Conjunctivitis - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Eye Disease

Conjunctivitis - a disease associated with inflammation of the conjunctiva (the membrane of columnar epithelium lining of the eyelid and covering the whites of the eyes).

Causes of conjunctivitis:

1. Infectious
- bacterial (staphylococci, gonococci, Pseudomonas aeruginosa)
- Chlamydia (chlamydial conjunctivitis of the newborn, trachoma)
- virus (adenovirus, herpes virus)
- fungal (actinomycosis, aspergillosis, candidiasis, spirotrihelёz)

2. Allergic (when equipped with a CR, atopic, drug seasonal)

3. Dystrophic

Predisposing factors: contact way through dirty hands (including infected after sexual intercourse is an infection gonococcal, chlamydial, etc.).nasopharyngitis, otitis media, sinusitis.

Symptoms of conjunctivitis

Staphylococcal conjunctivitis:

main symptoms: morning barely open her eyes because of the drying of the muco-purulent discharge.Objectively determined by hyperemia and edema of the eyelids, accompanied by itching, burning, photophobia, and a feeling of a foreign body

under the eyelid (due to the formation of follicles or papillae).First, one eye is affected, then the second (due to the contact pathway).But the symptoms of conjunctivitis staafilokokkovogo patognomanichny not, so you need to make an imprint smear to determine the pathogen and sensitivity to AB (antibiotics).Etiological treatment: to identify sensitivity to AB - used Pikloksidin 3p / day.After the establishment of the pathogen - erythromycin ointment 2p / d.Symptomatic therapy (NSAIDs) -Diklofenak by 2p / d.You can not tie my eyes, not to create anaerobic conditions for the favorable development of pathogens.Complications: keratitis (corneal inflammation).

Pseudomonas conjunctivitis:

Symptoms: acute onset accompanied by a sense of rezey, photophobia, redness, copious purulent discharge and strong lacrimation.Treatment: Tobramycin + = lomefloxacin in the first 2 to 6 days p / d, then p 3 / day.If any erosion of the cornea (as a result of delays in the start of treatment), use Ceftazidime + systemic administration of levofloxacin.When edema -Diklofenak 2p / d.Complications from keratitis rapid formation of ulcers and risk of perforation of the type "tunnel penetration" with a further loss of vision.In order to prevent such terrible consequences must be the early commencement of treatment.

gonococcal conjunctivitis:

- blennophthalmia births occurring on 2-5 day from birth.Symptoms: swelling of the eyelids with Bogrov-bluish tint, sanioserous discharge after 3 days is replaced by purulent discharge, and later acquires a greenish tint.There lymphadenopathy regional lymph nodes (BTE, cervical).

gonococcal conjunctivitis

Treatment: washing 2% p-th boric to-you + erythromycin ointment or lomefloksatsin 2p / day + Ceftriaxone (systemic treatment / m) + Diclofenac (with edema and inflammation) + Taurine 2p/ day (with keratitis).Complication: corneal ulcer with perforation risk.

Chlamydial conjunctivitis

causes trachoma newborns (infection occurs when passing through an infected mother's birth canal), the clinic appears 5-10 days after birth and occurs in adults, but more gently.Symptoms: (staging has symptoms, it is important at diagnosis and does not affect the principles of treatment): the presence of papillae or follicles on the conjunctiva with subsequent scarring (their presence causes a feeling of a foreign body under the eyelid);there is congestion, watery eyes, and mucous-purulent discharge.Treatment: For infants from the first day systemic administration of levofloxacin on 1 tab in tech 7 days + erythromycin ointment 4p / day from 3 weeks to 3 months (depending on the disease dynamics in response to treatment) + Diclofenac 2p / day + Dexamethasone (ifbackground of the above is not the desired effect) + Oksial or its analogs (artificial tear) 2p / day for no longer than 60 days.Complications: deformation of the age (when running process) - can be cured only by surgery;Trichiasis (abnormal growth of eyelashes), madarosis (alopecia ciliary edge), keratitis (inflammation of the cornea).

bacterial and chlamydial conjunctivitis are most typical for newborns.

Adenoviral conjunctivitis:

Symptoms: cutting pain, foreign body sensation after century, tearing, serous discharge, hyperemia, petechial hemorrhages.The above symptoms are accompanied by general symptoms of respiratory tract lesions and lymphadenopathy.Treatment: IF (interferon) in the first 6 days time, after - 3 p / day + Diclofenac + Olopatodin 2p / day + with 2nd week Oksial disease within 6 weeks of 2-4 times a day.Complications rarely occur corneal clouding, disturbance of tear film (preventing drugs artificial tears).

herpesvirus:

Symptoms: regional lymphadenopathy and follicular reaction is caused by the feeling of a foreign body.The defeat of the often one-sided with scanty mucous discharge.Treatment: IF + Diclofenac + antibacterial drops to prevent secondary bacterial lesions (pikloksidin or silver nitrate) + systemic treatment in a hospital (immunomodulation and immunostimulation with an individual selection of drugs).Complications with frequent relapses - scarring.

Fungal conjunctivitis:

Symptoms: 1. Lumpy (found on the skin and mucous membranes) - catarrhal / purulent conjunctivitis along the edge of the eyelid.2.Aspergilёz (on healthy skin and konnktive) - light common symptoms of conjunctivitis, and lymphadenopathy;Treatment: Amphotericin B 0.15% - 4p / day + Dexamethasone + or Olopatodin Pikloksidin or silver nitrate + in severe decompensated techenii- systemic administration of antifungal drugs.Complications during favorable, if not spread to the cornea.

Allergic conjunctivitis:

Symptoms: an unbearable itching and burning + + photophobia, lacrimation + hyperemia and edema.Treatment: Olopatodin 2p / day for 2 weeks + Tsitirizin + Ketotifen.Complication: no.Read more about allergic conjunctivitis & gt; & gt;

Diagnosis of conjunctivitis:

By passing the objective symptoms (edema, congestion, etc.) necessary to identify the pathogen to determine the choice of treatment.Specific diagnostic methods, in conjunctivitis of different etiologies include:

1. Mikroskopichesiky method of research - is aimed at the detection of the pathogen and sensitivity to antibiotics.This method can be used in cases of suspected staphylococcal, Pseudomonas, gonococcal, fungal.
2. IFA - immunofluorescence;using this method, the antibodies detected in smears to known antigens (direct RIF) or NRIF (indirect RIF).This method is applicable to chlamydia, gonococci, viruses (only NRIF = fluorescent antibody response).
3. PCR (polymerase chain reaction) - suitable only for the detection of viruses.
possible, you can send a smear on several diagnostic methods.Referral to the KLA (CBC) give rare - only a total of decompensation of the body, because when local changes on the part of the visual apparatus, this analysis will show only a picture of inflammation.

Treatment of conjunctivitis:

Before visiting the doctor, the main actions are the use of antiseptic eye drops (sulfacetamide 20%) and shirokospektornyh antibacterial drugs (tetracycline ointment and eye drops levomitsetinovye 0.25%), in the presence of pus - washed with p-th furatsilina 15000 (it is sold in a pharmacy) every 3 hours, but we need more systematic application Tsefatoksima the rate per kilogram of body weight (for a child up to 12 years).But still require supervision by a specialist or even hospitalization, because it uses expensive innovations among drugs, and specialized observation room with the provision of skilled care.

main treatments according nats.proekta «Health»

1. Antiseptic preparations: Pikloksidin and sulfacetamide 20%
2. Antibacterial (causal therapy):
- staphylococcus, gonococcus, chlamydia (erythromycin ointment)
- Pseudomonas aeruginosa (Tetracycline ointment and / or Levomitsetinovye drops)
- virusassotsiirovanny conjunctivitis (immunocorrective use the system and the immunostimulatory treatment and topically applied shirokospektornye antibiotics to prevent secondary bacterial destruction)
3. Anti-inflammatory drugs (either steroidal or non-steroidal origin) local and systemic usewith edema and hyperemia: Diclofenac, Dexamethasone, Olopatodin, Suprastin, Fenistil in drops.
4. The syndrome of "dry eye" (appears as a secondary or post-infectious defeat lacrimal apparatus, or goblet cells produce mucus, or loss of meibomian glands prevents evaporation of tears) - drugs used artificial tears (Oksial).

The above methods of treatment combine with each other and the difference in the treatment of adult and children contingent, as such, is not observed.

Systemic treatment of antiviral, antibacterial and fungicidal agents calculation performed per kg of body weight, parenterally and in stationary conditions.There are some groups of drugs that are not desirable in pediatric practice, but their application is possible if the risk of disability from infectious disease than the risk of complications.

GP Inna Shabanova