Conjunctivitis

Introduction to conjunctivitis Conjunctivitis is an inflammatory reaction that occurs in the conjunctiva of the eye and is generally classified into two major categories, infectious and non-infectious. When the conjunctiva is subjected to various stimuli, symptoms such as edema, red eyes, and increased secretion may occur, which may involve one or both eyes. According to the condition and course of conjunctivitis, it can be divided into acute, subacute and chronic; according to the cause, it can be divided into bacterial, viral, chlamydia, fungal and allergic; according to the characteristics of conjunctival lesions, Divided into acute follicular conjunctivitis, chronic follicular conjunctivitis, membranous and pseudomembranous conjunctivitis. basic knowledge Sickness ratio: 0.5% Susceptible people: no special people Mode of infection: partial conjunctivitis spreads through contact Complications: scarring inversion

Cause of conjunctivitis

Microbial infections (45%):

The cause of conjunctivitis can be divided into two major categories, microbial and non-microbial, according to their different properties. According to different sources, it can be divided into exogenous or endogenous, or it can be caused by the spread of inflammation in adjacent tissues. The most common is microbial infection. The pathogenic microorganisms can be bacteria, viruses, chlamydia, etc., occasionally fungi, rickettsia, parasitic infections.

Non-microbial infections (25%):

Physical irritation (sand sand, smoke, ultraviolet light, etc.) and chemical damage (medical drugs, acids and bases or toxic gases, etc.) can also cause conjunctivitis.

Conjunctivitis prevention

Conjunctivitis is mostly contagious, so it should be promoted to avoid washing and avoid blinking. It is recommended to wash your face, towels, handkerchiefs and other items to be separated from others, and often cleaned and disinfected. Patients with contagious conjunctivitis should take certain isolation measures, and it is not allowed to go to the public to swim in the swimming area. Medical personnel must also wash their hands after disinfection to prevent cross-infection. If you have conjunctivitis at a glance, you must tell your patient to protect your eyes from infection. Anyone who is irritating in the working environment, such as wind and dust, should improve the environment and wear protective glasses to prevent conjunctivitis. Health promotion, public inspection, and regular management of public places such as bathrooms, restaurants, and swimming pools.

Conjunctivitis complications Complications, scarring, varus

Conjunctivitis often causes conjunctival foreign body, conjunctival nipple hyperplasia, conjunctival dry spots, conjunctival nipple hyperplasia and so on.

Symptoms of conjunctivitis Common symptoms: Photophobia and tears, eyelids, loose eyes, redness, visual impairment, foreign body sensation, conjunctival congestion, conjunctival, large nipple, orbital palpebral palpebral palpebral

1. Symptoms: Foreign body sensation, burning sensation, heavy eyelids, and increased secretions. When the lesion involves the cornea, there may be photophobia, tearing, and varying degrees of visual loss.

2. Signs: The signs of conjunctivitis are an important basis for the correct diagnosis of various conjunctivitis.

(1) conjunctival hyperemia: the characteristic of conjunctival vascular congestion is that the more the congestion of the ankle is more obvious, the closer to the limbus, the lighter the blood vessels are, the blood vessels are distributed in the form of a network, the color is bright red, and it can extend into the cornea to form corneal vasospasm. After adrenaline, the congestion quickly disappears.

(2) Secretion: The nature of the secretion may vary depending on the cause of conjunctivitis. Purulent secretions are more common in gonococcal conjunctivitis; mucus purulent or catarrhal secretions are more common in bacterial or chlamydial conjunctivitis, often firmly adhered to the eyelashes, making it difficult to open the eyes in the morning; watery secretion The substance is usually found in viral conjunctivitis.

(3) Conjunctival edema: conjunctival inflammation causes conjunctival vasodilatation, exudation leads to tissue edema, due to relaxation of conjunctival and conjunctival tissue, edema is obvious when edema is formed; while sacral conjunctiva is closely connected with tarsal plate, edema is not significant.

(4) Subconjunctival hemorrhage: mostly punctate or lamellae, epidemic hemorrhagic conjunctivitis caused by virus can often be accompanied by subconjunctival hemorrhage.

(5) Nipple: a non-specific sign of conjunctival inflammation, located in the palpebral conjunctiva or limbus, which appears as a polygonal mosaic-like appearance of the bulge, and the congested area is separated by a pale gap. Under the slit lamp, there is a central blood vessel inside each nipple, which is sprinkled on the surface of the nipple. The nipple is actually a effusion and inflammatory cells derived from the central blood vessels, mainly the swelling of the conjunctiva caused by the infiltration of polymorphonuclear leukocytes. Histologically, it is important to separate the conjunctival epithelium from the fine connective tissue anchored by the underlying tissue in the formation of the nipple. These connective tissue partitions limit the size of the nipple to within 1 mm. The anchorage is less than the upper edge of the iliac crest, so when the upper palate is turned over, the conjunctiva at the upper edge of the iliac crest can be wavy, resembling a giant nipple or follicle, but in fact this may be a normal phenomenon. Therefore, it is not advisable to use the upper margin region to analyze the clinical signs of the nipple or follicle. Trachoma is often accompanied by significant papillary hyperplasia. The formation of giant nipples is caused by the disintegration and fracture of the small connective tissue anchoring. The diameter of the giant nipple is larger than lmm, which occurs mostly in the upper conjunctiva. Common catarrhal conjunctivitis in the spring, contact with giant papillary conjunctivitis. .

(6) Follicles: Follicles are yellow-white, smooth rounded ridges with a diameter of about 0.5-2.0 mm, but in some cases, such as chlamydial conjunctivitis, larger follicles can also occur; the center of the follicle is The germinal center and fibrous tissue of the lymphoid, without blood vessels, but with blood vessels on the surface. In children and young people, the normal follicles, especially the sacral follicles, are also seen in the subconjunctival conjunctiva. Viral conjunctivitis and chlamydial conjunctivitis are often associated with significant follicular formation and are known as acute follicular conjunctivitis or chronic follicular conjunctivitis.

(7) Membrane and pseudomembrane: Membrane is the cellulose exuded on the surface of the conjunctiva, the pseudomembrane is easy to peel off, and the true membrane is not easy to separate, and the wound is forced to be peeled off. The difference between the two is the difference in the degree of inflammation. The inflammatory reaction of the membrane is more severe, and diphtheria bacilli causes severe membranous conjunctivitis; ß-hemolytic streptococcus, Klebsiella, gonococcal, adenovirus, inclusion bodies, etc. can cause membranous or pseudomembranous conjunctivitis.

(8) Scar: Damage to the conjunctival epithelium does not cause scar formation, and damage to the stromal tissue is the histological basis of conjunctival scar formation. Early conjunctival scarring showed conjunctival humeral constriction and conjunctival subepithelial fibrosis. This subconjunctival scar can further cause a series of long-term complications, such as scarring varus and trichiasis. If the scarring process continues to develop and the conjunctival dome is further narrowed, gingival adhesions can occur; in the late stage of chronic scarring diseases such as pemphigus in the eye, the iliac crest completely disappears, the epithelial keratinization, and the sacral margin adhesion. Trachoma is usually accompanied by a prominent conjunctival scar, and a linear epithelial fibrous scar on the upper edge of the upper epithelium, called the Arlt line, is an important sign of trachoma.

(9) Lymph node enlargement before the ear: Viral conjunctivitis is often accompanied by swelling of the ear.

(10) False 'sexual ptosis: due to cell infiltration or scar formation, the upper jaw tissue is hypertrophied, causing mild ptosis, more common in the late trachoma.

(11) Conjunctival granuloma: less common, can be seen in chronic inflammation caused by tuberculosis, leprosy, syphilis and rickettsia.

Conjunctivitis examination

Clinical examination

Conjunctival hyperemia, reduced transparency, blurred structure, increased secretion of conjunctival sac, sputum conjunctival nipple follicle formation, some patients with condylar edema subconjunctival hemorrhage, pseudomembrane formation.

2. Cytological examination

In some special conjunctivitis, smear or smear examination of conjunctival secretions, such as eosinophilia, supports the diagnosis of allergic conjunctivitis; cell cytoplasmic inclusions support trachoma.

3. Pathogen examination

Including conjunctival sac secretion culture, virus isolation and antigen detection, etc., while culturing can conduct drug susceptibility experiments to guide clinical medication.

Diagnosis and diagnosis of conjunctivitis

Diagnostic criteria

1. Clinical examination is the most basic and most important. First, according to the patient's pathogenesis and clinical manifestations, there may be a preliminary judgment. For example, infectious conjunctivitis is usually caused by both eyes and may affect the family; most acute viral conjunctivitis is the most First, the incidence of the disease, and then the eyes of the other eyes; trachoma lesions above the main sputum; and the acute follicular conjunctivitis caused by the virus is the following sputum; bacterial conjunctivitis catarrhal symptoms are more significant; Neisseria gonorrhoeae The resulting inflammation has a large amount of purulent secretions; these lesion characteristics are helpful for diagnosis.

2. Gram staining and Giemsa staining of conjunctival scraping preliminarily determine the type of pathogen and the inflammatory response characteristics of the conjunctiva. If the infiltration of polymorphonuclear leukocytes is dominant, it often indicates bacterial or chlamydia infection; such as mononuclear cells or Multinucleated giant cells appear, which may be viral infections; there are inclusion bodies in the cytoplasm of the epithelial cells, and there are lymphocytes and plasma cells in the well, suggesting that Chlamydia infection.

3. Bacterial examination of the conjunctiva: Bacterial culture and drug susceptibility testing of conjunctival scrapings and secretions, aid in the diagnosis and guidance of pathogens, such as chlamydia or viral infections, laboratory pathogen isolation or PCR Technology helps diagnose.

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