Patients present with follicles on the eyelids and a thin, watery purulent discharge from both eyes. There is ocular pain, redness (hence the name pink eye) and eyelid and periorbital edema. Patients often complain of difficulty in opening the eyes in the mornings and pain upon straining the eyes. A study conducted about presenting symptoms of conjunctivitis in 2013 revealed that ocular complains such as itching, tearing, photophobia and discomfort of the eyes lead most of the patients to be diagnosed of allergic conjunctivitis [7].

• Anemia

  […] ear Meniere's disease, which affects the inner part of the ear Otosclerosis, a disease that results in stiffening of the small bones in the middle ear Other medical conditions such as high blood pressure, cardiovascular disease, circulatory problems, anemia [webmd.com]

  Other causes may be systemic disorders such as high or low blood pressure, anemia, diabetes, thyroid dysfunction, glucose metabolism abnormalities, vascular disorders, an abnormal growth on the jugular vein, acoustic tumors, and head or neck aneurysms [neuromodulation.com]

  […] such as: Anti-inflammatories such as aspirin, ibuprofen, nonsteroidal anti-inflammatories and quinine Sedatives Antidepressants Certain antibiotics and chemotherapeutic agents Other causes include: Systemic disorders such as high or low blood pressure, anemia [ucsfhealth.org]

  […] noise overexposure, there are other associated factors including: Middle ear obstructions Ear and sinus infections TMJ disorders Blood vessel or heart disorders Ménière’s disease Brain or neck tumors Hormonal changes in women Thyroid problems Allergies Anemia [uofmhealth.org]

  Sometimes, tinnitus is a sign of high blood pressure, an allergy, or anemia. In rare cases, tinnitus is a sign of a serious problem such as a tumor or aneurysm. [mountsinai.org]

• Infectious Mononucleosis

  Several systemic viral conditions have conjunctivitis as a feature, including measles, rubella, mumps, infectious mononucleosis, varicella and HIV. [patient.info]

  From Wikipedia, the free encyclopedia (Redirected from Viral infection) Jump to navigation Jump to search Viral disease Specialty Infectious disease A viral disease (or viral infection, or infectious disease) occurs when an organism's body is invaded [en.wikipedia.org]

• Photophobia

  In severe adenoviral conjunctivitis, patients may have photophobia and foreign body sensation due to corneal involvement. Chemosis may be present. [msdmanuals.com]

  Pain, loss of vision or photophobia require immediate referral to an ophthalmologist. [dermnetnz.org]

  Occasionally, severe photophobia and foreign-body sensation occurs, usually caused by adenovirus (epidemic keratoconjunctivitis [EKC]), when associated with keratitis. [emedicine.medscape.com]

• Blurred Vision

  Only rarely do symptoms persist causing scarring and blurred vision. [seeclearkalamazoo.com]

  vision Increased sensitivity to light Cleveland Clinic News & More Cleveland Clinic News & More [my.clevelandclinic.org]

  Some people have blurred vision, which may last for weeks or months before resolving. Epidemic keratoconjunctivitis resolves completely without specific treatment. [msdmanuals.com]

  These conditions may cause eye pain, a feeling that something is stuck in your eye (foreign body sensation), blurred vision and light sensitivity. If you experience these symptoms, seek urgent care. [mayoclinic.org]

• Eye Pain

  Care for Iritis Notify your eye doctor if any of the following signs or symptoms of iritis are present: Eye pain, including pain associated with bright light Blurred vision Redness in the eye, especially near the iris If you cannot reach your eye doctor [webmd.com]

  All patients with a history of contact lens wear and red flag symptoms such as eye pain, redness, reduction or change in vision, corneal epithelial defect, discharge, foreign body sensation or failure to respond to antibiotics should be referred for an [ncbi.nlm.nih.gov]

  These conditions may cause eye pain, a feeling that something is stuck in your eye (foreign body sensation), blurred vision and light sensitivity. If you experience these symptoms, seek urgent care. [mayoclinic.org]

• Blepharitis

  We report the case of a 79-year-old woman with a long history of red eye and relapsing conjunctivitis-blepharitis caused by ocular rosacea. [ncbi.nlm.nih.gov]

  This type of conjunctivitis is often associated with blepharitis. Symptoms can include redness of the conjunctiva, burning, frequent styes, foreign body sensation and morning eyelash crusting or eyelash loss. [hopkinsmedicine.org]

  Chronic and severe anterior blepharitis : the reduction in the tear film associated with blepharitis can cause chronic irritation and scarring. Drugs : may cause mild-to-severe irritation. [patient.info]

  Mild itching can also be a feature of blepharitis, dry eyes and, occasionally, bacterial or viral conjunctivitis. [aafp.org]

• Foreign Body Sensation

  It is important to be vigilant for retained foreign bodies as a cause of recalcitrant bacterial conjunctivitis, even in the absence of foreign body sensation. A relapsing-remitting history should prompt referral to an ophthalmology department. [ncbi.nlm.nih.gov]

  Other symptoms may include itching, burning, or a foreign-body sensation. Watery discharge, mucus, or pus may be present in the eyes. Some types of conjunctivitis present with light sensitivity. [news-medical.net]

  Symptoms include: Itching Puffiness Tearing Mucous discharge Blurred vision Poor tolerance for wearing contact lenses Foreign body sensation [acaai.org]

  Symptoms can include redness of the conjunctiva, burning, frequent styes, foreign body sensation and morning eyelash crusting or eyelash loss. Another type of chronic conjunctivitis is meibomitis. [hopkinsmedicine.org]

• Dizziness

  The noises occur with other unexplained symptoms, like dizziness, feeling off balance, nausea, or vomiting. You have unexplained ear noises that bother you even after you try self-help measures. [mountsinai.org]

  […] otolaryngologist (ear, nose and throat doctor) if you experience: Tinnitus in only one ear Tinnitus that sounds like your heartbeat or is pulsating (pulsatile tinnitus) Tinnitus with sudden or fluctuating hearing loss Pressure or fullness in one or both ears Dizziness [my.clevelandclinic.org]

  Cranial nerves, particularly vestibular function (see Dizziness and Vertigo), are tested along with peripheral strength, sensation, and reflexes. [msdmanuals.com]

  […] tube dysfunction, fluid, infection, otosclerosis, allergies or benign tumors Disorders in the inner ear, such as sensorineural hearing loss due to noise exposure, aging, inner ear infection or Meniere's disease often accompanied by hearing loss and dizziness [ucsfhealth.org]

  Other health issues that cause tinnitus include a viral infection of the inner ear (or ‘labyrinthitis’) and Meniere’s disease — a condition in which fluid pressure in the inner ear increases, which can also cause severe dizziness and nausea and a sudden [echolive.ie]

• Vertigo

  Vertigo is the feeling that you or your surroundings are moving when there is no actual movement. It may feel like spinning, whirling, or tilting. [uwhealth.org]

  Important associated symptoms include hearing loss, vertigo, ear pain, and ear discharge. [msdmanuals.com]

  […] your tinnitus is bothering you – for example, it's affecting your sleep or concentration Ask for an urgent GP appointment if you have tinnitus: after a head injury with sudden hearing loss, weakness in the muscles of your face, or a spinning sensation (vertigo [nhs.uk]

  She suggests trying a ginkgo extract, which she believes can improve blood flow to the inner ear, and possibly help tackle vertigo and tinnitus where symptoms are linked with abnormal circulation. [echolive.ie]

• Hyperactivity

  Hyperactivity and deep brain stimulation. Researchers have observed hyperactivity in neural networks after exposing the ear to intense noise. [nidcd.nih.gov]

  Brain imaging in the 1990s suggests that subjectively experienced tinnitus is a phantom phenomenon based on hyperactivity of the auditory system. [neuromodulation.com]

  It is felt that because those areas are no longer being stimulated by sound they become hyperactive. [audi-lab.com]

  Once the nerve cells become hyperactive and occur at the same time, they simulate a tone the brain “hears” as tinnitus. Analogous to a piano, the broken “keys” create a permanent tone without a pianist playing the keys. [soundrelief.com]

  The perception of chronic tinnitus has also been associated with hyperactivity in the central auditory system, especially in the auditory cortex.16 In such cases, the tinnitus is thought to be triggered by damage to the cochlea (the peripheral hearing [vestibular.org]

Laboratory tests

• Complete blood count
• Conjunctival scrapings and culture
• Eversion of eyelid at slit lamp
• Blood culture
• Tests for STDs if genital symptoms are also present

Imaging 

Imaging studies are not required to diagnose conjunctivitis. Orbital CT scan, MRI and a colour Doppler exam may be done to rule out other diseases.

Test results

Conjunctivitis is easily diagnosed with the help of a clinical examination. Laboratory tests may be done to confirm the diagnosis and identify the causative organism.

• Staphylococcus Aureus

  Pseudomonas aeruginosa was isolated in 1 patient and Staphylococcus aureus was isolated in the other 2 patients. [ncbi.nlm.nih.gov]

• Streptococcus Pneumoniae

  The most commonly isolated organisms were Staphylococcus aureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa. [ncbi.nlm.nih.gov]

  Acute bacterial conjunctivitis caused by Streptococcus pneumoniae. FIGURE 5. Acute bacterial conjunctivitis caused by Streptococcus pneumoniae. [aafp.org]

  A child who has had contact with any of the below are at risk for the condition: Staphylococcus aureus Haemophilus influenza Streptococcus pneumoniae Neisseria gonorrhea Chlamydia trachomatis Adenoviruses Herpes virus Chemicals in newborn eye drops What [urmc.rochester.edu]

  pneumoniae, non typable Hemophilus influenzae, and adenoviruses Clinical experience suggests viral the most common Bacterial is more common in children than adults In the neonate and young infant -Chlamydia and N. gonorrhea Type b Hemophilus often associated [pedclerk.bsd.uchicago.edu]

Benign cases of conjunctivitis usually do not require pharmacologic treatment as they tend to resolve on their own. Almost all the patients that suffer from bacterial conjunctivitis have a self-limiting condition and no treatment is required in uncomplicated cases. That said, it should be noted that conjunctivitis which is caused by such organisms that typically cause venereal diseases like chlamydia, and conjunctivitis occurring in optic lens wearers should be treated with appropriate antibiotics [8]. Medication is not required for viral conjunctivitis as the condition is mild, of short duration and seldom has any lasting effects.

The drugs that may be used include non steroidal anti-inflammatory drugs and glucocorticoids. Glucocorticoids suppress the late-phase reaction of allergic inflammation and are effective in treating bacterial conjunctivitis [9]. Antihistamines are only used for chronic conjunctivitis only because full efficacy is reached after 5 to 14 days after therapy and therefore these medicines are not useful for relieving acute symptoms of conjunctivitis [10]

Conjunctivitis has an excellent prognosis and often resolves spontaneously when the infection has run its course. It is also completely and effectively treated with the help of antibiotics and anti-inflammatory drugs.

Conjunctivitis is due to a bacterial, viral or fungal infection. Viral conjunctivitis is the most common overall cause of infectious conjunctivitis and usually does not require treatment; the signs and symptoms at presentation are variable. Bacterial infections are the second most common cause of conjunctivitis. Strains of the common human pathogen Streptococci pneumoniae lacking the capsule are the main virulence factor. This is the target of current vaccines [2]. Other bacteria that can cause conjunctivitis include Chlamydia trachomatis, Neisseria gonorrhoeae. A cross sectional descriptive study conducted on patients with acute conjunctivitis found that Chlamydia trachomatis accounts for one third of the cases of acute conjunctivitis [3].

Non-infectious causes of conjunctivitis include allergic agents like pollen grains and other particulate matter that enter and settle in the inner surface of the eyelids adjacent to the conjunctiva. This will cause local irritation and itching and inflammation, that manifest as conjunctivitis.

Incidence

Ocular allergy is estimated to affect at least 20 percent of the population on an annual basis, and the incidence is increasing [4]. According to a study, 4.4% out of a total of 1079 observed patients with ocular allergy had acute conjunctivitis [5].

Sex

Conjunctivitis is known to occur equally in both sexes.

Age

Conjunctivitis does not have a predisposition to any particular age group, however the age of patients of conjunctivitis is relevant in identifying the causative agent. For example, a young, sexually active person is more likely to be suffering from conjunctivitis from a sexually transmitted disease (STD).

The factors responsible the conjunctivitis and iritis associated with acute ocular infection and post enteric inflammatory disease are not fully known [6]. It is known however that the inflammatory markers and mediators such as leukotrienes, interleukins and cytokines play an important role in the development of conjunctivitis. When any irritant, be it in the form of virus, bacteria or a particulate matter enters and settles inside the eyelid, adjacent to the conjunctiva, it causes irritation of the conjunctiva. If the irritant remains there for sufficient time, and the person is unable to dislodge it with tearing and/or rubbing, inflammation begins.

Another pathway is the internal pathway where the causative agents, usually microbes such as the ones causing STDs, enter into the orbital blood supply and start to multiply in the orbital cavity, resulting in inflammation. Or the person may already be suffering from an infection such as an upper respiratory tract infection and the infectious agents may infect the eye as well, either due to direct contact such as rubbing the eyes with unclean fingers or through circulating antigens in the blood.
Whatever the initial route or pathway maybe, the end result is same: inflammation. Although the outer epithelial layer provides some defence, it is easily torn or broken and conjunctivitis develops.

Conjunctivitis may be prevented by maintaining good hygiene of the eyes. Regular testing for STDs in sexually active people is recommended and the patients suffering from upper respiratory tract infections or other easily transmissible infections should take appropriate treatment to eradicate the disease from their body.

Conjunctivitis is an inflammation of the conjunctiva, which is an outer transparent covering of the eyeball. It is also known as the ‘Pink Eye’ in many regions of North America [1]. It is a common condition and is seldom reported due to its mild nature. However, not all cases are benign and some may leave serious damage and lasting ill effects if not treated adequately with appropriate antibiotics.

Definition

Conjunctivitis is a condition in which inflammation of the conjunctiva, which is a membrane coating the eyeball and the inner surface of the eyelids, takes place.

Cause

It is most often due to a viral or bacterial infection but sometimes, the entry of tiny particulate matter, eyelashes, dust, pollen grains, etc can also cause conjunctivitis.

Signs and symptoms

Signs and symptoms include redness of the eye with watery, purulent discharge. There may be slight puffiness and swelling of the eye, pain on straining or exposure to bright lights, itching and burning. 

Diagnosis

Diagnosis is made clinically and is supported with laboratory tests.

Treatment

Treatment is mainly supportive, particularly in cases of viral conjunctivitis. If the condition is due to a foreign particle in the eye, it should be removed so that the eye can heal. If there is a bacterial infection, antibiotics and anti-inflammatory drugs may be used.

1. Richards A, Guzman-Cottrill JA. Conjunctivitis. Pediatr Rev, May 2010. 31 (5): 196–208.
2. Valentino MD, McGuire AM, Rosch JW, Bispo PJ, Burnham C, Sanfilippo CM, Carter RA, Zegans ME, Beall B, Earl AM, Tuomanen EI, Morris TW, Haas W, Gilmore MS. Unencapsulated Streptococcus pneumoniae from conjunctivitis encode variant traits and belong to a distinct phylogenetic cluster. Nat Commun. 2014 Nov 12;5:5411. 
3. Mowafy MA, Saad NE, El-Mofty HM, ElAnany MG, Mohamed MS. The prevalence of chlamydia trachomatis among patients with acute conjunctivitis in Kasr Alainy ophthalmology clinic. Pan Afr Med J. 2014 Mar 3;17:151. 
4. Wang HY, Pizzichini MM, Becker AB, et al. Disparate geographic prevalences of asthma, allergic rhinoconjunctivitis and atopic eczema among adolescents in five Canadian cities. Pediatr Allergy Immunol 2010; 21:867.
5. Uchio E, Kimura R, Migita H, et al. Demographic aspects of allergic ocular diseases and evaluation of new criteria for clinical assessment of ocular allergy. Graefes Arch Clin Exp Ophthalmol 2008; 246:291.
6. Langford MP, Foreman BD, Srur L, Ganley JP, Redens TB. Bilateral acute pyogenic conjunctivitis with iritis induced by unilateral topical application of bacterial peptidoglycan muramyl dipeptide in adult rabbits. Exp Eye Res. 2013 Nov;116:324-36.
7. Chiambaretta F, Gerbaud L, Fauquert JL. Management of allergic conjunctivitis. An observational study among ophthalmologists. [Article in French]. J Fr Ophtalmol. 2014 Jan;37(1):9-17. 
8. Azari AA, Barney NP. Conjunctivitis: a systematic review of diagnosis and treatment. JAMA. 2013 Oct 23;310(16):1721-9. 
9. Schleimer RP. Effects of glucocorticosteroids on inflammatory cells relevant to their therapeutic applications in asthma. Am Rev Respir Dis 1990; 141:S59.
10. Nizami RM. Treatment of ragweed allergic conjunctivitis with 2% cromolyn solution in unit doses. Ann Allergy 1981; 47:5.