General Ophthalmology

Infective Conjunctivitis

What is infective Conjunctivitis?

Infective conjunctivitis is an eye condition caused by infection of the conjunctiva, the transparent membrane that forms the inner lining of the upper and lower eyelids and covers the sclera, the white part of the eyeball. The conjunctiva is a thin, highly vascularized, semi-transparent tissue. When the small blood vessels in the conjunctiva get inflamed, they become more visible, and this is what causes the eye to appear red.

Symptoms and Signs

Conjunctivitis can affect one or both eyes. Eyes are usually red and swollen. Sometimes there can be mucus, pus or thick yellow discharge from the eye, so that the eyelashes stick together (usually with bacterial conjunctivitis). Symptoms include foreign body sensation (the feeling that something is in the eye) or gritty sensation (irritation that feels like sand in the eye), burning sensation, itching, pain, sensitivity to light and the vision can be blurry or hazy.

What are the causes of Infective Conjunctivitis?

Infective conjunctivitis is commonly caused by a bacterial or viral infection. Viral conjunctivitis is the most common type of conjunctivitis. It is most commonly caused by the same virus that causes the runny nose and sore throat of the common cold, including adenovirus, but can also be caused by herpes simplex virus, varicella-zoster virus, and various other viruses, including COVID-19. The viral form is very contagious. It usually causes burning sensation, redness and watery discharge. Bacterial conjunctivitis is caused by infection from bacteria, commonly Staphylococcus or Streptococcus. It is very contagious. It usually causes pain and redness, associated with sticky discharge, although some bacterial infections may cause little or no discharge.

Both bacterial and viral conjunctivitis are contagious and easily spread from person to person. The most common ways to get infected with the contagious form of conjunctivitis include:

  • Direct contact with bodily fluids of an infected person, usually through hand-to-eye contact
  • Spread of the infection from bacteria living in the person’s own nose and sinuses.
  • Contact lenses not cleaned properly

Children are more likely to get infective conjunctivitis, since are usually in close contact with many others in school and don’t practice good hygiene. Early diagnosis and prompt treatment can help limit its spread.

How to treat Infectious Conjunctivitis?

Treatment depends on the type of eye infection. There are no specific treatments for viral conjunctivitis. The viral form is usually self-limited and clears up on its own within 2-3 weeks. Applying cold compresses to the eyes can help make them feel more comfortable and reduce inflammation. If the conjunctivitis is caused by a bacterial infection, antibiotic eye drops for 5 to 7 days are recommended. Antibiotics do not treat viral conjunctivitis. Regular lid cleaning with a clean flannel soaked in warm water is recommended to clean sticky discharge or secretions from the eyes. Lubricant eye drops, gel or ointment may help reduce discomfort and grittiness, but will not reduce the duration of the illness. Steroid eye drops are occasionally used in severe cases upon medical prescription.

What are the complications of Infective Conjunctivitis?

Occasionally, infective conjunctivitis can cause inflammation of the cornea, the front window of the eye, or scarring of the conjunctiva. Both the complications can affect the sight.

Allergic Conjunctivitis

What is allergic conjunctivitis?

Allergic conjunctivitis is a common inflammatory eye condition caused by an allergic reaction of the conjunctiva, the transparent membrane that forms the inner lining of the upper and lower eyelids and covers the sclera, the white part of the eyeball. The conjunctiva contains a large number of mast cells, cells from the immune system that release substances, called mediators, in response to environmental stimuli (allergens), causing inflammation in the eye.

Seasonal allergic conjunctivitis is often caused by mold spores or tree and grass pollens, leading to its typical seasonal appearance. Perennial allergic conjunctivitis is more likely to manifest throughout the year and is most often caused by dust mites or animals.

What are the signs and symptoms?

The conjunctiva is a thin, highly vascularized, semi-transparent tissue. When the small blood vessels in the conjunctiva get inflamed, they become more visible, and this is what causes the eye to appear pink or red. Itching is the main symptom. Eyes are usually red and watery. Other allergic manifestations, including sneezing or runny nose, can be present.

What causes allergic conjunctivitis?

The disease originates from a disorder of the immune system in predisposed individuals exposed to environmental stimuli (allergens).

Treatment

Management of allergic conjunctivitis is aimed at controlling the inflammatory response and subsequently, the symptoms. Topical management with mast cell stabilizers and anti-histamine eye drops, lubricants, cold compresses and oral anti-histamines can control the ocular disease. Nonsteroidal anti-inflammatory eye drops can help relieve symptoms. Given their more potent anti-inflammatory effects, topical corticosteroid drops can sometimes be necessary.

Atopic Keratoconjunctivitis

What is atopic keratoconjunctivitis?

Atopic keratoconjunctivitis is the most severe form of allergic eye disease. It is a bilateral, chronic, inflammatory eye condition, affecting people who have tendency to develop allergic diseases such as asthma, atopic dermatitis (eczema) and rhinitis. The eye disease is commonly associated with these atopic diseases but is independent in its severity. The incidence of atopic keratoconjunctivitis increases with a family history of allergic disease. The peak of incidence is between 30-50 years old. Relapses and remits have little or no seasonal correlation.

The disease involves

  • the eye lid,
  • the conjunctiva, the transparent membrane that forms the inner lining of the upper and lower eyelids and covers the sclera, the white part of the eyeball,
  • the cornea, the clear front surface of the eye

How does atopic keratoconjunctivitis manifest?

  1. Periocular involvement, in terms of eyelid dermatitis, also known as periocular eczema, presents with a scaly, erythematous eruption of the upper and/or lower eyelids and the periorbital area.
  2. Lid manifestations, including:
  • blepharitis, when the edges of the eyelids become inflamed, red and swollen
  • hypertrophy (thickened lid margins)
  • crusting cicatrization (eyelid scarring)
  • ectropion (distortion of lid anatomy with outwardly turning eyelid)
  • madarosis (loss of eyelashes)
  1. The whole conjunctiva is affected and shows intense inflammatory infiltration (papillae), and sometimes scarring with palpebral lid to conjunctiva adhesions (symblepharon) and secondary lid distortions. What is atopic keratoconjunctivitis? the eye lid, the conjunctiva, the transparent membrane that forms the inner lining of the upper and lower eyelids and covers the sclera, the white part of the eyeball, the cornea, the clear front surface of the eye.
  2. The cornea can be affected directly by the inflammatory process or be damaged secondarily following the extensive changes to the protective ocular surface, including reduced lid protection and severe loss of tear production. Corneal involvement includes ulcers and erosions, that predispose to secondary corneal infections, that can lead to progressive scarring, thinning and corneal perforations. Corneal neovascularization, in-growth of new blood vessels into the corneal tissue, can also be present.
  3. Cataract can develop

What causes atopic keratoconjunctivitis?

The disease originates from a disorder of the immune system in predisposed individuals.

Diagnosis

The diagnosis of atopic keratoconjunctivitis is made clinically, based on both a history of allergic disorders and the ocular examination.

Treatment

Management of atopic keratoconjunctivitis is aimed at controlling the inflammatory response and subsequently, the symptoms. Most of the cases are treated in collaboration with an allergist or dermatologist. In early disease, topical management with mast cell stabilizers and anti-histamine eye drops, lubricants, cold compresses and oral anti-histamines can control the ocular disease. However, in more advanced cases, additional therapy, including topical corticosteroid drops, cyclosporine drops or tacrolimus ointment to the eyelid skin, is necessary. When topical treatments fail to induce remission, oral corticosteroids and steroid-sparing immunosuppressive agents, including tacrolimus or cyclosporine, are considered as treatment options, also useful for the dermatologic manifestations of the disease. Surgery can be necessary in case of cataract or to treat corneal or eyelid complications

Complications

In the final stages of aggressive and poorly controlled atopic keratoconjunctivitis visual loss due to corneal opacification can occur.

Corneal Abrasion

What is corneal abrasion?

The cornea is the clear front part of the eye. Corneal abrasion is a common eye injury manifesting as a scratch on the cornea.

What causes a corneal abrasion?

A corneal abrasion normally happens after an accident or injury to the front of the eye. Common causes involve fingernails, pen, make-up brush, or accidents in the home or while gardening, including sand, sawdust, ash or other foreign matters in the eye. If small pieces get trapped in the eye, rubbing the eye and blinking commonly lead to a corneal abrasion.

What are the symptoms?

Symptoms include

  • pain
  • foreign body sensation (the feeling that something is in the eye) or gritty sensation (irritation that feels like sand in the eye)
  • redness
  • sensitivity to light
  • watering

Vision can be blurry or hazy.

How long does it take to heal?

Ocular discomfort will only last a short time while the eye heals. Corneal abrasions will normally heal completely within 48 hours.

Treatment

Lubricating drops (artificial tear drops, gel or ointment) are usually given to help the eye feel more comfortable and keep it moist. Antibiotic drops or ointment are prescribed to prevent infection of the abrasion. Over-the-counter painkillers such as paracetamol will help with the pain and avoid rubbing or touching the eye as this makes the abrasion worse and slow down the rate of healing. Sunglasses are recommended because of sensitivity to light. Contact lenses should not be used.

Dry Eye

What is dry eye?

Dry eye is an eye condition caused by a problem with tears. Dry eye can make your eye feel uncomfortable, red, scratchy and irritated. Despite the name, having dry eye can also make your eyes watery. Typically, dry eye doesn’t cause a permanent change in your vision. It can make your eyesight blurry for short periods of time, but the blurriness will go away on its own or improve when you blink. Normally, dry eye affects both eyes but sometimes one eye is affected more than the other. Sometimes dry eye can make it feel like you’ve got something in your eye such as an eyelash or a piece of grit, even when there is nothing there. Your eyes may water more than usual.

Although dry eye doesn’t usually cause long term problems with your sight, it’s important to let someone know if your eyes are feeling uncomfortable, gritty and sore.

Most of the time, dry eye just causes discomfort and can be well controlled with the use of eye drops. Once you have dry eye, you tend to be always prone to it, but you will probably find that there are times when it is better than others. Very rarely, in severe cases, dry eye can be very painful and the dryness can cause permanent damage to the front of your eye. The severity of these problems depends on the cause. Medically, dry eye is known as keratoconjunctivitis sicca.

What are the causes of dry eye?

While dry eye can occur at any age, it is more common in women, especially after the menopause. Changes in hormonal levels such as in pregnancy and menopause can contribute to dry eye. The following can also affect your tear film and contribute to dry eye: Blepharitis and meibomian gland dysfunction Blepharitis and meibomian gland dysfunction (MGD) are both very common causes of dry eye. Blepharitis is an inflammation of the eyelids and can sometimes be caused by a bacterial infection. It can be divided into two types based on the location: • Anterior blepharitis is when the inflammation is primarily around the lashes and in front of the lid margin. • Posterior blepharitis is when there is inflammation present behind the lid margin and is often caused by MGD. 10 MGD happens when the glands lining your upper and lower lids are blocked. You have about 30 of these small meibomian glands on each upper and lower lid located just behind your lashes. These glands secrete oil onto the front of your tears. If too much or too little is produced, the tears tend to evaporate too fast leaving your eyes dry and uncomfortable. If you have blepharitis or MGD, practising lid hygiene can really help make your eyes feel more comfortable. You will need to do this twice a day for two to three weeks before you see an improvement.

How is dry eye diagnosed?

If your eyes feel uncomfortable and irritated, or you feel like there is something in your eye all the time, then you should tell your GP, optometrist or ophthalmologist.

There are a number of tests which your eye care professional may want to do to work out if you have dry eye and if you do, how dry your eyes are. These tests help them decide how to treat your eyes. The tests also check how many tears you produce and detect any areas on the front of your eye that don’t have enough tears. As well as examining the front of your eyes and the quality of the tears with a special microscope called a slit lamp, there are other tests your optometrist or ophthalmologist may want to do: the tear film break-up time test and the Schirmer test.

Tear film break-up time This test finds out how long after blinking your eye starts to dry out. The ophthalmologist or optometrist uses eye drops containing a special dye which makes your tears easy to see. They put the drops into your eye and ask you to blink a number of times to make sure that the dye is in your tears properly. They will then ask you to stop and keep your eyes open without blinking. A coloured light is used to see the dye and times the period between your last blink and the formation of dry patches. The dry patches are shown up by the dye. If your eyes start to show patches of dryness before 10 seconds, it usually means that there is some evidence of dry eye. The dye does not change the colour of your eye and only stays in your eye for a short while; however, it can temporarily stain your skin if tears run down but can easily be washed away.

Schirmer test This is a test with filter paper which may be performed to test tears. It involves using a special filter paper, which is placed into the area between your lower eyelid and the eye and then left in the eye for about five minutes. After this the ophthalmologist is able to see how many tears the eye produces in that period. This test isn’t performed very often as it doesn’t usually change the way someone with dry eye is treated, but it might be needed if your dry eye is very severe.

What is the treatment for dry eye?

Once the diagnosis is confirmed, the best option for you will be discussed. You cannot cure dry eye but there are some treatments that can help your eyes feel more comfortable. If your dry eye is caused by medication, then a switch in medication will be considered. If your dry eye is caused by wearing contact lenses, then having a break from your lenses may help the dry eye to improve. Often dry eye is caused by getting older, which can’t be helped, but there is treatment that can help with your symptoms.

There are three main ways to help your dry eye:

  • making the most of your natural tears
  • using artificial tears (eye drops)
  • reducing the draining away of the tears.

Blepharitis

Blepharitis is a common inflammatory condition where the edges of the eyelids become red, swollen and inflamed. Blepharitis is often caused by a build-up of bacteria living along the eyelid and eyelashes. The most important part of treating and managing Blepharitis is to keep the eyelids clean. If you do not treat it, it will not improve, and your symptoms will remain and possibly worsen. Blepharitis is one of the most common reasons to cancel elective (planned) eye surgery.

There are two main types of Blepharitis:

Anterior Blepharitis – This is where the inflammation affects the skin around the base of your eyelashes.

Posterior Blepharitis – This is where the inflammation affects your eyelid glands. Meibomian Gland Dysfunction (MGD) can occur when the eyelid glands become clogged. Sometimes, people will experience both types of Blepharitis because the causes are often connected.

Symptoms

  • Itchy, sore and red eyelids that stick together
  • Crusty or greasy eyelashes
  • Burning, gritty sensation in your eyes
  • Visible dandruff on your eyelashes

Possible Causes

  • A build-up of oil and debris on the eyelids and eyelashes
  • Bacterial eyelid infections
  • Complication of skin conditions such as Seborrhoeic Dermatitis or Rosacea
  • Meibomian Gland Dysfunction (MGD)

Treatment

Daily lid hygiene is key to the management of Blepharitis and other conditions of the eye such as Meibomian Gland Dysfunction (MGD) and Styes

Heat – Applying a heated eye mask or warm cloth* to closed eyelids for 10 minutes, can help soften the clogged oils in the eyelid glands. This allows the oils to flow more freely and helps prevent the tears from evaporating from the surface of the eye.

Massage – Following the heated eye mask, gently massage the eyelids using your forefinger. Massaging will help to push the oil out from the eyelid glands.

Cleansing your eyelids daily will help remove debris, bacteria and oil that can often lead to Blepharitis, MGD or Dry Eye symptoms. While lid scrubs using diluted baby shampoo applied by swab or cotton bud have been the most widely recommended method, there are newer, more effective methods of managing lid hygiene such as commercially available lid scrubs, wipes and foams. Lid scrubs and wipes are usually pre-soaked in a cleansing solution and ready to use. Using preservative free methods where possible is recommended, as the long-term use of preservatives can be harmful to the ocular surface.

Hydrate – the use of preservative free eye lubricants and sprays which have shown to be more effective than preserved eye drops or ointments in reducing inflammation on the eyes is recommended. Tear replacement with eye drops, sprays or ointments are traditionally considered a mainstay of Blepharitis management, however it is recommended these are used in conjunction with other therapies to target the underlying causes of Blepharitis.

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