**Infective Conjunctivitis – Its Pathogenesis, Management and Complications**

Adnaan Haq, Haseebullah Wardak and Narbeh Kraskian

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/52462

#### **1. Introduction**

The aims of this chapter are to briefly discuss infective conjunctivitis, its subtypes and its treatment. Other forms of conjunctivitis will also be considered and discussed in this chap‐ ter, namely, neonatal conjunctivitis, conjunctivitis in the immunocompromised. A compre‐ hensive assessment of the various treatments of conjunctivitis will also be discussed.

Conjunctivitis is a term broadly used to describe an inflammation of the conjunctiva. Con‐ junctivitis may be split into four main aspects; bacterial, viral, allergic and irritant. Infective conjunctivitis, namely bacterial and viral will be discussed in this chapter in details.

**Figure 1.** The conjunctiva in relation to the orbit and its structures

© 2013 Haq et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 Haq et al.; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

#### **1.1. Anatomy of the conjunctiva**

The conjunctiva is the fine mucous membrane which covers and joins the anterior surface of the eyeball to the posterior surface of eyelid. This translucent membrane lines the white part of the eye starting at the edge of the cornea (limbus) and runs behind the eye to cover the anterior part of the sclera. It then flows, loops forward, and forms the inside surface of the eyelids. At the medial canthus the conjunctiva fold thickens, which is called the semilunar fold.

**Figure 2.** The different parts of the conjunctiva and its relation to other obit anatomy

The conjunctiva is subdivided into three parts depending on location: palpebral conjunctiva, bulbar conjunctiva and conjunctival fornix. Histologically the conjunctiva is divided into three layers.From superficial to deep these are epithelial, adenoid and fibrous. These con‐ junctival layers contain a wide range of structures that includes glands, melanocytes, langer‐ hans cells, mast cells and lymphoid tissue.

The arterial blood supply to conjunctiva is made up of branches of ophthalmic artery, the anterior and posterior conjunctival arteries. These are branches of anterior ciliary arteries and palpebral arcades respectively. The venous drainage follows the arteries. Posterior con‐ junctival veins drain the veins of the lid and anterior conjunctival veins drain anterior ciliary vein to ophthalmic vein.

The lymphatic drainage of the conjunctiva depends on the region of the conjunctiva. Lym‐ phatics in palpebral region drain into the lymphatics of eyelids. In bulbar conjunctiva, lym‐ phatics from lateral side drain into the superficial preauricular lymph nodes & lymphatics from medial side drain to deep sub maxillary nodes.

The first division of the trigeminal provides nerve supply to the conjunctiva.

#### **1.2. Allergic and irritant conjunctivitis**

Before discussing the major contents of the chapter, it is necessary to briefly discuss allergic and irritant conjunctivitis.

Infective Conjunctivitis – Its Pathogenesis, Management and Complications http://dx.doi.org/10.5772/52462 23

**1.1. Anatomy of the conjunctiva**

22 Common Eye Infections

The conjunctiva is the fine mucous membrane which covers and joins the anterior surface of the eyeball to the posterior surface of eyelid. This translucent membrane lines the white part of the eye starting at the edge of the cornea (limbus) and runs behind the eye to cover the anterior part of the sclera. It then flows, loops forward, and forms the inside surface of the eyelids. At

The conjunctiva is subdivided into three parts depending on location: palpebral conjunctiva, bulbar conjunctiva and conjunctival fornix. Histologically the conjunctiva is divided into three layers.From superficial to deep these are epithelial, adenoid and fibrous. These con‐ junctival layers contain a wide range of structures that includes glands, melanocytes, langer‐

The arterial blood supply to conjunctiva is made up of branches of ophthalmic artery, the anterior and posterior conjunctival arteries. These are branches of anterior ciliary arteries and palpebral arcades respectively. The venous drainage follows the arteries. Posterior con‐ junctival veins drain the veins of the lid and anterior conjunctival veins drain anterior ciliary

The lymphatic drainage of the conjunctiva depends on the region of the conjunctiva. Lym‐ phatics in palpebral region drain into the lymphatics of eyelids. In bulbar conjunctiva, lym‐ phatics from lateral side drain into the superficial preauricular lymph nodes & lymphatics

Before discussing the major contents of the chapter, it is necessary to briefly discuss allergic

The first division of the trigeminal provides nerve supply to the conjunctiva.

the medial canthus the conjunctiva fold thickens, which is called the semilunar fold.

**Figure 2.** The different parts of the conjunctiva and its relation to other obit anatomy

hans cells, mast cells and lymphoid tissue.

from medial side drain to deep sub maxillary nodes.

**1.2. Allergic and irritant conjunctivitis**

vein to ophthalmic vein.

and irritant conjunctivitis.

**Figure 3.** Allergic conjunctivitis- look for follicles and papillae which are characteristic of allergic conjunctivitis

Allergic conjunctivitis is seen in two acute disorders; seasonal allergic conjunctivitis (which is prevalent in the summer months) and perennial allergic conjunctivitis (which presents in‐ termittently) and three chronic disorders, vernal keratoconjunctivitis, atopic keratoconjunc‐ tivitis and giant papillary conjunctivitis. Allergic conjunctivitis is considered to be a type I hypersensitivity reaction. Its treatment is largely supportive, although in severe cases, topi‐ cal corticosteroids may be of some benefit 1.

**Figure 4.** Irritant conjunctivitis- generalised redness around the eye and constant tearing are typical features

Irritant conjunctivitis is a form of conjunctivitis that is often bought on by an external source. The source, considered an 'irritant', directly affects the conjunctiva, causing an in‐ flammatory response. Not all causes of irritant conjunctivitis are external however. Caus‐ es of irritant conjunctivitis are vast, though some of the more common causes are hair products (e.g. shampoos), smoke or fumes, chlorinated water used in swimming pools. A common non-external source is trapped eyelashes, which continually irritate the conjunc‐ tiva. Treatment of irritant conjunctivitis is thorough cleansing of the eye and removing the irritant.
