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CONJUNCTIVITIS – A COMPLEX AND MULTIFACETED DISORDER Edited by Zdenek Pelikan Conjunctivitis – A Complex and Multifaceted Disorder Edited by Zdenek Pelikan Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Marina Jozipovic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright vlad_star, 2011. Used under license from Shutterstock.com First published November, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Conjunctivitis – A Complex and Multifaceted Disorder, Edited by Zdenek Pelikan p. cm. ISBN 978-953-307-750-5 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Epidemiology of Conjunctivitis 1 Chapter 1 Epidemiological Aspects of Infectious Conjunctivitis 3 Herlinda Mejía-López, Carlos Alberto Pantoja-Meléndez, Alejandro Climent-Flores and Victor M. Bautista-de Lucio Part 2 Clinical Aspects and Features of Conjunctivitis 19 Chapter 2 Clinical Features of Infectious Conjunctivitis 21 Udo Ubani Chapter 3 Allergic Conjunctivitis: An Immunological Point of View 33 Atzin Robles-Contreras, Concepción Santacruz, Julio Ayala, Eduardo Bracamontes, Victoria Godinez, Iris Estrada-García, Sergio Estrada-Parra, Raúl Chávez, Mayra Perez-Tapia, Victor M. Bautista-De Lucio and Maria C. Jiménez-Martínez Chapter 4 Mediators and Some Cytokines in Tears During the Late Conjunctival Response Induced by Primary Allergic Reaction in the Nasal Mucosa 57 Zdenek Pelikan Chapter 5 Cytologic Changes in Tears During the Late Type of Secondary Conjunctival Response Induced by Nasal Allergy 75 Zdenek Pelikan Part 3 Treatment and Therapeutical Management of Conjunctivitis 93 Chapter 6 Management of Conjunctivitis in General Practice 95 Soumendra Sahoo, Adnaan Haq, Rashmirekha Sahoo and Indramani Sahoo VI Contents Chapter 7 Leukotriene Antagonist Drugs as Treatment of Allergic Conjunctivitis and Comorbidities in Children 111 Salvatore Leonardi, Giovanna Vitaliti, Giorgio Ciprandi, Carmelo Salpietro and Mario La Rosa Chapter 8 The Evaluation of Anti-Adenoviral Therapeutic Agents for use in Acute Conjunctivitis 127 J.A. Capriotti, J.S. Pelletier, K.P. Stewart and C.M. Samson Chapter 9 Conjunctival Flora Before and After Application of 5% Povidone-Iodine Solution 135 Virginia Vanzzini-Zago, Jorge Villar-Kuri, Víctor Flores Alvarado, Alcántara Castro Marino and Pérez Balbuena Ana Lilia Part 4 Special Forms of Conjunctivitis 145 Chapter 10 Ophtalmia Neonatorum 147 Flora Abazi, Mirlinda Kubati, Blerim Berisha, Masar Gashi, Dardan Koçinaj and Xhevdet Krasniqi Chapter 11 Trachoma and Conjunctivitis 165 Imtiaz A. Chaudhry, Yonca O. Arat and Waleed Al-Rashed Chapter 12 Ocular Symptoms (Conjunctivitis, Uveitis) in Reactive Arthritis 183 Brygida Kwiatkowska and Maria Maślińska Chapter 13 Thelazia Species and Conjunctivitis 201 Soraya Naem Preface Conjunctivitis, a group of inflammatory disorders of the conjunctiva and often also in conjunction with cornea, lacrimal ways and eyelids, is very common condition affecting large adult as well as pediatric population. 1-3 These disorders, especially their chronic forms, can be a source of relatively extensive discomfort for the patients, which can negatively influence their professional carriers as well as their private lives. Conjunctivitis can be classified by various manners and according to various parameters. However, the classification according to the causal aspects might be preferred. 1-7 Conjunctivitis can be divided into two basic groups, with respect to the localization of the primary pathophysiologic process and involved mechanisms 8-11 ; (A) Primary conjunctivitis, including all primary and independent forms/disorders whose underlying pathophysiologic processes are initiated and localized in the conjunctival tissue, eventually in conjunction with the adjacent tissues, such as cornea, sclera, lacrimal ways or eyelid skin. (B) Secondary conjunctivitis, including all conjunctivitis forms, in which the primary pathophysiologic process is localized outside the conjunctivae, in another organ. This group can further be divided into two sub-groups; (B 1 ) Secondarily induced conjunctivitis including conjunctivitis forms induced by factors (mediators, cytokines, chemokines, neuropeptides,activated cells) released during the primary pathophysiologic and/or immunologic process in another tissue, e.g. nasal mucosa, middle ear, paranasal sinus mucosa, bronchial mucosa, eyelid skin, and reaching secondarily the conjunctivae; (B 2 ) Secondary conjunctivitis forms, being a part of a complex and multifaceted pathophysiologic processes, such as systemic diseases, metabolic disorders, some infectious and parasitic diseases, (auto)-immune disorders, immunodeficiencies, angio-neurotic (Quincke) edema, some malignancy forms, etc. Regarding the cause, the conjunctivitis can be divided into a number of categories. 1-7 [1] Allergic conjunctivitis Disorders of the conjunctiva, and sometimes also cornea, where an allergic component plays an important causal role, summarized by a term “allergic conjunctivitis”, are very common conditions affecting 15-25% of the adult and pediatric populations. This group includes: Seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), vernal keratoconjunctivitis (VKC), atopic X Preface keratoconjunctivitis (AKC) and giant papillary conjunctivitis (GPC). All these disorders can occur in a acute, recurrent or a chronic feature as well as in a primary or a secondarily induced form. With respect to the involved immunologic mechanisms and underlying hypersensitivity type, various types of the primary conjunctival response (immediate, late or delayed) can be recorded after the conjunctival provocation tests with allergen as well as the various types of the secondarily induced conjunctival response (immediate, late and delayed) can be measured after the nasal provocation tests with allergen. 1-14 The allergens causing the allergic conjunctivitis include various inhalant (aero) allergens, several food allergens, contact allergens, various drugs and a relatively high number of occupational allergens. 1-14 Allergic conjunctivitis due to the foods and food allergy represents a special sub- group of this entity. Various foods and/or their parts/ingredients, being ingested, can act as allergens causing either the primary or the secondarily induced conjunctival response. Moreover, various foods, in a powder, fluid or vapor form, can act as contact allergens, causing usually the primary form of allergic conjunctivitis or they can act as non-specific agents causing a conjunctival response through the non-specific hyperreactivity mechanism. 8, 11 Additionally, the same powdered, vaporized or liquid food, affecting the nasal mucosa, may cause a secondarily induced conjunctival response. The various drugs can also cause both the (allergic) conjunctivitis by means of the similar multi-facet pathophysiologic and immunologic mechanisms and the non- specific conjunctival response (=irritation). 15, 16 [2] Bacterial conjunctivitis may usually be caused by bacteria from the families Staphylococcus, Streptococcus, Gonococcus, Neisseria, Chlamidia, Haemophilus, Pneumococcus, Pseudomonas, Escherichia, Klebsiella, Proteus, Enterobacter, Mycobacterium, Meningococcus, Moraxella and Spirochetes. 4-7, 17-20 A special sub-groups of bacterial conjunctivitis are represented by conjunctival inflammation processes caused by Chlamydia trachomonas, occurring as a part of the complex ocular disorders termed “Trachoma”, and those due to a number of zoonoses. 4-7, 17-20 [3] Viral conjunctivitis is caused by a number of viruses, such as adenovirus (APC) virus, coxackie, herpes simplex , herpes zoster, influenza, measles, variola, varicella, enteroviruses, echo-virus and HIV. 4-7, 17-19 [4] Parasitic conjunctivitis is caused by amebae, trypanosomae, leishmaniae, toxoplasmae, nematodes, Rickettsiae. 4-7, 21- 23 [5] Mycotic conjunctivitis is caused by various kinds of actinomycetes, molds, fungi and yeasts and/or their spores, such as Aspergillus, Alternaria, Cladosporium, Penicillium, Fusarium, Actinomycetes, Zygomycetes, Candida albicans. 4-7, 24 [6] Chemical conjunctivitis (=conjunctival irritation) is usually caused by volatile, liquid or vaporized chemical compounds. 4-7 [...]... that follicular conjunctivitis can occur as part of the pharynx and respiratory syndrome, or as a separate entity 10 Conjunctivitis – A Complex and Multifaceted Disorder 5.1.2.1 Pharyingoconjunctival fever caused by adenovirus This disease is often accompanied by lymphadenopathy and most commonly associated with genotypes of the subgenera B and E (Ad3, Ad7 and Ad4).51-53 5.1.2.2 Epidemic keratoconjunctivitis... environments, and these factors are associated with epidemics It is increasingly becoming clear that medical staff also participate in the spread of an epidemic, as the handling of patients without appropriate risk management can make medical personnel a disease vector 4 Conjunctivitis – A Complex and Multifaceted Disorder Cases of epidemic hemorrhagic conjunctivitis are mainly caused by adenovirus However,... hyperlacrimation, discharges, palpebral edema, 22 Conjunctivitis – A Complex and Multifaceted Disorder follicular and papillary hypertrophy, membrane formation and reactions of lymphatic system On the cornea there is diminished sheen, transparency and reflexion; HornerTrantas dots, corneal epithelial defects and scars These signs and symptoms participate to varying degrees in the differential diagnosis... include all facets of this condition and all main aspects related to the possible causes of these disorders, basic and if necessary supplementary laboratory and bacteriological examinations (including the blood, tears, conjunctival, nasal and throat swab), complete ophthalmological examination (including the slit lamp examination, ophthalmoscopy, intraocular pressure measurement, cytologic examination... (2010) Chlamydia trachomatis causing neonatal conjunctivitis in a tertiary care center Indian J Med Microbiol, 28, 45-47 Krasny, J., Tomasova-Borovanska, J and Hruba D (2005) The Relationship between Chlamydia trachomatis and Chlamydia pneumoniae as the cause of neonatal conjunctivitis (ophthalmia neonatorum) Ophthalmologica, 219, 232-236 Thylefors, C., Dawson, C R., Jones, B R., West, S K and Taylor,... is related to the prevalence of infection in the community Trachoma is clinically characterized by the presence of papillae and follicular inflammation of the tarsal conjunctiva and is referred to as active trachoma.48 Trachoma can be produced by serovars A- C (A, B, Ba and C) of C trachomatis and is endemic in 55 countries around the world.49 Serovars D-K (genitals) may also affect the neonatal conjunctiva... well as additional facets of this condition; (d) administered for a sufficiently long period of time, and finished by a final control examination The only symptomatic and/ or empiric treatment is insufficient and not more acceptable An additional and very important remark concerns the treatment of bacterial (and exceptionally also viral) conjunctivitis by means of antibiotics and sulphonamides The treatment... air,etc) and/ or nasal provocation tests with allergens (and non-specific hyperreactivity agents), and if indicated also appropriate roentgen and/ or imaging examination.1-16 The therapeutic management of the conjunctivitis should be: (a) motivated and derived from the results of diagnostic procedure; (b) focused on the causal aspects, as far as possible; (c) as complex as possible, including all principal as... by Atopic Keratoconjunctivitis (AKC), Vernal Keratoconjunctivitis (VKC), Perennial Allergic Conjunctivitis (PAC) and Epidemiological Aspects of Infectious Conjunctivitis 5 Giant Papillary Conjunctivitis (GPC) The SAC and PAC occur in relatively mild forms, while VKC and AKC, in which also cornea is affected, and represent more severe, often bilateral, forms The GPC appears only sporadically.14 Allergic... (SNPs) in human beta-defensin 1: High-throughput SNP assays and association with Candida carriage in type I diabetics and nondiabetic controls J Clin Microbiol, 41, 90-96 Carter, J G., West, S K., Painter, S., Haynes, R J and Churchill, A J (2009) BetaDefensin 1 haplotype associated with postoperative endophthalmitis Acta Ophthalmol, 88, 786-790 Crum, N F, Barrozo C P., Chapman,F A , Ryan, M A and Russell, . Trachoma and Conjunctivitis 165 Imtiaz A. Chaudhry, Yonca O. Arat and Waleed Al-Rashed Chapter 12 Ocular Symptoms (Conjunctivitis, Uveitis) in Reactive Arthritis 183 Brygida Kwiatkowska and. Conjunctival Flora Before and After Application of 5% Povidone-Iodine Solution 135 Virginia Vanzzini-Zago, Jorge Villar-Kuri, Víctor Flores Alvarado, Alcántara Castro Marino and Pérez Balbuena Ana. Treatment and Therapeutical Management of Conjunctivitis 93 Chapter 6 Management of Conjunctivitis in General Practice 95 Soumendra Sahoo, Adnaan Haq, Rashmirekha Sahoo and Indramani Sahoo VI Contents