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Prognosis
Viral conjunctivitis, although usually benign and self-limited, tends to follow a longer course than acute bacterial conjunctivitis, lasting for approximately 2-4 weeks while bacterial usually only lasts for about 7-10 days. Allergic conjunctivitis tends to be recurring and seasonal.
Complications
- Allergic conjunctivitis, especially atopic or vernal forms of allergic conjunctivitis, can cause a sterile shield ulcer causing significant visual loss
- Bacterial conjunctivitis usually resolves without any complications. However, special forms of bacterial conjunctivitis such as Chlamydial or Gonococcal are associated with more severe complications.
- Chlamydial infection in the newborn can lead to pneumonia and/or otitis media.
- N gonorrhoeae
- Infections with N meningitidis may require systemic antibiotics to prevent meningitis Sepsis and meningitis caused by Neisseria gonorrhoeae can be life threatening.
- Penetration of the cornea can occur within 2 days in patients with untreated N gonorrhoeae.
- Viral Conjunctivitis
- EKC, A form of adenoviral conjunctivitis is typically self-limiting and resolves spontaneously within 2-3 weeks but can be associated with significant morbidity including subepithelial infiltrates (SEI or superficial corneal inflammatory deposits), lacrimal drainage scarring, and symblepharon.
- About 30% develop a pseudomembrane lining the inferior palpebral conjunctiva
- In 20-50% of cases, SEI’s can persist from a few weeks to months. These sterile infiltrates cause decreased visual acuity, foreign body sensation, glare, and light sensitivity
- Subepithelial corneal infiltrates can cause decreased visual acuity, foreign body sensation, glare, and light sensitivity
- Lacrimal drainage problems (tear drainage problems) leading to chronic epiphora or excessive tearing
- Conjunctival scarring and symblepharon
Follow up Care
- Usually patients are seen 10-14 days later for uncomplicated cases
- Any patient requiring topical corticosteroids should be observed routinely to monitor for side effects, including infection, elevated intraocular pressure, and cataract formation.
Summary & Advances
Currently infectious conjunctivitis is a clinical diagnosis and cell cultures and PCR are not routinely done. The RPS Adeno Detector would make a laboratory confirmation of the diagnosis of viral conjunctivitis readily available. Because the RPS Adeno Detector test empowers a physician to accurately make a diagnosis and appropriately treat or not treat a patient, it ultimately allows a physician to practice better medicine. Physicians often feel pressured by their patients to institute a treatment even if they think it is unnecessary. When patients visualize a positive test result themselves, physicians can achieve better patient acceptance for more supportive therapies.
This could dramatically limit over use of unnecessary antibiotics and thus, reduce ocular antibiotic resistance, toxicity, and allergies. It could also help isolate a contagious person who will not improve with topical antibiotics and may require more time away from work, school, or daycare.
Dr. William Boothe - Dr. Boothe