Chronic conjunctivitis

Conjunctiva is a thin transparent connective tissue membrane covering the inside of the eyelids and the front of the eyeball. At the level of the eyelashes it borders with the skin, on the inner surface of the eye it passes into the corneal epithelium. It also contains lacrimal glands.

Chronic conjunctivitis is an inflammatory reaction of the conjunctiva to irritating factors. It is manifested by an increase in the smallest vessels with the effect of a “pink eye”. It may have an infectious, non-infectious (mainly allergic) nature. An ophthalmologist is engaged in the diagnosis and treatment of the disease. The participation of a therapist, an allergist, an infectious disease specialist is possible.

General information about chronic conjunctivitis

The conjunctiva performs a protective, nourishing and moisturizing function. With inflammation, its capabilities automatically decrease, which leads to malfunctions of the visual apparatus and, in the long term, a decrease in vision.

Conjunctivitis accounts for more than 30% of all cases of eye diseases. In winter, this figure increases to 50%. The chronic form, unlike the acute one, more often affects middle-aged and elderly people, but in recent years, due to the computerization of the population, the disease has greatly rejuvenated and is often found in students.

Causes of chronic conjunctivitis

The chronic form of the disease appears as a consequence of untreated forms of acute inflammatory process or develops independently under the influence of negative environmental factors. Thus, in the list of the main causes of the disease, infectious and non-infectious factors can be conditionally distinguished.

Infectious development factors

The infection can be both exogenous – with direct contact of the pathogen in the eye, and endogenous – with infection through the blood or from neighboring organs (with sinusitis, acute respiratory infections, etc.). Depending on the pathogen, there are:

  • bacterial conjunctivitis – the causative agents are mainly staphylococci, streptococci, chlamydia;
  • viral – develops against the background of infection with adenovirus, enterovirus, herpes;
  • fungal – when affected by actinomycetes, coccidia, candida.

In adult patients, 80-85% of infectious conjunctivitis is caused by adenoviruses and only 10-15% by various types of bacterial pathogens. In children, the percentage of bacterial and viral conjunctival inflammations is approximately the same.

Attention! Infectious forms of conjunctivitis are contagious and can be transmitted from person to person, so the patient should be isolated.

Non-infectious development factors

Non-infectious conjunctivitis is associated with irritation of the conjunctiva by various physical and chemical factors. These include:

  • dust, smoke, and other minor contaminants;
  • acid and alkali vapors;
  • long-term work in the wind and in rooms with dry air;
  • low-quality or poorly selected cosmetics;
  • trichiasis – irritation causes improper growth of eyelashes;
  • long-term wearing of contact lenses;
  • some chronic diseases (anemia, diabetes mellitus);
  • allergic reactions of the body – mainly to airborne allergens (animal hair, pollen);
  • uncorrected refractive errors (astigmatism, hyperopia, etc.);
  • prolonged eye strain in poor lighting conditions;
  • lack of some vitamins (A, E, C, group B);
  • prolonged work at a computer monitor without protective glasses – dry eye syndrome develops.

Symptoms of chronic conjunctivitis

Chronic conjunctivitis is devoid of pronounced symptoms. The set of signs may vary depending on the type of conjunctivitis and the cause that caused it. A common set of symptoms:

  • itching, burning, feeling of sand in the eyes;
  • soreness during movement of the eyeball;
  • increased photosensitivity, up to photophobia;
  • eyelid heaviness, swelling of the ocular tissues;
  • increased tearfulness or, conversely, dry eyes;
  • rapid fatigue with visual tension;
  • conjunctival hyperemia with vasodilation;
  • purulent-mucous discharge.

Information! The main difference between the bacterial form of conjunctivitis is the presence of yellow or green purulent discharge, allergic – swelling and redness of the eyelids, pronounced itching; in the viral form, adjacent tissues and organs are often affected, which is accompanied by symptoms of a runny nose, cough and other signs of SARS.

The disease rarely manifests itself in an independent form and is often combined with other eye pathologies. Distinguish:

  • blepharoconjunctivitis;
  • keratoconjunctivitis;
  • episcleritis is a form of the disease without secretions;
  • conjunctivochalasis is a folded formation on the border of the eyeball and the inner mucous surface of the eyelid, which can cause irritation.

Information! With chronic eye damage with chlamydia (Clamydia trachomatis), a special form of chronic keratoconjunctivitis – trachoma develops. Frequent exacerbations of this disease lead to scarring of tissues with a high risk of complete blindness.

Diagnosis of chronic conjunctivitis

Mild symptoms do not allow us to fully assess the possible damage to eye health. Many patients attribute the signs of conjunctivitis to burst vessels and banal overstrain. Nevertheless, any inflammation of the organs of vision is a serious reason to go to the clinic, since the slightest changes in the structure of the eye can seriously affect the quality of vision.

For examination, an ophthalmologist attracts a full range of instrumental diagnostic methods and visual tests. Additionally prescribes a referral for laboratory tests – they are necessary to find out the causes of the disease and determine the methods of its treatment.

Instrumental diagnostic methods:

  • visometry – to assess visual acuity;
  • biomicroscopy – reveals changes in the structure of the conjunctiva (surface roughness, degree of hyperemia, presence of papillary growths);
  • skiascopy and refractometry – to detect refractive pathologies.

To assess the work of the lacrimal glands , a set of special tests is prescribed:

  • Schirmer’s test – evaluates the activity of lacrimation using filter paper, which is applied over the edge of the lower eyelid for 5 minutes, after which the border of the moistened area is marked. Norm: 18-25 mm; at 11-15 mm, the first stage of dry eye syndrome begins.
  • Norn test – determines the stability of the tear film in the absence of blinking. Norm: 11-22 sec. (depending on the age of the patient).
  • Fluorescein instillation test – determine the presence of tears in the structure of the tear film. 0.1–0.2% fluorescein solution is instilled, after which the eye is viewed under a slit fluorescent lamp.

Laboratory tests:

  • bakposev smear from the conjunctiva – identify the pathogen and determine the level of its sensitivity with the selection of a suitable antibiotic;
  • PCR and ELISA analysis for chlamydia;
  • the level of immunoglobulins in the blood and skin allergy tests – if an allergic form of the disease is suspected;
  • blood sugar test – to exclude diabetes.

Elimination of symptoms and treatment of chronic conjunctivitis

The main goal is not only to rid the patient of unpleasant symptoms, but also to eliminate the very cause of irritation. Etiotropic treatment is prescribed without fail (with the elimination of the cause):

  • remove foreign bodies;
  • do the epilation of eyelashes with pathological growth;
  • correct visual impairments;
  • select special glasses for working at the computer;
  • completely eliminate contact with an irritating allergen or minimize it.

To alleviate the symptoms of an inflammatory reaction , a complex of topical agents is prescribed:

  • anti–inflammatory compounds – infusion of chamomile, calendula, St. John’s wort, tea, resorcinol solution, if necessary – corticosteroids;
  • antihistamines – for allergic forms of the disease;
  • disinfectant and antibacterial drops;
  • moisturizing drops “artificial tear”;
  • vitamin preparations – in the form of drops and inside;
  • ointment applications with a restorative and healing composition – for the night.

Treatment of chronic conjunctivitis requires perseverance and patience. Some patients will need a change of job or even place of residence for complete and final healing. It is possible to let the disease take its course, the inflammatory process passes to the adjacent eye structures, which provokes more serious visual pathologies:

  • fusion of corneal and iris tissues;
  • loss of vision, up to complete blindness;
  • nearsightedness, farsightedness, astigmatism;
  • strabismus;
  • cataract;
  • glaucoma;
  • entropion – inversion of the eyelid towards the eyeball;
  • erosion and corneal ulcer;
  • hemorrhage in the eyeball;
  • iridocyclitis;
  • violation of the blood supply to the eye with retinal detachment.

Prognosis and prevention of chronic conjunctivitis

In case of adequate treatment, the prognosis for the future is favorable. However, in order to avoid relapses, follow the recommendations for the prevention of the disease:

  • use personal eye protection when working in production;
  • treat visual impairments in a timely manner;
  • do not start infectious diseases;
  • strengthen the immune system;
  • make up for vitamin deficiencies;
  • follow the rules of personal hygiene – wash your hands more often, change towels and bed linen, use disposable napkins.

A balanced diet, moderate physical activity and regular walks in the fresh air will bring great benefits. If you want to keep your eyes healthy until old age, lead a measured lifestyle and rest more.

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