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What Is Conjunctivitis (Pink Eye)? Symptoms, Diagnosis And Treatment

There are four main types of conjunctivitis: viral, allergic, bacterial and chemical. However, there are other, less common types such as immune-mediated and contact lens-related conjunctivitis.

Viral Conjunctivitis

Viral conjunctivitis is the most common form of pink eye, accounting for around 80% of cases . It's caused by a virus, such as the common cold. It may affect both eyes and can be spread through contact with an infected person's discharge, coughing or sneezing.

"Any virus that causes a cold or respiratory flu can also land in the eye and cause pink eye," explains Arthur Lavin, M.D., FAAP, a pediatrician at Akron Children's Hospital in Beachwood, Ohio.

According to Dr. Lavin, some of the most common viruses causing viral conjunctivitis include:

  • Adenovirus (a virus that typically causes colds)
  • Influenza
  • Respiratory syncytial virus (RSV)
  • Rhinovirus (another virus that can cause colds)
  • Children are most susceptible to viral conjunctivitis, which is highly contagious in schools and daycare centers. "Since kids get more colds, they get more pink eye, too," adds Dr. Lavin.

    Allergic Conjunctivitis

    Allergic conjunctivitis is caused by an allergic reaction to certain irritants, such as pollen, pet dander and dust mites. It usually affects both eyes and is not contagious like some other forms. The discharge associated with allergic conjunctivitis is usually clear and watery—unlike the thick discharge associated with bacterial conjunctivitis.

    Because allergens are more common in spring and summer, allergic conjunctivitis is more likely to occur during these times. This form may appear as an immediate response to an allergen, or it may happen hours or days later. The best way to prevent and treat this type of conjunctivitis is to avoid the allergens that cause it.

    Bacterial Conjunctivitis

    Bacterial conjunctivitis is caused by bacterial infections and can affect one or both eyes. When bacteria affect the eye, it can cause redness and swelling of the conjunctiva. Like viral conjunctivitis, this form is contagious and can spread through direct contact with an infected person or sharing items such as towels, pillows and makeup.  Unlike viral conjunctivitis which usually has a thin, watery discharge, bacterial conjunctivitis causes a very thick mucus discharge.

    The most common bacteria causing bacterial conjunctivitis in children include:

  • Haemophilus influenza
  • Streptococcus pneumonia
  • Moraxella catarrhalis
  • The most common bacteria causing bacterial conjunctivitis in adults include:

  • Staphylococcal aureus
  • Streptococcus pneumonia
  • Haemophilus influenzae
  • In infants, N. Gonorrhoeae is the most common bacteria causing bacterial conjunctivitis. This bacteria usually progresses quickly and can lead to more serious eye conditions if left untreated.

    Bacterial pink eye is most common from December to April. It typically lasts between seven and 10 days but may have a shorter duration if treated with antibiotics within the first few days of developing symptoms.

    Chemical Conjunctivitis

    Chemical conjunctivitis is an eye irritation caused by exposure to a chemical or irritant, such as chlorine from swimming pools or air pollution. This type of pink eye is not contagious and usually subsides within a few days.

    Flushing the eye with saline will help reduce the irritation. People who wear contacts should remove their lenses and speak with an optometrist or ophthalmologist if their eyes become overly irritated, red or painful. You may need to switch to a different type of lens or solution, or stop wearing contact lenses altogether.

    Sometimes, emergency medical attention is necessary if there is a severe reaction to the chemical irritant. Getting highly acidic or highly alkaline chemicals into the eye can cause serious risk of permanent vision loss, so initiate flushing the eye with an eye wash and immediately seek medical care.


    What To Know About Follicular Conjunctivitis

    Follicular conjunctivitis is usually due to infection from a virus or the bacterium that causes chlamydia. It can spread easily but is usually mild and goes away within a few weeks.

    Conjunctivitis is inflammation of the conjunctiva, the thin membrane that covers your eye and the inside of your eyelid. Infection or exposure to an irritant can cause it to become inflamed. Conjunctivitis is often called pink eye.

    Depending on how the inflammation looks, doctors or healthcare professionals can usually categorize conjunctivitis as either papillary or follicular. In papillary conjunctivitis, small flat-topped nodules (papillae) form on your conjunctiva. In follicular conjunctivitis, the inflammation results in tiny dome-shaped nodules (follicles).

    Follicular conjunctivitis usually suggests that a virus is the cause. Although bacteria are usually linked to papillary conjunctivitis, the bacterium that causes chlamydia, a common sexually transmitted infection, also causes follicular conjunctivitis.

    Read on to learn more about what can increase your risk of follicular conjunctivitis, what symptoms to watch out for, and how doctors diagnose and treat it.

    Certain kinds of bacteria or viruses most commonly cause follicular conjunctivitis. These often spread easily through touch or by air and include:

    Reactions to topical medications on your eye can also cause follicular conjunctivitis. This type is called toxic follicular conjunctivitis.

    In rare cases, exposure to infections from pets, such as cats, can also cause follicular conjunctivitis.

    Some infections that can increase your risk of follicular conjunctivitis include:

    Some of the most common symptoms of follicular conjunctivitis include:

  • feeling like something's stuck in your eye
  • pain in or around your eye
  • red eyes
  • itchy eyes
  • sensitivity to light (photophobia)
  • burning eyes
  • eye discharge that can range from thin and watery to thick and sludgy
  • crusty buildup around the outer edges of your eyelids (mattering)
  • inflammation of the oil glands around your eyelids (blepharitis)
  • Some types of follicular conjunctivitis can cause severe symptoms elsewhere in your body. Get immediate medical help if you notice:

  • excessive watering or fluid buildup around your eyes
  • fluid-filled blisters around your eyes (epiphora)
  • bleeding around your eyelids
  • fever
  • feeling exhausted for no obvious reason
  • pain in your arms and legs
  • sore and swollen throat
  • cough that won't go away
  • difficulty breathing
  • An eye doctor is usually the best specialist to diagnose and treat follicular conjunctivitis.

    The eye doctor can examine your eyes using a slit lamp and other tools to look closely at your eye and the surrounding area for symptoms.

    They may also take a swab of your eye to test fluid for the presence of bacteria and viruses. They may ask you to do this at their office or in a laboratory that can usually provide a definitive diagnosis of follicular conjunctivitis.

    Follicular conjunctivitis usually goes away on its own in about 3 weeks or less without any need for treatment. When due to a viral infection, the virus will shed as you produce tears and eventually disappear from the area entirely.

    Most treatments aim to help relieve pain or irritation from the infection. This may involve using eye drops 4 to 10 times a day to keep your eye lubricated and reduce irritation. You may also apply a cold compress to the area around your affected eye.

    A doctor may recommend medical treatments for more severe or long lasting cases, such as:

  • antibiotics, such as azithromycin, for chlamydia infections
  • prescription-strength topical corticosteroid eyedrops to help reduce inflammation around the affected area
  • povidone-iodine to disinfect the area if the infection is due to an adenovirus
  • using a small cotton swab or forceps to peel off any membrane formation from your eye or eyelid, especially when due to a molluscum contagiosum infection
  • Follicular conjunctivitis lasts between 14 and 30 days on average. It's usually most contagious during the first 10 to 14 days after you've contracted the infection.

    Whether you or someone close to you has an active infection, here are some tips to prevent the spread of the infection:

  • Avoid touching your eyes.
  • Don't share any objects that may touch your eyes.
  • Avoid swimming in public pools or using shared facilities such as Jacuzzis or steam rooms where bacteria or viruses can spread through droplets in the air.
  • Wash your hands frequently with soap and water for 20 seconds.
  • Clean and sterilize your glasses regularly to avoid contact with bacteria or viruses that may get on the surfaces of your glasses.
  • Consider switching to single-use contact lenses to avoid reusing any.
  • Avoid sexual contact with people who have an active infection.
  • Here are some of the most common questions about follicular conjunctivitis.

    Is follicular conjunctivitis contagious?

    Follicular conjunctivitis is very contagious in the first week or two after infection. If someone touches your infected area and then touches their own eyes, the infection can be spread immediately.

    Do I need to quarantine with follicular conjunctivitis?

    You don't have to quarantine with follicular conjunctivitis. But it can help keep the infection from spreading.

    Practice good hygiene, such as washing your hands and not sharing towels or clothes with others. This can reduce the risk of the infection spreading without the need for isolation.

    Will follicular conjunctivitis go away on its own?

    Follicular conjunctivitis usually goes away on its own. Chronic cases that last longer than 3 or 4 weeks may need medical attention.

    Follicular conjunctivitis is a mild eye infection most commonly due to a bacterial or viral infection. Chlamydia and molluscum contagioscum are among the most common causes.

    Follicular conjunctivitis is typically a short-term infection that goes away after a few weeks without treatment. But get medical help if you notice any other symptoms such as body aches, fever, or significant changes in your vision.


    Ask The Doctors: The Best Way To Fight Pink Eye Is With Hygiene

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