Conjunctivitis natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
The outcome is usually good with treatment. Conjunctivitis resolves, in 65% of cases, within 2 – 5 days.[1]
Natural History
If left untreated, most cases of viral conjunctivitis are mild and will clear up in 7 to 14 days without treatment and 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.
If left untreated, acute hemorrhagic conjunctivitis will clear up in 5 to 7 days, and almost always resolves without sequelae.
If left untreated, mild bacterial conjunctivitis may get better without causing any severe complications. However, hyperacute bacterial conjunctivitis presents with a severe copious purulent discharge and decreased vision, and there is often accompanying eyelid swelling, eye pain on palpation, and preauricular adenopathy. It is often caused by Neisseria gonorrhoeae and may lead to involvement and subsequent corneal perforation.
Allergic conjunctivitis usually improves by eliminating or significantly reducing contact with the allergen (pollen or animal dander).
Complications
Viral Conjunctivitis
- 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).
- Sepsis
- Meningitis
- corneal perforation
- keratitis
- Corneal epithelial defects
Neonatal Conjunctivitis
- 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
- Conjunctivochalasis (chronic recurrences)
- Ulceration
- Opacification
- Visual loss
- Steroid induced intraocular pressure elevations
- Cataract
Keratoconjunctivitis Sicca
Keratoconjunctivitis Sicca (Dry eye syndrome) may be complicated by sterile or infectious corneal ulceration, particularly in patients with SS. Ulcers are typically oval or circular, less than 3 mm in diameter, and located in the central or paracentral cornea. Occasionally, corneal perforation may occur. In rare cases, sterile or infectious corneal ulceration in dry eye syndrome can cause blindness. This risk is markedly increased with contact lens use, particularly with overnight wear. Punctate epithelial defects (PEDs) may be present. Significant punctate epitheliopathy can lead to corneal erosions, both sterile and infectious corneal ulceration, corneal neovascularization, corneal scarring, corneal thinning, and even corneal perforation. The prognosis of dry eye syndrome varies depending on the severity of the condition. Most patients have mild-to-moderate cases, and they can be treated symptomatically with lubricants, providing adequate relief of symptoms. In general, the prognosis for visual acuity in patients with dry eye syndrome is good. Patients with SS or prolonged untreated dry eye represent a subgroup with a worse prognosis, requiring a longer course of treatment.
- Corneal ulceration
- Corneal erosions
- Corneal neovascularization
- Corneal scarring
- Corneal thinning
- Corneal perforation
Prognosis
Acute hemorrhagic conjunctivitis almost always resolves without sequelae, and has a good visual prognosis. The prognosis of bacterial conjunctivitis is good. However, hyperacute bacterial conjunctivitis presents with a severe copious purulent discharge and decreased vision (Figure 3). There is often accompanying eyelid swelling, eye pain on palpation, and preauricular adenopathy. It is often caused by Neisseria gonorrhoeae and carries a high risk for corneal involvement and subsequent corneal perforation Prognosis of neonatal conjunctivitis is generally considered to be good as long as early diagnosis is made and prompt medical therapy is initiated. Most cases of infectious conjunctivitis respond to appropriate treatment. However, morbidity and mortality increases in cases of systemic involvement requiring hospitalization and intensive monitoring. The prognosis of allergic conjunctivitis is good. However, atopic keratovonjunctivitis and vernal keratoconjunctivitis may lead to leading to permanent visual loss.
In general, the prognosis for visual acuity in patients with dry eye syndrome is good. In general, the prognosis for superior limbic keratoconjunctivitis is excellent, with remission as the natural history and eventual total resolution, although symptoms may last for years.