conjunctivitis

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Inflammation of the conjunctiva, the thin protective membrane lining the eyelids and covering the front surface of the eye. Conjunctivitis may be due to a viral or bacterial infection, or chemical irritation. Bacterial infections can cause pus to form. Such purulent infections can be exacerbated by exercise. Chlorine in swimming pool water commonly acts as a chemical irritant resulting in conjunctivitis, similar to that caused by bacterial infections. Wearing goggles offers protection against this condition.

Definition

Conjuctivitis is an inflammation resulting in redness of the lining of the white part of the eye and the underside of the eyelid (conjunctiva) that can be caused by infection, allergic reaction, or physical agents like infrared or ultraviolet light.

Description

Conjunctivitis is the inflammation of the conjunctiva, a thin, delicate membrane that covers the eyeball and lines the eyelid. Conjunctivitis is an extremely common eye disease because the conjunctiva is continually exposed to microorganisms and environmental agents that can cause infections or allergic reactions. Conjunctivitis can be acute or chronic depending on how long the condition lasts, the severity of symptoms, and the type of organism or agent involved. It can affect one or both eyes and, if caused by infection, can be very easily transmitted to others during close physical contact, particularly among children in a school or daycare setting. Other names for conjunctivitis include pink eye and red eye.

Demographics

Conjunctivitis is the most common eye infection of childhood. It occurs so frequently that records are not kept, so exact demographic information has not been amassed.

Causes and Symptoms

Conjunctivitis may be caused by a viral infection, such as a cold; acute respiratory infection; or other disease such as measles, herpes simplex, or herpes zoster. Symptoms include mild to severe discomfort in one or both eyes; redness; swelling of the eyelids; and watery, yellow, or green discharge. Symptoms may last anywhere from several days to two weeks. Infection with an adenovirus, however, may also cause a significant amount of pus-like discharge and a scratchy, foreign-body-sensation in the eye. These symptoms may be accompanied by swelling and tenderness of the lymph nodes near the ear.

Bacterial conjunctivitis can occur in adults and children and is caused by organisms such as Staphylococcus, Streptococcus, and Hemophilus. Symptoms of bacterial conjunctivitis include a pus-like discharge and crusty eyelids after awakening. Redness of the conjunctiva can be mild to severe and may be accompanied by swelling. Persons with symptoms of conjunctivitis who are sexually active may possibly be infected with the bacteria that cause either gonorrhea or chlamydia. There may be large amounts of pus-like discharge, and symptoms may include intolerance to light (photophobia), watery mucus discharge, and tenderness in the lymph nodes near the ear that may persist for up to three months.

Conjunctivitis may also be caused by environmental hazards, such as wind, smoke, dust, and allergic reactions caused by pollen, dust, or grass. Symptoms range from itching and redness to a mucus discharge. Persons who wear contact lenses may develop allergic conjunctivitis caused by various eye solutions used and the foreign proteins contained in them.

Other less common causes of conjunctivitis include exposureto sun lamps or the electrical arcs used during welding and problems with inadequate drainage of the tear ducts.

Diagnosis

An accurate diagnosis of conjunctivitis centers on taking a patient's history to learn what symptoms are being experienced, when symptoms began, and other predisposing factors, such as upper respiratory complaints, allergies, sexually transmitted diseases, herpes simplex infections, and exposure to persons with pink eye. It may be helpful to learn whether an aspect of an individual's occupation may be the cause, for example, welding. Diagnostic tests are usually not indicated unless initial treatment fails or an infection with gonorrhea or chlamydia is suspected. In such cases, the discharge may be cultured and tested to determine the organism responsible for causing the condition.

Treatment

The treatment of conjunctivitis depends on what caused the condition. In all cases, warm compresses applied to the affected eye several times a day may help to reduce discomfort.

Conjunctivitis due to a viral infection, particularly those due to adenoviruses, are usually treated by applying warm compresses to the affected area and using topical antibiotic ointments to prevent secondary bacterial infections.

Viral conjunctivitis caused by herpes simplex should be referred to an ophthalmologist. Topical steroids are commonly prescribed in combination with antiviral therapy.

In cases of bacterial conjunctivitis, a physician may prescribe an antibiotic eye ointment or eye drops containing sodium sulfacetamide (Sulamyd) to be applied daily for seven to 14 days. If, after 72 hours, the condition does not improve, a physician or primary care provider should be notified, because the bacteria involved may be resistant to the antibiotic used or the cause may not be bacterial.

For cases of conjunctivitis caused by a gonococcal organism, a physician may prescribe an intramuscular injection of ceftriaxone (Rocephin) and a topical antibiotic ointment containing erythromycin or bactracin to be applied four times daily for two to three weeks. Sexual partners should also be treated.

With accompanying chlamydia infection, a topical antibiotic ointment containing erythromycin (Ilotycin) may be prescribed to be applied one to two times daily. In addition, oral erythromycin or tetracycline therapy may be indicated for three to four weeks. Again, sexual partners should also be treated.

Allergic conjunctivitis can be treated by removing the allergic substance from a person's environment, if possible; by applying cool compresses to the eye; and by administering eye drops four to six times daily for four days. Also, the antihistamine diphenhydramine hydrochloride (Benadryl) may help to relieve itchy eyes.

Prognosis

If treated properly, the prognosis for conjunctivitis is good. Conjunctivitis caused by an allergic reaction should clear up once the allergen is removed. However, allergic conjunctivitis will likely recur if the individual again comes into contact with the particular allergen. Conjunctivitis caused by bacteria or a virus, if treated properly, is usually resolved in ten to 14 days. If there is no relief of symptoms in 48 to 72 hours, or there is moderate to severe eye pain, changes in vision, or the conjunctivitis is suspected to be caused by herpes simplex, a physician should be notified immediately. If untreated or if treatment fails and is not corrected, conjunctivitis may cause visual impairment by spreading to other parts of the eye, such as the cornea.

Prevention

Conjunctivitis can, in many cases, be prevented, or at least the course of the disease can be shortened by following these simple practices:

• frequently washing hands with antiseptic soap and using single-use towels while the disease continues
• avoiding chemical irritants and known allergens
• in an area where welding occurs, using the proper protective eye wear and screens to prevent damaging the eyes
• using a clean tissue to remove discharge from eyes and washing hands to prevent the spread of infection
• if medication is prescribed, finishing the course of antibiotics, as directed, to make sure that the infection is cleared up and does not recur
• avoiding close contact, such as vigorous physical activities, with other persons until symptoms resolve

Resources

Books

"Disorder of the Conjunctiva." In Nelson Textbook of Pediatrics. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2004.

Weiss, Avery H. "Conjunctivitis Beyond the Neonatal Period." In Principles and Practice of Pediatric Infectious Diseases, 2nd ed. Edited by Sarah S. Long et al. St. Louis, MO: Elsevier, 2003.

Web Sites

Silverman, Michael A., et al. "Conjunctivitis." eMedicine, October 12, 2004. Available online at www.emedicine.com/emerg/topic110.htm (accessed December 25, 2004).

[Article by: Lisa Papp, RN Rosalyn Carson-DeWitt, MD]

Inflammation of the conjunctiva (the thin, protective mucous membrane lining the eyelids and covering the anterior surface of the eye). Conjunctivitis may be due to a viral or bacterial infection, or chemical irritation. Bacterial infections can cause pus formation. Such purulent infections can be exacerbated by exercise. Chlorine in the water of swimming pools commonly acts as a chemical irritant causing conjunctivitis similar to purulent infections. Conjunctivitis in skiers and ice skaters can also be caused by cold injury to the cornea. Wearing goggles offers protection against these conditions.

Inflammation of the conjunctiva, the transparent mucous membrane that lines the inner surface of the eyelid and covers the front part of the eyeball. Often called pinkeye.

Inflammation of the conjunctiva. Extension of the inflammation to the cornea is common, hence keratoconjunctivitis. Individual cases may be due to trauma or to grass seed or other foreign body intrusion. The most serious conjunctivitides are the infectious ones, including those in which conjunctivitis is only an incidental lesion to more serious problems, e.g. rinderpest, malignant catarrhal fever, canine distemper, infectious bovine rhinotracheitis. The common specific conjunctivitides are Moraxella bovis infection in cattle, Rickettsia conjunctivae in sheep, goats and pigs, but there is no such infection in horses. In cats, feline herpesvirus and Chlamydophila felis cause a conjunctivitis. Parasitic conjunctivitis may be caused by Habronema spp. in horses and Thelazia spp. in all species. Classical signs of the disease are ocular discharge, serous at first, purulent later, and blepharospasm. Both eyes may be affected. Under-running of the conjunctiva and permanent opacity, even rupture of the eyeball, may follow.

• equine seasonal c. — irritation caused by flies (Musca domestica) or release of Habronema larvae; called also summer conjunctivitis.
• fetal c. — present in many cases of intrauterine infection and the causative organism can be cultured from the site.
• follicular c. — proliferation of lymphoid tissue on the bulbar surface of the third eyelid, often extending to the adjacent bulbar and palpebral conjunctiva in response to any chronic inflammation or stimulation such as dust, entropion, ectropion, distichiasis or bacterial infection.
• ligneous c. — a chronic, membranous conjunctivitis involving the lids and third eyelid with deposition of amorphous eosinophilic hyaline material in the subconjunctival tissues. Young female Doberman pinschers may be predisposed.
• c. neonatorum — neonatal kittens infected by feline herpesvirus may have severe ocular involvement, even before their eyelids become unsealed. Ulcerative keratitis and panophthalmitis are common sequelae.
• primary c. — caused by infectious agents, parasites or toxic agents affecting the conjunctiva in the first instance.
• secondary c. — associated with foreign bodies or diseases of the cornea, lacrimal system, eyelids, orbit, or body as a whole.

An inflammation of the conjunctiva, caused by bacterial or viral infection, allergy, or environmental factors. Also called pinkeye.

• Diseases and Infestations - conjunctivitis: inflammation of mucous membrane covering front of eye, often with discharge of pus; pinkeye

"Pinkeye" redirects here. For the South Park episode, see Pinkeye (South Park).

This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (May 2012)

Conjunctivitis
Classification and external resources
An eye with conjunctivitis.
ICD-10	H10
ICD-9	372.0
DiseasesDB	3067
MedlinePlus	001010
eMedicine	emerg/110
MeSH	D003231

Conjunctivitis (also called pink eye^[1] or madras eye^[2]) is inflammation of the conjunctiva (the outermost layer of the eye and the inner surface of the eyelids).^[1] It is most commonly due to an infection (usually viral, but sometimes bacterial^[3]) or an allergic reaction.

Contents 1 Classification 1.1 By cause 1.2 By extent of involvement 2 Signs and symptoms 2.1 Viral 2.2 Bacterial 2.3 Chemical 2.4 Other 3 Causes 4 Diagnosis 4.1 Differential diagnosis 5 Prevention 6 Management 6.1 Allergic 6.2 Bacterial 6.3 Viral 6.4 Chemical 7 See also 8 References 9 External links

Classification

This unreferenced section requires citations to ensure verifiability.

Classification can be either by cause or by extent of the inflamed area.

By cause

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• Allergic conjunctivitis
• Bacterial conjunctivitis
• Viral conjunctivitis
• Chemical conjunctivitis
• Neonatal conjunctivitis is often defined separately due to different organisms

By extent of involvement

This unreferenced section requires citations to ensure verifiability.

Blepharoconjunctivitis is the dual combination of conjunctivitis with blepharitis (inflammation of the eyelids).

Keratoconjunctivitis is the combination of conjunctivitis and keratitis (corneal inflammation).

Episcleritis is an inflammatory condition that produces a similar appearance to conjunctivitis, but without discharge or tearing.

Signs and symptoms

Eye with allergic conjunctivitis

Eyes with conjunctivitis

An eye, red due to acute conjunctivitis.

An eye with bacterial conjunctivitis.

An eye with chlamydial conjunctivitis.

This unreferenced section requires citations to ensure verifiability.

Red eye (hyperaemia), irritation (chemosis) and watering (epiphora) of the eyes are symptoms common to all forms of conjunctivitis. However, the pupils should be normally reactive and the visual acuity normal.

Viral

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Viral conjunctivitis is often associated with an infection of the upper respiratory tract, a common cold, and/or a sore throat. Its symptoms include excessive watering and itching. The infection usually begins with one eye, but may spread easily to the other.

Viral conjunctivitis, commonly known as pink eye, shows a fine, diffuse pinkness of the conjunctiva, which is easily mistaken for the ciliary injection of iritis, but there are usually corroborative signs on microscopy, particularly numerous lymphoid follicles on the tarsal conjunctiva, and sometimes a punctate keratitis.

Bacterial

This unreferenced section requires citations to ensure verifiability.

Bacterial conjunctivitis due to common pyogenic (pus-producing) bacteria causes marked grittiness/irritation and a stringy, opaque, greyish or yellowish mucopurulent discharge that may cause the lids to stick together, especially after sleep. Another symptom that could be caused by bacterial conjunctivitis is severe crusting of the infected eye and the surrounding skin. However, contrary to popular belief, discharge is not essential to the diagnosis. Bacteria such as Chlamydia trachomatis or Moraxella can cause a non-exudative but persistent conjunctivitis without much redness. The gritty and/or scratchy feeling is sometimes localized enough for patients to insist they must have a foreign body in the eye. The more acute pyogenic infections can be painful. Like viral conjunctivitis, it usually affects only one eye but may spread easily to the other eye. Corynebacterium diphtheriae causes membrane formation in conjunctiva of non immunized children.

Chemical

Chemical eye injury is due to either an acidic or alkali substance getting in the eye.^[4] Alkalis are typically worse than acidic burns.^[5] Mild burns will produce conjunctivitis while more severe burns may cause the cornea to turn white.^[5] Litmus paper is an easy way to rule out the diagnosis by verifying that the pH is within the normal range of 7.0—7.2.^[4] Large volumes of irrigation is the treatment of choice and should continue until the pH is 6—8.^[5] Local anaesthetic eye drops can be used to decrease the pain.^[5]

Irritant or toxic conjunctivitis show primarily marked redness. If due to splash injury, it is often present only in the lower conjunctival sac. With some chemicals, above all with caustic alkalis such as sodium hydroxide, there may be necrosis of the conjunctiva with a deceptively white eye due to vascular closure, followed by sloughing of the dead epithelium. This is likely to be associated with slit-lamp evidence of anterior uveitis.

Other

Inclusion conjunctivitis of the newborn (ICN) is a conjunctivitis that may be caused by the bacteria Chlamydia trachomatis, and may lead to acute, purulent conjunctivitis.^[6] However, it is usually self-healing.^[6]

Conjunctivitis is identified by irritation and redness of the conjunctiva. Except in obvious pyogenic or toxic/chemical conjunctivitis, a slit lamp (biomicroscope) is needed to have any confidence in the diagnosis. Examination of the tarsal conjunctiva is usually more diagnostic than the bulbar conjunctiva.

Causes

Conjunctivitis is most commonly caused by viral infection, but bacterial infections, allergies, other irritants and dryness are also common etiologies for its occurrence. Both bacterial and viral infections are contagious. Commonly, conjunctival infections are passed from person-to-person, but can also spread through contaminated objects or water.

The most common cause of viral conjunctivitis is adenoviruses^{[citation needed]}. Herpetic keratoconjunctivitis (caused by herpes simplex viruses) can be serious and requires treatment with acyclovir. Acute hemorrhagic conjunctivitis is a highly contagious disease caused by one of two enteroviruses, Enterovirus 70 and Coxsackievirus A24. These were first identified in an outbreak in Ghana in 1969, and have spread worldwide since then, causing several epidemics.^[7]

Diagnosis

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Cultures are done infrequently because most cases of conjunctivitis are treated empirically and (eventually) successfully, but often only after running the gamut of the common possibilities.

Swabs for bacterial culture are necessary if the history and signs suggest bacterial conjunctivitis, but there is no response to topical antibiotics. Research studies indicate many bacteria implicated in low-grade conjunctivitis are not detected by the usual culture methods of medical microbiology labs, so false negative results are common.^{[citation needed]} Viral culture may be appropriate in epidemic case clusters. Conjunctival scrapes for cytology can be useful in detecting chlamydial and fungal infections, allergy and dysplasia, but are rarely done because of the cost and the general lack of laboratory staff experienced in handling ocular specimens. Conjunctival incisional biopsy is occasionally done when granulomatous diseases (e.g., sarcoidosis) or dysplasia are suspected.

Differential diagnosis

Conjunctivitis is a relatively nonspecific symptom.^[1] Even after biomicroscopy, laboratory tests are often necessary if proof of etiology is needed.

A purulent discharge (a whitish-yellow, yellow or yellow-brown substance, more commonly known as pus) suggests a bacterial infection. It can also be caused by bacteria from feces, pet hair, or by smoke or other fumes. Infection with Neisseria gonorrhoeae should be suspected if the discharge is particularly thick and copious.

Itching (rubbing eyes) is the hallmark symptom of allergic conjunctivitis. Other symptoms include history of eczema, or asthma.

A diffuse, less "injected" conjunctivitis (looking pink rather than red) suggests a viral cause, especially if numerous follicles are present on the lower tarsal conjunctiva on biomicroscopy.

Scarring of the tarsal conjunctiva suggests trachoma, especially if seen in endemic areas, if the scarring is linear (von Arlt's line), or if there is also corneal vascularisation.

Clinical tests for lagophthalmos, dry eye (Schirmer test) and unstable tear film may help distinguish the various types of conjunctivitis.

Other symptoms, including pain, blurring of vision and photophobia, should not be prominent in conjunctivitis. Fluctuating blurring is common, due to tearing and mucoid discharge. Mild photophobia is common. However, if any of these symptoms are prominent, it is important to exclude other diseases such as glaucoma, uveitis, keratitis and even meningitis or caroticocavernous fistula.

Many people with conjunctivitis have trouble opening their eyes in the morning because of the dried mucus on their eyelids. There is often excess mucus over the eye after sleeping for an extended period.

Prevention

This unreferenced section requires citations to ensure verifiability.

The best effective prevention is hygiene and not rubbing the eyes by infected hands. Vaccination against adenovirus, haemophilus influenzae, and neisseria meningiditis is also effective.^{[citation needed]}

Management

Conjunctivitis resolves in 65% of cases without treatment, within two to five days. The prescription of antibiotics is not necessary in most cases.^[8]

Allergic

This unreferenced section requires citations to ensure verifiability.

For the allergic type, cool water poured over the face with the head inclined downward constricts capillaries, and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, nonsteroidal anti-inflammatory medications and antihistamines may be prescribed. Persistent allergic conjunctivitis may also require topical steroid drops.

Bacterial

Bacterial conjunctivitis usually resolves without treatment. Antibiotics, eye drops, or ointment are thus only needed if no improvement is observed after three days.^[9] In patients receiving no antibiotics, recovery was in 4.8 days, with immediate antibiotics it was 3.3 days, and with delayed antibiotics 3.9 days. No serious effects were noted either with or without treatment.^[10][11]

Viral

This unreferenced section requires citations to ensure verifiability.

A new^[when?] treatment for viral eye infection involves an iodine treatment. A series of drops are given to the infected eye. It is advisable to avoid touching the eyes or sharing towels and washcloths.

Chemical

This unreferenced section requires citations to ensure verifiability.

Conjunctivitis due to chemicals is treated via irrigation with Ringer's lactate or saline solution. Chemical injuries (particularly alkali burns) are medical emergencies, as they can lead to severe scarring and intraocular damage. People with chemically induced conjunctivitis should not touch their eyes, regardless of whether or not their hands are clean, as they run the risk of spreading the condition to another eye.

See also

• List of cutaneous conditions

References

1. ^ ^{a b c} Richards A, Guzman-Cottrill JA (May 2010). "Conjunctivitis". Pediatr Rev 31 (5): 196–208. doi:10.1542/pir.31-5-196. PMID 20435711. 
2. ^ "Beware, `Madras eye' is here!". The Hindu. 12 October 2001. http://www.hinduonnet.com/2001/10/12/stories/0412402c.htm. Retrieved 30 October 2008. 
3. ^ Langley JM. Adenoviruses. Pediatr Rev. 2005;26:238-242.
4. ^ ^{a b} Zentani A, Burslem J (December 2009). "Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4: use of litmus paper in chemical eye injury". Emerg Med J 26 (12): 887. doi:10.1136/emj.2009.086124. PMID 19934140. 
5. ^ ^{a b c d} Hodge C, Lawless M (July 2008). "Ocular emergencies". Aust Fam Physician 37 (7): 506–9. PMID 18592066. 
6. ^ ^{a b} Fisher, Bruce; Harvey, Richard P.; Champe, Pamela C. (2007). Lippincott's Illustrated Reviews: Microbiology (Lippincott's Illustrated Reviews Series). Hagerstown, MD: Lippincott Williams & Wilkins. ISBN 0-7817-8215-5. 
7. ^ Lévêque N, Huguet P, Norder H, Chomel JJ (April 2010). "[Enteroviruses responsible for acute hemorrhagic conjunctivitis]" (in French). Med Mal Infect 40 (4): 212–8. doi:10.1016/j.medmal.2009.09.006. PMID 19836177. 
8. ^ Rose P (August 2007). "Management strategies for acute infective conjunctivitis in primary care: a systematic review". Expert Opin Pharmacother 8 (12): 1903–21. doi:10.1517/14656566.8.12.1903. PMID 17696792. 
9. ^ "Evidence-based treatment of acute infective conjunctivitis: Breaking the cycle of antibiotic prescribing -- Visscher et al. 55 (11): 1071 -- Canadian Family Physician". http://www.cfp.ca/cgi/content/abstract/55/11/1071?etoc. 
10. ^ Sheikh A, Hurwitz B (2006). Sheikh, Aziz. ed. "Antibiotics versus placebo for acute bacterial conjunctivitis". Cochrane Database Syst Rev (2): CD001211. doi:10.1002/14651858.CD001211.pub2. PMID 16625540. 
11. ^ Hazel A Everitt, Paul S Little, Peter W F Smith (16 July 2006). "A randomised controlled trial of management strategies for acute infective conjunctivitis in general practice". BMJ 333 (7563): 321. doi:10.1136/bmj.38891.551088.7C. PMC 1539078. PMID 16847013. http://bmj.bmjjournals.com/cgi/content/short/bmj.38891.551088.7Cv1?etoc. 

External links

• Conjunctivitis – causes, symptoms and treatment
• Facts About the Cornea and Corneal Disease The National Eye Institute (NEI).
• Eye burning - itching and discharge. U.S. National Library of Medicine
• Conjunctivitis: Do antibiotics make a difference? U.S. National Library of Medicine
• Conjunctivitis Mayo Clinic website.
• Comparison of symptoms of Conjunctivitis versus Orbital Cellulitis Medical notes and photographs of a real patient experience.
• Differentiating Viral and Bacterial conjunctivitis Medscape Article.
• Bacterial conjunctivitis: A review for internists AHMAD B. TARABISHY and BENNIE H. JENG. Cleveland Clinic Journal of Medicine July 2008 vol. 75 7 507-512.

v t e Eye disease · pathology of the eye (H00–H59, 360–379) Adnexa eyelid: inflammation (Stye, Chalazion, Blepharitis) · Entropion · Ectropion · Lagophthalmos · Blepharochalasis · Ptosis · Blepharophimosis · Xanthelasma · eyelash (Trichiasis, Madarosis) lacrimal system: Dacryoadenitis · Epiphora · Dacryocystitis · Xerophthalmia orbit: Exophthalmos · Enophthalmos · Orbital cellulitis · Periorbital cellulitis conjunctiva: Conjunctivitis (Allergic conjunctivitis) · Pterygium · Pinguecula · Subconjunctival hemorrhage Globe Fibrous tunic sclera: Scleritis cornea: Keratitis (Herpetic keratitis, Acanthamoeba keratitis, Fungal keratitis) · Corneal ulcer · Photokeratitis · Thygeson's superficial punctate keratopathy · Corneal dystrophy (Fuchs', Meesmann) · Keratoconus · Keratoconjunctivitis sicca · Keratoconjunctivitis · Corneal neovascularization · Kayser-Fleischer ring · Arcus senilis · Band keratopathy Vascular tunic Iris and ciliary body Iritis · Uveitis (Intermediate uveitis) · Iridocyclitis · Hyphema · Rubeosis iridis · Persistent pupillary membrane · Iridodialysis · Synechia Choroid Choroideremia · Choroiditis (Chorioretinitis) Lens Cataract · Aphakia · Ectopia lentis Retina Retinitis (Chorioretinitis, Cytomegalovirus retinitis) · Retinal detachment · Retinoschisis · Ocular ischemic syndrome/Central retinal vein occlusion · Retinopathy (Bietti's crystalline dystrophy, Coats disease, Diabetic retinopathy, Hypertensive retinopathy, Retinopathy of prematurity) · Macular degeneration · Retinitis pigmentosa · Retinal haemorrhage · Central serous retinopathy · Macular edema · Epiretinal membrane · Macular pucker · Vitelliform macular dystrophy · Leber's congenital amaurosis · Birdshot chorioretinopathy Other Glaucoma/Ocular hypertension · Floater · Leber's hereditary optic neuropathy · Red eye · Keratomycosis · Phthisis bulbi Pathways Optic nerve and optic disc Optic neuritis · Papilledema (Foster Kennedy syndrome) · Optic atrophy/Optic neuropathy (Leber's hereditary optic neuropathy, Kjer's optic neuropathy) · Optic disc drusen · Toxic and nutritional optic neuropathy · Ischemic optic neuropathy (AION, PION) Ocular muscles, binocular movement, accommodation Paralytic strabismus Ophthalmoparesis · Progressive external ophthalmoplegia · Palsy (III, IV, VI) · Kearns-Sayre syndrome Other strabismus Esotropia/Exotropia · Hypertropia · Heterophoria (Esophoria, Exophoria) · Brown's syndrome · Duane syndrome Other binocular Conjugate gaze palsy · Convergence insufficiency · Internuclear ophthalmoplegia · One and a half syndrome Refraction Refractive error: Hyperopia/Myopia · Astigmatism · Anisometropia/Aniseikonia · Presbyopia Visual disturbances and blindness Amblyopia · Leber's congenital amaurosis · Subjective (Asthenopia, Hemeralopia, Photophobia, Scintillating scotoma) · Diplopia · Scotoma · Anopsia (Binasal hemianopsia, Bitemporal hemianopsia, Homonymous hemianopsia, Quadrantanopia) · Color blindness (Achromatopsia, Dichromacy, Monochromacy) · Nyctalopia (Oguchi disease) · Blindness/Low vision Pupil Anisocoria · Argyll Robertson pupil · Marcus Gunn pupil · Adie syndrome · Miosis · Mydriasis · Cycloplegia · Parinaud's syndrome Other Nystagmus Eye infections Trachoma · Onchocerciasis M: EYE anat(g/a/p)/phys/devp/prot noco/cong/tumr, epon proc, drug(S1A/1E/1F/1L)

v t e Inflammation Acute Plasma derived mediators Bradykinin · complement (C3, C5a, MAC) · coagulation (Factor XII, Plasmin, Thrombin) Cell derived mediators preformed: Lysosome granules · vasoactive amines (Histamine, Serotonin) synthesized on demand: cytokines (IFN-γ, IL-8, TNF-α, IL-1) · eicosanoids (Leukotriene B4, Prostaglandins) · Nitric oxide · Kinins Chronic Macrophage · Epithelioid cell · Giant cell · Granuloma Processes Traditional: Rubor · Calor · Tumor · Dolor (pain) · Functio laesa Modern: Acute-phase reaction/Fever · Vasodilation · Increased vascular permeability · Exudate · Leukocyte extravasation · Chemotaxis Specific locations Nervous CNS (Encephalitis, Myelitis) · Meningitis (Arachnoiditis) · PNS (Neuritis) · eye (Dacryoadenitis, Scleritis, Keratitis, Choroiditis, Retinitis, Chorioretinitis, Blepharitis, Conjunctivitis, Iritis, Uveitis) · ear (Otitis, Labyrinthitis, Mastoiditis) Cardiovascular Carditis (Endocarditis, Myocarditis, Pericarditis) · Vasculitis (Arteritis, Phlebitis, Capillaritis) Respiratory upper (Sinusitis, Rhinitis, Pharyngitis, Laryngitis) · lower (Tracheitis, Bronchitis, Bronchiolitis, Pneumonitis, Pleuritis) · Mediastinitis Digestive mouth (Stomatitis, Gingivitis, Gingivostomatitis, Glossitis, Tonsillitis, Sialadenitis/Parotitis, Cheilitis, Pulpitis, Gnathitis) · tract (Esophagitis, Gastritis, Gastroenteritis, Enteritis, Colitis, Enterocolitis, Duodenitis, Ileitis, Caecitis, Appendicitis, Proctitis) · accessory (Hepatitis, Cholangitis, Cholecystitis, Pancreatitis) · Peritonitis Integumentary Dermatitis (Folliculitis) · Cellulitis · Hidradenitis Musculoskeletal Arthritis · Dermatomyositis · soft tissue (Myositis, Synovitis/Tenosynovitis, Bursitis, Enthesitis, Fasciitis, Capsulitis, Epicondylitis, Tendinitis, Panniculitis) Osteochondritis: Osteitis (Spondylitis, Periostitis) · Chondritis Urinary Nephritis (Glomerulonephritis, Pyelonephritis) · Ureteritis · Cystitis · Urethritis Reproductive female: Oophoritis · Salpingitis · Endometritis · Parametritis · Cervicitis · Vaginitis · Vulvitis · Mastitis male: Orchitis · Epididymitis · Prostatitis · Balanitis · Balanoposthitis pregnancy/newborn: Chorioamnionitis · Omphalitis Endocrine Insulitis · Hypophysitis · Thyroiditis · Parathyroiditis · Adrenalitis Lymphatic Lymphangitis · Lymphadenitis

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Dansk (Danish)
n. - bindehindebetændelse i øjet

Nederlands (Dutch)
bindvliesontsteking

Français (French)
n. - conjonctivite

Deutsch (German)
n. - Bindehautentzündung

Ελληνική (Greek)
n. - (παθολ.) επιπεφυκίτιδα

Italiano (Italian)
congiuntivite

Português (Portuguese)
n. - conjuntivite (f) (Med.)

Русский (Russian)
конъюнктивит

Español (Spanish)
n. - conjuntivitis

Svenska (Swedish)
n. - konjunktivit, bindhinneinflammation

中文（简体）(Chinese (Simplified))
结膜炎

中文（繁體）(Chinese (Traditional))
n. - 結膜炎

한국어 (Korean)
n. - 결막염

日本語 (Japanese)
n. - 結膜炎

العربيه (Arabic)
‏(الاسم) التهاب باطن الجفن‏

עברית (Hebrew)
n. - ‮דלקת הלחמית‬

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