Conjunctivitis

Conjunctivitis (Pink Eye) It is the inflammation of the conjunctiva that causes redness to the white part of the eye and underlying eyelid (conjunctiva). The conjunctiva is a thin, translucent membrane lining the anterior part of the sclera and inside the eyelids. It is the most common cause of red eye.

Conjunctivitis It can be acute or chronic. It is estimated that acute conjunctivitis affects 6 million people a year in the United States and treating can be very costly (Azari and Barney, 2013, p. 1721). A good history and exam will help differentiate between the different types of conjunctivitis. There are 3 primary causes of conjunctivitis.

3 Primary Types Viral Bacterial Allergic Besides the 3 primary reasons we get conjunctivitis it can also be caused by dry eye and chemical irritants. There is also Herpes, Chlamydial, and Gonococcal conjunctivitis.

Viral Viral conjunctivitis is the most common type and usually requires no treatment (Azari and Barney, 2013, p. 1722). Most are caused by Adenoviruses. Many people are misdiagnosed as bacterial. Highly contagious Spread by contact Can take up to 2-3 weeks to resolve (Papadakis, McPhee, and Rabow, 2015, p. 165).

Viral Symptoms Usually begin in 1 eye and spreads to other Tearing of eyes/watery/serous drainage Symptoms of URI are usually present such as runny nose, sore throat, sneezing, and fever. Photophobia Preauricular lymphadenopathy Feels like something in the eye

Viral Conjunctivitis Treatment There is no cure for viral conjunctivitis (Halloran, 2011, p. 783). Cool Compresses Artificial Tears Topical antihistamine/decongestant eye drop may help relieve some irritation such as allergy eye drops which are OTC. Topical antibiotics are not indicated

Bacterial Fast onset, usually 12-24 hours Contacted by direct contact of infected person Lasts 7-10 days If lasts longer than 4 weeks it is considered chronic bacterial conjunctivitis. Most commonly the Staphylococcal species followed by Streptococcus pneumoniae Affects children more often than adults, anyone in childcare setting , someone in close contact with conjunctivitis & people who wear contact lenses

Bacterial Symptoms Red eye Purulent/mucopurulent discharge Mattering of the eyelids Can present as beefy red conjunctiva Burning, stinging, or gritty sensation of eyes

Bacterial Treatment If have contact lenses ,take them out. Bacterial conjunctivitis is more common in contact lens users. Treated with antibiotic eye drops or ointments to lessen the duration and decrease the spread. A few example of meds—Ofloxcin 1-2 drops 4 times/day for 1 week, Trimethoprin/polymyxin B 1 or 2 drops 4 times/day for 1 week, Cipro drops or ointment, Gentamycin drops or ointment.

Allergic Caused by airborne allergens that come in contact with the eye. Can be seasonal or perennial Usually starts in childhood or early adulthood Sudden onset Affects up to 40% of population , but about 10% seek medical help. Not contagious

Allergic Symptoms Itching Watery/serous drainage Red conjunctiva Usually will have cobblestone papillae on the upper tarsal conjunctiva (Papdakis & et al., 2015, p. 164). May also go along with eczema and asthma flare. Usually bilateral eyes

Allergic Treatment Rid of antigen if possible Artificial tears/saline drops Topical antihistamines such as Visine-A Mast cell stabilizers such as Cromolyn and Nedocromil eyedrops Nsaids such as Ketoralac (Acular) Oral Antihistamines such as loratadine Opthalmic Steroid- low dose such as Alrex, Lotemax

Education/Prevention Bacterial and Viral are very contagious so proper hand washing is needed to prevent spread. No sharing tissues, clothes, cosmetics, bed sheets/pillows. Return to work/school 24 hours after antibiotics are started for bacterial this is not helpful or necessary for viral Viral spreads easily like common cold so hand washing is the best and should not return to work/school until discharge has resolved.

Diagnostic Tests Gram stain testing for discharge/exudate if thought to have gonococcal infection. Culture if suspect chlamydia infection Test vision by Snellen chart and assess peripheral and EOMs. Usually diagnosis is made by physical exam Fluorescein staining if suspect ulcer/abrasion

Subjective Data/Physical Exam Get subjective data such as onset, duration, and symptoms. Assess if vision problems or if any injury to the eye. Check Temperature Assess Eye for color, foreign body, assess eye lid for edema. Examine Skin Inspect ears, nose, and throat Listen to lungs and heart Palpate preauricular lymph nodes and anterior and posterior lymph nodes-drains to

Differential Diagnosis/Referral Conjunctivitis Corneal Abrasion Iritis-inflammation of the iris A red flag would be if they are not responding to treatment and suspected of having periorbital cellulitis (Cash and Glass, 2014, p. 92). Follow up and refer to opthalmologist if not responding to treatment

Outcomes/Prognosis Usually responds well to treatment without any complications If not responding to treatment than refer so no vision loss or infection does not spread beyond the eye Most important thing to remember is hand washing helps prevent the spread. Wash for 15-30 seconds with warm soapy water . When unable to wash use hand sanitizer.

References Azari, A. A., & Barney, N. P. (2013). Conjunctivits: a systematic review of diagnosis and treatment. Journal of American Medical Association, 310(16). 1721- 1729. doi:10.1001/jama.2013.280318 Cash, J. C., & Glass, C. A. (2014). Eye Guidelines. In Family practice guidelines (3rd ed., pp. 87-105). New York, NY: Springer Publishing Company. Goroll, A.H., and Mulley, A. G. (2014). Evaulation of red eye. In Primary care medicine (7th ed., pp. 1373-1378). Philadelphia, PA: Lipincott Williams & Wilkins

References Halloran, L. (2011). Assessment and Treatment of Conjunctivitis. Journal for Nurse Practitioners, 7(9). 783-784. doi:10.1016/j.nurpra.2011.08.008 Papadakis, M. A., McPhee, S, J., and Rabow, M. W. (2015). Disorders of the eyes and lids. In Current medical diagnosis & treatment 2015 (pp. 163-198). New York, NY: McGraw-Hill Educational Medical.