Published online 2012 March 22.
http://dx.doi.org/10.3341/kjo.2012.26.2.147
PMCID: PMC3325622
Copyright © 2012 The Korean Ophthalmological Society
Pegylated Interferon-Associated Severe Retinopathy in a Patient with Chronic Hepatitis
Hee Young Kang1 and Min Chul Shin21Konyang University Kim's Eye Hospital, Seoul, Korea.
2Department of Ophthalmology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea. Corresponding author.Corresponding Author: Min Chul Shin, MD, PhD. Department of Ophthalmology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, #77 Sakju-ro, Chuncheon 200-704, Korea. Tel: 82-33-240-5176, Fax: 82-33-241-8063, Email: mcshin@hallym.ac.kr
2Department of Ophthalmology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea. Corresponding author.Corresponding Author: Min Chul Shin, MD, PhD. Department of Ophthalmology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, #77 Sakju-ro, Chuncheon 200-704, Korea. Tel: 82-33-240-5176, Fax: 82-33-241-8063, Email: mcshin@hallym.ac.kr
Received May 19, 2008; Accepted August 4, 2010.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0 ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
This paper reports a case of pegylated interferon-associated retinopathy in a patient with chronic hepatitis C. A 32-year-old female with chronic hepatitis C undergoing pegylated interferon and ribavirin combination therapy complained of visual blurring. Features of interferon-associated retinopathy, including ocular complications such as cotton wool spots, retinal hemorrhages, macular edema, and branch retinal vein occlusion, were found in the fundus of both of her eyes. Pegylated interferon combination therapy was stopped, and the retinopathy of the patient was treated with intravitreal bevacizumab injections and panretinal photocoagulations. This case shows that pharmacokinetically improved pegylated interferon has ocular complications for patients with chronic hepatitis C. Accordingly, patients undergoing pegylated interferon treatment for hepatitis C need regular eye examinations for protection of their vision.
Keywords: Chronic hepatitis C, Interferon-associated retinopathy, Ocular vision, Pegyalted interferon
Interferon is a monotherapy or combination therapy antiviral drug for patients suffering from chronic hepatitis C. Certain ocular complications from interferon therapy have been reported, however, such as cotton wool spots [1-7], retinal hemorrhages [1-7], and optic neuropathy [8], among others. By pegylation of polyethylene glycol (PEG) to interferon, pharmacokinetially improved pegylated interferon has a larger molecular weight and a longer half life in the serum than non-pegylated interferon [3], which increases the efficacy of the drug for chronic hepatitis C patients. Non-pegylated interferon has a 12% to 16% clearance rate in the serum, whereas the 50% to 60% clearance rate of pegylated interferon makes it safer for long-term use by patients [3]. Even though pegyalted interferon is a more effective drug for chronic hepatitis C patients, to our knowledge there are no existing reports or studies about pegylated interferon-associated ocular complications such as interferon-associated retinopathy. To bring the issue to light, this study reports a case of pegylated interferon-associated acute and irreversible severe retinopathy in a patient with chronic hepatitis C.
Case Reports
A 32-year-old female was diagnosed with chronic hepatitis C (grade 3/4, stage 2/4, genotype 2a/c) in February of 2007. She underwent treatment with pegylated interferon-α2b 80 micrograms and ribavirin combination therapy for 5 months (from February of 2007 until July of 2007). She was also treated with subcutaneous insulin injections for a previous condition of pregnant diabetic mellitus diagnosed seven years before. She was first referred to ophthalmology in February of 2007 for a diabetic retinopathy examination. Her vision was 0.6 in both eyes, and intraocular pressure was 11 mmHg in the right eye and 12 mmHg in the left eye. Fundus examination found moderate nonproliferative diabetic retinopathy (NPDR) in the right eye and mild NPDR in the left eye. Accordingly, a follow-up visit to check her eyes was scheduled for six months later. She felt visual blurring two months later, and we referred to a past ophthalmologic exam in June of 2007. At that time, her best corrected visual acuity was 0.04 in both eyes. Previous fundoscopy revealed retinal hemorrhages, cotton wool spots, macular edema, and new vessels elsewhere (NVE) in both eyes (Fig. 1). The pegylated interferon and ribavirin combination therapy was stopped, and the patient was treated with intravitreal 0.05 mL bevacizumab (Avastin) injections. Panretinal photocoagulations were added.
Retinal hemorrhages, cotton wool spots, macular edema, and new vessels were found in both of the patient's eyes.
After completion of treatment, the patient's retinal hemorrhages, cotton wool spots, and macular edema improved (Fig. 2). The retinal non-perfusion areas (Figs. 3 and 4) and the best corrected visual acuity of the patient did not improve. As of June, we began regular ophthalmic examination of her eyes every other week.
(A,B) After intravitreal bevacizumab injections and panretinal photocoagulations, the cotton wool spots and retinal hemorrhages regressed, but the new vessels remained.
At the late arteriovenous phase (A,B), many microaneurys and new vessels were found. At the mid-venous phase, non-perfusion was more severe in the left eye (D) than in the right eye (C).
At the late arteriovenous phase (A,B) and mid-venous phase (C,D), new vessels and non-perfused areas progressed.Discussion
Standard interferon therapy in chronic hepatitis C patients causes various ocular complications, including branch retinal vein occlusion [2], subconjunctival hemorrhages [5], visual blurring, papilledema [8], neovascular glaucoma, and retinal detachment [9], among others. The most common among the ocular complications are retinopathy-parapapillary retinal hemorrhages at the posterior pole, and cotton wool spots [1,2,4]. These features of retinopathy occur in approximately 18% to 86% of alpha interferon-treated chronic hepatitis C patients [1]. A study by Jain et al. [4] has reported that these features of retinopathy may occur between 4 to 12 weeks after the start of interferon and ribavirin combination therapy, and will regress within 4 to 12 weeks after therapy stops. The pathogenesis of these features of retinopathy is unknown, however, the hypothesis that interferon interferes with retinal microcirculations is persuasive [7]. In this respect, interferon treatment for patients with abnormal microcirculation diseases, such as diabetic mellitus or hypertension, has a very high risk of causing interferon-associated ocular complications [6,7].
The patient in this case, due to previous diagnosis of diabetic mellitus, belonged to a high-risk group for interferon-associated ocular complications. The patient presented with retinal hemorrhages, cotton wool spots, macular edema, and retinal ischemic changes in both of her eyes. These ocular complications progress more acutely and severely than the progression of complications in a state of pre-pegylated interferon treatment, and the patient's vision decreased irreversibly.
Usually, interferon-treated patients have reversible interferon-associated retinopathy [1-7]. Cases of severe, irreversible visual impairment are very rare [10]. Chronic hepatitis C patients must undergo examination of their eyes before interferon treatment begins, and they must follow up with a second exam within three months of starting treatment. Particularly for high-risk patients with hypertension or diabetes mellitus, not only are regular follow-up examinations very important, but also stopping the interferon treatment at the right time is critical. This report shows that patients treated with pegylated interferon combined with ribavirin may have irreversible and severe ocular complications. This study proposes that chronic hepatitis C patients treated with pharmacokinetically improved pegylated interferon must also be managed with regular and exact ophthalmic examinations on an ongoing basis.
The patient in this case, due to previous diagnosis of diabetic mellitus, belonged to a high-risk group for interferon-associated ocular complications. The patient presented with retinal hemorrhages, cotton wool spots, macular edema, and retinal ischemic changes in both of her eyes. These ocular complications progress more acutely and severely than the progression of complications in a state of pre-pegylated interferon treatment, and the patient's vision decreased irreversibly.
Usually, interferon-treated patients have reversible interferon-associated retinopathy [1-7]. Cases of severe, irreversible visual impairment are very rare [10]. Chronic hepatitis C patients must undergo examination of their eyes before interferon treatment begins, and they must follow up with a second exam within three months of starting treatment. Particularly for high-risk patients with hypertension or diabetes mellitus, not only are regular follow-up examinations very important, but also stopping the interferon treatment at the right time is critical. This report shows that patients treated with pegylated interferon combined with ribavirin may have irreversible and severe ocular complications. This study proposes that chronic hepatitis C patients treated with pharmacokinetically improved pegylated interferon must also be managed with regular and exact ophthalmic examinations on an ongoing basis.
Dry eye - The Schirmer test
HCV infection has been associated with several eye disorders, according to this 2009 study hepatitis C patients, especially those with advanced stages of fibrosis, were more likely to exhibit severe ocular surface damage and signs of dry eye. In another 2011 study researchers concluded that the hepatitis C virus infection causes dry eye. The data also showed - "There was no linear association between time of hepatitis C infection and intensity observed in dry eye tests." *patients in the study did not undergo therapy
Dry eye
A dry eye is caused by a disturbance in the tear film overlying the ocular surface. It may be the result of deficient aqueous production (eg, Sjogren syndrome, lacrimal gland dysfunction/obstruction) or increased evaporation (eg, contact lens use, allergies, Meibomian gland dysfunction, low blink rate). Patients may report burning, pain, foreign body sensation, photophobia, and blurred vision. Diagnosis is usually made based on the history and clinical examination, but a number of more objective tests are available.
The Schirmer test
The Schirmer test uses filter paper to wick up tears and measure the amount of production, as shown in a patient with Sjogren syndrome. Treatment is initially supportive with artificial tears and the avoidance of offending medications or exposures. For patients with refractory cases, treatment of the underlying systemic illness or surgery may be required
Non-HCV Related Eye Conditions
Dry eye
A dry eye is caused by a disturbance in the tear film overlying the ocular surface. It may be the result of deficient aqueous production (eg, Sjogren syndrome, lacrimal gland dysfunction/obstruction) or increased evaporation (eg, contact lens use, allergies, Meibomian gland dysfunction, low blink rate). Patients may report burning, pain, foreign body sensation, photophobia, and blurred vision. Diagnosis is usually made based on the history and clinical examination, but a number of more objective tests are available.
The Schirmer test
The Schirmer test uses filter paper to wick up tears and measure the amount of production, as shown in a patient with Sjogren syndrome. Treatment is initially supportive with artificial tears and the avoidance of offending medications or exposures. For patients with refractory cases, treatment of the underlying systemic illness or surgery may be required
Non-HCV Related Eye Conditions
Blepharitis is an inflammation of the eyelash follicles, along the edge of the eyelid. The cause is overgrowth of the bacteria that is normally found on the skin.
Eyelids have the following symptoms:
Crusty
Reddened
Swollen
Itching
Burning
Blinking causes a granular sensation (like sand or dust in the eye)
Loss of eyelashes may occur
The primary treatment is careful daily cleansing of the edges of the eyelids, to remove the skin oils that the bacteria feed on. Your health care provider might recommend using baby shampoo or special cleansers. Antibiotic ointments may also be helpful in controlling bacteria on the lids.
Crusty
Reddened
Swollen
Itching
Burning
Blinking causes a granular sensation (like sand or dust in the eye)
Loss of eyelashes may occur
The primary treatment is careful daily cleansing of the edges of the eyelids, to remove the skin oils that the bacteria feed on. Your health care provider might recommend using baby shampoo or special cleansers. Antibiotic ointments may also be helpful in controlling bacteria on the lids.
If seborrheic dermatitis or rosacea are causing the problem, seek treatment for those conditions.
Causes
Causes
Blepharitis is usually caused by seborrheic dermatitis or a bacterial infection, and sometimes it is a combination of both. Allergies and eyelash infestation with lice may also cause blepharitis, although these causes are less common.
This condition is characterized by excess oil production in the glands near the eyelid. Too much oil creates an environment where the normal bacteria found on the skin can overgrow. The eyelids appear red and irritated, with scales that cling to the base of the eyelashes.
Blepharitis may be connected to repeated styes and chalazia. Risk factors are seborrheic dermatitis of the face or scalp, rosacea, lice, and allergies.
Tests & diagnosis
This condition is characterized by excess oil production in the glands near the eyelid. Too much oil creates an environment where the normal bacteria found on the skin can overgrow. The eyelids appear red and irritated, with scales that cling to the base of the eyelashes.
Blepharitis may be connected to repeated styes and chalazia. Risk factors are seborrheic dermatitis of the face or scalp, rosacea, lice, and allergies.
Tests & diagnosis
An examination of the eyelids during an eye examination is usually enough to diagnose blepharitis.
Prognosis
Prognosis
The likely outcome is good with treatment. Continued attention to lid cleanliness may be required to prevent repeated problems. Continued treatment will typically make the eyes less red and more comfortable.
Prevention
Cleaning eyelids carefully will help prevent blepharitis.
Prevention
Cleaning eyelids carefully will help prevent blepharitis.
If a specific skin condition is present, it should be treated.
Complications
Styes
Chalazia
The image shown is from a patient with ocular rosacea and shows eyelid telangiectasias (yellow arrow) and inspissated meibomian glands (white arrow). Treatment consists of eyelid hygiene, lubricant eye drops, systemic antibiotics for refractory cases, and the discriminate use of steroids in case of ulcers or conjunctivitis
Complications
Styes
Chalazia
The image shown is from a patient with ocular rosacea and shows eyelid telangiectasias (yellow arrow) and inspissated meibomian glands (white arrow). Treatment consists of eyelid hygiene, lubricant eye drops, systemic antibiotics for refractory cases, and the discriminate use of steroids in case of ulcers or conjunctivitis
What is a sty?
A sty (sometimes spelled stye) is a tender, painful red bump located at the base of an eyelash or under or inside the eyelid. The medical term for a sty is hordeolum (plural, hordeola).
A sty results from an acute infection of the oil glands of the eyelid (meibomian glands) that occurs after these glands have become clogged. A sty also may arise from an infected hair follicle at the base of an eyelash. The bacterium Staphylococcus aureus is responsible for 90%-95% of cases of styes. Staph aureus is frequently found on the skin. A sty can develop as a complication of blepharitis (inflammation of the eyelid).
The term external hordeolum has been used to refer to a sty that develops at the base of an eyelash involving a hair follicle of the eyelid, whereas the term internal hordeolum refers to a sty arising due to an inflamed meibomian gland under the eyelid.
A sty is sometimes confused with a chalazion (see below), which is a cyst or a specific type of scarring (due to chronic inflammation) arising in the meibomian glands of the eyelid. In contrast to a sty, a chalazion is usually painless.
What are the signs and symptoms of a sty?
The first symptoms of a sty are generally redness, tenderness, and pain in the affected area. The eye may feel irritated or "scratchy." Later symptoms can include swelling, discomfort during blinking of the eye, watering of the eye, and sensitivity to light. A common sign of a sty is a small, yellowish spot at the center of the bump that develops as pus expands in the area.
Who is most susceptible to the development of a sty?
Styes are very common. People of all ages can develop a sty, and males and females are equally affected. There is a slight increase in incidence of styes during the third to fifth decades of life. People with certain chronic conditions (diabetes mellitus, chronic blepharitis [inflammation of the eyelid], seborrhea, and chronic debilitating illnesses) are more prone to developing styes than the general population. In many susceptible people, stress seems to trigger the development of a sty. Studies have shown that those who have high levels of blood lipids are more susceptible to blockages in the oil glands, including those of the eyelid and, therefore, are more likely to develop a sty.
What is the treatment for a sty?
What are the signs and symptoms of a sty?
The first symptoms of a sty are generally redness, tenderness, and pain in the affected area. The eye may feel irritated or "scratchy." Later symptoms can include swelling, discomfort during blinking of the eye, watering of the eye, and sensitivity to light. A common sign of a sty is a small, yellowish spot at the center of the bump that develops as pus expands in the area.
Who is most susceptible to the development of a sty?
Styes are very common. People of all ages can develop a sty, and males and females are equally affected. There is a slight increase in incidence of styes during the third to fifth decades of life. People with certain chronic conditions (diabetes mellitus, chronic blepharitis [inflammation of the eyelid], seborrhea, and chronic debilitating illnesses) are more prone to developing styes than the general population. In many susceptible people, stress seems to trigger the development of a sty. Studies have shown that those who have high levels of blood lipids are more susceptible to blockages in the oil glands, including those of the eyelid and, therefore, are more likely to develop a sty.
What is the treatment for a sty?
Application of a warm compress or warm washcloth to the affected area for 10 minutes, four to six times a day, can speed rupture of the sty and aid in the relief of symptoms. A sty should not be pressed or squeezed to facilitate drainage, since this can spread or worsen the infection. If a sty persists for several days, a doctor may lance (drain) the infection under local anesthesia in his or her office. Children who require surgical drainage of a sty may need a general anesthetic. Antibiotic ointments and/or steroid ointments sometimes are prescribed to treat a sty. Rarely, systemic (oral) antibiotics are recommended for persistent or multiple styes. Over-the-counter pain medications may be used to alleviate pain and tenderness. Contact lenses and eye makeup should never be worn during treatment for a sty.
What is the prognosis (outcome) of a sty?
A sty is harmless in the majority of cases. In most cases, a sty ruptures on its own within a few days to a week, leading to relief from symptoms. Some people will require medical or surgical treatment of a sty, as described in the following section. A sty does not cause intraocular damage (damage to the eye). Styes often recur. Complications of styes are rare (see below).
Are there any potential complications resulting from a sty?
Complications of a sty are rare. The infection may spread to other eyelash follicles, leading to multiple styes. A chalazion (a form of scarring of the glands in the eyelid that may include the formation of cysts) is the most common complication that develops from a sty. Chalazia can be large enough to deform the cornea of the eye and interfere with vision, and they may cause a cosmetic problem. Other potential complications include a generalized infection (cellulitis) of the eyelid, and improper drainage of a sty may lead to deformity or disruption of eyelash growth. Progression of a sty to a systemic infection (spreading throughout the body) is extremely rare, and only a few instances of such spread have been recorded.
Can a sty be prevented?
While it is impossible to completely prevent the development of a sty, good hygienic practices, including proper hand washing, can help prevent all forms of infection, including a sty. Other measures that can help prevent styes include never sharing cosmetics or cosmetic eye tools (such as lash curlers or eyelash combs) with others, keeping eye tools clean, discarding old or contaminated eye makeup, keeping all cosmetics clean, and not touching the eye and surrounding areas.
Sty (Stye, Hordeolum) At A Glance
What is the prognosis (outcome) of a sty?
A sty is harmless in the majority of cases. In most cases, a sty ruptures on its own within a few days to a week, leading to relief from symptoms. Some people will require medical or surgical treatment of a sty, as described in the following section. A sty does not cause intraocular damage (damage to the eye). Styes often recur. Complications of styes are rare (see below).
Are there any potential complications resulting from a sty?
Complications of a sty are rare. The infection may spread to other eyelash follicles, leading to multiple styes. A chalazion (a form of scarring of the glands in the eyelid that may include the formation of cysts) is the most common complication that develops from a sty. Chalazia can be large enough to deform the cornea of the eye and interfere with vision, and they may cause a cosmetic problem. Other potential complications include a generalized infection (cellulitis) of the eyelid, and improper drainage of a sty may lead to deformity or disruption of eyelash growth. Progression of a sty to a systemic infection (spreading throughout the body) is extremely rare, and only a few instances of such spread have been recorded.
Can a sty be prevented?
While it is impossible to completely prevent the development of a sty, good hygienic practices, including proper hand washing, can help prevent all forms of infection, including a sty. Other measures that can help prevent styes include never sharing cosmetics or cosmetic eye tools (such as lash curlers or eyelash combs) with others, keeping eye tools clean, discarding old or contaminated eye makeup, keeping all cosmetics clean, and not touching the eye and surrounding areas.
Sty (Stye, Hordeolum) At A Glance
A sty (sometimes spelled stye and medically referred to as a hordeolum) is a tender, painful red bump located at the base of an eyelash or under or inside the eyelid.
Application of a warm compress or warm washcloth to the affected area for 10 minutes, four to six times a day, can speed rupture of the sty and aid in the relief of symptoms.
Application of a warm compress or warm washcloth to the affected area for 10 minutes, four to six times a day, can speed rupture of the sty and aid in the relief of symptoms.
Styes are common and are generally harmless.
A chalazion (a form of scarring of the glands in the eyelid that may include the formation of cysts) is the most common complication that develops from a sty.
Chalazion
Conservative treatment for small, asymptomatic chalazions begins with lid massage, moist heat, and topical mild steroid drops. Firm pressure on the lid may express thick secretions. Oral tetracyclines will minimize the risk of infection. Surgical incision and curettage allows for drainage and is performed for large, symptomatic chalazions (shown). Biopsy of recurrent chalazions should be performed to rule out sebaceous cell carcinoma.
Conservative treatment for small, asymptomatic chalazions begins with lid massage, moist heat, and topical mild steroid drops. Firm pressure on the lid may express thick secretions. Oral tetracyclines will minimize the risk of infection. Surgical incision and curettage allows for drainage and is performed for large, symptomatic chalazions (shown). Biopsy of recurrent chalazions should be performed to rule out sebaceous cell carcinoma.
Chalazion
A chalazion is a lump of the lid that is caused by obstruction of an oil gland within the upper or lower eyelid. This lump may increase in size over days to weeks and may occasionally become red, warm, or painful.
The gland involved in the formation of a chalazion is a modified oil gland that lies within the eyelid. There are about 40 of these glands within each of the upper and lower lids. These glands secrete oil into the tears. When one of these glands becomes blocked, it can increase in size and cause a visible lump.
Although a sty is also a lump in the eyelid caused by obstruction of an oil gland, a chalazion is not a sty. A sty, or hordeolum, represents an acute infection of the gland. A chalazion is not an infection but is an inflammation of the area. Inflammation is a process in which the body reacts to a condition and produces a swelling, redness, pain, or warmth. A sty is usually more painful than a chalazion and may look infected.
Chalazions are lipogranulomas of either a meibomian gland or a Zeis gland. They develop when lipid breakdown products leak into the surrounding tissues from either bacterial enzymes or retained sebaceous secretions and incite a granulomatous inflammatory reaction. On examination, chalazions appear as single, firm, nontender nodules deep within the lid or tarsal plate (shown). They are more common on the upper vs lower lid because of the increased number and length of meibomian glands on the upper lid. Eversion of the eyelid may show a dilated meibomian gland.
Basal cell carcinomas
Basal cell carcinomas are the most common form of skin cancer overall, and also the most common epithelial tumor of the eyelid. Patients may describe a nonhealing ulcer that bleeds with only mild trauma. On examination the tumor may have the following characteristics: painless nodule, shiny and waxy, indurated, firm and immobile, pearly, rolled border, and small telangiectatic vessels.
Treatment is surgical excision, radiation therapy, chemotherapy, or photodynamic therapy depending on the tumor size, location, and histologic type. The image shown is of a biopsy-proven basal cell carcinoma of the upper lid margin. Note the loss of cilia (madarosis) in the area of the tumor.
Conjunctivitis - Pinkeye
Conjunctivitis, also known as pinkeye, is an inflammation of the conjunctiva, the thin, clear tissue that lies over the white part of the eye and lines the inside of the eyelid.
What Causes Pinkeye?
Pinkeye has a number of different causes, including:
Viruses
Bacteria (such as
gonorrhea or chlamydia)
Irritants such as shampoos, dirt, smoke, and pool chlorine
Allergies, like dust, pollen, or a special type of allergy that affects some contact lens wearers
Pinkeye caused by some bacteria and viruses can spread easily from person to person, but are not a serious health risk if diagnosed promptly. Pinkeye in newborn babies, however, should be reported to a doctor immediately.
Viral conjunctivitis is an infection of the mucous membrane of the surface of the eye. The most common virus responsible is adenovirus, but other viruses have also been identified including herpes simplex, varicella-zoster, picorna, pox, and human immunodeficiency virus. Infections are usually self-limited, but compared to bacterial conjunctivitis they last longer (2-4 weeks), show less inflammation, do not have purulent discharge, and a preauricular lymph node may be palpable. Most patients report itching, foreign body sensation, tearing, redness, and photophobia.
Treatment is largely supportive with artificial tears, cold compresses, and good hand hygiene. Antiviral therapy is reserved for cases of varicella-zoster and herpes simplex infection. Patients in whom appropriate therapy fails or corneal involvement develops should be referred to an ophthalmologist.
Bacterial conjunctivitis
Types of Conjunctivitis Bacterial conjunctivitis is a common type of pink eye, caused by bacteria that infect the eye through various sources of contamination. The bacteria can be spread through contact with an infected individual, exposure to contaminated surfaces or through other means such as sinus or ear infections.
The most common types of bacteria that cause bacterial conjunctivitis include Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae and Pseudomonas aeruginosa. Bacterial conjunctivitis usually produces a thick discharge or pus and can affect one or both eyes.
As with any bacterial infection, antibiotics are required to eliminate the bacteria. Treatment of bacterial conjunctivitis is typically accomplished with topical antibiotic eye drops and/or eye ointments. The treatment usually takes from one to two weeks, depending on the severity of the infection.
Viral conjunctivitis is another common type of pink eye that is highly contagious, because airborne viruses can be spread through sneezing and coughing. Viral conjunctivitis also can accompany common viral upper respiratory infections such as measles, the flu or the common cold.
Viral conjunctivitis usually produces a watery discharge. Typically the infection starts in one eye and quickly spreads to the other eye.
Unlike with bacterial infections, antibiotics will not work against viruses. No eye drops or ointments are effective against the common viruses that cause viral conjunctivitis. But viral conjunctivitis is self-limited, which means it will go away by itself after a short time.
Typically with viral conjunctivitis, the third through the fifth days are the worst. After that, eyes begin to improve on their own. Treatment of viral conjunctivitis usually involves supportive therapies, such as eye drops, that help reduce the symptoms: for example, vasoconstrictors to whiten the eye, decongestants to reduce the surface swelling and antihistamines to reduce
occasional itching. Treatments are usually continued for one to two weeks, depending on the severity of the infection.
Gonococcal and chlamydial conjunctivitis are bacterial forms related to infections from sexually transmitted diseases including gonorrhea and chlamydia. Newborn babies may be exposed when they pass through the birth canal of an infected mother.
Trachoma is a form of chlamydial infection that causes scarring on the eye's surface. Trachoma is the world's leading cause of preventable blindness.
Neonatal conjunctivitis found in newborn babies can cause blindness when left untreated. Up to 10 percent of all pregnant women in the United States have a sexually transmitted chlamydial infection. If these infections are untreated in mothers, the possibility that a newborn infant will develop a related eye infection ranges from 10 percent to 20 percent.*
Another type of sexually transmitted disease related to the herpes simplex
virus type 2 found in the genital area can infect eyes of infants as they are born. Herpes simplex virus type 1, a cause of cold sores on the mouth, also can cause a type of eye herpes that results in pink eye.
If you are pregnant and suspect you may have a sexually transmitted disease, you need to be checked and possibly treated for any infection before the birth of your baby.
Allergic conjunctivitis caused by eye allergies is very common. Eye allergies, like other types, can be triggered by allergens including pollen, animal dander and dust mites.
The most common symptom of allergic conjunctivitis is itchy eyes, which may be relieved with special eye drops containing antihistamines to control allergic reactions. These eye drops are available both over the counter and by prescription.
Avoiding the allergen is also important in the treatment of allergic conjunctivitis. Allergic conjunctivitis can be seasonal or perennial (year-round), depending on the allergen causing the reaction.
Giant papillary conjunctivitis (GPC) usually involves both eyes and often affects soft contact lens wearers. This condition may cause contact lens intolerance, itching, a heavy discharge, tearing and red bumps on the underside of the eyelids.
Non-infectious conjunctivitis from eye irritation causing a pink eye can result from many sources, including smoke, diesel exhaust, perfumes and certain chemicals. Some forms of conjunctivitis also result from sensitivity to certain ingested substances, including herbs such as eyebright and turmeric.**
Certain forms of pink eye, including giant papillary conjunctivitis, can be caused by the eye's immune responses, such as a reaction to wearing contact lenses or ocular prosthetics (artificial eyes).
A reaction to preservatives in eye drops or ointments also can cause toxic conjunctivitis.
Bacterial conjunctivitis is a microbial infection involving the mucous membrane on the surface of the eye. It can be differentiated from viral conjunctivitis by the purulent discharge (shown). It is typically benign and self-limiting, but significant ocular morbidity may develop. In sexually active individuals, Neisseria gonorrhoeae and Chlamydia must be considered. If clinically suspicious, culture specimens and gram stains can be used to identify the specific etiologic agent. The mainstay of treatment is empiric topical antibiotic therapy with a broad-spectrum agent, with systemic antibiotics reserved for N gonorrhoeae and Chlamydia. Frequent handwashing and avoidance of shared linens can help prevent the spread of infection.
Pterygia
A pterygium is an elevated, superficial, external ocular mass that forms over the perilimbal conjunctiva and extends onto the corneal surface. Pterygia are caused by collagen degeneration and fibrovascular proliferation. Increased exposure to ultraviolet light is a risk factor. Clinically, patients may be asymptomatic, or complain of symptoms related to the elevation of the conjunctiva such as redness, itching, blurred vision, and irritation. Patients are typically observed without intervention unless there is significant discomfort or obstruction of the visual axis.
Corneal abrasion
If the cornea (the membrane that covers the front of the eye) is damaged, the eye becomes inflamed and often very sensitive to light. Damage may occur as a result of an injury, often you get a scratch on your eye from a foreign object or from something else like if you walk through some tall bushes and get scratched in the eye by a branch. Or, if you fall in some dirt while rollerblading or cycling and your eye gets scratched by a pebble.
Call your health care provider right away if you do get a scratch like this on the surface of the eyeball. An infection can occur from the ulceration. You will be given prescription eye drops and sometimes oral medication to prevent infection. The eye can heal very quickly, but you must seek attention quickly with this kind of injury.
With the use of blue light, the fluorescein defect of a corneal abrasion may be more pronounced and will appear yellow-green (shown). Corneal abrasions typically heal without serious complications over time with supportive care: ice compresses and nonsteroidal anti-inflammatory eye drops. Prophylactic antibiotics are commonly prescribed, especially for traumatic or surgical abrasions. Close follow-up is necessary because of the risk of developing a corneal ulcer.
Subconjunctival hemorrhage
Subconjunctival hemorrhage is a bright red patch appearing in the white of the eye. This condition is also called red eye.
Symptoms
With the use of blue light, the fluorescein defect of a corneal abrasion may be more pronounced and will appear yellow-green (shown). Corneal abrasions typically heal without serious complications over time with supportive care: ice compresses and nonsteroidal anti-inflammatory eye drops. Prophylactic antibiotics are commonly prescribed, especially for traumatic or surgical abrasions. Close follow-up is necessary because of the risk of developing a corneal ulcer.
Subconjunctival hemorrhage
Subconjunctival hemorrhage is a bright red patch appearing in the white of the eye. This condition is also called red eye.
Symptoms
A bright red patch appears on the white of the eye. The patch does not cause pain and there is no discharge from the eye. Vision does not change.
Treatment
Treatment
No treatment is needed. You should have your blood pressure regularly checked.
Causes
Causes
A subconjunctival hemorrhage occurs when a small blood vessel breaks open and bleeds near the surface of the white of the eye (bulbar conjunctiva). It may happen without injury, and is often first noticed when you wake up and look in a mirror.
Sudden increases in pressure such as violent sneezing or coughing can cause a subconjunctival hemorrhage. The hemorrhage may also occur in persons with high blood pressure or who take blood thinners.
A subconjunctival hemorrhage is common in newborn infants. In this case, the condition is thought to be caused by the pressure changes across the infant's body during childbirth.
Tests & diagnosis
Sudden increases in pressure such as violent sneezing or coughing can cause a subconjunctival hemorrhage. The hemorrhage may also occur in persons with high blood pressure or who take blood thinners.
A subconjunctival hemorrhage is common in newborn infants. In this case, the condition is thought to be caused by the pressure changes across the infant's body during childbirth.
Tests & diagnosis
The health care provider will perform a physical exam and look at your eyes.
Blood pressure should be tested. If you have other areas of bleeding or bruising, more specific tests may be needed.
Prognosis
Blood pressure should be tested. If you have other areas of bleeding or bruising, more specific tests may be needed.
Prognosis
A subconjunctival hemorrhage usually goes away on its own in about 1 week.
Prevention
Prevention
There is no known prevention.
Complications
Complications
There are usually no complications.
The image shown is of a subconjunctival hemorrhage, a condition that can be easily managed with conservative treatment on an outpatient basis.
Images courtesy of Wikimedia Commons
Source
Images courtesy of Wikimedia Commons
Source
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