Conjunctivitis natural history: Difference between revisions

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{{Conjunctivitis}}
{{Conjunctivitis}}
{{CMG}} {{AE}} {{SaraM}}
{{CMG}}; {{AE}} {{SaraM}}


==Overview==
==Overview==
The conjunctivitis outcome is usually good with [[treatment]]. Infective conjunctivitis resolves, in 65% of cases, within 2 – 5 days. If left untreated. Most cases of [[viral]] conjunctivitis are mild and will clear up without any [[complications]].  
If left untreated, viral conjunctivitis will generally clear without any complications. Bacterial conjunctivitis is often self-limited. If left untreated, bacterial conjunctivitis will clear within 1 or 2 weeks without any complications, and it is generally associated with a favorable long-term prognosis.<ref name="pmid10922425">{{cite journal| author=Leibowitz HM| title=The red eye. | journal=N Engl J Med | year= 2000 | volume= 343 | issue= 5 | pages= 345-51 | pmid=10922425 | doi=10.1056/NEJM200008033430507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10922425  }} </ref> [[Allergic conjunctivitis]] improves by eliminating or significantly reducing contact with the [[allergen]]. If left untreated, most cases of allergic conjunctivitis may resolve without any long-term consequences. Keratoconjunctivitis sicca associated with Sjögren's syndrome is associated with a particularly poor prognosis and requiring a longer course of treatment.<ref name="pmid17696792">{{cite journal| author=Rose P| title=Management strategies for acute infective conjunctivitis in primary care: a systematic review. | journal=Expert Opin Pharmacother | year= 2007 | volume= 8 | issue= 12 | pages= 1903-21 | pmid=17696792 | doi=10.1517/14656566.8.12.1903 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17696792  }} </ref><ref name="pmid19506195">{{cite journal| author=Schaumberg DA, Dana R, Buring JE, Sullivan DA| title=Prevalence of dry eye disease among US men: estimates from the Physicians' Health Studies. | journal=Arch Ophthalmol | year= 2009 | volume= 127 | issue= 6 | pages= 763-8 | pmid=19506195 | doi=10.1001/archophthalmol.2009.103 | pmc=2836718 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19506195  }} </ref><ref name="pmid11914237">{{cite journal| author=Watson S, Tullo AB, Carley F| title=Treatment of superior limbic keratoconjunctivitis with a unilateral bandage contact lens. | journal=Br J Ophthalmol | year= 2002 | volume= 86 | issue= 4 | pages= 485-6 | pmid=11914237 | doi= | pmc=1771108 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11914237  }} </ref> Prognosis for conjunctivitis is generally good with treatment.
Most cases of [[bacterial]] conjunctivitis will clear up without any long-term consequences. However, if left untreated, in patients who have ''[[chlamydial]]'' or ''[[gonococcal]]'' conjunctivitis may cause [[corneal]] damage. This may lead to lead to permanent [[blindness]].
Hyperacute bacterial conjunctivitis is associated with [[corneal]] involvement, and therefore it has a poor long term [[prognosis]].
Allergic conjunctivitis improves by eliminating or significantly reducing contact with the [[allergen]]. If left untreated, most cases of allergic conjunctivitis may resolve without any long-term consequences<ref name="pmid17696792">{{cite journal| author=Rose P| title=Management strategies for acute infective conjunctivitis in primary care: a systematic review. | journal=Expert Opin Pharmacother | year= 2007 | volume= 8 | issue= 12 | pages= 1903-21 | pmid=17696792 | doi=10.1517/14656566.8.12.1903 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17696792  }} </ref>


==Natural History==
==Natural History==
'''Viral conjunctivitis''' is often caused by ''[[adenovirus]]''. It presents with watery discharge, [[hyperemia]], [[chemosis]], and [[lymphadenopathy]]. If left untreated, most cases of [[viral]] conjunctivitis are mild and will clear up in 7 to 14 days without any long-term consequences. if [[complications]] arise, viral conjunctivitis can take two or more weeks to resolve. If the conjunctivitis persists, the [[epithelial]] [[abnormalities]] may occur. In general, the [[stromal]] or subepithelial [[abnormalities]] may resolved. However, the stromal abnormalities may persist for months to years, long after the [[epithelial]] changes have resolved.  In such cases,  If  subepithelial infiltrates are in the [[pupillary]] [[axis]], they may lead to decreased [[vision]].<ref name="pmid17696792">{{cite journal| author=Rose P| title=Management strategies for acute infective conjunctivitis in primary care: a systematic review. | journal=Expert Opin Pharmacother | year= 2007 | volume= 8 | issue= 12 | pages= 1903-21 | pmid=17696792 | doi=10.1517/14656566.8.12.1903 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17696792  }} </ref>
'''Viral conjunctivitis''' is often caused by [[adenovirus]]. It presents with watery discharge, [[hyperemia]], [[chemosis]], and [[lymphadenopathy]]. If left untreated, most cases of viral conjunctivitis are mild and will clear in 7 to 14 days without any long-term consequences. if [[complications]] arise, viral conjunctivitis can take two or more weeks to resolve. Some cases of viral conjunctivitis may develop stromal or subepithelial abnormalities. In such cases, if subepithelial infiltrates are in the pupillary axis, they may lead to decreased vision. Usually stromal abnormalities may persist for months to years, long after the epithelial changes have resolved.<ref name="pmid10922425">{{cite journal| author=Leibowitz HM| title=The red eye. | journal=N Engl J Med | year= 2000 | volume= 343 | issue= 5 | pages= 345-51 | pmid=10922425 | doi=10.1056/NEJM200008033430507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10922425 }} </ref><ref name="pmid17696792">{{cite journal| author=Rose P| title=Management strategies for acute infective conjunctivitis in primary care: a systematic review. | journal=Expert Opin Pharmacother | year= 2007 | volume= 8 | issue= 12 | pages= 1903-21 | pmid=17696792 | doi=10.1517/14656566.8.12.1903 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17696792 }} </ref><ref name="pmid26077630">{{cite journal| author=Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB| title=Adenoviral keratoconjunctivitis. | journal=Surv Ophthalmol | year= 2015 | volume= 60 | issue= 5 | pages= 435-43 | pmid=26077630 | doi=10.1016/j.survophthal.2015.04.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26077630 }} </ref>


'''Acute hemorrhagic conjunctivitis'''  is often caused by ''[[picornavirus]]''. It presents with a severe red, [[swollen]] [[eyes]] as well as subconjuntival [[hemorrhaging]], and will clear up in 5 to 7 days. If left untreated, almost always resolves without [[sequelae]].<ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468 }} </ref>
'''Acute hemorrhagic conjunctivitis'''  is often caused by [[picornavirus]]. It presents with a severe red, swollen eyes as well as subconjuntival hemorrhaging, and will clear up in 5 to 7 days. If left untreated, acute hemorrhagic conjunctivitis almost always resolves without [[sequelae]].<ref name="pmid1088513">{{cite journal| author=Yin-Murphy M| title=Simple tests for the diagnosis of picornavirus epidemic conjunctivitis (acute haemorrhagic conjunctivitis). | journal=Bull World Health Organ | year= 1976 | volume= 54 | issue= 6 | pages= 675-9 | pmid=1088513 | doi= | pmc=2366581 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1088513 }} </ref>


'''Bacterial conjunctivitis''' presents with [[red eye]], [[purulent]] or [[mucopurulent]] discharge, and [[chemosis]]. The [[incubation period]]  for [[bacterial]] conjunctivitis is estimated to be 1 to 7 days. If left untreated, most cases of bacterial conjunctivitis will clear up in 7 to 10 days without any long-term consequences.  
'''Bacterial conjunctivitis''' presents with [[red eye]], [[mucopurulent discharge]], and [[chemosis]]. The [[incubation period]]  for bacterial conjunctivitis is estimated to be 1 to 7 days. If left untreated, most cases of bacterial conjunctivitis will clear in 7 to 10 days without any long-term consequences.  
If left untreated, In patients who have [[purulent]] or mucopurulent discharge (suspected ''[[chlamydial]]'' and ''[[gonococcal]]'' conjunctivitis), who wear [[contact lenses]], and who are [[immunocompromised]] may cause [[corneal]] damage (such as [[corneal ulcer]], [[scar]], and [[perforation]]), [[sepsis]], and [[meningitis]]. This may lead to permanent [[blindness]] and death.<ref name="pmid10922425">{{cite journal| author=Leibowitz HM| title=The red eye. | journal=N Engl J Med | year= 2000 | volume= 343 | issue= 5 | pages= 345-51 | pmid=10922425 | doi=10.1056/NEJM200008033430507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10922425  }} </ref>
If left untreated, In patients who have purulent or mucopurulent discharge (suspected [[chlamydial]] and [[gonococcal]] conjunctivitis), who wear [[contact lenses]], and who are [[immunocompromised]], conjunctivitis may cause corneal damage (such as [[corneal ulcer]], [[scar]], and [[perforation]]), [[sepsis]], and [[meningitis]]. This may lead to permanent [[blindness]] and death.<ref name="pmid10922425">{{cite journal| author=Leibowitz HM| title=The red eye. | journal=N Engl J Med | year= 2000 | volume= 343 | issue= 5 | pages= 345-51 | pmid=10922425 | doi=10.1056/NEJM200008033430507 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10922425 }} </ref><ref name="pmid17696792">{{cite journal| author=Rose P| title=Management strategies for acute infective conjunctivitis in primary care: a systematic review. | journal=Expert Opin Pharmacother | year= 2007 | volume= 8 | issue= 12 | pages= 1903-21 | pmid=17696792 | doi=10.1517/14656566.8.12.1903 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17696792  }} </ref><ref name="pmid24150468">{{cite journal| author=Azari AA, Barney NP| title=Conjunctivitis: a systematic review of diagnosis and treatment. | journal=JAMA | year= 2013 | volume= 310 | issue= 16 | pages= 1721-9 | pmid=24150468 | doi=10.1001/jama.2013.280318 | pmc=4049531 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24150468 }} </ref>
   
   
'''Hyperacute bacterial conjunctivitis''' is often caused by ''[[neisseria gonorrhoeae]]'' in sexually active adults. It presents with a severe copious [[purulent]] discharge, [[eyelid]] [[swelling]], [[eye pain]] on [[palpation]], preauricular [[adenopathy]], and decreased [[vision]]. If left untreated, may cause [[corneal]] involvement. this may lead to [[corneal perforation]].<ref name="pmid17970823">{{cite journal| author=Høvding G| title=Acute bacterial conjunctivitis. | journal=Acta Ophthalmol | year= 2008 | volume= 86 | issue= 1 | pages= 5-17 | pmid=17970823 | doi=10.1111/j.1600-0420.2007.01006.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17970823  }} </ref>
'''Hyperacute bacterial conjunctivitis (HBC)''' is often caused by ''[[Neisseria gonorrhoeae]]'' in sexually active adults. It presents with a severe copious purulent discharge, eyelid swelling, [[eye pain]] on palpation, preauricular [[adenopathy]], and decreased vision. If left untreated, hyperacute bacterial conjunctivitis may cause corneal involvement, and ultimately [[corneal perforation]].<ref name="pmid17970823">{{cite journal| author=Høvding G| title=Acute bacterial conjunctivitis. | journal=Acta Ophthalmol | year= 2008 | volume= 86 | issue= 1 | pages= 5-17 | pmid=17970823 | doi=10.1111/j.1600-0420.2007.01006.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17970823  }} </ref>


'''Neonatal conjunctivitis''' is one of the most common infections occurring in the first month of life. [[Chemical]] conjunctivitis secondary to silver nitrate solution application usually occurs in the first day of life, disappearing spontaneously within 2-4 days. In the absence of adequate [[prophylaxis]], 30% to 42% of infants born by vaginal delivery to infected mothers will develop ''[[gonococcal]]'' conjunctivitis. ''[[Gonococcal]]'' conjunctivitis tends to occur 2-7 days after birth, and tends to be more severe than other causes of [[ophthalmia neonatorum]]. It presents with severe [[bilateral]] [[purulent]] conjunctivitis, tearing, [[eyelid]] [[swelling]]. If left untreated, may cause [[corneal]] involvement such as [[diffuse]] [[epithelial]] [[edema]], [[ulceration]], [[diffuse]] opacification, and [[corneal perforation]] . This may lead to [[blindness]], ultimately [[sepsis]] or death. The onset of ''[[chlamydial]]'' conjunctivitis is usually later than ''gonococcal'' conjunctivitis. In the absence of adequate prophylaxis, 30% to 50% of infants born by vaginal delivery to infected mothers will develop ''[[chlamydial]]'' conjunctivitis. The [[incubation period]] is 5-14 days. ''[[Chlamydial]]'' conjunctivitis presents with mild [[hyperemia]], watery discharge, [[eyelid]] [[swelling]], [[papillary]] reaction, and pseudomembrane formation. If left untreated, can progress to [[copious]] and purulent discharge.This may lead to central [[corneal]] opacification and [[blindness]]. ''[[Herpetic]]'' conjunctivitis is a rare cause of neonatal conjunctivitis. It usually occurs within the first 2 weeks after birth and has an incubation period of approximately 6-14 days.
'''Neonatal conjunctivitis''' is one of the most common infections occurring in the first month of life. Chemical conjunctivitis secondary to silver nitrate solution application usually occurs in the first day of life, and disappears spontaneously within 2- 4 days. In the absence of adequate [[prophylaxis]], 30% to 42% of infants born by vaginal delivery to infected mothers will develop [[gonococcal]] conjunctivitis. Gonococcal conjunctivitis tends to occur 2-7 days after birth, and tends to be more severe than other causes of [[ophthalmia neonatorum]]. It presents with severe [[bilateral]] purulent conjunctivitis, tearing, and eyelids swelling. If left untreated, gonococcal conjunctivitis may cause [[corneal]] involvement such as corneal [[ulceration]], diffuse opacification, and [[corneal perforation]]. This may lead to [[blindness]], [[sepsis]], or death. The onset of [[chlamydial]] conjunctivitis is usually later than gonococcal conjunctivitis. In the absence of adequate prophylaxis, 30%-50% of infants born by vaginal delivery to infected mothers will develop chlamydial conjunctivitis. The [[incubation period]] is 5-14 days. Chlamydial conjunctivitis presents with mild [[hyperemia]], watery discharge, eyelid swelling, papillary reaction, and pseudomembrane formation. If left untreated, chlamydial conjunctivitis can progress to copious and purulent discharge. This may lead to central corneal opacification and blindness. [[Herpetic]] conjunctivitis is a rare cause of neonatal conjunctivitis. Herpetic conjunctivitis usually occurs within the first 2 weeks after birth and has an incubation period of approximately 6-14 days.
If left untreated, [[HSV]] conjunctivitis can cause [[corneal]] [[scarring]] and [[ulceration]]. Additionally, disseminated ''HSV'' infection can cause [[central nervous system|central nervous system (CNS)]] involvement. [[Ophthalmia neonatorum]] caused by ''[[pseudomonas]]'' is rare but can present with [[eyelid]] edema, [[erythema]], and [[purulent]] discharge. If left untreated, can progress to corneal perforation, [[endophthalmitis]], blindness, and possibly death.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid24235191">{{cite journal| author=Matejcek A, Goldman RD| title=Treatment and prevention of ophthalmia neonatorum. | journal=Can Fam Physician | year= 2013 | volume= 59 | issue= 11 | pages= 1187-90 | pmid=24235191 | doi= | pmc=3828094 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24235191  }} </ref>
If left untreated, [[HSV]] conjunctivitis can cause corneal scarring and ulceration. Additionally, disseminated ''HSV'' infection can cause [[central nervous system|central nervous system (CNS)]] involvement. [[Ophthalmia neonatorum]] caused by [[pseudomonas]] is rare but can present with eyelid edema, [[erythema]], and purulent discharge. If left untreated, ophthalmia neonatorum can progress to corneal perforation, [[endophthalmitis]], blindness, and possibly death.<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid24235191">{{cite journal| author=Matejcek A, Goldman RD| title=Treatment and prevention of ophthalmia neonatorum. | journal=Can Fam Physician | year= 2013 | volume= 59 | issue= 11 | pages= 1187-90 | pmid=24235191 | doi= | pmc=3828094 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24235191 }} </ref><ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of ''[[Neisseria gonorrhoeae]]'' and ''[[Chlamydia trachomatis]]''. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664 }} </ref>


'''[[Allergic conjunctivitis]]''' usually presents with [[itching]] of the eyes and [[eyelid]] [[swelling]]. Seasonal allergic conjunctivitis is the most common form of the condition, and symptoms are related to season-specific aeroallergens. If left untreated, most cases of allergic conjunctivitis improves by eliminating or significantly reducing contact with the [[allergen]] ([[pollen]] or [[animal dander]]) without any long-term consequences.<ref name="pmid23497516">{{cite journal| author=La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S et al.| title=Allergic conjunctivitis: a comprehensive review of the literature. | journal=Ital J Pediatr | year= 2013 | volume= 39 | issue=  | pages= 18 | pmid=23497516 | doi=10.1186/1824-7288-39-18 | pmc=3640929 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23497516  }} </ref>
'''[[Allergic conjunctivitis]]''' usually presents with [[itching]] of the eyes and eyelid swelling. Seasonal allergic conjunctivitis is the most common form of the condition, and [[symptoms]] are related to season-specific aeroallergens. If left untreated, most cases of allergic conjunctivitis improve by eliminating or significantly reducing contact with the [[allergen]] ([[pollen]] or [[animal dander]]) without any long-term consequences.<ref name="pmid23497516">{{cite journal| author=La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S et al.| title=Allergic conjunctivitis: a comprehensive review of the literature. | journal=Ital J Pediatr | year= 2013 | volume= 39 | issue=  | pages= 18 | pmid=23497516 | doi=10.1186/1824-7288-39-18 | pmc=3640929 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23497516 }} </ref><ref name="pmid18282546">{{cite journal| author=Jun J, Bielory L, Raizman MB| title=Vernal conjunctivitis. | journal=Immunol Allergy Clin North Am | year= 2008 | volume= 28 | issue= 1 | pages= 59-82, vi | pmid=18282546 | doi=10.1016/j.iac.2007.12.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18282546  }} </ref><ref name="pmid15245362">{{cite journal| author=Bonini S| title=Atopic keratoconjunctivitis. | journal=Allergy | year= 2004 | volume= 59 Suppl 78 | issue=  | pages= 71-3 | pmid=15245362 | doi=10.1111/j.1398-9995.2004.00570.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15245362 }} </ref>


'''[[keratoconjunctivitis sicca|keratoconjunctivitis sicca (dry eye syndrome)]]''' presents with a [[foreign body]] sensation, mucoid discharge, ocular dryness, [[excessive tearing]] (reflex secretion), [[photophobia]], [[itching]], and [[blurry vision]]. , [[symptoms]] tend to be worse toward the end of the day. If left untreated, with prolonged use of the eyes, or with exposure to extreme environmental conditions, [[corneal perforation]], and [[corneal]] [[ulceration]]  may occur. This may lead to permanent [[blindness]].<ref name="pmid19506195">{{cite journal| author=Schaumberg DA, Dana R, Buring JE, Sullivan DA| title=Prevalence of dry eye disease among US men: estimates from the Physicians' Health Studies. | journal=Arch Ophthalmol | year= 2009 | volume= 127 | issue= 6 | pages= 763-8 | pmid=19506195 | doi=10.1001/archophthalmol.2009.103 | pmc=2836718 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19506195  }} </ref>
'''[[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]]''' presents with a foreign body sensation, mucoid discharge, ocular dryness, [[excessive tearing]] (reflex secretion), [[photophobia]], [[itching]], and [[blurry vision]]. [[Symptoms]] tend to be worse toward the end of the day with prolonged use of the eyes. If left untreated, it can progress to corneal ulceration, [[corneal perforation]], and ultimately permanent blindness.<ref name="pmid19506195">{{cite journal| author=Schaumberg DA, Dana R, Buring JE, Sullivan DA| title=Prevalence of dry eye disease among US men: estimates from the Physicians' Health Studies. | journal=Arch Ophthalmol | year= 2009 | volume= 127 | issue= 6 | pages= 763-8 | pmid=19506195 | doi=10.1001/archophthalmol.2009.103 | pmc=2836718 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19506195 }} </ref><ref name="pmid16309672">{{cite journal| author=Zoukhri D| title=Effect of inflammation on lacrimal gland function. | journal=Exp Eye Res | year= 2006 | volume= 82 | issue= 5 | pages= 885-98 | pmid=16309672 | doi=10.1016/j.exer.2005.10.018 | pmc=1361268 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16309672  }} </ref><ref name="pmid9820935">{{cite journal| author=Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC| title=The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. | journal=Cornea | year= 1998 | volume= 17 | issue= 6 | pages= 584-9 | pmid=9820935 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9820935 }} </ref>


'''Superior limbic keratoconjunctivitis''' symptoms develop around the sixth decade of life, and include a foreign body sensation, burning sensation, pruritus, and [[dry eye]] sensation. Superior limbic keratoconjunctivitistypically is associated with [[remission]] as the natural history and eventual total [[resolution]], although symptoms may last for years.<ref name="pmid11914237">{{cite journal| author=Watson S, Tullo AB, Carley F| title=Treatment of superior limbic keratoconjunctivitis with a unilateral bandage contact lens. | journal=Br J Ophthalmol | year= 2002 | volume= 86 | issue= 4 | pages= 485-6 | pmid=11914237 | doi= | pmc=1771108 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11914237  }} </ref>
'''[[Superior limbic keratoconjunctivitis|Superior limbic keratoconjunctivitis (SLK)]]''' symptoms develop around the sixth decade of life, and include a foreign body sensation, burning sensation, [[pruritus]], and dry eye sensation. Superior limbic keratoconjunctivitis is typically associated with [[remission]] as the natural history and eventual total [[resolution]], although symptoms may last for years.<ref name="pmid11914237">{{cite journal| author=Watson S, Tullo AB, Carley F| title=Treatment of superior limbic keratoconjunctivitis with a unilateral bandage contact lens. | journal=Br J Ophthalmol | year= 2002 | volume= 86 | issue= 4 | pages= 485-6 | pmid=11914237 | doi= | pmc=1771108 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11914237 }} </ref><ref name="pmid2695351">{{cite journal| author=Nelson JD| title=Superior limbic keratoconjunctivitis (SLK). | journal=Eye (Lond) | year= 1989 | volume= 3 ( Pt 2) | issue=  | pages= 180-9 | pmid=2695351 | doi=10.1038/eye.1989.26 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2695351 }} </ref>


==Complications==
==Complications==
===Viral Conjunctivitis===
===Viral Conjunctivitis===
[[Complications]] to [[viral]] conjunctivitis include:<ref name="pmid21733975">{{cite journal| author=Drug and Therapeutics Bulletin| title=Management of acute infective conjunctivitis. | journal=Drug Ther Bull | year= 2011 | volume= 49 | issue= 7 | pages= 78-81 | pmid=21733975 | doi=10.1136/dtb.2011.02.0043 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21733975  }} </ref>
[[Complications]] to viral conjunctivitis include:<ref name="pmid26077630">{{cite journal| author=Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB| title=Adenoviral keratoconjunctivitis. | journal=Surv Ophthalmol | year= 2015 | volume= 60 | issue= 5 | pages= 435-43 | pmid=26077630 | doi=10.1016/j.survophthal.2015.04.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26077630  }} </ref><ref name="pmid21733975">{{cite journal| author=Drug and Therapeutics Bulletin| title=Management of acute infective conjunctivitis. | journal=Drug Ther Bull | year= 2011 | volume= 49 | issue= 7 | pages= 78-81 | pmid=21733975 | doi=10.1136/dtb.2011.02.0043 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21733975  }} </ref>
*Bacterial [[superinfection]]
*Bacterial [[superinfection]]
*[[Keratitis]]
*[[Keratitis]]
*Subepithelial infiltrates
*Subepithelial infiltrates
*[[Corneal]] [[ulceration]] with [[keratoconjunctivitis]]
*Corneal ulceration with keratoconjunctivitis
*[[Chronic]] infection
*Chronic infection
===Bacterial Conjunctivitis===
===Bacterial Conjunctivitis===
[[Complications]] are expected to develop only in cases caused by extremely [[pathogenic]] [[bacteria]] (such as ''[[chlamydia trachomatis]]'' or ''[[neisseria gonorrhoeae]]''). Complications to bacterial conjunctivitis include:<ref name="pmid15195156">{{cite journal| author=Høvding G| title=[Acute bacterial conjunctivitis]. | journal=Tidsskr Nor Laegeforen | year= 2004 | volume= 124 | issue= 11 | pages= 1518-20 | pmid=15195156 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15195156  }} </ref>
Complications to bacterial conjunctivitis include:<ref name="pmid15195156">{{cite journal| author=Høvding G| title=[Acute bacterial conjunctivitis]. | journal=Tidsskr Nor Laegeforen | year= 2004 | volume= 124 | issue= 11 | pages= 1518-20 | pmid=15195156 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15195156 }} </ref><ref name="pmid17585426">{{cite journal| author=| title=Bacterial conjunctivitis in children: antibiotic eye drops only if eye washing is ineffective. | journal=Prescrire Int | year= 2007 | volume= 16 | issue= 89 | pages= 120-1 | pmid=17585426 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17585426 }} </ref>
*[[Sepsis]]
*[[Corneal perforation]]
*[[Meningitis]]
*[[Keratitis]]
*[[corneal perforation]]
*Corneal epithelial defects
*[[keratitis]]
 
*[[Corneal]] epithelial defects
===Neonatal Conjunctivitis===
===Neonatal Conjunctivitis===
Complications to neonatal conjunctivitis include:<ref name=Neonatal-conjunctivitis >Centers for Disease Control and Prevention (2015)[http://www.cdc.gov/conjunctivitis/newborns.html] Accessed on June 30, 2016 </ref>  
Complications to neonatal conjunctivitis include:<ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of ''[[Neisseria gonorrhoeae]]'' and ''[[Chlamydia trachomatis]]''. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref><ref name=Neonatal-conjunctivitis >Centers for Disease Control and Prevention (2015)[http://www.cdc.gov/conjunctivitis/newborns.html] Accessed on June 30, 2016 </ref>  
*[[Ocular]] complications
*Ocular complications
**Pseudomembrane formation
**Pseudomembrane formation
**[[Corneal]] [[edema]]
**Corneal edema
**Thickened palpebral [[conjunctiva]]  
**Thickened palpebral [[conjunctiva]]  
**[[Peripheral]] [[pannus]] formation
**Peripheral pannus formation
**Corneal opacification  
**Corneal opacification  
**Staphyloma
**Staphyloma
Line 55: Line 51:
**[[Endophthalmitis]]
**[[Endophthalmitis]]
**Loss of eye and blindness
**Loss of eye and blindness
*[[Systemic]] complications of ''[[chlamydia]]'' conjunctivitis  
*Systemic complications of [[chlamydia]] conjunctivitis  
**[[Pneumonia]]  
**[[Pneumonia]]  
**[[Otitis]]
**[[Otitis]]
**[[Pharyngeal]] and [[rectal]] colonization
**Pharyngeal and rectal colonization
*Systemic complications of ''[[gonococcal]]'' conjunctivitis
*Systemic complications of [[gonococcal]] conjunctivitis
**[[Arthritis]]
**[[Arthritis]]
**[[Meningitis]]
**[[Meningitis]]
**[[Anorectal]] infection
**Anorectal infection
**[[Septicemia]]
**[[Septicemia]]
===Allergic Conjunctivitis===
===Allergic Conjunctivitis===
[[Complications]] to [[allergic conjunctivitis]] include:<ref name="pmid18282546">{{cite journal| author=Jun J, Bielory L, Raizman MB| title=Vernal conjunctivitis. | journal=Immunol Allergy Clin North Am | year= 2008 | volume= 28 | issue= 1 | pages= 59-82, vi | pmid=18282546 | doi=10.1016/j.iac.2007.12.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18282546  }} </ref><ref name="pmid15245362">{{cite journal| author=Bonini S| title=Atopic keratoconjunctivitis. | journal=Allergy | year= 2004 | volume= 59 Suppl 78 | issue=  | pages= 71-3 | pmid=15245362 | doi=10.1111/j.1398-9995.2004.00570.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15245362  }} </ref>
Complications to [[allergic conjunctivitis]] include:<ref name="pmid18282546">{{cite journal| author=Jun J, Bielory L, Raizman MB| title=Vernal conjunctivitis. | journal=Immunol Allergy Clin North Am | year= 2008 | volume= 28 | issue= 1 | pages= 59-82, vi | pmid=18282546 | doi=10.1016/j.iac.2007.12.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18282546  }} </ref><ref name="pmid15245362">{{cite journal| author=Bonini S| title=Atopic keratoconjunctivitis. | journal=Allergy | year= 2004 | volume= 59 Suppl 78 | issue=  | pages= 71-3 | pmid=15245362 | doi=10.1111/j.1398-9995.2004.00570.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15245362  }} </ref>
*Conjunctivochalasis (chronic recurrences)
*Conjunctivochalasis (chronic recurrences)
*[[Ulceration]]
*Corneal ulceration
*Opacification
*Corneal opacification
*Visual loss
*Visual loss
*[[Steroid]] induced [[intraocular pressure]] elevations
*Steroid induced intraocular pressure elevations
*[[Cataract]]
*[[Cataract]]
===Keratoconjunctivitis Sicca===
===Keratoconjunctivitis Sicca===
[[Complications]]] to keratoconjunctivitis sicca include:<ref name="pmid16309672">{{cite journal| author=Zoukhri D| title=Effect of inflammation on lacrimal gland function. | journal=Exp Eye Res | year= 2006 | volume= 82 | issue= 5 | pages= 885-98 | pmid=16309672 | doi=10.1016/j.exer.2005.10.018 | pmc=1361268 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16309672  }} </ref>
Complications to [[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]] include:<ref name="pmid16309672">{{cite journal| author=Zoukhri D| title=Effect of inflammation on lacrimal gland function. | journal=Exp Eye Res | year= 2006 | volume= 82 | issue= 5 | pages= 885-98 | pmid=16309672 | doi=10.1016/j.exer.2005.10.018 | pmc=1361268 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16309672 }} </ref><ref name="pmid9820935">{{cite journal| author=Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC| title=The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. | journal=Cornea | year= 1998 | volume= 17 | issue= 6 | pages= 584-9 | pmid=9820935 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9820935 }} </ref>
*[[Corneal]] [[ulceration]]
*Corneal ulceration
*Corneal [[erosions]]
*Corneal erosions
*[[Corneal neovascularization]]
*[[Corneal neovascularization]]
*Corneal [[scarring]]
*Corneal scarring
*Corneal thinning
*Corneal thinning
*Corneal [[perforation]]
*Corneal perforation


==Prognosis==
==Prognosis==
'''Viral conjunctivitis''' is often self-limited and most patients recover in 2 to 4 weeks, and is associated with a favorable long-term [[prognosis]]. However, [[viral]] conjunctivitis associated with Subepithelial infiltrates may last for several months, and may cause decreased [[vision]].<ref name="pmid26077630">{{cite journal| author=Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB| title=Adenoviral keratoconjunctivitis. | journal=Surv Ophthalmol | year= 2015 | volume= 60 | issue= 5 | pages= 435-43 | pmid=26077630 | doi=10.1016/j.survophthal.2015.04.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26077630  }} </ref>
*'''Viral conjunctivitis''' is often associated with a favorable long-term [[prognosis]]. However, viral conjunctivitis associated with subepithelial infiltrates may last for several months and cause decreased vision.<ref name="pmid26077630">{{cite journal| author=Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB| title=Adenoviral keratoconjunctivitis. | journal=Surv Ophthalmol | year= 2015 | volume= 60 | issue= 5 | pages= 435-43 | pmid=26077630 | doi=10.1016/j.survophthal.2015.04.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26077630  }} </ref><ref name="pmid21733975">{{cite journal| author=Drug and Therapeutics Bulletin| title=Management of acute infective conjunctivitis. | journal=Drug Ther Bull | year= 2011 | volume= 49 | issue= 7 | pages= 78-81 | pmid=21733975 | doi=10.1136/dtb.2011.02.0043 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21733975  }} </ref>
 
*'''Acute hemorrhagic conjunctivitis''' almost always resolves without [[sequelae]], and has a good visual prognosis.<ref name="pmid1088513">{{cite journal| author=Yin-Murphy M| title=Simple tests for the diagnosis of picornavirus epidemic conjunctivitis (acute haemorrhagic conjunctivitis). | journal=Bull World Health Organ | year= 1976 | volume= 54 | issue= 6 | pages= 675-9 | pmid=1088513 | doi= | pmc=2366581 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1088513  }} </ref>
'''Acute hemorrhagic conjunctivitis''' almost always resolves without [[sequelae]], and has a good visual prognosis.<ref name="pmid1088513">{{cite journal| author=Yin-Murphy M| title=Simple tests for the diagnosis of picornavirus epidemic conjunctivitis (acute haemorrhagic conjunctivitis). | journal=Bull World Health Organ | year= 1976 | volume= 54 | issue= 6 | pages= 675-9 | pmid=1088513 | doi= | pmc=2366581 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1088513  }} </ref>
*'''Bacterial conjunctivitis''' is often associated with a favorable long-term prognosis.
 
Early detection and early treatment of extremely pathogenic bacteria, such as ''[[Chlamydia trachomatis]]'' or ''[[Neisseria gonorrhoeae]]'', is associated with a good prognosis.<ref name="pmid15195156">{{cite journal| author=Høvding G| title=[Acute bacterial conjunctivitis]. | journal=Tidsskr Nor Laegeforen | year= 2004 | volume= 124 | issue= 11 | pages= 1518-20 | pmid=15195156 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15195156 }} </ref><ref name="pmid17585426">{{cite journal| author=| title=Bacterial conjunctivitis in children: antibiotic eye drops only if eye washing is ineffective. | journal=Prescrire Int | year= 2007 | volume= 16 | issue= 89 | pages= 120-1 | pmid=17585426 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17585426 }} </ref>
'''Bacterial conjunctivitis''' is often self-limited and most patients recover in 1 or 2 weeks, and generally is associated with a favorable long-term prognosis. However, [[bacterial]] conjunctivitis associated with extremely [[pathogenic bacteria]], such as ''[[chlamydia trachomatis]]''or ''[[neisseria gonorrhoeae]]'', is associated with significant [[morbidity]] and may result in systemic involvement and [[mortality]].<ref name="pmid17585426">{{cite journal| author=| title=Bacterial conjunctivitis in children: antibiotic eye drops only if eye washing is ineffective. | journal=Prescrire Int | year= 2007 | volume= 16 | issue= 89 | pages= 120-1 | pmid=17585426 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17585426 }} </ref>
*Early detection and early treatment of '''hyperacute bacterial conjunctivitis (HBC)''' is associated with a good prognosis.<ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459 }} </ref>
 
*Early detection and early treatment of '''neonatal conjunctivitis''' is associated with a good prognosis.<ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of ''[[Neisseria gonorrhoeae]]'' and ''[[Chlamydia trachomatis]]''. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664 }} </ref><ref name=Neonatal-conjunctivitis >Centers for Disease Control and Prevention (2015)[http://www.cdc.gov/conjunctivitis/newborns.html] Accessed on June 30, 2016 </ref>
'''Hyperacute bacterial conjunctivitis''' is associated with corneal involvement and subsequent [[corneal perforation]], and therefore these patients have a poorer [[long term prognosis]].<ref name="pmid21160459">{{cite journal| author=Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC)| title=Sexually transmitted diseases treatment guidelines, 2010. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-12 | pages= 1-110 | pmid=21160459 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160459 }} </ref>
*'''[[Allergic conjunctivitis]]''' is associated with a favorable long-term prognosis. However, atopic keratovonjunctivitis and vernal keratoconjunctivitis (allergic conjunctivitis subtypes) are associated with poor outcomes.<ref name="pmid18786127">{{cite journal| author=Kumar S| title=Vernal keratoconjunctivitis: a major review. | journal=Acta Ophthalmol | year= 2009 | volume= 87 | issue= 2 | pages= 133-47 | pmid=18786127 | doi=10.1111/j.1755-3768.2008.01347.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18786127 }} </ref>
 
*The prognosis of '''[[Keratoconjunctivitis sicca|Keratoconjunctivitis sicca (dry eye syndrome)]]''' associated with [[Sjögren's syndrome]] is poor. These patients require a longer course of treatment.<ref name="pmid9820935">{{cite journal| author=Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC| title=The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. | journal=Cornea | year= 1998 | volume= 17 | issue= 6 | pages= 584-9 | pmid=9820935 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9820935  }} </ref>
Early detection and early treatment of '''neonatal conjunctivitis''' is associated with a good prognosis.
*'''[[Superior limbic keratoconjunctivitis|Superior limbic keratoconjunctivitis (SLK)]]''' is associated with  excellent prognosis.<ref name="pmid11914237">{{cite journal| author=Watson S, Tullo AB, Carley F| title=Treatment of superior limbic keratoconjunctivitis with a unilateral bandage contact lens. | journal=Br J Ophthalmol | year= 2002 | volume= 86 | issue= 4 | pages= 485-6 | pmid=11914237 | doi= | pmc=1771108 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11914237  }} </ref><ref name="pmid2695351">{{cite journal| author=Nelson JD| title=Superior limbic keratoconjunctivitis (SLK). | journal=Eye (Lond) | year= 1989 | volume= 3 ( Pt 2) | issue=  | pages= 180-9 | pmid=2695351 | doi=10.1038/eye.1989.26 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2695351  }} </ref>
Neonatal conjunctivitis associated with misdiagnosis is associated with [[systemic]] involvement and may result in more complicated course and poorer outcomes.<ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of ''[[Neisseria gonorrhoeae]]'' and ''[[Chlamydia trachomatis]]''. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664 }} </ref>
 
'''[[Allergic conjunctivitis]]''' is associated with a favorable long-term prognosis. However, atopic keratovonjunctivitis and vernal keratoconjunctivitis (allergic conjunctivitis subtypes) are associated with poor outcomes.<ref name="pmid18786127">{{cite journal| author=Kumar S| title=Vernal keratoconjunctivitis: a major review. | journal=Acta Ophthalmol | year= 2009 | volume= 87 | issue= 2 | pages= 133-47 | pmid=18786127 | doi=10.1111/j.1755-3768.2008.01347.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18786127 }} </ref>
 
'''Keratoconjunctivitis sicca (dry eye syndrome)''' is associated with a favorable long-term prognosis. Keratoconjunctivitis sicca associated with [[Sjögren's syndrome]] is associated with a particularly [[poor prognosis]] and requiring a longer course of treatment.<ref name="pmid9820935">{{cite journal| author=Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC| title=The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. | journal=Cornea | year= 1998 | volume= 17 | issue= 6 | pages= 584-9 | pmid=9820935 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9820935 }} </ref>
 
'''Superior limbic keratoconjunctivitis''' is associated with  excellent prognosis, with [[remission]] as the natural history and eventual total [[resolution]].<ref name="pmid2695351">{{cite journal| author=Nelson JD| title=Superior limbic keratoconjunctivitis (SLK). | journal=Eye (Lond) | year= 1989 | volume= 3 ( Pt 2) | issue=  | pages= 180-9 | pmid=2695351 | doi=10.1038/eye.1989.26 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2695351  }} </ref>


==References==
==References==
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Latest revision as of 21:07, 29 July 2020

Conjunctivitis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [3]

Overview

If left untreated, viral conjunctivitis will generally clear without any complications. Bacterial conjunctivitis is often self-limited. If left untreated, bacterial conjunctivitis will clear within 1 or 2 weeks without any complications, and it is generally associated with a favorable long-term prognosis.[1] Allergic conjunctivitis improves by eliminating or significantly reducing contact with the allergen. If left untreated, most cases of allergic conjunctivitis may resolve without any long-term consequences. Keratoconjunctivitis sicca associated with Sjögren's syndrome is associated with a particularly poor prognosis and requiring a longer course of treatment.[2][3][4] Prognosis for conjunctivitis is generally good with treatment.

Natural History

Viral conjunctivitis is often caused by adenovirus. It presents with watery discharge, hyperemia, chemosis, and lymphadenopathy. If left untreated, most cases of viral conjunctivitis are mild and will clear in 7 to 14 days without any long-term consequences. if complications arise, viral conjunctivitis can take two or more weeks to resolve. Some cases of viral conjunctivitis may develop stromal or subepithelial abnormalities. In such cases, if subepithelial infiltrates are in the pupillary axis, they may lead to decreased vision. Usually stromal abnormalities may persist for months to years, long after the epithelial changes have resolved.[1][2][5]

Acute hemorrhagic conjunctivitis is often caused by picornavirus. It presents with a severe red, swollen eyes as well as subconjuntival hemorrhaging, and will clear up in 5 to 7 days. If left untreated, acute hemorrhagic conjunctivitis almost always resolves without sequelae.[6]

Bacterial conjunctivitis presents with red eye, mucopurulent discharge, and chemosis. The incubation period for bacterial conjunctivitis is estimated to be 1 to 7 days. If left untreated, most cases of bacterial conjunctivitis will clear in 7 to 10 days without any long-term consequences. If left untreated, In patients who have purulent or mucopurulent discharge (suspected chlamydial and gonococcal conjunctivitis), who wear contact lenses, and who are immunocompromised, conjunctivitis may cause corneal damage (such as corneal ulcer, scar, and perforation), sepsis, and meningitis. This may lead to permanent blindness and death.[1][2][7]

Hyperacute bacterial conjunctivitis (HBC) is often caused by Neisseria gonorrhoeae in sexually active adults. It presents with a severe copious purulent discharge, eyelid swelling, eye pain on palpation, preauricular adenopathy, and decreased vision. If left untreated, hyperacute bacterial conjunctivitis may cause corneal involvement, and ultimately corneal perforation.[8]

Neonatal conjunctivitis is one of the most common infections occurring in the first month of life. Chemical conjunctivitis secondary to silver nitrate solution application usually occurs in the first day of life, and disappears spontaneously within 2- 4 days. In the absence of adequate prophylaxis, 30% to 42% of infants born by vaginal delivery to infected mothers will develop gonococcal conjunctivitis. Gonococcal conjunctivitis tends to occur 2-7 days after birth, and tends to be more severe than other causes of ophthalmia neonatorum. It presents with severe bilateral purulent conjunctivitis, tearing, and eyelids swelling. If left untreated, gonococcal conjunctivitis may cause corneal involvement such as corneal ulceration, diffuse opacification, and corneal perforation. This may lead to blindness, sepsis, or death. The onset of chlamydial conjunctivitis is usually later than gonococcal conjunctivitis. In the absence of adequate prophylaxis, 30%-50% of infants born by vaginal delivery to infected mothers will develop chlamydial conjunctivitis. The incubation period is 5-14 days. Chlamydial conjunctivitis presents with mild hyperemia, watery discharge, eyelid swelling, papillary reaction, and pseudomembrane formation. If left untreated, chlamydial conjunctivitis can progress to copious and purulent discharge. This may lead to central corneal opacification and blindness. Herpetic conjunctivitis is a rare cause of neonatal conjunctivitis. Herpetic conjunctivitis usually occurs within the first 2 weeks after birth and has an incubation period of approximately 6-14 days. If left untreated, HSV conjunctivitis can cause corneal scarring and ulceration. Additionally, disseminated HSV infection can cause central nervous system (CNS) involvement. Ophthalmia neonatorum caused by pseudomonas is rare but can present with eyelid edema, erythema, and purulent discharge. If left untreated, ophthalmia neonatorum can progress to corneal perforation, endophthalmitis, blindness, and possibly death.[9][10][11]

Allergic conjunctivitis usually presents with itching of the eyes and eyelid swelling. Seasonal allergic conjunctivitis is the most common form of the condition, and symptoms are related to season-specific aeroallergens. If left untreated, most cases of allergic conjunctivitis improve by eliminating or significantly reducing contact with the allergen (pollen or animal dander) without any long-term consequences.[12][13][14]

Keratoconjunctivitis sicca (dry eye syndrome) presents with a foreign body sensation, mucoid discharge, ocular dryness, excessive tearing (reflex secretion), photophobia, itching, and blurry vision. Symptoms tend to be worse toward the end of the day with prolonged use of the eyes. If left untreated, it can progress to corneal ulceration, corneal perforation, and ultimately permanent blindness.[3][15][16]

Superior limbic keratoconjunctivitis (SLK) symptoms develop around the sixth decade of life, and include a foreign body sensation, burning sensation, pruritus, and dry eye sensation. Superior limbic keratoconjunctivitis is typically associated with remission as the natural history and eventual total resolution, although symptoms may last for years.[4][17]

Complications

Viral Conjunctivitis

Complications to viral conjunctivitis include:[5][18]

  • Bacterial superinfection
  • Keratitis
  • Subepithelial infiltrates
  • Corneal ulceration with keratoconjunctivitis
  • Chronic infection

Bacterial Conjunctivitis

Complications to bacterial conjunctivitis include:[19][20]

Neonatal Conjunctivitis

Complications to neonatal conjunctivitis include:[11][21]

Allergic Conjunctivitis

Complications to allergic conjunctivitis include:[13][14]

  • Conjunctivochalasis (chronic recurrences)
  • Corneal ulceration
  • Corneal opacification
  • Visual loss
  • Steroid induced intraocular pressure elevations
  • Cataract

Keratoconjunctivitis Sicca

Complications to Keratoconjunctivitis sicca (dry eye syndrome) include:[15][16]

Prognosis

  • Viral conjunctivitis is often associated with a favorable long-term prognosis. However, viral conjunctivitis associated with subepithelial infiltrates may last for several months and cause decreased vision.[5][18]
  • Acute hemorrhagic conjunctivitis almost always resolves without sequelae, and has a good visual prognosis.[6]
  • Bacterial conjunctivitis is often associated with a favorable long-term prognosis.

Early detection and early treatment of extremely pathogenic bacteria, such as Chlamydia trachomatis or Neisseria gonorrhoeae, is associated with a good prognosis.[19][20]

References

  1. ↑ 1.0 1.1 1.2 Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
  2. ↑ 2.0 2.1 2.2 Rose P (2007). "Management strategies for acute infective conjunctivitis in primary care: a systematic review". Expert Opin Pharmacother. 8 (12): 1903–21. doi:10.1517/14656566.8.12.1903. PMID 17696792.
  3. ↑ 3.0 3.1 Schaumberg DA, Dana R, Buring JE, Sullivan DA (2009). "Prevalence of dry eye disease among US men: estimates from the Physicians' Health Studies". Arch Ophthalmol. 127 (6): 763–8. doi:10.1001/archophthalmol.2009.103. PMC 2836718. PMID 19506195.
  4. ↑ 4.0 4.1 4.2 Watson S, Tullo AB, Carley F (2002). "Treatment of superior limbic keratoconjunctivitis with a unilateral bandage contact lens". Br J Ophthalmol. 86 (4): 485–6. PMC 1771108. PMID 11914237.
  5. ↑ 5.0 5.1 5.2 Jhanji V, Chan TC, Li EY, Agarwal K, Vajpayee RB (2015). "Adenoviral keratoconjunctivitis". Surv Ophthalmol. 60 (5): 435–43. doi:10.1016/j.survophthal.2015.04.001. PMID 26077630.
  6. ↑ 6.0 6.1 Yin-Murphy M (1976). "Simple tests for the diagnosis of picornavirus epidemic conjunctivitis (acute haemorrhagic conjunctivitis)". Bull World Health Organ. 54 (6): 675–9. PMC 2366581. PMID 1088513.
  7. ↑ Azari AA, Barney NP (2013). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.
  8. ↑ Høvding G (2008). "Acute bacterial conjunctivitis". Acta Ophthalmol. 86 (1): 5–17. doi:10.1111/j.1600-0420.2007.01006.x. PMID 17970823.
  9. ↑ Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G (2008). "Neonatal conjunctivitis - a review". Malays Fam Physician. 3 (2): 77–81. PMC 4170304. PMID 25606121.
  10. ↑ Matejcek A, Goldman RD (2013). "Treatment and prevention of ophthalmia neonatorum". Can Fam Physician. 59 (11): 1187–90. PMC 3828094. PMID 24235191.
  11. ↑ 11.0 11.1 11.2 Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC; et al. (1986). "Ophthalmia neonatorum in Nairobi, Kenya: the roles of [[Neisseria gonorrhoeae]] and [[Chlamydia trachomatis]]". J Infect Dis. 153 (5): 862–9. PMID 3084664. URL–wikilink conflict (help)
  12. ↑ La Rosa M, Lionetti E, Reibaldi M, Russo A, Longo A, Leonardi S; et al. (2013). "Allergic conjunctivitis: a comprehensive review of the literature". Ital J Pediatr. 39: 18. doi:10.1186/1824-7288-39-18. PMC 3640929. PMID 23497516.
  13. ↑ 13.0 13.1 Jun J, Bielory L, Raizman MB (2008). "Vernal conjunctivitis". Immunol Allergy Clin North Am. 28 (1): 59–82, vi. doi:10.1016/j.iac.2007.12.007. PMID 18282546.
  14. ↑ 14.0 14.1 Bonini S (2004). "Atopic keratoconjunctivitis". Allergy. 59 Suppl 78: 71–3. doi:10.1111/j.1398-9995.2004.00570.x. PMID 15245362.
  15. ↑ 15.0 15.1 Zoukhri D (2006). "Effect of inflammation on lacrimal gland function". Exp Eye Res. 82 (5): 885–98. doi:10.1016/j.exer.2005.10.018. PMC 1361268. PMID 16309672.
  16. ↑ 16.0 16.1 16.2 Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC (1998). "The pathology of dry eye: the interaction between the ocular surface and lacrimal glands". Cornea. 17 (6): 584–9. PMID 9820935.
  17. ↑ 17.0 17.1 Nelson JD (1989). "Superior limbic keratoconjunctivitis (SLK)". Eye (Lond). 3 ( Pt 2): 180–9. doi:10.1038/eye.1989.26. PMID 2695351.
  18. ↑ 18.0 18.1 Drug and Therapeutics Bulletin (2011). "Management of acute infective conjunctivitis". Drug Ther Bull. 49 (7): 78–81. doi:10.1136/dtb.2011.02.0043. PMID 21733975.
  19. ↑ 19.0 19.1 Høvding G (2004). "[Acute bacterial conjunctivitis]". Tidsskr Nor Laegeforen. 124 (11): 1518–20. PMID 15195156.
  20. ↑ 20.0 20.1 "Bacterial conjunctivitis in children: antibiotic eye drops only if eye washing is ineffective". Prescrire Int. 16 (89): 120–1. 2007. PMID 17585426.
  21. ↑ 21.0 21.1 Centers for Disease Control and Prevention (2015)[1] Accessed on June 30, 2016
  22. ↑ Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC) (2010). "Sexually transmitted diseases treatment guidelines, 2010". MMWR Recomm Rep. 59 (RR-12): 1–110. PMID 21160459.
  23. ↑ Kumar S (2009). "Vernal keratoconjunctivitis: a major review". Acta Ophthalmol. 87 (2): 133–47. doi:10.1111/j.1755-3768.2008.01347.x. PMID 18786127.


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