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Î Conjunctivitis has been cited as one of the most frequent causes of
patient self-referral. Conjunctivitis infrequently causes permanent
visual loss or structural damage, but the economic impact of the
disease in terms of lost work time, cost of medical visits, diagnostic
testing, and medication is considerable.
Î Chronic and/or recalcitrant conjunctivitis may be indicative of an
underlying malignancy, such as sebaceous or squamous cell carcinoma.
Î The ophthalmologist plays a critical role in breaking the chain of
transmission of epidemic adenoviral conjunctivitis, primarily by
educating the patient and family about proper hygiene. Infected
individuals should be counseled to wash hands frequently and use
separate towels, and to avoid close contact with others during the
period of contagion.
Î Wiping with 70% alcohol may not be effective in eliminating adenovirus
from tonometer tips. Surfaces should be disinfected with an
Environmental Protection Agency (EPA)-registered hospital disinfectant
in accordance with the label's use directions and safety precautions.
Î Treatment of conjunctivitis is ideally directed at the root cause.
Indiscriminate use of topical antibiotics or corticosteroids should be
avoided, because antibiotics can induce toxicity and corticosteroids
can potentially prolong adenoviral infections and worsen herpes
simplex virus infections. Viral conjunctivitis will not respond to
anti-bacterial agents, and mild bacterial conjunctivitis is likely to
be self-limited. Moreover, the choice of topical antibiotic agent for
treatment of bacterial conjunctivitis is empiric since no evidence exists
demonstrating the superiority of any particular agent.
Î In adults, conjunctivitis caused by ocular mucous membrane
pemphigoid (OMMP), graft-versus-host disease (GVHD), gonococcus,
and chlamydia is important to detect early because it is necessary to
treat the concomitant systemic disorder. Diagnosis of superior limbic
keratoconjunctivitis (SLK) may lead to further investigations that reveal
a thyroid disorder. Early detection of conjunctivitis associated with
neoplasms may be lifesaving.
