Conjunctivitis - Causes, symptoms and treatment. MF.

Conjunctivitis is a disease associated with inflammation of the conjunctiva( a membrane of cylindrical epithelium lining a part of the eyelid and covering the eye proteins).

Conjunctivitis causes:

1. Infectious
- bacterial( staphylococcus, gonococcus, Pseudomonas aeruginosa)
- chlamydia( chlamydia conjunctivitis of the newborn, trachoma)
- viral( adenovirus, herpesvirus)
- fungal( actinomycosis, aspergillosis, candidomycosis, spirotrichelezis)

2. Allergic( when wearing KL, atopic, medicinal, seasonal)

3. Dystrophic

Predisposing factors: contact path through dirty hands( including after an infected sexual intercourse occurs forAgen gonococcal, chlamydial et al.), nasopharyngitis, otitis media, sinusitis.

Symptoms of conjunctivitis

Staphylococcal conjunctivitis:

The main symptoms: in the morning, eyes with difficulty open their eyes due to the drying of the mucopurulent discharge. Objectively determined 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, and then the second( due to the contact path of transmission).But the symptoms of staphylococcal conjunctivitis are not pathognomonic, so you need to make a smear-imprint to determine the pathogen and sensitivity to antibodies( antibiotics).Treatment is etiologic: before detection of sensitivity to AB - use Pikloksidin 3p / day. After the establishment of the pathogen - Erythromycin ointment 2p / day. Symptomatic therapy:( NSAIDs) -Diclofenac at 2p / day. You can not blindfold your eyes so as not to create anaerobic conditions for the beneficial development of pathogens. Complications: keratitis( inflammation of the cornea).

Pseudomonas aeruginosa:

Symptoms: acute onset accompanied by a feeling of cuts, photophobia, hyperemia, abundant purulent discharge and strong lachrymation. Treatment: Lomefloxacin + Tobramycin = in the first 2 days for 6 r / day, after that 3 r / day. If there are erosions on the cornea( as a result of untimely initiation of treatment), Ceftazidime + systemic use of Levofloxacin is used. With edema-Diclofenac 2p / d. Complications: keratitis with rapid ulcer formation and threat of perforation as "tunnel penetration" with further loss of vision. To prevent such terrible consequences, a prompt start of treatment is necessary.

Gonococcal conjunctivitis:

is a gonorrhea of ​​newborns that occurs on the 2nd-5th day of birth. Symptoms: edema of the eyelids with a bluish-cyanotic shade, serous-bloody discharge after 3 days is replaced by a purulent discharge, and later acquires a greenish tinge. There is lymphadenopathy of regional lymph nodes( behind, cervical).

Gonococcal conjunctivitis

Treatment: 2% rinse boric acid wash + Erythromycin ointment or Lomefloxacin 2p / day + Ceftriaxone( systemic IM treatment) + Diclofenac( with swelling and inflammation) + Taurine 2p / day( with keratitis).Complication: an ulcer on the cornea with the risk of perforation.

Chlamydial conjunctivitis

causes trachoma of newborns( infection occurs when passing through the mother's infected maternal pathways), the clinic manifests itself on the 5th-10th day after birth and proceeds as in adults, but more mildly. Symptoms:( there is a staging of symptoms, it is important at the time of diagnosis and does not affect the principles of treatment): the presence of papillae or follicles on the conjunctiva with subsequent scarring( their presence determines the feeling of a foreign body under the eyelid);there is hyperemia, lacrimation and mucopurulent discharge. Treatment: For newborns from the first day, the systemic use of Levofloxacin 1 tab per 7 days + Erythromycin ointment 4p / day from 3 weeks to 3 months( depending on the dynamics of the disease in response to treatment) + Diclofenac 2p / day + Dexamethasone( if onbackground of the above, there is no expected effect) + Oxyal or its analogues( artificial tear preparation) 2p / day no longer than 60 days. Complications: eyelid deformity( at the start of the process) - is treated only surgically;Trichiasis( abnormal growth of eyelashes), Madaroz( alopecia alopecia), keratitis( inflammation of the cornea).

Bacterial and chlamydial conjunctivitis are most characteristic of newborns.

Adenoviral conjunctivitis:

Symptoms: cutting pain, foreign body sensation after the eyelid, lacrimation, serous discharge, hyperemia, pinpoint hemorrhages. The above symptoms are accompanied by a common symptom of the defeat of the respiratory tract and lymphadenopathy. Treatment: IF( interferon) in the first days 6 times, after - 3 r / day + Diclofenac + Olopathodine 2p / day + from the 2nd week of the disease. Oxal for 6 weeks 2-4 times a day. Complications: rarely corneal opacity, tearing of the tear film( prevented by artificial tears).

Herpesvirus:

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

Fungal conjunctivitis:

Symptoms: 1. With actinomycosis( found on the skin and mucous membranes) - catarrhal / purulent conjunctivitis along the edge of the eyelids.2. Aspergillosis( on healthy skin and conjunctiva) - mild general symptoms of conjunctivitis and lymphadenopathy;Treatment: Amphotericin B 0.15% - 4p / day + Dexamethasone or Olopathodine + Picloxidine or silver nitrate + with severe decompensated flow - systemic use of fungicidal drugs. Complications: the course is favorable, if there is no spread to the cornea.

Allergic conjunctivitis:

Symptoms: unbearable itching and burning + photophobia + lacrimation + hyperemia and edema. Treatment: Olopathodine 2p / day for 2 weeks + Cityrizine + Ketotifen. Complication: no. More on allergic conjunctivitis & gt; & gt;

Diagnosis of conjunctivitis:

In addition to objective symptoms( edema, congestion, etc.), it is necessary to identify the causative agent for determining the choice of treatment. To specific diagnostic methods, with conjunctivitis of different etiology are:

1. Microscopic research method - is aimed at detecting the pathogen and the sensitivity of antibiotics to it. This method can be used for suspected staphylococcal, pseudomonas aeruginosa, gonococcal, fungal.
2. RIF - the reaction of immunofluorescence;with the help of this method, antibodies are detected in the smear-print to known antigens( direct RIF) or NIRF( indirect RIF).This method is applicable to chlamydiae, gonococci, viruses( only with NERIF = reaction of fluorescent antibodies).
3. PCR( polymerase valuable reaction) - suitable only for detecting viruses.
If possible, you can send a smear test to several diagnostic methods. The direction to the UAC( general blood test) is rarely given - only with general decompensation of the body, because with local changes on the part of the visual apparatus, this analysis will show only the picture of inflammation.

Treatment of conjunctivitis:

Before the visit to the doctor, the main actions are the use of antiseptic eye drops( Albucid 20%) and broad-spectrum antibacterial drugs( tetracycline ointment and levomycetin eye drops 0.25%), in the presence of pus - rinse furachilina 1: 5000(it is sold at the pharmacy) every 3 hours, but it is also necessary to use the systemic use of Cefatoxime per kilogram of body weight( for a child under 12 years old).But nevertheless, a specialist must be observed or even hospitalized, because they use expensive innovations among the drugs, and 24-hour specialized observation with the provision of qualified care.

The main methods of treatment according to the national project "Health"

1. Antiseptic drugs: Pikloksidin and Albucid 20%
2. Antibacterial( etiotropic therapy):
- staphylococcus, gonococcus, chlamydia( Erythromycin ointment)
- Pseudomonas aeruginosa( Tetracyclin ointment and / or Levomycetin droplets)
- virus-associated conjunctivitissystemic immunocorrective and immunostimulating treatment, and locally use broad-spectrum antibacterial drugs to prevent secondary bacterial damage)
3. Anti-inflammatory drugs( either erasedoid, or non-steroidal origin) are topically and systemically used for edema and hyperemia: Diclofenac, Dexamethasone, Olopathodine, Suprastin, Fenistil in droplets.
4. With the "dry eye" syndrome( which occurs as a secondary post-infection lesion of either the tear apparatus, or goblet cells producing mucus, or the defeat of meibomia glands that prevent evaporation, tears), artificial tears( Oxial) are used.

The above mentioned treatment methods combine with each other and there are no differences in treatment in the adult contingent and children as such.

Systemic treatment with antiviral, antibacterial and fungicidal agents is carried out with the calculation for kg of body weight, parenterally and only under 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 an infectious disease exceeds the risk of complications.

General Practitioner Inna Shabanova