Summary about Disease
Follicular conjunctivitis is an inflammation of the conjunctiva (the clear membrane covering the white part of the eye and the inside of the eyelids) characterized by the presence of follicles. Follicles are small, raised bumps that appear on the conjunctiva, particularly on the lower eyelid. The condition can be caused by various factors, including viral infections (most commonly adenovirus), bacterial infections (less common), chlamydial infections, or irritants/allergens. It can be acute or chronic, depending on the underlying cause.
Symptoms
Redness of the eye
Gritty or sandy feeling in the eye
Excessive tearing or discharge (watery or mucoid)
Itching or burning sensation
Sensitivity to light (photophobia)
Swollen eyelids
Visible follicles (small bumps) on the conjunctiva, especially on the lower eyelid
Blurred vision (temporary)
Causes
Viral Infections: Adenovirus is the most common cause. Other viruses include herpes simplex virus (HSV) and varicella-zoster virus (VZV).
Bacterial Infections: Less common, but can be caused by bacteria like Streptococcus pneumoniae or *Haemophilus influenzae*.
Chlamydial Infections: Chlamydia trachomatis can cause follicular conjunctivitis, especially in adults.
Irritants/Allergens: Exposure to certain chemicals, pollutants, or allergens can trigger follicular conjunctivitis.
Medications: Certain medications can cause follicular conjunctivitis as a side effect.
Medicine Used
Viral Conjunctivitis: Typically treated with supportive care, such as artificial tears, cool compresses, and good hygiene. Antiviral medications (e.g., ganciclovir) may be prescribed in severe cases of herpes simplex virus (HSV) or varicella-zoster virus (VZV) infection.
Bacterial Conjunctivitis: Treated with topical antibiotic eye drops or ointments (e.g., erythromycin, polymyxin B/trimethoprim, ciprofloxacin).
Chlamydial Conjunctivitis: Treated with oral antibiotics (e.g., azithromycin, doxycycline).
Allergic Conjunctivitis: Treated with antihistamine eye drops or oral antihistamines. Mast cell stabilizers may also be used.
Irritant-induced Conjunctivitis: Treatment involves removing the irritant and using artificial tears for symptomatic relief.
Steroid eye drops: In some cases, steroid eye drops may be prescribed to reduce inflammation, but these should be used with caution and under the supervision of an ophthalmologist.
Is Communicable
Yes, follicular conjunctivitis caused by viral or bacterial infections is highly communicable. It can spread through direct contact with infected eye secretions, contaminated surfaces, or respiratory droplets (in the case of adenovirus infections). Chlamydial conjunctivitis is spread through sexual contact.
Precautions
Handwashing: Wash hands frequently with soap and water, especially after touching the eyes or face.
Avoid touching eyes: Avoid touching or rubbing your eyes.
Avoid sharing: Do not share towels, washcloths, eye makeup, or contact lenses.
Clean surfaces: Regularly clean and disinfect surfaces that may be contaminated (e.g., doorknobs, countertops).
Stay home: If you have infectious conjunctivitis, stay home from school or work to prevent spreading it to others.
Proper contact lens hygiene: If you wear contact lenses, follow proper cleaning and disinfection procedures.
Avoid close contact: Avoid close contact with others, especially during the acute phase of the infection.
How long does an outbreak last?
The duration of an outbreak depends on the underlying cause:
Viral Conjunctivitis: Typically lasts 1-3 weeks.
Bacterial Conjunctivitis: Usually resolves within a few days with antibiotic treatment.
Chlamydial Conjunctivitis: Can persist for weeks or months if left untreated.
Allergic Conjunctivitis: Lasts as long as the allergen is present.
Irritant-induced Conjunctivitis: Resolves quickly once the irritant is removed.
How is it diagnosed?
Clinical Examination: A thorough eye examination by an ophthalmologist or optometrist, including examination of the conjunctiva and eyelids.
Medical History: Gathering information about symptoms, possible exposures, and medical history.
Slit-lamp Examination: Use of a slit lamp (a microscope with a bright light) to examine the eye in detail and visualize follicles.
Conjunctival Swab or Scraping: A sample of conjunctival cells or secretions may be taken for laboratory testing to identify the causative agent (e.g., virus, bacteria, chlamydia). PCR testing is often used to detect viral or chlamydial infections.
Allergy Testing: If allergic conjunctivitis is suspected, allergy testing may be performed.
Timeline of Symptoms
The timeline of symptoms varies depending on the cause:
Viral Conjunctivitis: Symptoms typically develop gradually over 1-2 days, with redness, tearing, and follicular formation. Symptoms peak within a week and then gradually resolve over 1-3 weeks.
Bacterial Conjunctivitis: Symptoms usually appear suddenly, with redness, discharge, and a gritty feeling. Symptoms improve rapidly with antibiotic treatment.
Chlamydial Conjunctivitis: Symptoms may develop gradually over several weeks, with chronic redness, tearing, and follicular formation.
Allergic Conjunctivitis: Symptoms appear rapidly after exposure to the allergen, with itching, redness, and tearing. Symptoms resolve quickly once the allergen is removed.
Irritant-induced Conjunctivitis: Symptoms appear rapidly after exposure to the irritant, with redness, tearing, and a burning sensation. Symptoms resolve quickly once the irritant is removed.
Important Considerations
Differential Diagnosis: Follicular conjunctivitis should be differentiated from other causes of red eye, such as allergic conjunctivitis, bacterial conjunctivitis, and dry eye syndrome.
Complications: Complications are rare but can include corneal involvement (keratitis), scarring, and vision loss (especially with herpes simplex virus infection).
Contact Lens Wearers: Contact lens wearers are at increased risk of developing conjunctivitis and should follow proper lens hygiene practices. It is advised to discontinue contact lens wear until the infection has resolved.
Children: Conjunctivitis is common in children, especially viral conjunctivitis. Good hygiene practices are essential to prevent spread in schools and daycare centers.
Chronic Follicular Conjunctivitis: Chronic follicular conjunctivitis may be caused by molluscum contagiosum or chronic exposure to irritants.
Treatment Adherence: It is important to follow the prescribed treatment regimen and complete the full course of antibiotics (if prescribed) to prevent recurrence or complications.
Follow-up: Follow-up with an ophthalmologist or optometrist is recommended to ensure that the infection is resolving and to monitor for any complications.