Conjunctivitis caused by physical and chemical irritants

Industrial and other chemicals can cause follicular conjunctivitis. Treatment of acute conjunctivitis in patients using contact lenses requires special attention. These patients are prone to the development of corneal ulcers, caused by prolonged hypoxia. In some cases, the presence of a pathogenic bacterial flora leads to the emergence of rapidly progressing bacterial ulcers. Defects in choosing contact lenses can play a negative role, as well as individual reaction to their wearing.

[1], [2], [3], [4], [5]

"Artificial" conjunctivitis

"Artificial" conjunctivitis develops in connection with the targeted actions of the patient himself (for example, as a result of a burn or exposure to chemical stimuli). The process is usually localized in the lower third of the eyeball and on the conjunctiva of the lower eyelid, accompanied by irritation of the eyelid and cheek.

[6], [7], [8]

Phlyctenuletic conjunctivitis

Fluke-venous conjunctivitis in some cases accompanies tuberculosis or lesion of the eyelids by staphylococcus, although it usually has an idiopathic origin:

• a single limited inflammatory focus with a white center, usually located in the limb region;
• transient flow;
• duration of existence about two weeks;
• propensity to exacerbations;
• poor clinical symptoms.

Treelike conjunctivitis

• Thickened knotty "woody" conglomerates in the conjunctiva.
• The cause of the disease is unknown, in some cases occurs after surgery or transferred infection.
• Sometimes it has an autosomal recessive type of inheritance.
• At surgical removal of the centers of a lesion shows a propensity to relapses. Sometimes there is spontaneous resorption.

Deficiency of biotinidase

• Conjunctivitis.
• Atrophy of the optic nerve.
• Hypotension.
• Convulsions.
• Alopecia.
• The appointment of biotin is shown.

[9], [10], [11], [12], [13], [14], [15]

Episcleritis

• Moderate local conjunctival and episcleral injection (Figure 6.3).
• There is a knotty form.
• Irritation of the eyeball.
• Local and general non-steroidal anti-inflammatory therapy is indicated.
• Steroid drugs are recommended in cases that are resistant to the treatment.

Fig. 6.3. Episcleritis. Local deep injection and edema of the episcleral tissue

[16], [17]

Multiform erythema - Stevens-Johnson syndrome

Cause

Apparently, the disease is a consequence of an acute allergic reaction.

Early manifestations

It occurs as a consequence of infectious diseases, most often herpes simplex, or individual intolerance to drugs, especially sulfonamides.

• Common skin eruptions are "signaling" lesions (leading to coin-like foci of different colors - from red to blue, painful on palpation).
• Mucous false films of red color, creating the impression of swelling and slowly absorbable.
• Pathology of the conjunctiva:
  • conjunctivitis;
  • mucous discharge;
  • a reaction in the form of follicle formation is possible;
  • defects of the conjunctiva (Figure 6.4);
  • the formation of false films;
  • simblypharon;
  • secondary bacterial infection.

Syndrome Stevens-Johnson. Two-sided desquamative conjunctivitis with areas of necrosis. Heavy keratitis, which caused the appearance of scars on the cornea. The situation was complicated by the addition of the syndrome of "dry" eyes

Late manifestations

• Scarring.
• Infection of lacrimal canals.
• Syndrome of "dry" eyes.
• Keratitis.
• Vascularization and scarring of the cornea.
• Scarring and keratinization of the eyelids.

Treatment

Acute phase

• Hospitalization.
• General use of steroid agents.
• Intensive topical application of steroid preparations that do not contain preservatives.
• Local use of antibiotics that do not contain preservatives.
• Cycloplegic drugs.
• Separation of interstitial splices with a glass rod.
• Treatment of skin.

The chronic phase

• With the syndrome of "dry" eyes, mitigants are used
• With xerosis, prescribe drugs from the retinoid group.
• When trichiasis occurs, epilation and cryotherapy are performed.
• Entropion is an indication for surgical intervention.

Xerophthalmus. Bito's plaques look elevated, with the deposition of multiple scales, conjunctiva sites located in a zone not covered by eyelids. As in this case, pathological areas are often pigmented. (By courtesy of Mr. Michael Eckstein)

Avitaminosis A

• One of the most common causes of blindness in the world.
• It is associated with protein-energy malnutrition.
• It is accompanied by night blindness.
• Dry, folded, dull conjunctiva.
• Bitot's plaques (Bitot's) in the region of the eye gap, not covered by eyelids.
• Syndrome of "dry" eyes.
• Acute keratitis with the phenomena of keratomalacia and rapidly advancing perforation of the cornea.

[18], [19], [20], [21], [22], [23], [24]