Conjunctivitis: Signs, Symptoms, and Treatment

by Richard Mitchell, MD

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    00:01 So the signs and symptoms, how to recognize this? Well, it's not hard.

    00:04 First of all, you don't see the whites of their eyes anymore.

    00:07 What you see here is a very injected, very erythematous, very prominent vessels within the eyes, because there's inflammation.

    00:17 Not only we've seen that injection, that redness, which looks angry and hot.

    00:22 We're also getting increased exudate or transudate of fluids, so there will be excessive tearing.

    00:32 The hyperemia is very prominent with the injection of the vessels, it has that so-called "pink eye" appearance, and because we're getting edema, it's not just increased vascular dilation, it's also increased vascular permeability.

    00:46 That vascular permeability has edema and the edema has no place to go except making the eyelids swell or even making the conjunctiva swell, so the eyes can look puffy.

    00:56 With the inflammation of the conjunctiva, the pupillary, the iris apparatus tends to be dilated so there's mydriasis, that means that if you walk into a very bright situation, all that light coming through an open pupil, you might squint or kind of withdraw.

    01:17 Nevertheless, the pupils are normally light reactive.

    01:22 They will eventually accommodate with miosis.

    01:24 There will also be, in general, normal visual acuity.

    01:27 However, if there is a significant exudate or fluid over the surface of the eye, that can impact how well you see.

    01:37 There will clearly be an itching or burning or foreign body sensation in the eye.

    01:40 This is driven by the inflammatory mediators.

    01:43 And depending on the nature of the infection or in the virus versus the bacterial case, There will be a discharge in a crust formation.

    01:54 The crust is typically indicative of having the transudate neutrophils that are sitting there on now the surface of the eye, and as they die or as they get dehydrated, they form a crust.

    02:06 Not too appetizing.

    02:09 You will also have some other local manifestations of conjunctivitis because the external portions of the eyes, the eyelids and the extraocular structures drain their inflammatory cells, excess fluid, inflammatory cells into the draining lymph nodes.

    02:27 You may have lymphadenopathy that involves the preauricular nodes or the submandibular nodes.

    02:33 So those may be enlarged as well.

    02:36 How do we treat this? So in every case across the board, we want to get increased fluid over the eye to help dilute some of those inflammatory mediators and wash away some of the evil humors that are driving the inflammatory process.

    02:51 So artificial tears are going to be an important kind of adjunct all the way along.

    02:56 In viral conjunctivitis, we will also give antihistamines.

    02:59 Antihistamines will have a net effect of causing vasoconstriction.

    03:03 So we don't have that angry redness, but they will also diminish the increased vascular permeability.

    03:10 So antihistamine drops are very helpful and good hygiene is really very, very critical.

    03:15 It's not so much, although you can have transmission from person to person to person, particularly in daycare centers.

    03:22 A little bit of conjunctivitis goes a long way when little kids are poking each other in the face.

    03:28 But it's also very possible that you can go from one eye to the other eye very easily with these infectious causes.

    03:36 Bacterial conjunctivitis are going to require topical antibiotics, and when you see that yellow discharge in a crust, you need to provide appropriate topical antibiotics to go into the eye to treat the bacteria.

    03:48 And it's also very highly contagious, easily go from one eye to the next eye and can also be transmitted from person to person again, if you're poking each other in the eye.

    03:58 Allergic conjunctivitis.

    04:00 We're going to do artificial tears that will help us to wash away and dilute the potential allergens that are there.

    04:05 Topical antihistamines work great if you have an allergy anywhere else.

    04:10 They work great in your eye as well and we can give it either orally or topically.

    04:14 Cold compresses because they cause vasoconstriction, will also limit the amount of vascular transudate and exudate.

    04:23 So those can be helpful, giving drugs that are anti-inflammatory.

    04:29 So the nonsteroidal anti-inflammatory drugs, by blocking the production of prostaglandins that are going to be pro-inflammatory, will be helpful, especially in allergic conjunctivitis.

    04:39 And in some cases where there's severe inflammatory infiltrates, we may have to go to the big guns and give topical steroids.

    04:48 Finally for the non-allergic conjunctivitis, remember, this is sicca syndrome and this is Sjogren Syndrome.

    04:54 Clearly, we want to provide artificial tears to wash away as much kind of evil humors as we can.

    05:01 We will also want to give anti-inflammatory agents and particularly more systemically, because this is largely driven as an autoimmune process and we may in that case, have to go to very high dose, well, not high dose, but big gun, anti-inflammatory agents such as systemic corticosteroids.

    05:21 With that, we've covered the topic of pink eye, conjunctivitis, that inflammation of the membrane over the surface of the eye.

    About the Lecture

    The lecture Conjunctivitis: Signs, Symptoms, and Treatment by Richard Mitchell, MD is from the course External Eye Diseases.

    Included Quiz Questions

    1. Hyperemia of the conjunctiva
    2. Swelling of the conjunctiva
    3. Excessive tearing
    4. Scratching and rubbing of the eye
    5. Purulent discharge in the eye
    1. Photophobia
    2. Myopia
    3. Hyperopia
    4. Presbyopia
    5. Strabismus
    1. Preauricular
    2. Supraclavicular
    3. Submental
    4. Axillary
    5. Occipital
    1. Antihistamines, NSAIDs, and artificial tears
    2. Antibiotics and saline irrigation
    3. Antivirals and antifungals
    4. NSAIDs and PPIs
    5. NSAIDs and multivitamins

    Author of lecture Conjunctivitis: Signs, Symptoms, and Treatment

     Richard Mitchell, MD

    Richard Mitchell, MD

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