may cause [[corneal]] involvement such as [[diffuse]] [[epithelial]] [[edema]], [[ulceration]] and [[diffuse]] opacification. This may lead to[[Sepsis]], ultimately [[blindness]] and death. | ||
''[[Chlamydial]]'' conjunctivitis presents with [[mild]] [[hyperemia]], mucoid discharge, [[eyelid]] [[swelling]], pseudomembrane formation. If left untreated, can gradually progress to central corneal opacification by mechanisms reminiscent of [[trachoma]]. This may lead to [[blindness]].<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> | ''[[Chlamydial]]'' conjunctivitis presents with [[mild]] [[hyperemia]], mucoid discharge, [[eyelid]] [[swelling]], pseudomembrane formation. If left untreated, can gradually progress to central corneal opacification by mechanisms reminiscent of [[trachoma]]. This may lead to [[blindness]].<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''' 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 improves by eliminating or significantly reducing contact with the [[allergen]] ([[pollen]] or [[animal dander]]) without any long-term consequences.<ref name="pmid23497516">{{cite journal| author=La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S et al.| title=Allergic conjunctivitis: a comprehensive review of the literature. | journal=Ital J Pediatr | year= 2013 | volume= 39 | issue= | pages= 18 | pmid=23497516 | doi=10.1186/1824-7288-39-18 | pmc=3640929 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23497516 }} </ref> | '''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 improves by eliminating or significantly reducing contact with the [[allergen]] ([[pollen]] or [[animal dander]]) without any long-term consequences.<ref name="pmid23497516">{{cite journal| author=La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S et al.| title=Allergic conjunctivitis: a comprehensive review of the literature. | journal=Ital J Pediatr | year= 2013 | volume= 39 | issue= | pages= 18 | pmid=23497516 | doi=10.1186/1824-7288-39-18 | pmc=3640929 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23497516 }} </ref> | ||
Revision as of 20:14, 30 June 2016
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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
The conjunctivitis outcome is usually good with treatment. Conjunctivitis resolves, in 65% of cases, within 2 – 5 days.[1]
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 up in 7 to 14 days without any long-term consequences. if complications arise, viral conjunctivitis can take two or more weeks to resolve. If the conjunctivitis persists, the epithelial abnormalities may occur. In general, the stromal or subepithelial abnormalities may resolved. However, the stromal abnormalities may persist for months to years, long after the epithelial changes have resolved. In such cases, If subepithelial infiltrates are in the pupillary axis, they may lead to decreased vision.[1]
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, almost always resolves without sequelae.[2]
Bacterial conjunctivitis presents with red eye, purulent or 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 up in 7 to 10 days without any long-term consequences. However, for patients who have purulent or mucopurulent discharge (suspected chlamydial and gonococcal conjunctivitis), who wear contact lenses, and who are immunocompromised, if left untreated, may cause corneal damage (such as corneal ulcer, scar, and perforation), sepsis, and meningitis. This may lead to permanent blindness and death.[3]
Hyperacute bacterial conjunctivitis 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, may cause corneal involvement. this may lead to corneal perforation.[4]
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, disappearing spontaneously within 2-4 days. Gonococcal conjunctivitis tends to occur 2-7 days after birth but can present later. The onset of chlamydial conjunctivitis is usually later than gonococcal conjunctivitis, the incubation period is 5-14 days. Herpetic conjunctivitis usually occurs within the first 2 weeks after birth and has an incubation period of approximately 6-14 days.Gonococcal conjunctivitis tends to be more severe than other causes of ophthalmia neonatorum. It presents with severe bilateral purulent conjunctivitis, tearing, eyelid swelling. If left untreated, may cause corneal involvement such as diffuse epithelial edema, ulceration and diffuse opacification. This may lead toSepsis, ultimately blindness and death. Chlamydial conjunctivitis presents with mild hyperemia, mucoid discharge, eyelid swelling, pseudomembrane formation. If left untreated, can gradually progress to central corneal opacification by mechanisms reminiscent of trachoma. This may lead to blindness.[5]
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 improves by eliminating or significantly reducing contact with the allergen (pollen or animal dander) without any long-term consequences.[6]
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. If left untreated, with prolonged use of the eyes, or with exposure to extreme environmental conditions, corneal perforation, and corneal ulceration may occur. This may lead to permanent blindness.[7]
Superior limbic keratoconjunctivitis symptoms develop around the sixth decade of life, and include a foreign body sensation, burning sensation, pruritus, and dry eye sensation. Superior limbic keratoconjunctivitistypically is associated with remission as the natural history and eventual total resolution, although symptoms may last for years.[8]
Complications
Viral Conjunctivitis
Complications to viral conjunctivitis include:[9]
- Bacterial superinfection
- Keratitis
- Subepithelial infiltrates
- Corneal ulceration with keratoconjunctivitis
- Chronic infection
Bacterial Conjunctivitis
Complications are expected to develop only in cases caused by extremely pathogenic bacteria (such as chlamydia trachomatis or neisseria gonorrhoeae). Complications to bacterial conjunctivitis include:[10]
- Sepsis
- Meningitis
- corneal perforation
- keratitis
- Corneal epithelial defects
Neonatal Conjunctivitis
Complications to neonatal conjunctivitis include:[11]
- 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
- Pneumonia
- Otitis
- Pharyngeal and rectal colonization
- Systemic complications of gonococcal conjunctivitis
- Arthritis
- Meningitis
- Anorectal infection
- Septicemia
- Death
Allergic Conjunctivitis
Complications to allergic conjunctivitis include:[12][13]
- Conjunctivochalasis (chronic recurrences)
- Ulceration
- Opacification
- Visual loss
- Steroid induced intraocular pressure elevations
- Cataract
Keratoconjunctivitis Sicca
Complications to keratoconjunctivitis sicca include:[14]
- Corneal ulceration
- Corneal erosions
- Corneal neovascularization
- Corneal scarring
- Corneal thinning
- Corneal perforation
Prognosis
Viral conjunctivitis is often self-limited and most patients recover in 2 to 4 weeks. viral conjunctivitis associated with Subepithelial infiltrates may last for several months, and may cause decreased vision.[15]
Acute hemorrhagic conjunctivitis almost always resolves without sequelae, and has a good visual prognosis.[16]
Bacterial conjunctivitis is often self-limited and most patients recover in 1 or 2 weeks, and generally is associated with a favorable long-term prognosis. However, bacterial conjunctivitis associated with extremely pathogenic bacteria, such as chlamydia trachomatisor neisseria gonorrhoeae, is associated with significant morbidity and may result in systemic involvement and mortality.[17]
Hyperacute bacterial conjunctivitis is associated with corneal involvement and subsequent corneal perforation, and therefore these patients have a poorer long term prognosis.[18]
Early detection and early treatment of neonatal conjunctivitis is associated with a good prognosis.
Neonatal conjunctivitis associated with misdiagnosis is associated with systemic involvement and may result in more complicated course and poorer outcomes.[19]
Allergic conjunctivitis is associated with a favorable long-term prognosis. However, atopic keratovonjunctivitis and vernal keratoconjunctivitis (allergic conjunctivitis subtypes) are associated with poor outcomes.[20]
Keratoconjunctivitis sicca (dry eye syndrome) is associated with a favorable long-term prognosis. Keratoconjunctivitis sicca associated with Sjögren's syndrome is associated with a particularly poor prognosis and requiring a longer course of treatment.[21]
Superior limbic keratoconjunctivitis is associated with excellent prognosis, with remission as the natural history and eventual total resolution, although symptoms may last for years.[22]
References
- ↑ 1.0 1.1 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.
- ↑ 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.
- ↑ Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Høvding G (2004). "[Acute bacterial conjunctivitis]". Tidsskr Nor Laegeforen. 124 (11): 1518–20. PMID 15195156.
- ↑ Centers for Disease Control and Prevention (2015)[1] Accessed on June 30, 2016
- ↑ 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.
- ↑ Bonini S (2004). "Atopic keratoconjunctivitis". Allergy. 59 Suppl 78: 71–3. doi:10.1111/j.1398-9995.2004.00570.x. PMID 15245362.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ "Bacterial conjunctivitis in children: antibiotic eye drops only if eye washing is ineffective". Prescrire Int. 16 (89): 120–1. 2007. PMID 17585426.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Nelson JD (1989). "Superior limbic keratoconjunctivitis (SLK)". Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.