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Viral conjunctivitis is often associated with an infection of the upper respiratory tract, a common cold, or a sore throat. Its symptoms include excessive watering and itching. The infection usually begins with one eye, but may spread easily to the other.
Viral conjunctivitis shows a fine, diffuse pinkness of the conjunctiva, which is easily mistaken for the ciliary infection of iris (iritis), but there are usually corroborative signs on microscopy, particularly numerous lymphoid follicles on the tarsal conjunctiva, and sometimes a punctate keratitis.
Allergic conjunctivitis is inflammation of the conjunctiva (the membrane covering the white part of the eye) due to allergy. Allergens differ among patients.
Symptoms consist of redness (mainly due to vasodilation of the peripheral small blood vessels), swelling of the conjunctiva, itching, and increased lacrimation (production of tears). If this is combined with rhinitis, the condition is termed "allergic rhinoconjunctivitis". The symptoms are due to release of histamine and other active substances by mast cells, which stimulate dilation of blood vessels, irritate nerve endings, and increase secretion of tears.
In the acute stage of the disease, a catarrhal conjunctivitis is present, with signs of ocular pain, usually blepharospasm, increased lacrimation, and photophobia. Miosis is also usually present. After a few days, this will progress to a keratitis and iridocyclitis. Other ocular problems may also occur, including conjunctival and corneal oedema, and aqueous flare.
After an acute flare-up, no clinical signs of disease may be seen for a prolonged period, which can vary from a few hours to a few years. With frequent acute incidents, though, additional clinical signs may be seen, including anterior and posterior synechiae, poor pupillary responses, cataracts, and a cloudy appearance to the vitreous humour.
Ligneous conjunctivitis is a rare form of chronic conjunctivitis characterized by recurrent, fibrin-rich pseudomembranous lesions of wood-like consistency that develop mainly on the underside of the eyelid (tarsal conjunctiva). It is generally a systemic disease which may involve the periodontal tissue, the upper and lower respiratory tract, kidneys, middle ear, and female genitalia. It can be sight-threatening, and death can occasionally occur from pulmonary involvement.
It has been speculated that ligneous conjunctivitis may be a manifestation of IgG4-related disease (IgG4-RD) involving the conjunctiva.
Neonatal conjunctivitis by definition presents during the first month of life. It may be infectious or non infectious. In infectious conjunctivitis, the organism is transmitted from the genital tract of an infected mother during birth or by infected hands.
- Pain and tenderness in the eyeball.
- Conjunctival discharge: purulent, mucoid or mucopurulent depending on the cause.
- Conjunctiva shows hyperaemia and chemosis. Eyelids are usually swollen.
- Corneal involvement (rare) may occur in herpes simplex ophthalmia neonatorum.
Symptoms of scleritis include:
- Redness of the sclera and conjunctiva, sometimes changing to a purple hue
- Severe ocular pain, which may radiate to the temple or jaw. The pain is often described as deep or boring.
- Photophobia and tearing
- Decrease in visual acuity, possibly leading to blindness
The pain of episcleritis is less severe than in scleritis. In hyperemia, there is a visible increase in the blood flow to the sclera (hyperaemia), which accounts for the redness of the eye. Unlike in conjunctivitis, this redness will not move with gentle pressure to the conjunctiva.
Conjunctival suffusion is an eye finding occurring early in Weil’s disease, which is caused by "Leptospira interrogans". Conjunctival suffusion is characterized by redness of the conjunctiva that resembles conjunctivitis, but it does not involve inflammatory exudates. Swelling of the conjunctiva (chemosis) is seen along the corners of the eye (palpebral fissures).
About 30 percent of patients with Weil's disease develop conjunctival suffusion. When it does occur, it develops towards the end of the early phase of the illness. Even in severe cases, the suffusion occurs in the first phase of the illness.
Conjunctival suffusion may also occur in patients with a Hantavirus infection. In a 1994 study of 17 patients with Hantavirus infections, 3 had conjunctival suffusion.
Equine recurrent uveitis (ERU), also known as moon blindness, recurrent iridocyclitis or periodic ophthalmia, is an acute, nongranulomatous inflammation of the uveal tract of the eye, occurring commonly in horses of all breeds, worldwide. The causative factor is not known, but several pathogeneses have been suggested. It is the most common cause of blindness in horses. In some breeds, a genetic factor may be involved.
Blepharitis is characterized by chronic inflammation of the eyelid, usually at the base of the eyelashes. Symptoms include inflammation, irritation, itchiness, a burning sensation, excessive tearing, and crusting and sticking of eyelids. Additional symptoms may include visual impairment such as photophobia and blurred vision. Symptoms are generally worse in the mornings and patients may experience exacerbation and several remissions if left untreated. It is typically caused by bacterial infection or blockage of the meibomian oil glands. Diseases and conditions that may lead to blepharitis include: rosacea, herpes simplex dermatitis, varicella-zoster dermatitis, molluscum contagiosum, allergic dermatitis, contact dermatitis, seborrheic dermatitis, staphylococcal dermatitis, demodicosis (Demodex), and parasitic infections ("e.g.", Demodex and Phthiriasis palpebrarum).
The parasite, "Demodex folliculorum" ("D. folliculorum"), causes blepharitis when the parasite is present in excessive numbers within the dermis of the eyelids. These parasites can live for approximately 15 days. The parasites (both adult and eggs) live on the hair follicle, inhabiting the sebaceous and apocrine gland of the human lid. Direct contact allows this pathogen to spread. Factors that allow this pathogen to multiply include hypervascular tissue, poor hygienic conditions, and immune deficiency. In treating Blepharitis caused by "D. folliculorum", mechanical cleaning and proper hygiene are important towards decreasing the parasites numbers.
Associated Symptoms:
- Watery eyes - due to excessive tearing.
- Red eyes - due to dilated blood vessels on the sclera.
- Swollen eyelids - due to inflammation.
- Crusting at the eyelid margins/base of the eyelashes/medial canthus, generally worse on waking - due to excessive bacterial buildup along the lid margins.
- Eyelid sticking - due to crusting along the eyelid margin.
- Eyelid itching - due to the irritation from inflammation and epidermis scaling of the eyelid.
- Flaking of skin on eyelids - due to tear film suppressed by clog meibomian glands.
- Gritty/burning sensation in the eye, or foreign-body sensation - due to crusting from bacteria and clogged oil glands
- Frequent blinking - due to impaired tear film from clogged oil glands unable to keep tears from evaporating.
- Light sensitivity/photophobia
- Misdirected eyelashes that grow abnormally - due to permanent damage to the eyelid margin
- Eyelash loss - due to excessive buildup of bacteria along the base of the eyelashes.
- Infection of the eyelash follicle/sebaceous gland (hordeolum)
- Debris in the tear film, seen under magnification (improved contrast with use of fluorescein drops)
Chronic blepharitis may result in damage of varying severity and, in the worst cases, may have a negative effect on vision. This can be resolved with a proper eyeglass prescription. Long-term untreated blepharitis can lead to eyelid scarring, excess tearing, difficulty wearing contact lenses, development of a stye (an infection near the base of the eyelashes, resulting in a painful lump on the edge of the eyelid) or a chalazion (a blockage/bacteria infection in a small oil glands at the margin of the eyelid, just behind the eyelashes, leading to a red, swollen eyelid), chronic pink eye (conjunctivitis), keratitis, and corneal ulcer or irritation. The lids may become red and may have ulcerate, non-healing areas that may lead to bleeding. Blepharitis can also cause blurred vision due to a poor tear film. Tears may be frothy or bubbly, which can contribute to mild scarring along the eyelids. Symptoms and signs of blepharitis are often erroneously ascribed by the patient as "recurrent conjunctivitis".
Staphylococcal blepharitis and Posterior blepharitis or "rosacea-associated" blepharitis Symptoms
Symptoms include a foreign body sensation, matting of the lashes, and burning. Collarette around eyelashes, a ring-like formation around the lash shaft, can be observed. Other symptoms include loss of eyelashes or broken eyelashes. The condition can sometimes lead to a chalazion or a stye. Chronic bacterial blepharitis may also lead to ectropion. Posterior blepharitis or "rosacea-associated" blepharitis is manifested by a broad spectrum of symptoms involving the lids including inflammation and plugging of the meibomian orifices and production of abnormal secretion upon pressure over the glands.
Primary infection most commonly manifests as blepharoconjunctivitis i.e. infection of lids and conjunctiva that heals without scarring. Lid vesicles and conjunctivitis are seen in primary infection. Corneal involvement is rarely seen in primary infection.
Histopathological findings from affected humans indicate that wound healing is impaired due to a deficiency in plasmin-mediated extracellular fibrinolysis. Episodes may be triggered by minor trauma, eye surgery, or by systemic events such as infections or antifibrinolytic therapy. Histology shows amorphous subepithelial deposits of eosinophilic material consisting predominantly of fibrin.
Untreated cases may develop corneal ulceration, which may perforate resulting in corneal opacification and Staphyloma formation.
The conjunctiva is a thin membrane that covers the eye. When an allergen irritates the conjunctiva, common symptoms that occur in the eye include: ocular itching, eyelid swelling, tearing, photophobia, watery discharge, and foreign body sensation (with pain).
Itching is the most typical symptom of ocular allergy, and more than 75% of patients report this symptom when seeking treatment. Symptoms are usually worse for patients when the weather is warm and dry, whereas cooler weather with lower temperatures and rain tend to assuage symptoms. Signs in phlyctenular keratoconjunctivitis include small yellow nodules that develop over the cornea, which ulcerate after a few days.
A study by Klein et al. showed that in addition to the physical discomfort allergic conjunctivitis causes, it also alters patients' routines, with patients limiting certain activities such as going outdoors, reading, sleeping, and driving. Therefore, treating patients with allergic conjunctivitis may improve their everyday "quality of life."
This classic herpetic lesion consists of a linear branching corneal ulcer (dendritic ulcer). During eye exam the defect is examined after staining with fluorescein dye. The underlying cornea has minimal inflammation.
Patients with epithelial keratitis complain of foreign-body sensation, light sensitivity, redness and blurred vision.
Focal or diffuse reduction in corneal sensation develops following recurrent epithelial keratitis.
In immune deficient patients or with the use of corticosteroids the ulcer may become large and in these cases it is called geographic ulcer.
Keratoconjunctivitis is inflammation ("-itis") of the cornea and conjunctiva.
When only the cornea is inflamed, it is called "keratitis"; when only the conjunctiva is inflamed, it is called "conjunctivitis".
There are several potential causes of the inflammation:
- Keratoconjunctivitis sicca is used when the inflammation is due to dryness. ("Sicca" means "dryness" in medical contexts.) It occurs with 20% of rheumatoid arthritis patients.
- The term "Vernal keratoconjunctivitis" (VKC) is used to refer to keratoconjunctivitis occurring in spring, and is usually considered to be due to allergens.
- "Atopic keratoconjunctivitis" is one manifestation of atopy.
- "Epidemic keratoconjunctivitis" is caused by an adenovirus infection.
- "Infectious bovine keratoconjunctivitis" (IBK) is a disease affecting cattle caused by the bacteria "Moraxella bovis".
- "Pink eye in sheep and goat" is another infectious keratoconjunctivitis of veterinary concern, mostly caused by "Chlamydophila pecorum"
- "Superior limbic keratoconjunctivitis" is thought to be caused by mechanical trauma.
- "Keratoconjunctivitis photoelectrica" (arc eye) means inflammation caused by photoelectric UV light. It is a type of ultraviolet keratitis. Such UV exposure can be caused by arc welding without wearing protective eye glass, or by high altitude exposure from sunlight reflected from snow ("snow blindness"). The inflammation will only appear after about 6 to 12 hours. It can be treated by rest, as the inflammation usually heals after 24–48 hours. Proper eye protection should be worn to prevent keratoconjunctivitis photoelectrica.
Secondary keratitis or uveitis may occur with scleritis. The most severe complications are associated with necrotizing scleritis.
Conjunctivitis eye condition contracted from exposure to actinic rays. Symptoms are redness and swelling.
Actinic conjunctivitis is an inflammation of the eye contracted from prolonged exposure to actinic (ultraviolet) rays. Symptoms are redness and swelling of the eyes. Most often the condition is caused by prolonged exposure to Klieg lights, therapeutic lamps, or acetylene torches. Other names for the condition include Klieg conjunctivitis, eyeburn, arc-flash, welder's conjunctivitis, flash keratoconjunctivitis, actinic ray ophthalmia, x-ray ophthalmia, and ultraviolet ray ophthalmia.
Patients typically present within one week of surgery with eye pain, photophobia, conjunctivitis, or excessive tear production.
Blepharitis ( ) is one of the most common ocular conditions characterized by inflammation, scaling, reddening, and crusting of the eyelid. This condition may also cause burning, itching, or a grainy sensation when introducing foreign objects or substances to the eye. Although blepharitis is not sight-threatening, it can lead to permanent alterations of the eyelid margin. The overall etiology is a result of bacteria and inflammation from congested meibomian oil glands at the base of each eyelash. Other conditions may give rise to blepharitis, whether they be infectious or noninfectious, including, but not limited to, bacterial infections or allergies.
Different variations of blepharitis can be classified as seborrheic, staphylococcal, mixed, posterior or meibomitis, or parasitic. In a survey of US ophthalmologists and optometrists, 37% to 47% of patients seen by those surveyed had signs of blepharitis, which can affect all ages and ethnic groups. One single-center study of 90 patients with chronic blepharitis found that the average age of patients was 50 years old.
Allergic conjunctivitis is inflammation of the conjunctiva (the membrane covering the white part of the eye) due to allergy. Although allergens differ among patients, the most common cause is hay fever. Symptoms consist of redness (mainly due to vasodilation of the peripheral small blood vessels), edema (swelling) of the conjunctiva, itching, and increased lacrimation (production of tears). If this is combined with rhinitis, the condition is termed allergic rhinoconjunctivitis.
The symptoms are due to release of histamine and other active substances by mast cells, which stimulate dilation of blood vessels, irritate nerve endings, and increase secretion of tears.
Treatment of allergic conjunctivitis is by avoiding the allergen ("e.g.", avoiding grass in bloom during "hay fever season") and treatment with antihistamines, either topical (in the form of eye drops), or systemic (in the form of tablets). Antihistamines, medications that stabilize mast cells, and nonsteroidal anti-inflammatory drugs (NSAIDs) are generally safe and usually effective.
It is usually caused by allergies or viral infections, often inciting excessive eye rubbing. Chemosis is also included in the Chandler Classification system of orbital infections.
If chemosis has occurred due to excessive rubbing of the eye, the first aid to be given is a cold water wash for eyes.
Other causes of chemosis include:
- Superior vena cava obstruction, accompanied by facial oedema
- Hyperthyroidism, associated with exophthalmos, periorbital puffiness, lid retraction, and lid lag
- Cavernous sinus thrombosis, associated with infection of the paranasal sinuses, proptosis, periorbital oedema, retinal haemorrhages, papilledema, extraocular movement abnormalities, and trigeminal nerve sensory loss
- Carotid-cavernous fistula - classic triad of chemosis, pulsatile proptosis, and ocular bruit
- Cluster headache
- Trichinellosis
- Systemic lupus erythematosus (SLE)
- Angioedema
- Acute glaucoma
- Panophthalmitis
- Orbital cellulitis
- Gonorrheal conjunctivitis
- Dacryocystitis
- Spitting cobra venom to the eye
- High concentrations of phenacyl chloride in chemical mace spray
- Urticaria
- Trauma
- Post surgical
- Rhabdomyosarcoma of the orbit
Diffuse lamellar keratitis (DLK) is a sterile inflammation of the cornea which may occur after refractive surgery, such as LASIK. Its incidence has been estimated to be 1 in 500 patients, though this may be as high as 32% in some cases.
Chemosis is the swelling (or edema) of the conjunctiva. It is due to the oozing of exudate from abnormally permeable capillaries. In general, chemosis is a nonspecific sign of eye irritation. The outer surface covering appears to have fluid in it. The conjunctiva becomes swollen and gelatinous in appearance. Often, the eye area swells so much that the eyes become difficult or impossible to close fully. Sometimes, it may also appear as if the eyeball has moved slightly backwards from the white part of the eye due to the fluid filled in the conjunctiva all over the eyes except the iris. The iris is not covered by this fluid and so it appears to be moved slightly inwards.
Ophthalmia (also called ophthalmitis) is inflammation of the eye. It is a medical sign which may be indicative of various conditions, including sympathetic ophthalmia (inflammation of both eyes following trauma to one eye), gonococcal ophthalmia, trachoma or "Egyptian" ophthalmia, ophthalmia neonatorum (a conjunctivitis of the newborn due to either of the two previous pathogens), photophthalmia and actinic conjunctivitis (inflammation resulting from prolonged exposure to ultraviolet rays), and others.