Symptoms of conjunctivitis include foreign body sensation, burning sensation, itching, photophobia, and tearing.

(1) Conjunctival congestion: the most common sign of acute conjunctivitis. Conjunctival hyperemia is characterized by congestion of superficial blood vessels, which is obvious in the fornix and extends toward the limbus of the cornea. Congestion is reduced in the direction, and these superficial blood vessels can move with the mechanical movement of the conjunctiva, and can be filled after local dripping of epinephrine. The blood disappears.

(2) Conjunctival secretions

(3) True membrane and false membrane: True membrane is formed by the condensation of exudate from severe inflammatory reaction on the conjunctival surface, involving the entire epithelium. After forcible removal, the wound surface will be rough and easy to rupture. Bleeding.

(4) Subconjunctival hemorrhage: severe conjunctivitis such as epidemic conjunctivitis caused by adenovirus and enterovirus and acute conjunctivitis caused by Kochweeks bacilli etc., in addition to conjunctival congestion, punctate or flaky subconjunctival hemorrhage may also occur, which is bright red in color and dark red when the amount is large. color.

Cytological examination: Bacterial conjunctivitis smears account for the majority of polymorphonuclear leukocytes. In viral conjunctivitis, monocytes, especially lymphocytes, predominate. An increase in neutrophils during pseudomembrane formation (epidemic keratoconjunctivitis) suggests conjunctival necrosis. chlamydial conjunctivitis smear neutrophils Cells and lymphocytes account for half each. Allergic conjunctivitis shows eosinophils and basophils in biopsy specimens, but in conjunctival smears The amount is very small. A large number of eosinophilic granules are seen in the epithelial cells of vernal conjunctivitis.

Caused by bacteria of the genus Neisseria (gonococci or meningococci). The disease progresses rapidly, with conjunctival congestion and edema accompanied by large amounts of purulent secretions. About 15% to 40% of patients quickly develop corneal opacity, infiltration, and peripheral or central corneal ulcers. If not treated in time, corneal perforation may occur in a few days, seriously threatening vision.

The incubation period of neonatal gonococcal conjunctivitis is 2 to 5 days, and it is mostly a birth canal infection. Those who develop the disease 7 days after birth are postpartum infections. Both eyes are often affected at the same time. There are photophobia, tearing, and high degree of edema of the conjunctiva. In severe cases, it protrudes beyond the palpebral fissure, and pseudomembrane may be formed. The secretion quickly changes from the serous nature at the beginning of the disease to purulent. The amount of pus is large and constantly flows out of the palpebral fissures, so it is also known as "pus leaking eyes".

Also known as "acute catarrhal conjunctivitis", commonly known as "pink eye", the onset is acute, with an incubation period of 1 to 3 days, and the disease occurs in both eyes at the same time or 1 to 2 days apart. The inflammation is the most severe 3 to 4 days after the onset of symptoms, and then gradually decreases.

(1) Haemophilus influenzae: The incubation period is about 24 hours, and the clinical manifestations are conjunctival congestion, edema, and subconjunctival discharge. Blood, purulent or mucopurulent discharge, symptoms peak in 3 to 4 days.

(2) Others: acute membranous or pseudomembranous conjunctivitis caused by Diphtheria bacilli.

It is more common in patients with nasolacrimal duct obstruction or chronic dacryocystitis, or in patients with chronic blepharitis or meibomian gland dysfunction.

Chronic conjunctivitis progresses slowly, lasts for a long time, and can occur unilaterally or bilaterally. The symptoms of patients are diverse, with the main symptoms being eye itching, burning, dryness, eye stinging and visual fatigue. The conjunctiva is mildly congested, and there may be thickening of the palpebral conjunctiva, hyperplasia of the nipple, and the secretion is mucus or self-colored foam.

epidemic keratoconjunctivitis

Clinical manifestations: short incubation period, 18 to 48 hours; short course of disease, 5 to 7 days. Common symptoms include eye pain, photophobia, foreign body sensation, tearing, subconjunctival hemorrhage, Eyelid edema, etc. Subconjunctival hemorrhage occurs in the form of spots or patches, starting from the upper bulbar conjunctiva and spreading to the lower bulbar conjunctiva. Most patients have follicular with epithelial keratitis and preauricular lymphadenopathy.

Treatment and prevention: No special treatment, self-limiting, mainly symptomatic treatment, local application of broad-spectrum antiviral drugs such as interferon eye drops and ribavirin Eye drops, etc. Strengthening personal hygiene and hospital management to prevent transmission is the key to prevention.

Cause: Endemic trachoma is mostly caused by A, B, C or Ba antigen types. Types D~K mainly cause genitourinary system infection and inclusion conjunctivitis.

clinical manifestations

Diagnosis: WHO requires that at least 2 of the following criteria be met when diagnosing trachoma: ① There are more than 5 follicles in the upper palpebral conjunctiva; ②Typical conjunctival scar; ③ Limbal follicle or Herbert's fovea; ④Extensive corneal pannus.

Differential diagnosis

Treatment: For active trachoma, it is recommended to use 1% tetracycline eye ointment, 2 times a day, levofloxacin eye drops, 4 times a day, and oral administration of azithromycin 1g, once a day. The course of treatment is 8 weeks; you can also use erythromycin eye ointment topically, twice a day, and take 1.5~2.0g of tetracycline daily, divided into three times, for a course of 3 weeks, which is equally effective.

Vernal keratoconjunctivitis (VCK), also known as vernal catarrhal conjunctivitis, seasonal conjunctivitis, etc., is a recurrent bilateral chronic ocular surface disease with environmental and racial tendencies. It mainly affects children and adolescents, and is more common in men under the age of 20.

Cause: VKC is a hypersensitivity reaction involving both humoral and cellular immunity.

clinical manifestations

Diagnosis: Patients with severe VKC have typical signs: paving stone hyperplasia of the palpebral conjunctival papilla, corneal shield ulcers, Horner-Trantas nodules, etc. in the conjunctiva Eosinophils or eosinophilic granules were found in the scraping, suggesting a local allergic reaction.

Clinical manifestations: The main signs are conjunctival congestion and non-specific palpebral conjunctival papilla hyperplasia, sometimes combined with conjunctival edema or eyelid edema, which is more likely to occur in young children. It rarely affects the cornea, with occasional mild punctate epithelial keratitis. Many patients have a history of allergic rhinitis and bronchial asthma.

Clinical manifestations: Since the antigen is present all year round, the symptoms persist, and some patients experience seasonal aggravation. Eye symptoms are often more common than seasonal allergies Conjunctivitis is mild. Conjunctival congestion, papillary conjunctivitis with a few follicles, and transient eyelid edema are often found during examination. Some patients may There may be no obvious positive signs.

Cause: Giant papillary conjunctivitis (GPC) is more common in people who wear contact lenses or prosthetic eyes.

clinical manifestations

Treatment: Find the allergen. Type I hypersensitivity reactions can be relieved by avoiding contact with the allergen or discontinuing medication. Topical glucocorticoid eye drops (such as 0.1% dexamid pine), vasoconstrictor (0.1% epinephrine or 1% ephedrine), if the eyelid skin is red, swollen and papules, you can use 2% to 3% boric acid water for wet compress. Severe cases Systemic anti-allergic drugs, such as chlorpheniramine, astemizole and other antihistamines or glucocorticoids, can be added.

Common pathogenic microorganisms include: Mycobacterium tuberculosis, Staphylococcus aureus, Candida albicans, Coccidioides, and Chlamydia trachomatis.

Clinical manifestations: More common in women, adolescents and children.

Diagnosis: A correct diagnosis can be made based on the typical solid nodular vesicles at the limbus or bulbar conjunctiva and symptoms such as congestion around them.

Treatment: topical corticosteroid eye drops.

(1) Conjunctival dermoid tumor and dermoid lipoma: Conjunctival dermoid tumor and dermoid lipoma are common congenital benign tumors. Dermoid lipoma is more common in the superior temporal quadrant near the lateral canthus Under the bulbar conjunctiva, there is a yellow, soft, smooth mass.

(2) Conjunctival hemangioma: Conjunctival hemangioma is mostly congenital and appears at birth or soon after birth. Conjunctival hemangiomas can appear solitary, massy, ​​or diffuse Dilated cavernoma.

(1) Palpebral fissure spots: Palpebral fissure spots are horizontal, triangular or oval, raised, gray-yellow bulbar conjunctival nodules at the junction of the corneoscleral limbus in the palpebral fissure area.

(2) Pterygium

Subconjunctival hemorrhage can occur due to rupture of subconjunctival vessels or increased permeability. Relevant medical history includes: trauma (eye trauma or head crush injury), conjunctival inflammation, hypertension, arteriosclerosis, nephritis, blood diseases (such as leukemia, hemophilia), certain infectious diseases (such as sepsis, typhoid fever) wait.