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Conjunctivitis: Conjunctiva
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Conjunctivitis is inflammation of the conjunctiva, the mucous membrane covering the inside of the eyelids and the outer part of the eye, which is better known as "pink eye." There are several types of conjunctivitis:
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DEFINITIONS — Conjunctivitis literally means "inflammation of the conjunctiva." The conjunctiva is the mucus membrane that lines the inside surface of the lids and covers the surface of the globe up to the limbus (the junction of the sclera and the cornea). The portion covering the globe is the "bulbar conjunctiva," and the portion lining the lids is the "tarsal conjunctiva."
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Culture and sensitivity of conjunctival scrapings typically are not performed for simple conjunctivitis. Obtain cultures in all newborns, neonates, persons who are immunosuppressed, or when N gonorrhoeae is under consideration as the etiology. When performed, collect exudate from the lower conjunctival fornix with a calcium alginate swab moistened with saline. Sheep blood and mannitol agar plates routinely are used. Expect viral and chlamydial causes in culture-negative conjunctivitis.
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Pharyngoconjunc-tival fever (PCF) is characterized by fever, sore throat and follicular conjunctivitis. It may be unilateral or bilateral. It is caused regularly by adenovirus 3 and occasionally 4 or 7. Corneal infiltrates are rare. The disorder varies in severity but usually persists for four days to two weeks. While the virus is shed from the conjunctiva within 14 days, it remains in fecal matter for 30 days.
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Adult inclusion conjunctivitis has an incubation period of 2 to 19 days. It is usually characterized by a unilateral mucopurulent discharge. The tarsal conjunctiva is often more hyperemic than the bulbar conjunctiva. Characteristically, there is a marked tarsal follicular response. Occasionally, superior corneal opacities and vascularization occur. Preauricular lymph nodes may be swollen on the side of the involved eye.
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Inclusion conjunctivitis is usually considered when the patient has a follicular conjunctivitis that will not go away, even after using topical antibiotics. Diagnosis depends upon tests performed on the discharge from the eye. Gram stains determine the type of microorganism, while culture and sensitivity tests determine which antibiotic will kill the harmful microorganism. Conjunctival scraping determines whether chlamydia is present in cells taken from the conjunctiva.
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