Chronic Conjunctivitis

This is a common cause of the red eye and almost a daily problem in nonspecialised ophthalmic practice. If we consider that the conjunctiva is a mucous membrane that is exposed daily to the elements, it is perhaps not surprising that after many years it tends to become chronically inflamed and irritable. The frequency and nuisance value of the symptoms are reflected in the large across-the-counter sales of various eyewashes and solutions aimed at relieving "eyestrain" or "tired eyes". The symptoms of chronic conjunctivitis are, therefore, redness and irritation of the eyes, with a minimal degree of discharge and sticking of the lids. If there is an allergic background, itching might also be a main feature. The chronically inflamed conjunctiva accumulates minute particles of calcium salts within the mucous glands. These conjunc-tival concretions are shed from time to time,pro-ducing a feeling of grittiness. When confronted with such a patient, there are a number of key symptoms to be elicited and these can be related to a checklist of causes mentioned below.

The key symptoms of chronic conjunctivitis are as follows:

• Environmental factors, especially eye drops, make-up or foreign bodies.

• Lids stick in mornings?

• Emotional stress or psychiatric illness?

The following is a checklist of causes of chronic conjunctivitis:

• Eyelids: deformities, such as entropion or ectropion.

• Displaced eyelashes.

• Chronic blepharitis.

• Refractive error: a proportion of patients who have never worn glasses and need them or who are wearing incorrectly prescribed or out-of-date glasses present with the features of chronic conjunctivitis, the symptoms being relieved by the proper use of spectacles. The cause is not clear but possibly related to rubbing the eyes.

Dry eye syndrome: the possibility of a defect in the secretion of tears or mucus can only be confirmed by more elaborate tests, but this should be suspected in patients with rheumatoid arthritis or sarcoidosis.

• Foreign body: contact lenses and mascara particles are the commonest foreign bodies to cause chronic conjunctivitis.

• Stress: often a period of stress seems to be closely related to the symptoms and perhaps eye rubbing is also the cause in these patients.

Allergy: it is unusual to be able to incriminate a specific allergen for chronic conjunctivitis, unlike allergic blepharitis. On the other hand,hay fever and asthma could be the background cause.

• Infection: chronic conjunctivitis can begin as an acute infection, usually viral and usually following an upper respiratory tract infection.

• Drugs: the long-term use of adrenaline drops can cause dilatation of the conjunc-tival vessels and irritation in the eye. In 1974, it was shown that the beta-blocking drug practolol (since withdrawn from the market) could cause a severe dry eye syndrome in rare instances. Since then there have been several reports of mild reactions to other available beta-blockers, although such reactions are difficult to distinguish from chronic conjunctivitis from other causes.

• Systemic causes: congestive cardiac failure, renal failure,Reiter's disease,polycythaemia, gout, rosacea, as well as other causes of orbital venous congestion, such as orbital tumours, can all cause vascular congestion and irritation of the conjunctiva. Migraine can also be associated with redness of the eye on one side and chronic alcoholism is a cause of bilateral conjunctival congestion.

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