Infective, Inflammatory, and Allergic Eye Disorders

Definition | Infective Conjunctivitis | Uveitis | Allergic Conjunctivitis | References

Definition

Infective, inflammatory, and allergic eye disorders encompass a range of conditions that affect the eyes, causing symptoms such as redness, pain, itching, and visual disturbances. These conditions can result from infections, immune responses, or allergic reactions.

Infective Conjunctivitis

Definition: Infective conjunctivitis is an inflammation of the conjunctiva, typically caused by bacteria or viruses.

Aetiology: Common causative agents include:

• Bacteria: Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae
• Viruses: Adenovirus, herpes simplex virus

Pathophysiology: Pathogens invade the conjunctiva, leading to inflammation, increased vascular permeability, and discharge.

Risk Factors: Contact with infected individuals, poor hygiene, contact lens use.

Signs and Symptoms:

• Redness of the eye
• Discharge (purulent in bacterial, watery in viral)
• Gritty sensation
• Swollen eyelids

Investigations:

• Clinical history and physical examination
• Swab for bacterial culture if discharge is purulent

Management:

Primary Care Management

• Hygiene advice: Frequent handwashing, avoiding touching the eyes
• Topical antibiotics: For bacterial conjunctivitis (e.g., chloramphenicol eye drops)
• Lubricating eye drops: To relieve symptoms
• Referral to an ophthalmologist: If no improvement, or if herpes simplex is suspected

Uveitis

Definition: Uveitis is an inflammation of the uveal tract, which includes the iris, ciliary body, and choroid.

Aetiology: Can be caused by infections (e.g., herpes simplex, syphilis), autoimmune diseases (e.g., ankylosing spondylitis, sarcoidosis), or trauma.

Pathophysiology: Inflammatory cells infiltrate the uveal tract, leading to tissue damage, fluid accumulation, and potential vision loss.

Risk Factors: Autoimmune conditions, infections, trauma, genetic predisposition.

Signs and Symptoms:

• Eye pain
• Redness
• Photophobia
• Blurred vision
• Floaters

Investigations:

• Clinical history and physical examination
• Slit-lamp examination to detect inflammatory cells and flare in the anterior chamber
• Blood tests to identify underlying systemic conditions
• Imaging (e.g., OCT, fluorescein angiography) if posterior uveitis is suspected

Management:

Primary Care Management

• Urgent referral to an ophthalmologist: For further evaluation and treatment
• Pain management: Oral analgesics such as paracetamol or ibuprofen

Specialist Management

• Topical corticosteroids: To reduce inflammation (e.g., prednisolone eye drops)
• Mydriatic eye drops: To relieve pain and prevent posterior synechiae (e.g., cyclopentolate)
• Systemic immunosuppressants: For severe or chronic cases (e.g., methotrexate, azathioprine)
• Treatment of underlying causes: Such as antibiotics for infectious uveitis
• Regular follow-up to monitor treatment response and detect complications

Allergic Conjunctivitis

Definition: Allergic conjunctivitis is an inflammation of the conjunctiva caused by an allergic reaction to substances like pollen, dust mites, or animal dander.

Aetiology: Common allergens include pollen, dust mites, animal dander, mould spores.

Pathophysiology: Allergen exposure leads to IgE-mediated hypersensitivity reactions, resulting in the release of histamines and other inflammatory mediators from mast cells.

Risk Factors: Personal or family history of allergies, exposure to allergens, atopic conditions.

Signs and Symptoms:

• Itchy eyes
• Redness
• Watery discharge
• Swollen eyelids
• Sneezing and nasal congestion (if associated with allergic rhinitis)

Investigations:

• Clinical history and physical examination
• Allergy testing (skin prick test or serum IgE) if the allergen is unknown

Management:

Primary Care Management

• Avoidance of allergens: Identifying and reducing exposure to known allergens
• Lubricating eye drops: To relieve symptoms
• Topical antihistamines: To reduce itching and inflammation (e.g., olopatadine)
• Oral antihistamines: For systemic allergic symptoms (e.g., cetirizine, loratadine)
• Referral to an ophthalmologist: If symptoms are severe or persistent

Specialist Management

• Topical corticosteroids: Short-term use for severe inflammation (e.g., fluorometholone)
• Immunotherapy: For long-term management in cases of severe allergic conjunctivitis

References

1. NICE. (2024). Eye Conditions: Diagnosis and Management. Retrieved from NICE
2. NHS. (2023). Eye Conditions. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Eye Conditions: Diagnosis and Management. Retrieved from BMJ
4. American Academy of Ophthalmology (AAO). (2021). Clinical Practice Guidelines: Eye Conditions. Retrieved from AAO

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