Diseases » Sjogren's Syndrome » Causes

Causes of Sjogren's Syndrome

List of causes of Sjogren's Syndrome

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Sjogren's Syndrome) that could possibly cause Sjogren's Syndrome includes:

• Rheumatoid arthritis
• Lupus
• Defecient tear production
• Abnormal tear composition
• Normal aging process
• Hot, dry or windy climates
• High altitudes
• Air-conditioning
• Cigarette smoke
• Reading or working on a computer for a long duration
• Contact lens wearers
• Certain medications
• Thyroid conditions
• Vitamin A deficiency
• Diseases such as Parkinson's and Sjogren's
• Women frequently experience problems with dry eyes as they enter menopause because of hormonal changes

Causes of Sjogren's Syndrome (Diseases Database):

The follow list shows some of the possible medical causes of Sjogren's Syndrome that are listed by the Diseases Database:

• Vitamin A deficiency

Source: Diseases Database

Sjogren's Syndrome Causes: Book Excerpts

• Differential Diagnosis - Red Eye
• Differential Diagnosis - Scleral Injection (Red Eye)
• Causes and incidence - Conjunctivitis
• Causes and incidence - Inclusion conjunctivitis
• Causes and incidence - Sjögren's syndrome
• Causes - Keratitis
• Medical causes - Conjunctival injection
• Differential Overview - Red Eye
• Causes - Conjunctivitis
• Causes - Inclusion conjunctivitis
• Causes - Sjögren's syndrome
• Causes - Keratitis
• Medical causes - Conjunctival injection
• Principal Causes of Red Eye - Red Eye
• Medical causes - Conjunctival injection

Sjogren's Syndrome as a complication of other conditions:

Other conditions that might have Sjogren's Syndrome as a complication may, potentially, be an underlying cause of Sjogren's Syndrome. Our database lists the following as having Sjogren's Syndrome as a complication of that condition:

• Chat room addiction
• Computer addiction
• Gaming addiction
• Mickulicz disease
• Sjogren's Syndrome

Sjogren's Syndrome as a symptom:

Conditions listing Sjogren's Syndrome as a symptom may also be potential underlying causes of Sjogren's Syndrome. Our database lists the following as having Sjogren's Syndrome as a symptom of that condition:

• Biliary cirrhosis
• Ectodermal dysplasia
• Eye muscle strain
• Herpes zoster oticus
• Homologous wasting disease
• Keratomalacia
• Linear IgA dermatosis
• Marijuana abuse
• Night blindness
• Primary biliary cirrhosis
• Rheumatoid arthritis
• Secondary Biliary Cirrhosis
• Sjogren's Syndrome
• Sjogren's syndrome, juvenile, secondary to autoimmune disease
• Sjögren syndrome, primary
• Sjögren syndrome, secondary
• Tropical Spastic Paraparesis
• Vitamin A deficiency

What causes Sjogren's Syndrome?

Causes: Sjogren's Syndrome: Autoimmune disorder primarily of saliva and tear glands.
Normally, the immune system works to protect us from disease by destroying harmful invading organisms like viruses and bacteria. In the case of Sjögren's syndrome, disease-fighting cells attack the glands that produce tears and saliva (the lacrimal and salivary glands). Damage to these glands keeps them from working properly and causes dry eyes and dry mouth. (Source: excerpt from Questions and Answers About Sjögren's Syndrome: NIAMS)
Article excerpts about the causes of Sjogren's Syndrome:
Researchers think Sjögren's syndrome is caused by a combination of genetic and environmental factors. Several different genes appear to be involved, but scientists are not certain exactly which ones are linked to the disease since different genes seem to play a role in different people. For example, there is one gene that predisposes Caucasians to the disease. Other genes are linked to Sjögren's in people of Japanese, Chinese, and African American descent. Simply having one of these genes will not cause a person to develop the disease, however. Some sort of trigger must activate the immune system.

Scientists think that the trigger may be a viral or bacterial infection. It might work like this: A person who has a Sjögren's-associated gene gets a viral infection. The virus stimulates the immune system to act, but the gene alters the attack, sending fighter cells (lymphocytes) to the eye and mouth glands. Once there, the lymphocytes attack healthy cells, causing the inflammation that damages the glands and keeps them from working properly. These fighter cells are supposed to die after their attack in a natural process called apoptosis, but in people with Sjögren's syndrome, they continue to attack, causing further damage. Scientists think that resistance to apoptosis may be genetic.

The possibility that the endocrine and nervous systems play a role is also under investigation. (Source: excerpt from Questions and Answers About Sjögren's Syndrome: NIAMS)

Medical news summaries relating to Sjogren's Syndrome:

The following medical news items are relevant to causes of Sjogren's Syndrome:

• Chronic dry eye is treatable
• More news »

Related information on causes of Sjogren's Syndrome:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Sjogren's Syndrome may be found in:

• Risk factors for Sjogren's Syndrome
• Hidden causes of Sjogren's Syndrome

Causes of Sjogren's Syndrome: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Sjogren's Syndrome.

Red Eye: Differential Diagnosis
(In a Page: Signs and Symptoms)

• Conjunctivitis
  –Allergic (allergens, irritants)
  –Viral (adenovirus, HSV, varicella)
  –Bacterial: Adults (Staphylococcus aureus, S. epidermidis, E. coli, Pseudomonas spp, Streptococcus spp), children (Haemophilus influenzae can cause otitis/conjunctivitis syndrome), Streptococcus pneumoniae, Moraxella catarrhalis, Staphylococcus spp), newborns (gonorrhea, Chlamydia)

Corneal abrasion/ulceration

Subconjunctival hemorrhage

Episcleritis

Scleritis (inflammation of conjunctiva and deep layers of globe)

Keratoconjunctivitis sicca
–Rheumatoid arthritis
–Sjögren's syndrome

Acute angle closure glaucoma

Acute iritis

Anterior uveitis

Pinguecula

Pterygium

Viral keratitis (disruption of the corneal epithelium): Herpes simplex/Zoster
Contact lens complications (e.g., infections with Acanthamoeba, Pseudomonas)

Trauma

Chemical burns (e.g., cyanoacrylate injury)

Orbital cellulitis (especially in children)

Acute ethmoiditis

Eyelid abnormalities

Trichiasis

Entropion

Molluscum contagiosum

Kawasaki's disease

Measles

UV radiation-induced photokeratitis

Pseudotumor cerebri

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Scleral Injection (Red Eye): Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Bacterial conjunctivitis: Common; usually BL; acute-onset purulent/mucopurulent discharge; conjunctival hyperemia; caused by Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae

• Allergic conjunctivitis: Common; BL; seasonal/perennial; lid edema, watery, stringy discharge, conjunctival hyperemia
• Viral conjunctivitis: Common; very contagious; usually BL; lid edema, watery discharge, conjunctival hyperemia, preauricular adenopathy, cornea infiltrates and ulcers possible; caused by adenovirus, HSV, enterovirus
• Neonatal conjunctivitis: Conjunctival inflammation in first month; etiologies chemical, Gonococcus, HSV-2, Chlamydia, bacterial
• Corneal ulcer: Bacterial, viral, autoimmune, parasitic, fungal
• Corneal abrasion: Contact lens use; trauma; recurrent corneal erosions
• Giant papillary conjunctivitis: Common; secondary to foreign body (contact lens)
• Vernal keratoconjunctivitis: Common, recurrent; BL; mucoid discharge; limbal infiltrates and vascularization
• Atopic keratoconjunctivis: Uncommon; lid eczema; mucoid discharge; corneal vascularization
• Blepharitis/meibomitis: Infection, inflammation of eyelid margin lead to conjunctival and corneal irritation
• Mucocutaneous: Stevens-Johnson syndrome; atopic dermatitis; toxic epidermolysis bullosa; keratoconjunctivitis sicca, rosacea
• Scleritis/episcleritis: Red, tender, no significant discharge; with connective tissue disease and vasculitis
• Canaliculitis/dacrocystitis: Infection of nasolacrimal system
• Subconjunctival hemorrhage: Bright red; resolves over 7–14 days; spontaneous or associated with valsalva
• Iritis: Autoimmune disease associations; perilimbal injection; photophobia, ache
• Angle closure glaucoma: Halos, headache, nausea and vomiting, history of hyperopia

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

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

Sjögren's syndrome: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

The cause of Sjögren’s syndrome is unknown, but genetic and environmental factors probably contribute to its development. Viral or bacterial infection or perhaps exposure to pollen may trigger Sjögren’s syndrome in a genetically susceptible individual. Tissue damage results from infiltration by lymphocytes or from the deposition of immune complexes. Lymphocytic infiltration may be classified as benign, malignant, or pseudolymphoma (nonmalignant, but tumorlike aggregates of lymphoid cells).

This syndrome occurs mainly in females (90% of patients); mean age of onset is 40 to 50.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Keratitis: Causes
(Professional Guide to Diseases (Eighth Edition))

The most common cause of keratitis is infection by herpes simplex virus, type 1 (known as dendritic corneal ulcer because of a characteristic branched lesion of the cornea resembling the veins of a leaf). Bacterial corneal ulcers frequently occur as a result of an infected corneal abrasion or a contaminated contact lens. Fungal keratitis is more frequently encountered in tropical climates. Poor lid closure can result in exposure keratitis. Chemicals accidentally splashed into the eye and exposure to ultraviolet light (sunlamps, sunlight, or welding arcs) also can produce keratitis. Vaccinial keratitis may result when the patient has red eye or periocular vesicles coinciding with a history of recent vaccine exposure (such as smallpox vaccination or close contact with a vaccine recipient).

» 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

Red Eye: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Viral conjunctivitis

❑ Allergic conjunctivitis

❑ Bacterial conjunctivitis

❑ Corneal abrasion

❑ Foreign body

❑ Subconjunctival hemorrhage

❑ Hordeolum

❑ Blepharitis

❑ Photophthalmia

❑ Acute angle closure glaucoma

❑ Chlamydial conjunctivitis

❑ Hypopyon

❑ Dacryocystitis

❑ Herpes simplex keratitis

❑ Iritis

❑ Scleritis

❑ Gonococcal conjunctivitis

❑ Keratoconjunctivitis sicca

❑ Measles

❑ Endophthalmitis

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

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

Sjögren's syndrome: Causes
(Handbook of Diseases)

The cause of SS is unknown. Most likely, genetic and environmental factors contribute to its development. Viral or bacterial infection or perhaps exposure to pollen may trigger SS in a genetically susceptible individual.

Tissue damage results from infiltration by lymphocytes or from the deposition of immune complexes. Lymphocytic infiltration may be classified as benign lymphoma, malignant lymphoma, or pseudolymphoma (nonmalignant but tumorlike aggregates of lymphoid cells).

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Keratitis: Causes
(Handbook of Diseases)

Keratitis may result from exposure (as in Bell’s palsy where the eyelids don’t close), wearing contact lenses for prolonged periods (overnight), or corneal trauma. It may also result from infection by herpes simplex virus, type 1 (known as dendritic keratitis because of a characteristic branched lesion of the cornea resembling the veins of a leaf). Less commonly, it stems from bacterial or fungal infection; rarely, from congenital syphilis.

» 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

Red Eye: Principal Causes of Red Eye
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

1. Conjunctivitis
   1. Chemicalsand irritants
   2. Infectious conjunctivitis
      1. Neonatal
      2. Postneonatal
   3. Allergic conjunctivitis
2. Trauma
   1. Corneal abrasion
   2. Foreign body
   3. Hemorrhage
   4. Burn
   5. Blunt or penetrating injury
   6. Contact lens problems
   7. Child abuse
3. Lid disorders
   1. Hordeolum
   2. Blepharitis
4. Nasolacrimal duct obstruction includingdacryocystitis
5. Allergic reactions
6. Preseptal and orbital cellulitis
7. Keratitis
   1. Superficial keratitis
   2. Nonsuperficial keratitis
8. Uveitis

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

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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