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 conjunctivitis outcome is usually good with treatment. Conjunctivitis resolves, in 65% of cases, within 2 – 5 days.

Natural History

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.

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.

The incubation period for bacterial conjunctivitis is estimated to be 1 to 7 days. Bacterial conjunctivitis presents with red eye, purulent or mucopurulent discharge, and chemosis. 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.

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.

Allergic conjunctivitis usually improves by eliminating or significantly reducing contact with the allergen (pollen or animal dander).

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.

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.

Complications

Viral Conjunctivitis

Complications to viral conjunctivitis include:

• 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:

• Sepsis
• Meningitis
• corneal perforation
• keratitis
• Corneal epithelial defects

Neonatal Conjunctivitis

Complications to neonatal conjunctivitis include:

• 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:

• Conjunctivochalasis (chronic recurrences)
• Ulceration
• Opacification
• Visual loss
• Steroid induced intraocular pressure elevations
• Cataract

Keratoconjunctivitis Sicca

Complications to keratoconjunctivitis sicca include:

• 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.

Acute hemorrhagic conjunctivitis almost always resolves without sequelae, and has a good visual prognosis.

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.

Hyperacute bacterial conjunctivitis is associated with corneal involvement and subsequent corneal perforation, and therefore these patients have a poorer long term prognosis.

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.

Allergic conjunctivitis is associated with a favorable long-term prognosis. However, allergic conjunctivitis subtypes (such as atopic keratovonjunctivitis and vernal keratoconjunctivitis) are associated with worse outcomes.

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.

Superior limbic keratoconjunctivitis is associated with excellent prognosis, with remission as the natural history and eventual total resolution, although symptoms may last for years.

References

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