Causes of Conjunctival disorders
Conjunctival disorders Causes: Book Excerpts
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Causes of Conjunctival disorders: Online Medical Books
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Conjunctivitis:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
The most common causative organisms include:
❑ bacterial — Staphylococcus aureus, Streptococcus pneumoniae, Neisseria gonorrhoeae, Neisseria meningitidis
❑ chlamydial — Chlamydia trachomatis (inclusion conjunctivitis)
❑ viral — adenovirus types 3, 7, and 8; herpes simplex virus, type 1.
Other causes include allergic reactions to pollen, grass, topical medications, air pollutants, smoke, or unknown seasonal allergens (vernal conjunctivitis); environmental (wind, dust, and smoke) and occupational irritants (acids and alkalies); and a hypersensitivity to contact lenses or solutions.
Vernal conjunctivitis (so-called because symptoms tend to be worse in the spring) is a severe form of immunoglobulin E-mediated mast cell hypersensitivity reaction. This form of conjunctivitis is bilateral. It usually begins at age 3 to 5 years and persists for about 10 years. It’s sometimes associated with other signs of allergy commonly related to pollens, asthma, and allergic rhinitis.
Epidemic keratoconjunctivitis is an acute, highly contagious viral conjunctivitis caused by adenovirus types 8 and 19. It’s commonly complicated by visual loss due to corneal subepithelial infiltrates. Health care providers must be careful to wash their hands and sterilize equipment to prevent the spread of this disease.
In the Western hemisphere, conjunctivitis is probably the most common eye disorder.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Inclusion conjunctivitis:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
C. trachomatis is an obligate intracellular organism of the lymphogranuloma venereum serotype group. Serotypes D through K are sexually transmitted, and secondary eye involvement in adults occurs in about 1 in 300 genital cases. Because contaminated cervical secretions infect the eyes of the neonate during birth, inclusion conjunctivitis is an important cause of ophthalmia neonatorum. Ocular chlamydial disease occurs most frequently in adults between ages 18 and 30.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Conjunctival injection:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Blepharitis
This disorder produces diffuse conjunctival injection. Ulcerations appear on the eyelids, which burn, itch, and have no lashes.
Chemical burns
Diffuse conjunctival injection occurs in this ocular emergency, but severe pain is the main symptom. The patient also displays photophobia, blepharospasm, and decreased visual acuity in the affected eye; the cornea may appear gray, and the pupil may be unilaterally smaller.
Conjunctival foreign bodies and abrasions
These conditions feature localized conjunctival injection with sudden, severe eye pain. The patient may have increased tearing and photophobia, but his visual acuity usually isn’t impaired.
Conjunctivitis
Allergic conjunctivitis produces milky, diffuse peripheral conjunctival injection. Related findings include a watery, stringy eye discharge; increased tearing; itching; palpebral conjunctival follicles; and (with hay fever) conjunctival edema, photophobia, and a feeling of fullness around the eyes.
Bacterial conjunctivitis causes diffuse peripheral conjunctival injection along with a thick, purulent eye discharge that contains mucous threads. The patient’s lids and lashes stick together, and he has excessive tearing, photophobia, burning, and itching. He may have pain and a foreign body sensation if the cornea is involved.
Besides diffuse peripheral conjunctival injection, the patient with fungal conjunctivitis complains of photophobia and increased tearing, itching, and burning. The discharge is thick and purulent, making his eyelids crusted, sticky, and swollen. Corneal involvement causes pain.
In viral conjunctivitis, the conjunctival injection is bright red, diffuse, and peripheral. The patient may also have conjunctival edema, follicles on the palpebral conjunctiva, and lid edema; a local viral rash; and signs of upper respiratory tract infection. He complains of itching, increased tearing and, possibly, a foreign body sensation.
Corneal abrasion
Diffuse conjunctival injection is extremely painful in this disorder, especially when the eyelids move over the abrasion. The patient may also report photophobia, excessive tearing, blurred vision, and a foreign body sensation.
Corneal erosion
Recurrent corneal erosion produces diffuse conjunctival injection; severe, continuous pain from rubbing of the eyelid over the eroded area of the cornea; and photophobia.
Corneal ulcer
Bacterial, viral, and fungal corneal ulcers produce diffuse conjunctival injection that increases in the circumcorneal area. Accompanying findings include severe photophobia, severe pain in and around the eye, markedly decreased visual acuity, and a copious amount of purulent eye discharge and crusting. If the patient develops associated iritis, a physical examination will also reveal corneal opacities and an abnormal pupillary response to light.
Dacryoadenitis
This disorder produces diffuse conjunctival injection, pain over the temporal part of the eye, considerable lid swelling and, possibly, a purulent eye discharge.
Episcleritis
Conjunctival injection is localized and raised and may be violet or purplish pink in patients with episcleritis. Associated signs and symptoms include an inflamed sclera, deep pain, photophobia, increased tearing, and conjunctival edema.
Glaucoma
In acute angle-closure glaucoma, conjunctival injection is typically circumcorneal. Other signs and symptoms include severe eye pain, nausea and vomiting, severely elevated IOP, blurred vision, and the perception of rainbow-colored halos around lights. Corneas appear steamy because of corneal edema. The pupil of the affected eye is moderately dilated and completely unresponsive to light.
Hyphema
Depending on the type and extent of traumatic injury, a hyphema may produce diffuse conjunctival injection, possibly with lid and orbital edema. The patient may complain of pain in and around the eye. The extent of visual impairment depends on the hyphema’s size and location.
Iritis
In acute iritis, marked conjunctival injection is found mainly around the cornea. Other findings include moderate to severe pain, photophobia, blurred vision, constricted pupils, and poor pupillary response to light.
Kawasaki syndrome
Conjunctival injection is a characteristic sign of Kawasaki syndrome and usually occurs bilaterally. This febrile illness, which primarily affects children under age 5, also causes erythema, lymphadenopathy, and swelling in the peripheral extremities. Treatment with I.V. gamma globulin is extremely effective if given immediately, so early detection is essential. Delaying treatment may cause coronary artery dilation and aneurysm, resulting in ischemic heart disease and, possibly, sudden death.
Keratoconjunctivitis sicca
This disorder produces severe diffuse conjunctival injection. The patient reports generalized eye pain along with burning, itching, a foreign body sensation, excessive mucus secretion from the eye, absence of tears, and photophobia.
Lyme disease
Spread by tick bites, Lyme disease may cause conjunctival injection, diffuse urticaria, malaise, fatigue, headache, fever, chills, aches, and lymphadenopathy.
Ocular lacerations and intraocular foreign bodies
Diffuse conjunctival injection may be increased in the area of injury. The patient experiences impaired visual acuity and moderate to severe pain that varies with the type and extent of injury. He may also develop lid edema, photophobia, excessive tearing, and an abnormal pupillary response to light.
Ocular tumors
A tumor located in the orbit behind the globe may produce conjunctival injection together with exophthalmos. Conjunctival edema, ocular deviation, and diplopia usually occur if muscles are involved.
Refractive error
An uncorrected or poorly corrected refractive error can produce conjunctival injection. The patient may complain of headache, eye pain, and eye fatigue.
Scleritis
In this relatively rare disorder, conjunctival injection can be diffuse or localized over the area of the scleritis nodule. The patient has severe pain on moving the eye, photophobia, tenderness, and tearing.
Stevens-Johnson syndrome
This disorder produces diffuse conjunctival injection, a purulent eye discharge, severe eye pain, photophobia, decreased tearing, entropion, and trichiasis.
Trachoma
Conjunctival injection is an early sign of trachoma, a leading cause of blindness in Third World countries and among Native Americans in the southwestern United States. Caused by a bacterial infection, trachoma may also produce eyelid swelling and corneal cloudiness.
Uveitis
Diffuse conjunctival injection, which may be increased in the circumcorneal area, characterizes this disorder. Accompanying signs and symptoms include constricted, irregularly shaped pupils; blurred vision; tenderness; photophobia; and possibly sudden, severe ocular pain.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Conjunctivitis:
Causes
(Handbook of Diseases)
The most common causative organisms are the following:
❑ bacterial: Staphylococcus aureus, Streptococcus pneumoniae, Neisseria gonorrhoeae, Neisseria meningitidis
❑ chlamydial: Chlamydia trachomatis (inclusion conjunctivitis)
❑ viral: adenovirus types 3, 7, and 8; herpes simplex virus type 1.
Other causes include allergic reactions to pollen, grass, topical medications, air pollutants, and smoke; occupational irritants (acids and alkalies); rickettsial diseases (Rocky Mountain spotted fever); parasitic diseases caused by Phthirus pubis and Schistosoma haematobium; and, rarely, fungal infections.
Vernal conjunctivitis (also called seasonal or warm-weather conjunctivitis) results from allergy to an unidentified allergen. This form of conjunctivitis is bilateral; it usually begins before puberty and persists for about 10 years. Sometimes it’s associated with other signs and symptoms of allergy commonly related to grass or pollen sensitivity.
An idiopathic form of conjunctivitis may be associated with certain systemic diseases, such as erythema multiforme, chronic follicular conjunctivitis (orphan’s conjunctivitis), thyroid disease, and Stevens-Johnson syndrome. Conjunctivitis may be secondary to pneumococcal dacryocystitis or canaliculitis from candidal infection.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Inclusion conjunctivitis:
Causes
(Handbook of Diseases)
C. trachomatis is an obligate intracellular organism. It usually infects the urethra in males and the cervix in females and is transmitted during sexual activity.
Because contaminated cervical secretions infect the eyes of the neonate during birth, inclusion conjunctivitis is an important cause of ophthalmia neonatorum. Rarely, inclusion conjunctivitis results from autoinfection, by hand-to-eye transfer of the organism from the genitourinary tract.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Conjunctival injection:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Blepharitis
Blepharitis produces diffuse conjunctival injection. Ulcerations appear on the eyelids, which burn, itch, and have no lashes. The patient may report the sensation of a foreign body in his eye. Constant irritation results in rubbing of the eyes causing reddened rims or continuous blinking.
Chemical burns
With chemical burns (an ocular emergency), diffuse conjunctival injection occurs, but severe pain is the most prominent symptom. The patient also displays photophobia, blepharospasm, and decreased visual acuity in the affected eye; the cornea may appear gray, and the pupil may be unilaterally smaller.
Conjunctival foreign bodies and abrasions
Conjunctival foreign bodies and abrasions feature localized conjunctival injection with sudden, severe eye pain. The patient may have increased tearing and photophobia, but usually his visual acuity isn’t impaired.
Conjunctivitis
Allergic conjunctivitis produces a milky, diffuse, peripheral conjunctival injection. Related findings include watery, stringy eye discharge; increased tearing; itching; palpebral conjunctival follicles; and (with hay fever) conjunctival edema; photophobia; and a feeling of fullness around the eyes.
Bacterial conjunctivitis causes diffuse peripheral conjunctival injection along with a thick, purulent eye discharge that contains mucus threads. The patient’s lids and lashes stick together, and he has excessive tearing, photophobia, burning, and itching. He may have pain and a foreign body sensation if the cornea is involved.
In addition to diffuse peripheral conjunctival injection, the patient with fungal conjunctivitis complains of photophobia and increased tearing, itching, and burning. The discharge is thick and purulent, making his eyelids crusted, sticky, and swollen. Corneal involvement causes pain.
With viral conjunctivitis, the conjunctival injection is brilliant red, diffuse, and peripheral. The patient may also have conjunctival edema, follicles on the palpebral conjunctiva, and lid edema; local viral rash; and signs of upper respiratory tract infection. He complains of itching, increased tearing and, possibly, a foreign body sensation.
Corneal abrasion
With corneal abrasion, diffuse conjunctival injection is extremely painful, especially when the eyelids move over the abrasion. The patient may also report photophobia, excessive tearing, blurred vision, and a foreign body sensation.
Corneal erosion
Recurrent corneal erosion produces diffuse conjunctival injection; severe, continuous pain from rubbing of the eyelid over the eroded area of the cornea; and photophobia. The patient may have reduced vision.
Corneal ulcer
Bacterial, viral, and fungal corneal ulcers produce diffuse conjunctival injection that increases in the circumcorneal area. Accompanying findings include severe photophobia, severe pain in and around the eye, markedly decreased visual acuity, and copious and purulent eye discharge and crusting. If the patient develops associated iritis, a physical examination also reveals corneal opacities and an abnormal pupillary response to light.
Dacryoadenitis
With dacryoadenitis, the patient has large, diffuse conjunctival injection; pain over the temporal part of the eye; considerable lid swelling; and, possibly, purulent eye discharge. The hallmark of this disorder is constant tearing.
Episcleritis
Conjunctival injection is localized and raised and may be violet or purplish pink in patients with episcleritis. The sclera is also inflamed. Associated signs and symptoms include deep pain, photophobia, increased tearing, and conjunctival edema.
Glaucoma
With acute angle-closure glaucoma, conjunctival injection is typically circumcorneal. Signs and symptoms include severe eye pain, nausea and vomiting, severely elevated IOP, blurred vision, and the perception of rainbow-colored halos around lights. Corneas appear steamy because of corneal edema. The pupil of the affected eye is moderately dilated and completely unresponsive to light.
Hyphema
Depending on the type and extent of traumatic injury, a hyphema may produce diffuse conjunctival injection, possibly with lid and orbital edema. The patient may complain of pain in and around the eye. The extent of visual impairment depends on the hyphema’s size and location.
Iritis
In acute iritis, marked conjunctival injection is found mainly around the cornea. Other findings include moderate to severe pain, photophobia, blurred vision, constricted pupils, and poor pupillary response to light.
Keratoconjunctivitis sicca
Keratoconjunctivitis sicca produces severe diffuse conjunctival injection. The patient reports generalized eye pain along with burning, itching, a foreign body sensation, excessive mucus secretion from the eye, absence of tears, and photophobia.
Lyme disease
Spread by tick bites, Lyme disease causes conjunctival injection. It may occur with diffuse urticaria, malaise, fatigue, headache, fever, chills, aches, and lymphadenopathy. Other ocular symptoms include pain, photophobia, conjunctivitis, and blurry or double vision.
Ocular lacerations and intraocular foreign bodies
In patients with ocular lacerations and intraocular foreign bodies, diffuse conjunctival injection may be increased in the area of injury. The patient also experiences impaired visual acuity and moderate to severe pain that varies with the type and extent of injury. He may also develop lid edema, photophobia, excessive tearing, and abnormal pupillary response.
Ocular tumors
If an ocular tumor is located in the orbit behind the globe, conjunctival injection may occur together with exophthalmos. With muscle involvement, conjunctival edema, ocular deviation, and diplopia usually occur.
Uveitis
Diffuse conjunctival injection, which may be increased in the circumcorneal area, characterizes uveitis. Accompanying signs and symptoms include constricted, irregularly shaped pupils; blurred vision; tenderness; photophobia; and possibly sudden, severe ocular pain.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Conjunctival injection:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Blepharitis.This disorder produces diffuse conjunctival injection. Ulcerations appear on the eyelids, which burn, itch, and have no lashes.
Chemical burns.Diffuse conjunctival injection occurs in this ocular emergency, but severe pain is the main symptom. The patient also displays photophobia, blepharospasm, and decreased visual acuity in the affected eye; the cornea may appear gray, and the pupil may be unilaterally smaller.
Conjunctival foreign bodies and abrasions.These conditions feature localized conjunctival injection with sudden, severe eye pain. The patient may have increased tearing and photophobia, but his visual acuity usually isn't impaired.
Conjunctivitis.Allergic conjunctivitis produces milky, diffuse peripheral conjunctival injection. Related findings include a watery, stringy eye discharge; increased tearing; itching; palpebral conjunctival follicles; and (with hay fever) conjunctival edema, photophobia, and a feeling of fullness around the eyes.
Bacterial conjunctivitis causes diffuse peripheral conjunctival injection along with a thick, purulent eye discharge that contains mucous threads. The patient's lids and lashes stick together, and he has excessive tearing, photophobia, burning, and itching. He may have pain and a foreign body sensation if the cornea is involved.
Besides diffuse peripheral conjunctival injection, the patient with fungal conjunctivitis complains of photophobia and increased tearing, itching, and burning. The discharge is thick and purulent, making his eyelids crusted, sticky, and swollen. Corneal involvement causes pain.
In viral conjunctivitis, the conjunctival injection is bright red, diffuse, and peripheral. The patient may also have conjunctival edema, follicles on the palpebral conjunctiva, and lid edema; a local viral rash; and signs of upper respiratory tract infection. He complains of itching, increased tearing and, possibly, a foreign body sensation.
Corneal abrasion.Diffuse conjunctival injection is extremely painful in this disorder, especially when the eyelids move over the abrasion. The patient may also report photophobia, excessive tearing, blurred vision, and a foreign body sensation.
Corneal erosion.Recurrent corneal erosion produces diffuse conjunctival injection; severe, continuous pain from rubbing of the eyelid over the eroded area of the cornea; and photophobia.
Corneal ulcer.Bacterial, viral, and fungal corneal ulcers produce diffuse conjunctival injection that increases in the circumcorneal area. Accompanying findings include severe photophobia, severe pain in and around the eye, markedly decreased visual acuity, and a copious amount of purulent eye discharge and crusting. If the patient develops associated iritis, a physical examination will also reveal corneal opacities and an abnormal pupillary response to light.
Dacryoadenitis.This disorder produces diffuse conjunctival injection, pain over the temporal part of the eye, considerable lid swelling and, possibly, a purulent eye discharge.
Episcleritis.Conjunctival injection is localized and raised and may be violet or purplish pink in patients with episcleritis. Associated signs and symptoms include an inflamed sclera, deep pain, photophobia, increased tearing, and conjunctival edema.
Glaucoma.In acute angle-closure glaucoma, conjunctival injection is typically circumcorneal. Other signs and symptoms include severe eye pain, nausea and vomiting, severely elevated IOP, blurred vision, and the perception of rainbow-colored halos around lights. Corneas appear steamy because of corneal edema. The pupil of the affected eye is moderately dilated and completely unresponsive to light.
Hyphema.Depending on the type and extent of traumatic injury, a hyphema may produce diffuse conjunctival injection, possibly with lid and orbital edema. The patient may complain of pain in and around the eye. The extent of visual impairment depends on the hyphema's size and location.
Iritis.In acute iritis, marked conjunctival injection is found mainly around the cornea. Other findings include moderate to severe pain, photophobia, blurred vision, constricted pupils, and poor pupillary response to light.
Kawasaki syndrome.Conjunctival injection is a characteristic sign of Kawasaki syndrome and usually occurs bilaterally. This febrile illness, which primarily affects children younger than age 5, also causes erythema, lymphadenopathy, and swelling in the peripheral extremities. Treatment with I.V. gamma globulin is extremely effective if given immediately, so early detection is essential. Delaying treatment may cause coronary artery dilation and aneurysm, resulting in ischemic heart disease and, possibly, sudden death.
Keratoconjunctivitis sicca.This disorder produces severe diffuse conjunctival injection. The patient reports generalized eye pain along with burning, itching, a foreign body sensation, excessive mucus secretion from the eye, absence of tears, and photophobia.
Lyme disease.Spread by tick bites, Lyme disease may cause conjunctival injection, diffuse urticaria, malaise, fatigue, headache, fever, chills, aches, and lymphadenopathy.
Ocular lacerations and intraocular foreign bodies.Diffuse conjunctival injection may be increased in the area of injury. The patient experiences impaired visual acuity and moderate to severe pain that varies with the type and extent of injury. He may also develop lid edema, photophobia, excessive tearing, and an abnormal pupillary response to light.
Ocular tumors.A tumor located in the orbit behind the globe may produce conjunctival injection together with exophthalmos. Conjunctival edema, ocular deviation, and diplopia usually occur if muscles are involved.
Refractive error.An uncorrected or poorly corrected refractive error can produce conjunctival injection. The patient may complain of headache, eye pain, and eye fatigue.
Scleritis.In this relatively rare disorder, conjunctival injection can be diffuse or localized over the area of the scleritis nodule. The patient has severe pain on moving the eye, photophobia, tenderness, and tearing.
Stevens-Johnson syndrome.This disorder produces diffuse conjunctival injection, a purulent eye discharge, severe eye pain, photophobia, decreased tearing, entropion, and trichiasis.
Trachoma.Conjunctival injection is an early sign of trachoma, a leading cause of blindness in Third World countries and among Native Americans in the southwestern United States. Caused by a bacterial infection, trachoma may also produce eyelid swelling and corneal cloudiness.
Uveitis.Diffuse conjunctival injection, which may be increased in the circumcorneal area, characterizes this disorder. Accompanying signs and symptoms include constricted, irregularly shaped pupils; blurred vision; tenderness; photophobia; and possibly sudden, severe ocular pain.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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