Conjunctivitis

Conjunctivitis is an inflammation or infection of the conjunctiva, the thin transparent layer of tissue that lines the inner surface of the eyelid and covers the white part of the eye. Conjunctivitis, often called “pink eye,” is a common eye disease, especially in children. It may affect one or both eyes. Some forms of conjunctivitis can be highly contagious and easily spread in schools and at home. While conjunctivitis is usually a minor eye infection, sometimes it can develop into a more serious problem.

Conjunctivitis may be caused by a viral or bacterial infection. It can also occur due to an allergic reaction to irritants in the air like pollen and smoke, chlorine in swimming pools, and ingredients in cosmetics or other products that come in contact with the eyes. Sexually transmitted diseases like Chlamydia and gonorrhea are less common causes of conjunctivitis.

symptoms:

* A gritty feeling in one or both eyes
* Itching or burning sensation in one or both eyes
* Excessive tearing
* Discharge coming from one or both eyes
* Swollen eyelids
* Pink discoloration to the whites of one or both eyes
* Increased sensitivity to light

What causes conjunctivitis?
Allergic Conjunctivitis occurs more commonly among people who already have seasonal allergies.

Allergic Conjunctivitis occurs more commonly among people who already have seasonal allergies.

The cause of conjunctivitis varies depending on the offending agent. There are three main categories of conjunctivitis: allergic, infectious and chemical:
Allergic Conjunctivitis

* Allergic Conjunctivitis occurs more commonly among people who already have seasonal allergies. At some point they come into contact with a substance that triggers an allergic reaction in their eyes.

* Giant Papillary Conjunctivitis is a type of allergic conjunctivitis caused by the chronic presence of a foreign body in the eye. This condition occurs predominantly with people who wear hard or rigid contact lenses, wear soft contact lenses that are not replaced frequently, have an exposed suture on the surface or the eye, or have a glass eye.

Infectious Conjunctivitis

* Bacterial Conjunctivitis is an infection most often caused by staphylococcal or streptococcal bacteria from your own skin or respiratory system. Infection can also occur by transmittal from insects, physical contact with other people, poor hygiene (touching the eye with unclean hands), or by use of contaminated eye makeup and facial lotions.

* Viral Conjunctivitis is most commonly caused by contagious viruses associated with the common cold. The primary means of contracting this is through exposure to coughing or sneezing by persons with upper respiratory tract infections. It can also occur as the virus spreads along the body’s own mucous membranes connecting lungs, throat, nose, tear ducts, and conjunctiva.

* Ophthalmia Neonatorum is a severe form of bacterial conjunctivitis that occurs in newborn babies. This is a serious condition that could lead to permanent eye damage unless it is treated immediately. Ophthalmia neonatorum occurs when an infant is exposed to Chlamydia or gonorrhea while passing through the birth canal.

Chemical Conjunctivitis

Chemical Conjunctivitis can be caused by irritants like air pollution, chlorine in swimming pools, and exposure to noxious chemicals.

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How is conjunctivitis diagnosed?
Comprehensive Eye Exam

Conjunctivitis can be diagnosed through a comprehensive eye examination.

Conjunctivitis can be diagnosed through a comprehensive eye examination. Testing, with special emphasis on evaluation of the conjunctiva and surrounding tissues, may include:

* Patient history to determine the symptoms the patient is experiencing, when the symptoms began, and the presence of any general health or environmental conditions that may be contributing to the problem.

* Visual acuity measurements to determine the extent to which vision may be affected.

* Evaluation of the conjunctiva and external eye tissue using bright light and magnification.

* Evaluation of the inner structures of the eye to ensure that no other tissues are affected by the condition.

* Supplemental testing may include taking cultures or smears of conjunctival tissue, particularly in cases of chronic conjunctivitis or when the condition is not responding to treatment.

Using the information obtained from these tests, your optometrist can determine if you have conjunctivitis and advise you on treatment options.

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How is conjunctivitis treated?

Treatment of conjunctivitis is directed at three main goals:

1. To increase patient comfort.
2. To reduce or lessen the course of the infection or inflammation.
3. To prevent the spread of the infection in contagious forms of conjunctivitis.

The appropriate treatment for conjunctivitis depends on its cause:

* Allergic conjunctivitis – The first step should be to remove or avoid the irritant, if possible. Cool compresses and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, non-steroidal anti-inflammatory medications and antihistamines may be prescribed. Cases of persistent allergic conjunctivitis may also require topical steroid eye drops.

* Bacterial conjunctivitis – This type of conjunctivitis is usually treated with antibiotic eye drops or ointments. Improvement can occur after three or four days of treatment, but the entire course of antibiotics needs to be used to prevent recurrence.

* Viral Conjunctivitis – There are no available drops or ointments to eradicate the virus for this type of conjunctivitis. Antibiotics will not cure a viral infection. Like a common cold, the virus just has to run its course, which may take up to two or three weeks in some cases. The symptoms can often be relieved with cool compresses and artificial tear solutions. For the worst cases, topical steroid drops may be prescribed to reduce the discomfort from inflammation, but do not shorten the course of the infection. Some doctors may perform an ophthalmic iodine eye wash in the office in hopes of shortening the course of the infection. This newer treatment has not been well studied yet, therefore no conclusive evidence of the success exists.

* Chemical Conjunctivitis – Treatment for chemical conjunctivitis requires careful flushing of the eyes with saline and may require topical steroids. The more acute chemical injuries are medical emergencies, particularly alkali burns, which can lead to severe scarring, intraocular damage or even loss of the eye.

Contact Lens Wearers
Contact lens wearers may need to discontinue wearing their lenses while the conjunctivitis is active.

Contact lens wearers may need to discontinue wearing their lenses while the conjunctivitis is active.

Contact lens wearers may need to discontinue wearing their lenses while the condition is active. Your doctor can advise you on the need for temporary restrictions on contact lens wear.

If the conjunctivitis developed due to wearing contact lenses, your eye doctor may recommend that you switch to a different type of contact lens or disinfection solution. Your optometrist might need to alter your contact lense prescription to a type of lens that you replace more frequently to prevent the conjunctivitis from recurring.
Self-care

Practicing good hygiene is the best way to control the spread of conjunctivitis. Once an infection has been diagnosed, follow these steps:

* Don't touch your eyes with your hands.
* Wash your hands thoroughly and frequently.
* Change your towel and washcloth daily, and don't share them with others.
* Discard eye cosmetics, particularly mascara.
* Don't use anyone else's eye cosmetics or personal eye-care items.
* Follow your eye doctor's instructions on proper contact lens care.

You can soothe the discomfort of viral or bacterial conjunctivitis by applying warm compresses to your affected eye or eyes. To make a compress, soak a clean cloth in warm water and wring it out before applying it gently to your closed eyelids.

For allergic conjunctivitis, avoid rubbing your eyes. Instead of warm compresses, use cool compresses to soothe your eyes. Over the counter eye drops are available. Antihistamine eye drops should help to alleviate the symptoms, and lubricating eye drops help to rinse the allergen off of the surface of the eye.

See your doctor of optometry when you experience conjunctivitis to help diagnose the cause and the proper course of action.

Removal of Guinea worm Methos Video

Guinea Worm : Dracunculiais CDC article

Source: CDC

What is dracunculiasis?

Dracunculiasis, more commonly known as Guinea worm disease (GWD), is a preventable infection caused by the parasite Dracunculus medinensis. Infection affects poor communities in remote parts of Africa that do not have safe water to drink.

Currently, many organizations, including The Global 2000 program of The Carter Center of Emory University, UNICEF, Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO) are helping the last 5 countries in the world (Sudan, Ghana, Mali, Niger, and Nigeria) to eradicate the disease. Since 1986, when an estimated 3.5 million people were infected annually, the campaign has eliminated much of the disease.

In 2007, only 9,585 cases of GWD were reported. Most of those cases were from Sudan (61%) and Ghana (35%). All affected countries are aiming to eliminate Guinea worm disease as soon as possible.

How does Guinea worm disease spread?

Approximately 1 year after a person drinks contaminated water, the adult female Guinea worm emerges from the skin of the infected person. Persons with worms protruding through the skin may enter sources of drinking water and unwittingly allow the worm to release larvae into the water. These larvae are ingested by microscopic copepods (tiny "water fleas") that live in these water sources. Persons become infected by drinking water containing the water fleas harboring the Guinea worm larvae.

Once ingested, the stomach acid digests the water fleas, but not the Guinea worm larvae. These larvae find their way to the small intestine, where they penetrate the wall of the intestine and pass into the body cavity. During the next 10-14 months, the female Guinea worm larvae grow into full size adults, 60-100 centimeters (2-3 feet) long and as wide as a cooked spaghetti noodle. These adult femal worms then migrate and emerge from the skin anywhere on the body, but usually on the lower limbs.

A blister develops on the skin at the site where the worm will emerge. This blister causes a very painful burning sensation and it ruptures within 24-72 hours. Immersion of the affected limb into water helps relieve the pain but it also triggers the Guinea worm to release a milky white liquid containing millions of immature larvae into the water, thus contaminating the water supply and starting the cycle over again. For several days after it has emerged from the ulcer, the female Guinea worm is capable of releasing more larvae whenever it comes in contact with water.

What are the signs and symptoms of Guinea worm disease?

Infected persons do not usually have symptoms until about one year after they become infected. A few days to hours before the worm emerges, the person may develop a fever, swelling, and pain in the area. More than 90% of the worms appear on the legs and feet, but may occur anywhere on the body.

People, in remote, rural communities who are most commonly affected by Guinea worm disease (GWD) frequently do not have access to medical care. Emergence of the adult female worm can be very painful, slow, and disabling. Frequently, the skin lesions caused by the worm develop secondary bacterial infections, which exacerbate the pain, and extend the period of incapacitation to weeks or months. Sometimes permanent disability results if joints are infected and become locked.

What is the treatment for Guinea worm disease?

There is no drug to treat Guinea worm disease (GWD) and no vaccine to prevent infection. Once the worm emerges from the wound, it can only be pulled out a few centimeters each day and wrapped around a piece of gauze or small stick. Sometimes the worm can be pulled out completely within a few days, but this process usually takes weeks or months. Analgesics, such as aspirin or ibuprofen, can help reduce swelling; antibiotic ointment can help prevent bacterial infections. The worm can also be surgically removed by a trained doctor in a medical facility before an ulcer forms.

Where is Guinea worm disease found?

Dracunculiasis now occurs only in 5 countries in sub-Saharan Africa. Transmission of the disease is most common in very remote rural villages and in areas visited by nomadic groups. In 2007, the two most endemic countries, Sudan and Ghana, reported 9,173; 5,815 and 3,358 cases of Guinea worm disease (GWD), respectively. Other endemic countries reporting cases of GWD in 2007 were: Mali (313 cases), Nigeria (73 cases), and Niger (14 cases).

Asia is now free of the disease. Transmission of GWD no longer occurs in several African countries, including Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Cote d'Ivoire, Ethiopia, Kenya, Mauritania, Senegal, Togo, and Uganda. No locally acquired cases of disease have been reported in these countries in the last year or more. The treat of case importations from the remaining endemic countries requires that surveillance be maintained in formerly endemic areas until offical certification. The World Health Organization has certified 180 countries free of transmission of dracunculiasis, including six formerly endemic countries: Pakistan (in 1996), India (in 2000), Senegal and Yemen (in 2004), Central African Republic and Cameroon (in 2007).

Who is at risk for infection?

Anyone who drinks standing pond water contaminated by persons with GWD is at risk for infection. People who live in villages where the infection is common are at greatest risk.

Is Guinea worm disease a serious illness?

Yes. The disease causes preventable suffering for infected persons and is a heavy economic and social burden for affected communities. Emgerence of the adult female worms can be very painful, slow, and disabling. Parents who have active Guinea worm disease may not be able to care for their children. They are also prevented from working in their fields and tending their animals. Because worm emergence usually occurs during planting and harvesting season, heavy crop losses may result leading to financial problems for the entire family. Children may be required to work the fields or tend animals in place of their disabled parents, preventing them from attending school. Therefore, GWD is both a disease of poverty and also a cause of poverty because of the disability it causes.

Is a person immune to Guinea worm disease once he or she has it?

No. Infection does not produce immunity, and many people in affected villages suffer disease year after year.

How can Guinea worm disease be prevented?

Because GWD can only be transmitted via drinking contaminated water, educating people to follow these simple control measures can completely prevent illness and eliminate transmission of the disease:

Drink only water from underground sources (such as from borehole or hand-dug wells) free from contamination.

Prevent persons with an open Guinea worm ulcer from entering ponds and wells used for drinking water.

Always filter drinking water, using a cloth filter, to remove the water fleas.

Additionally, unsafe sources of drinking water can be treated with an approved larvicide, such as ABATE®*, that kills copepods, and communities can be provided with new safe sources of drinking water, or have existing dysfunctional ones repaired.

*Use of trade names is for identification only and does not imply endorsement by the Public Health Service or by the U.S. Department of Health and Human Services.