So the signs and symptoms, how
to recognize this? Well, it's not hard.
First of all, you don't see the
whites of their eyes anymore.
What you see here is a very
injected, very erythematous,
very prominent vessels within the
eyes, because there's inflammation.
Not only we've seen that injection,
that redness, which looks angry and hot.
We're also getting increased
exudate or transudate of fluids,
so there will be excessive tearing.
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.
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.
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.
Nevertheless, the pupils are normally light reactive.
They will eventually accommodate with miosis.
There will also be, in general, normal visual acuity.
However, if there is a significant
exudate or fluid over the surface of the eye,
that can impact how well you see.
There will clearly be an itching or
burning or foreign body sensation in the eye.
This is driven by the inflammatory mediators.
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.
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.
Not too appetizing.
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.
You may have lymphadenopathy that involves
the preauricular nodes or the submandibular nodes.
So those may be enlarged as well.
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.
So artificial tears are going to be an
important kind of adjunct all the way along.
In viral conjunctivitis, we
will also give antihistamines.
Antihistamines will have a net
effect of causing vasoconstriction.
So we don't have that angry redness,
but they will also diminish
the increased vascular permeability.
So antihistamine drops are very helpful
and good hygiene is really very, very critical.
It's not so much, although you can have
transmission from person to person to person,
particularly in daycare centers.
A little bit of conjunctivitis goes a long way
when little kids are poking each other in the face.
But it's also very possible that you can
go from one eye to the other eye very easily
with these infectious causes.
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.
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.
We're going to do artificial tears that will help us to
wash away and dilute the potential allergens that are there.
Topical antihistamines work great if
you have an allergy anywhere else.
They work great in your eye as well
and we can give it either orally or topically.
Cold compresses because they cause vasoconstriction,
will also limit the amount of
vascular transudate and exudate.
So those can be helpful, giving
drugs that are anti-inflammatory.
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.
And in some cases where there's severe inflammatory
infiltrates, we may have to go to the big guns
and give topical steroids.
Finally for the non-allergic conjunctivitis, remember,
this is sicca syndrome and this is Sjogren Syndrome.
Clearly, we want to provide artificial tears to
wash away as much kind of evil humors as we can.
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,
such as systemic corticosteroids.
With that, we've covered the
topic of pink eye, conjunctivitis,
that inflammation of the membrane
over the surface of the eye.