Table Of ContentCONJUNCTIVITIS –
A COMPLEX AND
MULTIFACETED DISORDER
Edited by Zdenek Pelikan
Conjunctivitis – A Complex and Multifaceted Disorder
Edited by Zdenek Pelikan
Published by InTech
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Conjunctivitis – A Complex and Multifaceted Disorder, Edited by Zdenek Pelikan
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Contents
Preface IX
Part 1 Epidemiology of Conjunctivitis 1
Chapter 1 Epidemiological Aspects of Infectious Conjunctivitis 3
Herlinda Mejía-López, Carlos Alberto Pantoja-Meléndez,
Alejandro Climent-Flores and Victor M. Bautista-de Lucio
Part 2 Clinical Aspects and Features of Conjunctivitis 19
Chapter 2 Clinical Features of Infectious Conjunctivitis 21
Udo Ubani
Chapter 3 Allergic Conjunctivitis:
An Immunological Point of View 33
Atzin Robles-Contreras, Concepción Santacruz, Julio Ayala,
Eduardo Bracamontes, Victoria Godinez, Iris Estrada-García,
Sergio Estrada-Parra, Raúl Chávez, Mayra Perez-Tapia,
Victor M. Bautista-De Lucio and Maria C. Jiménez-Martínez
Chapter 4 Mediators and Some Cytokines in Tears During
the Late Conjunctival Response Induced
by Primary Allergic Reaction in the Nasal Mucosa 57
Zdenek Pelikan
Chapter 5 Cytologic Changes in Tears During the
Late Type of Secondary Conjunctival
Response Induced by Nasal Allergy 75
Zdenek Pelikan
Part 3 Treatment and Therapeutical Management
of Conjunctivitis 93
Chapter 6 Management of Conjunctivitis in General Practice 95
Soumendra Sahoo, Adnaan Haq,
Rashmirekha Sahoo and Indramani Sahoo
VI Contents
Chapter 7 Leukotriene Antagonist Drugs as Treatment of Allergic
Conjunctivitis and Comorbidities in Children 111
Salvatore Leonardi, Giovanna Vitaliti, Giorgio Ciprandi,
Carmelo Salpietro and Mario La Rosa
Chapter 8 The Evaluation of Anti-Adenoviral Therapeutic
Agents for use in Acute Conjunctivitis 127
J.A. Capriotti, J.S. Pelletier, K.P. Stewart and C.M. Samson
Chapter 9 Conjunctival Flora Before and After Application
of 5% Povidone-Iodine Solution 135
Virginia Vanzzini-Zago, Jorge Villar-Kuri, Víctor Flores Alvarado,
Alcántara Castro Marino and Pérez Balbuena Ana Lilia
Part 4 Special Forms of Conjunctivitis 145
Chapter 10 Ophtalmia Neonatorum 147
Flora Abazi, Mirlinda Kubati, Blerim Berisha, Masar Gashi,
Dardan Koçinaj and Xhevdet Krasniqi
Chapter 11 Trachoma and Conjunctivitis 165
Imtiaz A. Chaudhry, Yonca O. Arat and Waleed Al-Rashed
Chapter 12 Ocular Symptoms (Conjunctivitis, Uveitis)
in Reactive Arthritis 183
Brygida Kwiatkowska and Maria Maślińska
Chapter 13 Thelazia Species and Conjunctivitis 201
Soraya Naem
Preface
Conjunctivitis, a group of inflammatory disorders of the conjunctiva and often also in
conjunction with cornea, lacrimal ways and eyelids, is very common condition
affecting large adult as well as pediatric population.1-3 These disorders, especially their
chronic forms, can be a source of relatively extensive discomfort for the patients,
which can negatively influence their professional carriers as well as their private lives.
Conjunctivitis can be classified by various manners and according to various parameters.
However, the classification according to the causal aspects might be preferred.1-7
Conjunctivitis can be divided into two basic groups, with respect to the localization of
the primary pathophysiologic process and involved mechanisms 8-11; (A) Primary
conjunctivitis, including all primary and independent forms/disorders whose
underlying pathophysiologic processes are initiated and localized in the conjunctival
tissue, eventually in conjunction with the adjacent tissues, such as cornea, sclera,
lacrimal ways or eyelid skin. (B) Secondary conjunctivitis, including all conjunctivitis
forms, in which the primary pathophysiologic process is localized outside the
conjunctivae, in another organ. This group can further be divided into two sub-groups;
(B1 ) Secondarily induced conjunctivitis including conjunctivitis forms induced by factors
(mediators, cytokines, chemokines, neuropeptides,activated cells) released during the
primary pathophysiologic and/or immunologic process in another tissue, e.g. nasal
mucosa, middle ear, paranasal sinus mucosa, bronchial mucosa, eyelid skin, and
reaching secondarily the conjunctivae; (B2 ) Secondary conjunctivitis forms, being a part
of a complex and multifaceted pathophysiologic processes, such as systemic diseases,
metabolic disorders, some infectious and parasitic diseases, (auto)-immune disorders,
immunodeficiencies, angio-neurotic (Quincke) edema, some malignancy forms, etc.
Regarding the cause, the conjunctivitis can be divided into a number of categories.1-7
[1] Allergic conjunctivitis
Disorders of the conjunctiva, and sometimes also cornea, where an allergic
component plays an important causal role, summarized by a term “allergic
conjunctivitis”, are very common conditions affecting 15-25% of the adult and
pediatric populations. This group includes: Seasonal allergic conjunctivitis (SAC),
perennial allergic conjunctivitis (PAC), vernal keratoconjunctivitis (VKC), atopic
X Preface
keratoconjunctivitis (AKC) and giant papillary conjunctivitis (GPC). All these
disorders can occur in a acute, recurrent or a chronic feature as well as in a
primary or a secondarily induced form. With respect to the involved immunologic
mechanisms and underlying hypersensitivity type, various types of the primary
conjunctival response (immediate, late or delayed) can be recorded after the
conjunctival provocation tests with allergen as well as the various types of the
secondarily induced conjunctival response (immediate, late and delayed) can be
measured after the nasal provocation tests with allergen. 1-14
The allergens causing the allergic conjunctivitis include various inhalant (aero)
allergens, several food allergens, contact allergens, various drugs and a relatively
high number of occupational allergens. 1-14
Allergic conjunctivitis due to the foods and food allergy represents a special sub-
group of this entity. Various foods and/or their parts/ingredients, being ingested,
can act as allergens causing either the primary or the secondarily induced
conjunctival response. Moreover, various foods, in a powder, fluid or vapor form,
can act as contact allergens, causing usually the primary form of allergic
conjunctivitis or they can act as non-specific agents causing a conjunctival
response through the non-specific hyperreactivity mechanism. 8, 11Additionally,
the same powdered, vaporized or liquid food, affecting the nasal mucosa, may
cause a secondarily induced conjunctival response.
The various drugs can also cause both the (allergic) conjunctivitis by means of the
similar multi-facet pathophysiologic and immunologic mechanisms and the non-
specific conjunctival response (=irritation). 15, 16
[2] Bacterial conjunctivitis may usually be caused by bacteria from the families
Staphylococcus, Streptococcus, Gonococcus, Neisseria, Chlamidia, Haemophilus,
Pneumococcus, Pseudomonas, Escherichia, Klebsiella, Proteus, Enterobacter,
Mycobacterium, Meningococcus, Moraxella and Spirochetes.4-7, 17-20
A special sub-groups of bacterial conjunctivitis are represented by conjunctival
inflammation processes caused by Chlamydia trachomonas, occurring as a part of
the complex ocular disorders termed “Trachoma”, and those due to a number of
zoonoses.4-7, 17-20
[3] Viral conjunctivitis is caused by a number of viruses, such as adenovirus (APC)
virus, coxackie, herpes simplex , herpes zoster, influenza, measles, variola,
varicella, enteroviruses, echo-virus and HIV.4-7, 17-19
[4] Parasitic conjunctivitis is caused by amebae, trypanosomae, leishmaniae,
toxoplasmae, nematodes, Rickettsiae.4-7, 21- 23
[5] Mycotic conjunctivitis is caused by various kinds of actinomycetes, molds, fungi
and yeasts and/or their spores, such as Aspergillus, Alternaria, Cladosporium,
Penicillium, Fusarium, Actinomycetes, Zygomycetes, Candida albicans.4-7, 24
[6] Chemical conjunctivitis (=conjunctival irritation) is usually caused by volatile,
liquid or vaporized chemical compounds.4-7
