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Conjunctivitis (commonly called "pinkeye" in the USA and "Madras Eye" in India) is an inflammation of the conjunctiva (the outermost layer of the eye and the inner surface of the eyelids), most commonly due to an allergic reaction or an infection (usually bacterial or viral). Blepharoconjunctivitis is the combination of conjunctivitis with blepharitis (inflammation of the eyelids). Keratoconjunctivitis is the combination of conjunctivitis and keratitis (corneal inflammation). The Three Most Common Varieties of Pink Eye There are three common varieties of conjunctivitis, viral, allergic, and bacterial. Other causes of conjunctivitis include thermal and ultraviolet burns, chemicals, toxins, overuse of contact lenses, foreign bodies, vitamin deficiency, dry eye, dryness due to inadequate lid closure, exposure to chickens infected with Newcastle disease, epithelial dysplasia (pre-cancerous changes), and some conditions of unknown cause such as sarcoidosis. Bacterial conjunctivitis is most often caused by pyogenic bacteria such as Staphylococcus or Streptococcus from the patient's own skin or respiratory flora. Others are due to infection from the environment (e.g. insect-borne), from other people (usually by touch—especially in children), but occasionally via eye makeup or facial lotions. An example of this is conjunctivitis due to the bacteria Haemophilus influenzae biogroup aegyptius. Viral conjunctivitis is spread by aerosol or contact of a variety of contagious viruses, including many that cause the common cold, so that it is often associated with upper respiratory tract symptoms. It may also be caused by adenoviruses which was first identified in Chennai(Madras), India, during early 20th Century, hence the name "Madras Eye". This disease mostly appears during Rainy season and during winter months and spreads faster via air due to increased dampness and humidity. Clusters of cases have been due to transfer from inadequately-sterilised ophthalmic instruments that make contact with the eye (e.g., tonometers). Allergic conjunctivitis occurs more frequently among those with allergic conditions, with the symptoms having a seasonal correlation. It can also be caused by allergies to substances such as cosmetics, perfume, protein deposits on contact lenses, or drugs. It usually affects both eyes, and is accompanied by swollen eyelids. Irritant, toxic, thermal and chemical conjunctivitis are associated with exposure to the specific agents, such as flame burns, irritant plant saps, irritant gases (e.g., chlorine or hydrochloric acid ("pool acid") fumes), natural toxins (e.g., ricin picked up by handling castor oil bean necklaces), or splash injury from an enormous variety of industrial chemicals, the most dangerous being strongly alkaline materials. Xerophthalmia is a term that usually implies a destructive dryness of the conjunctival epithelium due to dietary vitamin A deficiency—a condition virtually forgotten in developed countries, but still causing much damage in developing countries. Other forms of dry eye are associated with aging, poor lid closure, scarring from previous injury, or autoimmune diseases such as rheumatoid arthritis, and these can all cause chronic conjunctivitis. Symptoms Eyes with conjunctivitis.Redness, irritation and watering of the eyes are symptoms common to all forms of conjunctivitis. Itch is variable. Acute allergic conjunctivitis is typically itchy, sometimes distressingly so, and the patient often complains of some lid swelling. Chronic allergy often causes just itch or irritation, and often much frustration because the absence of redness or discharge can lead to accusations of hypochondria. Viral conjunctivitis is often associated with an infection of the upper respiratory tract, a common cold, or a sore throat. Its symptoms include watery discharge and variable itch. The infection usually begins with one eye, but may spread easily to the fellow eye. Bacterial conjunctivitis due to the common pyogenic (pus-producing) bacteria causes marked grittiness/irritation and a stringy, opaque, grey or yellowish mucopurulent discharge (gowl, goop, sleep, or other regional names) that may cause the lids to stick together (matting), especially after sleeping. However discharge is not essential to the diagnosis, contrary to popular belief. Many other bacteria (e.g., Chlamydia, Moraxella) can cause a non-exudative but very persistent conjunctivitis without much redness. The gritty feeling is sometimes localised enough for patients to insist they must have a foreign body in the eye. The more acute pyogenic infections can be painful. Like viral conjunctivitis, it usually affects only one eye but may spread easily to the other eye. Irritant or toxic conjunctivitis is irritable or painful. Discharge and itch are usually absent. This is the only group in which severe pain may occur. Common Signs of Conjunctivitis Infection Infection (redness) of the conjunctiva on one or both eyes should be apparent, but may be quite mild. Except in obvious pyogenic or toxic/chemical conjunctivitis, a slit lamp (biomicroscope) is needed to have any confidence in the diagnosis. Examination of the tarsal conjunctiva is usually more diagnostic than the bulbar conjunctiva. Allergic conjunctivitis shows pale watery swelling or edema of the conjunctiva and sometimes the whole eyelid, often with a ropy, non-purulent mucoid discharge. There is variable redness. Viral conjunctivitis, commonly known as "pink eye", shows a fine diffuse pinkness of the conjunctiva which is easily mistaken for the 'ciliary infection' of iritis, but there are usually corroborative signs on biomicroscopy, particularly numerous lymphoid follicles on the tarsal conjunctiva, and sometimes a punctate keratitis. Pyogenic bacterial conjunctivitis shows an opaque purulent discharge, a very red eye, and on biomicroscopy there are numerous #016EBB cells and desquamated epithelial cells seen in the 'tear gutter' along the lid margin. The tarsal conjunctiva is a velvety red and not particularly follicular. Non-pyogenic infections can show just mild injection and be difficult to diagnose. Scarring of the tarsal conjunctiva is occasionally seen in chronic infections, especially in trachoma. Irritant or toxic conjunctivitis show primarily marked redness. If due to splash injury, it is often present only in the lower conjunctival sac. With some chemicals—above all with caustic alkalis such as sodium hydroxide—there may be necrosis of the conjunctiva with a deceptively #016EBB eye due to vascular closure, followed by sloughing of the dead epithelium. This is likely to be associated with slit-lamp evidence of anterior uveitis.
staphylococcus is involved. As always you should see your doctor as soon as possible for a diagnosis.
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