herpes zoster, also known as shingles, zoster, or zona, is a viral disease characterized by a painful skin rash with blisters involving a limited area. These “excludes” are used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. Viral conjunctivitis is often associated with an infection of the upper respiratory tract, a common cold, and/or a sore throat. Its symptoms include excessive watering and itching. the rash usually heals within two to four weeks; however, some people develop ongoing nerve pain which may last for months or years, a condition called postherpetic neuralgia. ICD-10 Research was designed and developed by Tim Dietrich, a custom software developer. Symptoms consist of redness (mainly due to vasodilation of the peripheral small blood vessels), swelling of the conjunctiva, itching, and increased lacrimation (production of tears).
If this is combined with rhinitis, the condition is termed “allergic rhinoconjunctivitis”. The symptoms are due to release of histamine and other active substances by mast cells, which stimulate dilation of blood vessels, irritate nerve endings, and increase secretion of tears. Bacteria such as Chlamydia trachomatis or Moraxella can cause a non-exudative but persistent conjunctivitis without much redness. Bacterial conjunctivitis may cause the production of membranes or pseudomembranes that cover the conjunctiva. Pseudomembranes consist of a combination of inflammatory cells and exudates, and are loosely adherent to the conjunctiva, while true membranes are more tightly adherent and cannot be easily peeled away. Cases of bacterial conjunctivitis that involve the production of membranes or pseudomembranes are associated with Neisseria gonorrhoeae, β-hemolytic streptococci, and C. diphtheriae.
Corynebacterium diphtheriae causes membrane formation in conjunctiva of non-immunized children. Irritant or toxic conjunctivitis show primarily marked redness. If due to splash injury, it is often present in only the lower conjunctival sac. With some chemicals, above all with caustic alkalis such as sodium hydroxide, there may be necrosis of the conjunctiva with a deceptively white eye due to vascular closure, followed by sloughing of the dead epithelium. This is likely to be associated with slit-lamp evidence of anterior uveitis. Conjunctivitis is identified by irritation and redness of the conjunctiva. Except in obvious pyogenic or toxic/chemical conjunctivitis, a slit lamp (biomicroscope) is needed to have any confidence in the diagnosis.
Examination of the tarsal conjunctiva is usually more diagnostic than the bulbar conjunctiva. Conjunctivitis when caused by an infection is most commonly caused by a viral infection. Bacterial infections, allergies, other irritants and dryness are also common causes. Both bacterial and viral infections are contagious and passed from person to person, but can also spread through contaminated objects or water. The most common causes of acute bacterial conjunctivitis are Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae. Though very rare, hyperacute cases are usually caused by Neisseria gonorrhoeae or N. meningitidis. Chronic cases of bacterial conjunctivitis are those lasting longer than 3 weeks, and are typically caused by Staphylococcus aureus, Moraxella lacunata, or gram-negative enteric flora. Cultures are not often taken or needed as most cases resolve either with time or typical antibiotics.
Swabs for bacterial culture are necessary if the history and signs suggest bacterial conjunctivitis but there is no response to topical antibiotics. Viral culture may be appropriate in epidemic case clusters. Conjunctival scrapes for cytology can be useful in detecting chlamydial and fungal infections, allergy, and dysplasia, but are rarely done because of the cost and the general lack of laboratory staff experienced in handling ocular specimens. Conjunctival incisional biopsy is occasionally done when granulomatous diseases (e.g., sarcoidosis) or dysplasia are suspected. There are more serious conditions that can present with a red eye such as infectious keratitis, angle closure glaucoma, or iritis. These conditions require the urgent attention of an ophthalmologist. Signs of such conditions include decreased vision, significantly increased sensitivity to light, inability to keep eye open, a pupil that does not respond to light, or a severe headache with nausea. Fluctuating blurring is common, due to tearing and mucoid discharge.
Mild photophobia is common. However, if any of these symptoms are prominent, it is important to consider other diseases such as glaucoma, uveitis, keratitis and even meningitis or carotico-cavernous fistula. For the allergic type, cool water poured over the face with the head inclined downward constricts capillaries, and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, nonsteroidal anti-inflammatory medications and antihistamines may be prescribed. Persistent allergic conjunctivitis may also require topical steroid drops. When appropriate, the choice of antibiotic varies, differing based on the cause (if known) or the likely cause of the conjunctivitis. Fluoroquinolones, sodium sulfacetamide, or trimethoprim/polymyxin may be used, typically for 7–10 days. Cases of meningococcal conjunctivitis can also be treated with systemic penicillin, as long as the strain is sensitive to penicillin.
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