Conjunctivitis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Sara Mehrsefat, M.D. [3]
Overview
The history of a patient with conjunctivitis should include a thorough ocular, medical and medication history. The history establish whether the condition is acute, subacute, chronic or recurrent, and whether it is associated with any specific environmental or work-related exposure.Complete history will help determine the correct therapy. A detailed and thorough history from the patient is necessary. The symptoms of conjunctivitis differ based on the cause of the inflammation. Redness, excessive tearing, and irritation are symptoms common to all forms of conjunctivitis. Photophobia, itching, mucopurulent or non-purulent discharge, chemosis, burning eyes, blurred vision and eyelid swelling are variable.[1][2]
History
The history of a patient with conjunctivitis should include a thorough ocular, medical and medication history. The history establish whether the condition is acute, subacute, chronic or recurrent, and whether it is associated with any specific environmental or work-related exposure.Complete history will help determine the correct therapy. A detailed and thorough history from the patient is necessary.[1]
Viral Conjunctivitis
Specific areas of focus when obtaining a history from the patient include:[2]
- Exposure history
- Recent upper respiratory infection (URI)
- Swimming in contaminated pools
- Contact lens use
Bacterial Conjunctivitis
Specific areas of focus when obtaining a history from the patient include:[3]
- History of sexually transmitted disease (STD)
- Exposure history (contaminated fingers, oculogenital spread, and contaminated fomites)
- Contact lens use
- Chronic use of topical medications
Neonatal Conjunctivitis
Specific areas of focus when obtaining a history from the patient include:[4]
- History of sexually transmitted disease (STD) in mother
- Ocular prophylaxis with silver nitrate
Allergic Conjunctivitis
Specific areas of focus when obtaining a history from the patient include:[5][6][7]
- Family history of atopic disease such as:
Keratoconjunctivitis Sicca
Specific areas of focus when obtaining a history from the patient include:[8][9]
- History of connective tissue disease
- History of sjögren's syndrome
- History of rheumatoid arthritis
- History of thyroid abnormalities
- Contact lens use
- History of neurologic conditions (stroke, Bell's palsy, Parkinson's, trigeminal nerve problem)
- Prior eye surgery
Superior limbic keratoconjunctivitis
Specific areas of focus when obtaining a history from the patient include:[10]
- Prolonged condition with gradual clearing
- Often have seen numerous eye specialists
Symptoms
The symptoms of conjunctivitis differ based on the cause of the inflammation. Redness, excessive tearing, and irritation are symptoms common to all forms of conjunctivitis. Photophobia, itching, mucopurulent or non-purulent discharge, chemosis, burning eyes, blurred vision and eyelid swelling are variable.
Viral Conjunctivitis
Adenovirus is the most common cause of viral conjunctivitis. It has Acute or subacute onset, and often occurs in community epidemics. Both eyes may be affected simultaneously, or the second eye may become involved a few days after the first eye. Symptoms of viral conjunctivitis may include the following:[11]
Pharyngoconjunctival Fever
- High fever
- Pharyngitis
- Bilateral conjunctivitis
- Periauricular swollen lymph nodes
- Itchy eyes
- Tearing
- Minimal pain level
- Light sensitivity (with corneal involvement)
Epidemic Keratoconjunctivitis
- Watery discharge
- Hyperemia
- Chemosis
- Ipsilateral swollen lymph node
- Itchy eyes
- Tearing
- Minimal pain level
Acute Hemorrhagic Conjunctivitis
Acute hemorrhagic conjunctivitis (AHC) is a rapidly progressive and contagious viral infection. The infection starts unilaterally but rapidly involves the fellow eye within 1 or 2 days and resolves within 5-7 days, during which the symptoms of pain and irritation are present. Symptoms of acute hemorrhagic conjunctivitis may include the following:[12]
- Chemosis
- Tearing
- Redness
- Severe pain level
- Purulent discharge
- Subconjunctival hemorrhage
Bacterial Conjunctivitis
Bacterial conjunctivitis has Hyperacute, acute, and chronic onset. Symptoms of bacterial conjunctivitis may include the following: [13]
Hyperacute Bacterial Conjunctivitis
Hyperacute bacterial conjunctivitis is a severe, sight-threatening ocular infection that warrants immediate ophthalmic work-up and management. The infection has an abrupt onset and rapid progression. Symptoms of Hyperacute Bacterial conjunctivitis may include the following:[14]
- Chemosis
- Tearing
- Redness
- Eye pain
- Decreased vision
- Severe purulent discharge (yellow-green)
- Preauricular swollen lymph nodes
Neonatal Conjunctivitis
Symptoms of various types of neonatal conjunctivitis or ophthalmia neonatorum may include the following:[15][16]
Gonococcal Conjunctivitis
Gonococcal conjunctivitis is more severe than chlamydial conjunctivitis. The incubation period is 2-5 days. It is usually bilateral. Symptoms of gonococcal conjunctivitis may include the following:
Chlamydial Conjunctivitis
It has a later onset than gonococcal conjunctivitis. The incubation period is 5-14 days and the colonization of the eye after birth does not always result in infection. Symptoms of chlamydial conjunctivitis may include the following:
Chemical conjunctivitis
Chemical conjunctivitis usually occurs within 24 hours of instillation of silver nitrate solution and resolves spontaneously within a few days. Symptoms of 'chemical conjunctivitis may include the following:
- Eyelids swelling
- Redness
Allergic Conjunctivitis
Symptoms of allergic conjunctivitis may include the following:[17]
- Itchy eyes (most impotant)
- Tearing
- Bilateral redness
- Watery discharge
- Photophobia (with corneal involvement)
- Foreign body sensation
Keratoconjunctivitis Sicca
Symptoms of keratoconjunctivitis sicca (dry eye syndrome) may include the following:[18]
- Foreign-body sensation
- Grittiness
- Hyperemia
- Mucoid discharge
- Excessive tearing (secondary to reflex secretion)
- Photophobia
- Itchy eye
- Fluctuating] blurry vision
- Malaise
- Weight loss
Superior Limbic Keratoconjunctivitis
Symptoms of superior limbic keratoconjunctivitis may include the following:[19]
- Foreign body sensation
- Photophobia
- Excessive blinking
- Burning sensation
- Itchy eye
- Dry eye sensation
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.
- ↑ 2.0 2.1 Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
- ↑ "Bacterial conjunctivitis in children: antibiotic eye drops only if eye washing is ineffective". Prescrire Int. 16 (89): 120–1. 2007. PMID 17585426.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Høvding G (2004). "[Acute bacterial conjunctivitis]". Tidsskr Nor Laegeforen. 124 (11): 1518–20. PMID 15195156.
- ↑ 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.
- ↑ 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.
- ↑ Centers for Disease Control and Prevention (2015)[1] Accessed on June 30, 2016
- ↑ 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.
- ↑ 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.
- ↑ Nelson JD (1989). "Superior limbic keratoconjunctivitis (SLK)". Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.