Conjunctivitis

Conjunctivitis

Conjunctivitis or red eye is a common eye problem typified by inflammation of the membrane that lines the eyelid. It is contagious and usually affects children. ^[1][2]

Epidemiology

The prevalence of bacterial conjunctivitis varies in different geographic areas as a reflection of the distribution of the causative organisms. Males and females are affected equally. ^[3] Conjunctivitis caused by bacteria is more common among children while those caused by viruses are more frequent among adults. About half of acute cases in primary care are viral in origin. About 90% of allergic types are represented by seasonal conjunctivitis. ^[4]

Causes

Conjunctivitis can arise due to several causes. The infective type is brought about by bacterial or viral infection. Among the risk factors are direct contact to infected persons or objects, wearing of contact leans and immunodeficiency. Conjunctivitis may also be an allergic reaction to certain substances like pollen, dirt or cosmetics. Newborns can also develop the condition upon passing to the birth canal of mothers who have chlamydia or gonorrhea. Chemical conjunctivitis occurs when one is exposed to chemicals like chlorine in swimming pools and to other irritants.  ^{[3] [5] [6]}

Signs and Symptoms                                                                                         

Patients typically develop redness in the white part of the eye or in the inner eyelid that may be accompanied by increased sensitivity to light, tearing and blurred vision. Those caused by viruses generally give a watery discharge. In bacterial conjunctivitis, the discharge is commonly thicker and the color is usually yellow or green. Crusting may occur over the eyelashes particularly after sleeping. In allergic conjunctivitis, both eyes are affected and the person may experience itching, tearing, sneezing and watery nasal discharge. ^{[5] [6]}

Diagnosis

Conjunctivitis is usually diagnosed after obtaining the patient’s medical history and doing a comprehensive eye examination. ^[2]

Treatment

Viral conjunctivitis often resolves spontaneously without the need for prescription drugs. Care must be taken to avoid the spread of infection to other people. Antibiotics in the form of eyedrops or ointments are used to treat bacterial conjunctivitis. The allergen must be removed and avoided for allergic types. Moreover, drugs may be given such as antihistamines. For those caused by irritants, the eye must be washed with water immediately. If vision does not improve, a visit to the doctor may be necessary. ^{[2] [6]}

References:

1.      http://www.nlm.nih.gov/medlineplus/ency/article/001010.htm

2.      http://www.aoa.org/conjunctivitis.xml

3.      http://emedicine.medscape.com/article/1191730-overview#a0156

4.      http://bestpractice.bmj.com/best-practice/monograph/68/basics/epidemiology.html

5.      http://www.nhs.uk/Conditions/Conjunctivitis-infective/Pages/Introduction.aspx

6.      http://www.webmd.com/eye-health/eye-health-conjunctivitis

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Vitamin A [1, 13, 14, 15, 16, 17, 18, 19]:

Please note, this management does NOT treat the condition itself. It may mildly help in preventing some of the symptoms, and even then has insufficient evidence to back up this claim at present. Please note, this acts as a PREVENTATIVE treatment, and not necessarily symptomatic relief.

Recommendation: Strong (Vitamin A may help to prevent conjunctivitis due to its role in the body's immune function)

Grade of Evidence: high quality of evidence

Strychnos Nux-Vomica (Maqianzi, Poison Nut) [1, 10, 11, 12]:

WARNING! This substance is HIGHLY POISONOUS. The seeds contain Strychnine, which may cause convulsions, breathing difficulties and death, even if as little as 5 milligrams is ingested

Recommendation: Strongly against (There is no evidence in the form of clinical trials which reports the effectiveness of Strychnos Nux-Vomica, because it is highly poisonous to humans, and is not recommended.)

Grade of Evidence: very low quality of evidence

Gotu Kola (Centella Asiatica, Hydrocotyle Asiatica)[1, 4, 5, 6, 7, 8, 9]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (There is insufficient evidence to support claims that Gotu Kola helps in the treatment of conjunctivitis in any way. More research is needed.)

Grade of Evidence: low quality of evidence

Chamomile (Matricaria Chamomilla) [1, 2, 3]:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: weakly against (Available evidence does not support claims that Chamomile helps treat conjunctivitis. In addition, allergic reactions and side effects like cramps, itching, rashes and difficulty breathing can be relatively common)

Grade of Evidence: low quality of evidence

Castor Oil:

Recommendation: strongly in favor (Castor Oil is used conventionally as an eye drop to treat some eye irritations)

Grade of Evidence: Moderate quality of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.abchomeopathy.com/r.php/Cham

3. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html

4. Winston, D., Maimes, S., Adaptogens: Herbs For Strength, Stamina, and Stress Relief, 2007, pp. 226-7

5. "A Double-Blind, Placebo-Controlled Study on the Effects of Gotu Kola (Centella asiatica) on Acoustic Startle Response in Healthy Subjects". Journal of Clinical Psychopharmacology. 20(6):680-684, December 2000. Bradwejn, Jacques MD, FRCPC *; Zhou, Yueping MD, PhD ++; Koszycki, Diana PhD *; Shlik, Jakov MD, PhD

6.  B. M. Hausen (1993) "Centella asiatica (Indian pennywort), an effective therapeutic but a weak sensitizer." Contact Dermatitis 29 (4), 175–179 doi:10.1111/j.1600-0536.1993.tb03532.x

7. Cataldo, A., Gasbarro, V., et al., "Effectiveness of the Combination of Alpha Tocopherol, Rutin, Melilotus, and Centella asiatica in The Treatment of Patients With Chronic Venous Insufficiency", Minerva Cardioangiology, 2001, Apr; 49(2):159-63

8. http://en.wikipedia.org/wiki/Gotu_kola#Medicinal_effects

9. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/gotu-kola

10. David Michael Wood et al. Case report: Survival after deliberate strychnine self-poisoning, with toxicokinetic data. Critical Care October 2002 Vol 6 No 5

11. Arnold, M.D., Harry L. (1968). Poisonous Plants of Hawaii. Tokyo, Japan: Charles E. Tuttle Co.. p. 20. ISBN 0804804745.

12. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/strychnos-nux-vomica

13. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-vitamina.html

14. http://www.nlm.nih.gov/medlineplus/vitamina.html

15. http://ods.od.nih.gov/factsheets/vitamina.asp

16. http://www.who.int/nutrition/topics/vad/en/

17. Latham, Michael E. (1997). Human Nutrition in the Developing World (Fao Food and Nutrition Paper). Food & Agriculture Organization of the United. ISBN 92-5-103818-X.

18. Sommer, Alfred (1995). Vitamin a Deficiency and Its Consequences: A Field Guide to Detection and Control. Geneva: World Health Organization. ISBN 92-4-154478-3.

19. http://www.unicef.org/worldfitforchildren/files/A-RES-S27-2E.pdf
 

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