Management of Acute Conjunctivitis

Ocular mucosal homeostasis of teleost fish provides insight into the coevolution between microbiome and mucosal immunity

BACKGROUND

The visual organ plays a crucial role in sensing environmental information. However, its mucosal surfaces are constantly exposed to selective pressures from aquatic or airborne pathogens and microbial communities. Although few studies have characterized the conjunctival-associated lymphoid tissue (CALT) in the ocular mucosa (OM) of birds and mammals, little is known regarding the evolutionary origins and functions of immune defense and microbiota homeostasis of the OM in the early vertebrates.

RESULTS

Our study characterized the structure of the OM microbial ecosystem in rainbow trout (Oncorhynchus mykiss) and confirmed for the first time the presence of a diffuse mucosal-associated lymphoid tissue (MALT) in fish OM. Moreover, the microbial communities residing on the ocular mucosal surface contribute to shaping its immune environment. Interestingly, following IHNV infection, we observed robust immune responses, significant tissue damage, and microbial dysbiosis in the trout OM, particularly in the fornix conjunctiva (FC), which is characterized by the increase of pathobionts and a reduction of beneficial taxa in the relative abundance in OM. Critically, we identified a significant correlation between viral-induced immune responses and microbiome homeostasis in the OM, underscoring its key role in mucosal immunity and microbiota homeostasis.

CONCLUSIONS

Our findings suggest that immune defense and microbiota homeostasis in OM occurred concurrently in early vertebrate species, shedding light on the coevolution between microbiota and mucosal immunity. Video Abstract.

Indication-prescription study for the management of conjunctivitis in a Colombian population

PURPOSE

Conjunctivitis is one of the most common ocular pathologies. Its treatment depends on its etiology, but an excessive use of antibiotics and corticosteroids, which in many cases are contraindicated, has been described. The objective was to describe the prescription patterns of medications used to treat conjunctivitis in a Colombian population.

METHODS

This was a cross-sectional study on the pharmacological treatment of patients diagnosed with conjunctivitis between April 1, 2020, and March 31, 2021; based on a drug-dispensing database of approximately 8.5 million people affiliated with the Colombian Health System. Some sociodemographic and pharmacological variables and comorbidities were considered. A descriptive analysis was performed.

RESULTS

A total of 8708 patients were identified; they had a median age of 44.7 years, and 59.3% were women. The most common causes of conjunctivitis were unspecified (53.1%) and allergic (37.4%). The most commonly used drug was olopatadine (26.1%), followed by dexamethasone with neomycin and polymyxin B (25.0%). A total of 97.0% of the patients received ophthalmic prescriptions, while 12.8% received systemic medications. Glucocorticoids (40.3%), antibiotics (37.7%) and antihistamines (31.7%) were the most commonly used groups of ophthalmic drugs. Glucocorticoids and ophthalmic antibiotics were the medications most frequently prescribed by general practitioners for the treatment of viral or bacterial conjunctivitis.

CONCLUSIONS

Many patients with conjunctivitis are not being managed according to the recommendations of clinical practice guidelines, which highlights that the widespread use of antibiotics with ophthalmic glucocorticoids could be considered potentially inappropriate prescriptions in many cases.

Recent incidence of infectious conjunctivitis in Bangladesh: Are we aware?

Bangladesh has seen a recent surge of infectious conjunctivitis nationwide for the last few weeks. Reported by journalists of daily newspapers, the incidence is now 33.33% in some eye outpatient departments (OPDs) of the country, which is surprisingly higher than the usual expected rate of the disease. In some districts, educational institutions have been shut down and it is greatly hampering the daily life of the citizens. Though the causative agent of the infection is yet unknown, the higher disease notification rate solicits rapid epidemiological studies and microbial assessment. Also, Bangladesh should be more aware in its hygiene practice and take adequate measures to halt the transmission of the disease to its South Asian neighbouring countries.

The Social-environmental Risk Factor for Conjunctivitis

BACKGROUND: Conjunctivitis is one of the most common eye disorders in the worldwide. The incidence of conjunctivitis in Indonesia reached 73% of the population. Conjunctivitis cases in Yogyakarta City have increased from year to year. AIM: This study purposed to identify the social-environmental risk factors that influence the incidence of conjunctivitis in Yogyakarta. METHODS: Design study was an observational analytic method with a case–control research design. The population study was all the patients visited at the Eye Clinic of PKU Muhammadiyah Gamping Hospital and private hospital Yogyakarta in 2019. The total sample is 204 respondents who were divided into case and control. One hundred and four respondents were in a case while 100 were controlled. The case was a conjunctivitis patient treated at the Eye Clinic of PKU Muhammadiyah Gamping Hospital and private hospital Yogyakarta in 2019, while the control was a non-conjunctivitis patient who went to the same two hospitals as the case respondent. Data were collected by direct interviews using a structured questionnaire covering the respondents’ demographics and social-environmental conditions. Then, the data were analyzed using SPSS 15.0 univariate and bivariate using Chi-square. RESULTS: The results of the bivariate analysis showed that age, the distance between the house and the river, the distance between the place and the temporary garbage dump, contacted from a close friend, the windows of the house were always opened every day as risk factors affecting the incidence of conjunctivitis. CONCLUSION: The study’s decision is the social-environmental as a risk factor for conjunctivitis in Yogyakarta.

Use of Topical Steroids in Conjunctivitis: A Review of the Evidence

PURPOSE

Conjunctivitis, or inflammation of the conjunctiva, is a common condition that can be caused by infectious (eg, bacterial or viral infections) and noninfectious (eg, allergy) etiologies. Treatment involves diagnosis of the underlying cause and use of appropriate therapies. A broad-spectrum therapy that can address multiple etiologies, and also the accompanying inflammation, would be very useful. In this review, we discuss the usefulness of topical ophthalmic corticosteroids and ophthalmic formulations that combine corticosteroids with anti-infectives/antibiotics for treating acute infectious conjunctivitis.

METHODS

A review of the published literature and relevant treatment guidelines.

RESULTS

Topical corticosteroids are useful in treating ocular inflammation, but most treatment guidelines recommend steroid use generally in severe cases of conjunctivitis. This is partly due to risks associated with steroid use. These risks include potential for prolonging adenoviral infections and potentiating/worsening herpes simplex virus infections, increased intraocular pressure, glaucoma, and cataracts. Most of these perceived risks are not, however, supported by high-quality clinical data. They are also associated with long-term steroid uses that are dissimilar to applications for infectious conjunctivitis. Clinical data show that ophthalmic formulations that combine corticosteroids with broad-spectrum anti-infectives could be effective and well tolerated when used for short-term treatment (≤2 weeks).

CONCLUSIONS

Corticosteroids, in combination with anti-infectives, could be a promising treatment option for acute conjunctivitis subject to development of further evidence on their effectiveness and safety in conjunctivitis treatment.

The Epidemic Genotypes of Human Adenovirus in Outpatient Children with Adenoviral Conjunctivitis from 2011 to 2012 in Jiangxi, China

BACKGROUND

Human adenoviruses (HAdV) are a common cause of viral conjunctivitis, making surveillance of them from sporadic cases of conjunctivitis important.

METHODS

To acquire a better understanding of the epidemic genotypes of HAdV in outpatient children with adenoviral conjunctivitis in Jiangxi Province, China (2011-2012), 179 samples from cases with a high suspicion of HAdV were analyzed by PCR. Samples confirmed to be HAdV-positive by PCR were cultured in Hep-2 cells to isolate the viruses, which were then identified through hexon gene sequencing.

RESULTS

The adenoviral conjunctivitis positivity rate was 74.86% (134/179), from which 71.64% (96/134) were infections in boys, and 92.54% (124/134) were infections in children under 5 years of age. Sixty-nine HAdV strains were isolated from the positive samples and 69 sequences were obtained. Phylogenetic analysis indicated that 33 strains (47.82%) clustered with HAdV-B7, 21 (30.43%) with HAdV-B3, 6 (8.70%) with HAdV-B55, 6 (8.70%) with HAdV-E4, 1 with HAdV-B21 (1.45%), 1 with HAdV-D37 (1.45%), and 1 with HAdV-D64 (1.45%).

CONCLUSIONS

This is the first identification of HAdV-B55 relating to adenoviral conjunctivitis in China. These findings provide a firm basis for future surveillance of adenoviral conjunctivitis in China or other East Asian regions.

Molecular detection and characterization through analysis of the hexon and fiber genes of Adenoviruses causing conjunctivitis in Tunisia, North Africa

Human adenoviruses (HAdVs) are common causes of conjunctivitis. This study describes the epidemiological features and characterizes by phylogenetic analysis HAdVs isolated from patients with conjunctivitis in Tunisia, North Africa. Data on out-patients presenting with conjunctivitis during 2 years (2012-2013) were analyzed. Conjunctival swabs obtained from 240 patients were assessed for the presence of HAdVs by PCR amplification on the fiber and hexon genes. Positive PCR products, together with those of nine viral isolates from previous years, were sequenced and analyzed phylogenetically. Conjunctivitis represented 11.5% of all reasons of consultations with a slight increase between mid-March and mid-June. Sixty-five percent of samples (n = 156) revealed positive by at least one PCR test. PCR amplification in the hexon gene was slightly more sensitive as compared to the fiber gene. Genotyping in the two genomic regions gave concordant results for almost all isolates. HAdV-D8 was the most predominant genotype (87.6%) and was detected continuously from 2000 to 2013. Minor co-circulating genotypes including HAdV-E4, HAdV-B3, HAdV-B55, and HAdV-D37 were identified; most of them were detected by amplification in the hexon gene. In conclusion, this work reports molecular data on adenoviral conjunctivitis from a region where such information is scarce and contributes to a better knowledge of the worldwide distribution of causative genotypes. It revealed a predominance and endemic circulation of HAdV-D8, a genotype that was mainly reported from epidemic keratoconjunctivitis. It shows that PCR amplification in two different genomic regions enhances the sensitivity of HAdV detection in clinical samples and the identification of minor genotypes. J. Med. Virol. 89:304-312, 2017. © 2016 Wiley Periodicals, Inc.