Abstract
Conjunctivitis is a commonly encountered condition in ophthalmology clinics throughout the world. In the management of suspected cases of conjunctivitis, alarming signs for more serious intraocular conditions, such as severe pain, decreased vision, and painful pupillary reaction, must be considered.
Additionally, a thorough medical and ophthalmic history should be obtained and a thorough physical examination should be done in patients with atypical findings and chronic course. [1][2]
Concurrent physical exam findings with relevant history may reveal the presence of a systemic condition with involvement of the conjunctiva. Viral conjunctivitis remains to be the most common overall cause of conjunctivitis.
Bacterial conjunctivitis is encountered less frequently and it is the second most common cause of infectious conjunctivitis. Allergic conjunctivitis is encountered in nearly half of the population and the findings include itching, mucoid discharge, chemosis, and eyelid edema. Long-term usage of eye drops with preservatives in a patient with conjunctival irritation and discharge points to the toxic conjunctivitis as the underlying etiology. Effective management of conjunctivitis includes timely diagnosis, appropriate differentiation of the various etiologies, and appropriate treatment. [3][4][5]
Keywords: Allergic, Bacterial, Conjunctivitis, COVID-19, Coronavirus, Viral, Toxic
INTRODUCTION
Conjunctivitis is characterized by inflammation and swelling of the conjunctival tissue, accompanied by engorgement of the blood vessels, ocular discharge, and pain. Many subjects are affected with conjunctivitis worldwide, and it is one of the most frequent reasons for office visits to general medical and ophthalmology clinics. More than 80% of all acute cases of conjunctivitis are reported to be diagnosed by non-ophthalmologists including internists, family medicine physicians, pediatricians, and nurse practitioners. [6]
There are several ways to categorize conjunctivitis; it may be classified based on etiology, chronicity, severity, and extend of involvement of the surrounding tissue. The etiology of conjunctivitis may be infectious or non-infectious. Viral conjunctivitis followed by bacterial conjunctivitis is the most common cause of infectious conjunctivitis, while allergic and toxin-induced conjunctivitis are among the most common non-infectious etiologies .[7][8][9]
In terms of chronicity, conjunctivitis may be divided into acute with rapid onset and duration of four weeks or less, subacute, and chronic with duration longer than four weeks .[10] Furthermore, conjunctivitis may be labeled as severe when the affected individuals are extremely symptomatic and there is an abundance of mucopurulent discharge.
Conjunctivitis may be associated with the involvement of the surrounding tissue such as the eyelid margins and cornea in blepharo conjunctivitis and viral kerato conjunctivitis, respectively.
Additionally, conjunctivitis may be associated with systemic conditions, including immune-related diseases [e.g., Reiter’s, Stevens-Johnson syndrome (SJS), and kerato conjunctivitis sicca in rheumatoid arthritis], nutritional deprivation (vitamin A deficiency), and congenital metabolic syndromes (Richner- Hanhart syndrome and porphyria) [13][14][15]
CLINICAL FEATURES : [16][17][18]
Conjunctival injection, often referred to as “red eye,” is a common manifestation observed across various eye conditions and constitutes about 1% of primary care office visits.
Clinicians, regardless of their specialty, should recognize that a “red eye” might signal serious eye conditions like uveitis, keratitis, or scleritis.
Alternatively, it could stem from less severe issues limited to the conjunctival tissue, such as conjunctivitis or subconjunctival hemorrhage. Previously, it was thought that more serious eye problems correlated with vision disturbances, severe pain, and sensitivity to light.
REPERTORIAL APPROACH TOWARDS CONJUCTIVITIS : [19]
Inflammation (conjunctivitis)
Acute and subacute catarrhal — Acon., Apis, Arg.
n., Ars., Bell., Canth., Chloral., Dub., Dulc., Euphras., Ferr. p., Guarea, Hep.,
Kali m., Merc. c., Merc. per., Merc., Nat. ars., Op., Picr. ac., Puls., Rhus r.,
Sep., Sticta, Sul., Upas.
Chronic — Alum., Ant. t., Arg. n., Ars., Aur. mur., Bell., Euphras., Kali bich.,
Merc. s., Picr. ac., Psor., Puls., Sul., Thuya, Zinc. m.
Croupous, diphtheritic — Acet. ac., Apis, Guarea., Iod., Kali bich., Merc. cy.
Follicular (granular) — Apis, Arg. n., Ars., Aur. m., Aur. mur., Calc. iod.,
Crot. t., Jequir., Kali bich., Nat. m., Phyt., Puls., Thuya., Zinc. s.
Gonorrhœal — Acon., Ant. t., Apis, Arg. n., Calc. hypoph., Hep., Kali bich.,
Merc. c., Merc., Puls., Rhus t., Ver. v.
Sympathetic form — Arg. n., Euphras., Merc., Puls.
Phlyctenular — Ant. t., Calc. c., Calc. picr., Con., Euphras., Graph., Ign.,
Merc. c., Puls., Rhus t., Sil., Sul.
Purulent — Arg. n., Calc. hypoph., Hep., Merc. c., Merc., Puls., Rhus t., Sil.
Pustular — Ant. t., Arg. n., Ars., Calc. c., Graph., Hep., Jequir., Kali
bich., Merc. c., Merc. nit., Puls., Rhus t.
Traumatic — Acon., Arn., Bell., Calend., Canth., Euphras., Ham., Led.,
Symphyt.
Hyperemia — Acon., Ars., Bell., Cepa., Ipec., Nux v., Rhus t., Sul., Thuya.
Discharge
Acrid — Ars., Arum, Euphras., Merc. c., Merc., Psor., Rhus t.
Clear mucus — Ipec., Kali m.
Creamy, profuse — Arg. n., Calc. s., Dulc., Hep., Nat. p., Nat. s., Picr.
ac., Puls., Rhus t., Syph.
Ropy — Kali-bi.
Foreign bodies, irritation — Acon., Sul.
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- W Boericke (1998) Pocket Manual of Homeopathic Materia Medica and Repertory and a Chapter on Rare and Uncommon Remedies. Wazirpur, Delhi, India: B. Jain Publishers.
