INTRODUCTION:

Conjunctivitis, or pinkeye, is an irritation of the membrane covering the inside of eyelids and the outer part of eye. It is typically not serious, but can be highly communicable. Conjunctivitis often feels like have something in eye that can't get out. A healthy conjunctiva is necessary for the maintenance of a healthy cornea and thus the visual acuity of the eye. The conjunctiva contributes to the tear film which has three layers.⁽¹⁾

· (Inner) mucous – adherence to the cornea (from the conjunctiva)

· (Middle) aqueous – wetting agent (from the lacrimal glands)

· (Outer) oil – prevention of evaporation (Meibomian and Zeis glands)

Infections of the conjunctiva can spread to the cornea and can cause a perforation, e.g., gonococcal infection. Allergic conjunctivitis or limbal catarrh can spread over the cornea. ‘Cobblestones’ form under the lid on the tarsal conjunctiva, and can cause corneal ulcers. Chemical injury to the limbal area can destroy the stem cells that are responsible for the re-epithelialization of the cornea. Dryness will damage the surface of the cornea.

Signs and Symptoms⁽²⁾

Conjunctivitis causes the following symptoms in one or both eyes:

Ø Redness and tearing

Ø Itching

Ø Swollen eyelid

Ø Discharge (watery or thick)

Ø Crust that forms overnight

Ø Sensitivity to light

Ø Gritty feeling.

Physiology of the Conjunctiva :^{( 3)}

The conjunctiva provides a barrier to exogenous communicable agents and foreign bodies and allows rotation of the globe. The human conjunctiva occupies 17 times more surface area than the cornea, is more porous than the cornea, and likely exerts more effect on the tear film than the cornea. The conjunctival epithelium has sufficient water permeability and the transporters necessary to contribute significantly to tear film volume that may represent basal tear secretion. The conjunctiva not only secretes electrolytes, water, and mucin into the tear film but also is capable of absorbing electrolytes, water, and other compounds from the tear film. It plays an important role in the absorption of ophthalmic drugs applied to the ocular surface. Under pathological conditions such as inflammation or the application of substances that increase vascular permeability, there is leak of plasma, electrolytes, water, and proteins, which can alter the composition of the tear film. Under normal conditions there is fluid transport across the epithelium. This secretion is regulated by nerves, growth factors, and other types of agonists such as the P2Y₂ agonists UTP and ATP. Mucin secretion by goblet cells and fluid secretion by stratified squamous cells is likely controlled by different nerves. Nutrition to the conjunctiva comes from underlying blood vessels and the tear film. Conjunctival epithelium differs from corneal epithelium in gross and histologic appearance and in its biochemical functions. The cornea is a clear, regular, refracting and reflecting surface without blood vessels. The conjunctiva, in contrast, is translucent, irregular, and vascularized. The cornea is devoid of goblet cells; the conjunctiva has numerous goblet cells. The corneal epithelium is five to six layers thick with an orderly progression from basal to wing to superficial cells on an avascularized stroma, whereas the conjunctiva consists of six to nine layers of cells arranged in an irregular fashion on a vascularized stromal bed. Nutrition for the cornea must diffuse across a great distance through the corneal epithelium, endothelium, and stroma. Conjunctival nutrition comes directly from nearby blood vessels. The corneal epithelial cells maintain and require large stores of glycogen for epithelial wound healing.

Conjunctivitis (Pink Eye) in Babies & Children :^{( 4)}

Newborns are very susceptible to pink eye, especially if the mother has an STD. It is very easy for bacteria or virus to pass through the birth canal into the baby's eyes, thus causing pink eye. Also, some babies are born with a very small tear duct, this tear duct can become blocked and lead to conjunctivitis. Since pink eye is acquired through bacteria, it is important to make sure your baby doesn’t contract it through you or anyone that touches him/her. Pregnant women should get screened for bacteria laden STD’s to ensure the health of their unborn baby. School aged children seem to be affected by conjunctivitis a lot; this is due to the constant interaction with other children and the lack of proper hygiene knowledge. Alternatively, pink eye is obtained from allergies. Children who have frequent allergic reactions to substances such as, ragweed, pollen, grass and animal dander are at risk. In addition, outside irritants or chemicals like chlorine, smoke, smog, fumes, and soaps can all cause pink eye in children.

What Causes It? :⁽⁵⁾

Ø Conjunctivitis is most often the result of viruses, such as those that cause the common cold.

Ø Other causes can be bacterial infections, allergies, chemicals, irritation from contact lenses, or eye injury.

Ø Viral and bacterial conjunctivitis are very contagious.

Some studies recommend :^{( 6)}

Ø Sun exposure makes the disease more severe. The infection of the outermost layer of the eye is commonly called pink-eye, the condition is medically known as conjunctivitis, it is an infection of the outermost layer of the eye or the conjunctiva, hence the name conjunctivitis.

Ø As a medical condition, it is a somewhat short lived infection and is not usually considered serious; from the time of infection to recovery taking very little time and it is commonly resolved within ten days at the most. Folded as a layer over the inner and upper eyelid the conjunctiva serves a protective function, to the lids. While there is a burning and tearing sensation, including the secretion of a gluey liquid, vision is not impaired or affected in any serious way, but there can be a lot of discomfort attached to having conjunctivitis, the inflammation irritates the eyes greatly, there is redness in the white of the eyes and an uncomfortable and persistent itchiness takes over for the duration of the infection.⁽⁷⁾

Ø The infection starts with a mild irritation in the eyes but rapidly becomes apparent with the production of a sticky, gluey secretion that seals the lids and makes it difficult to open the eyes in the morning, once this symptom has arrived, full fledged conjunctivitis is said to have set in, and medication is not needed to alleviate some of the symptoms.

Ø The illness is characterized by the accumulation of mucus in the corner of the eye, all through the day. Swelling and puffiness in the region of the lids is persistent and painful.

Ø The eyes seem to be affected in turn as the infection even though beginning in one eye, seems to affect the other eye as well. Professional advice should be sought once, any sign of visual impairment is seen or if there is an acute and long lasting pain, as these signs could foretell serious infection. Certain strains of bacteria and or viruses seem to be the culprits that cause the inflation of the conjunctiva.

Ø It can be said that some other physical irritants seem to the reason, physical things such as dust, sand, smoke, make-up or chlorine may find their way into the eyes, irritate them and create a condition whereby the infection can enter and inflame the conjunctiva.

Ø Other ways to the onset of conjunctivitis probably involve a few other physical causes also exists such as the constant irritation caused by contact lenses in many people who use them, an overexposure to sunlight and rough wind and cold drafts can also start inflammations to begin and be the reason that infections set in an unresolved condition of conjunctivitis especially occurring in the spring, may be due to other outside agencies- for like pollen allergies especially in cases where the infection cannot be resolved, the consequent itching will be quite terrible and both the eyes are deeply affected at the same time.

Ø The eyes are affected during the course of a cold, from bacteria in the nose or throat being transmitted to the conjunctiva. Physical methods of transmission of the infection are usually by actions such as rubbing the eyes which will spread the infection to other areas. The more serious conditions are often due to things such as viral infections . These conditions like herpes virus can affect the vision even if starting out from a very benign condition.⁽⁸⁾

Treatment Options :^{(9, 10)}

Ø Conjunctivitis is usually not serious and will often go away by itself. we should still, however, see our doctor. If left untreated, chronic conjunctivitis can cause permanent eye damage.

Ø Treatment varies depending on what is causing the inflammation. Bacterial conjunctivitis is generally treated with antibiotic eye drops or ointment.

Ø Viral conjunctivitis does not respond to antibiotics. But antihistamines and anti-inflammatory medications may help relieve symptoms.

Ø Warm or cool compresses may help reduce itching and swelling.

Ø Artificial tears may also help flush irritants out of the eye.

Supplements and herbs :^{( 11-13)}

Ø The fat soluble vitamin such as vitamin A which is very rich in substances like the retinols is an important nutrient for healthy eyes and proper vision.

Ø Eyes become susceptible to dryness, to many types of irritants and to various infections if they are not found in proper amounts in the body.

Ø The provitamin A, also known as the beta-carotene, is an excellent medium through which ample amounts of vitamin A in a non-toxic, water-soluble form can be obtained.

Ø During all kinds of infections, vitamin C with the bioflavonoid should be used for properimmune system strength and support. These plant based bioflavonoids, especially the pycnogenol- soured from pine bark, other plants like bilberry, from easily found grape seed extract and compounds like quercetin provide a strong antioxidant base in the body.

Ø There are other bioflavonoids commonly found and in abundant quantities in all good antioxidant supplements including rutin, hesperidin and catechin. In high dosages, vitamin C together with all these bioflavonoids will greatly help in the reduction of the need for antihistamines the anti-allergy component of many eye drops used in treating eye infections.

Ø The essential mineral zinc is also helpful during an infection, and assists in the assimilation of vitamin A and other required substances.

Ø Herbal infusions and compresses can be used to wash the eyes four to five times daily these greatly, strengthen glands and nerves, draw out toxins and kill infective pathogens. In order to avoid injuring the eyes, the infusions must be strained through a sterilized, cotton cloth or gauze that has been doubly folded.

Ø In order to increase the amount of blood flowing toward the eyes, eyebright compresses can be utilized. This compress helps in alleviating the pain associated with the redness and helps in the reduction of the swelling that comes on during conjunctivitis.

Ø The ideal way to carry this out would be to moisten a cotton ball in a lukewarm infusion and apply this to the eye's leaving them on the inflamed eye for about five to fifteen minutes; the discharge from the eye can then be wiped away after this action is completed. Every time the compress is to be used, it should be kept in mind that it is a fresh cotton ball that is being used.⁽¹⁴⁾

Ø The herb chamomile possesses phlegm-reducing properties besides being effective as an anti-inflammatory; it also has astringent properties and helps in the healing process. To take it in a liquid form, or as a tea dilute 5-10 drops of tincture in some water; this liquid can also be drunk by warming as a tea or can be used topically to bathe the eyes. Compresses can also be made using goldenseal root tincture as the liquid. Compresses made from marigold are both antiseptic and anti-inflammatory and can be very effective. They can be prepared by diluting 5 drops of tincture in about 1/4 cup of water and this liquid mixture can then be used as the infusion. Compresses made from aloe are very soothing to the eyes. They can be used five times a day and are prepared by mixing about 1/4 tsp. of aloe in 3 cups of hot water; this infusion is used to prepare the compress.

Herbs :^{( 15-17)}

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, take herbs with care, under the supervision of a health care provider trained in botanical medicine. Compresses and eye washes are external treatments. A trained herbal practitioner may prescribe an herbal eyewash. The following are some examples of the herbs used in these treatments. Do not attempt to use treatments on your own. You should use these treatment only under the supervision of a trained practitioner.

Ø Eyebright (Euphrasia officinalis): helps fight infection and dry up excess fluid.

Ø Chamomile (Matricaria recutita): helps fight infection.

Ø Fennel seed (Foeniculum vulgare): helps fight infection.

Ø Marigold (Calendula officinalis): soothes irritation.

Ø Plantain (Plantago lanceolata, P. major): astringent and soothing. The fresh leaves are the most effective plant part.

Ø Other herbal treatments may include:

Ginkgo biloba extract with hyaluronic acid. In one study, using an eyewash made of this solution for 1 month caused a significant decrease in symptoms of conjunctivitis compared to hyaluronic acid alone.

Ø Premade herbal eyewashes are available in many health food stores. Many of them contain diluted solutions of goldenseal (Hydrastis Canadensis), which in undiluted forms can be extremely irritating to the eye. Follow manufacturer's directions carefully.

Preparation of home remedies and list of herbs :^(
18-21)

Ø Licorice Root

Extract from the root of the licorice plant may have properties that would benefit symptoms of conjunctivitis and keratitis. Licorice has anti-inflammatory components that could reduce swelling and associated discomfort on the surface of your eyes. Some people believe licorice may also help infections that result from a bacteria or a virus.

Ø Elderberry

Elderberry extract comes from the fruit of the elder tree. This extract has properties that help reduce inflammation. In theory, this could have some benefits to inflammation associated with conjunctivitis and keratitis. Elderberry may also help infections that result from viruses. If you and your doctor determine that elderberry could help relieve your symptoms, your doctor will explain how to use elderberry and when you should discontinue using the extract.

Ø Ginger

Ginger is well-known for having many uses for flavor and seasoning in food. This supplement may also have medicinal qualities that could help treat inflammation. Some believe ginger could help relieve symptoms from the common cold virus, and if you have viral conjunctivitis or keratitis that results from a viral infection, your doctor may recommend a ginger supplement. Ginger comes in powered, dry or whole root form, and your doctor can help you determine the best form to use for your condition. Talk with your doctor before starting a garlic treatment. Ginger may not offer the best treatment for your eyes, especially for those on anti-coagulant medications, since ginger could interfere with blood-thinning medication.

Ø Warm saltwater

Put a coffee mug of water. Filled it half way and put it in the microwave for 4 minutes. Added 2 1/2 tablespoons of salt. Waited until the hot salt water cooled down and take a piece of paper towel and just squeeze the warm salt water in eye 5 times every 5 minutes for 20minutes...Repeat until looking better.

Ø Cold milk

Get a cup of cold milk and splash some in your eye then repeat until it feels better.

Ø Coconut oil (all natural from Whole Foods, put a dab over my eye and let it melt in. This provided the most relief of all remedies and immediately took away some of the redness. Vision was blurry for about 30 minutes afterwards so apply before bed.)

Ø Golden Seal (just boiled some water, added some Golden Seal powder and dabbed in on eye. Eventually use a straw to add a drop of the water after it settled straight into eye.)

Ø Activated charcoal (Boiled water, added charcoal, let it settle, added a drop of the mixture of to eye using a straw)

Ø Squeeze of lime

Ø Garlic (Rubbed a bulb on eyelid.

Ø Colloidal Silver (drops in eye once every hour.)

Ø Own fresh urine - the very best - quick relief and will not sting.

Ø Pure lemon - second best, but it sting

Ø Honey.

Ø Aloe vera.

Ø Rose water (a mixture can be made of 2, 3 and 4).

Ø Ocean water or sea salt in water.

Ø Comfrey solution w/ distilled water.

Ø Golden seal solution w distilled water.

Ø Apple cider vinegar w/ distilled water.

Ø Boric acid solution

Other beneficial herbs :^{( 22- 24)}

Ø Agrimony

Ø Bird's-foot

Ø Celandine

Ø Fumitory

Ø Licorice

Ø Meadowsweet

Ø Motherwort

Ø Pokeroot

Ø Raspberry

Ø Red Clover

Ø Self-Heal

Ø Turmeric

Ø Walnut

Drug Therapies :^{( 25-28)}

Ø Viral conjunctivitis: Usually Doctor may prescribe antiviral eye drops, such as acyclovir trifluridine. Treatment is supportive and may include ocular decongestants and artificial tears. Cold compresses applied 3 times daily for 1 to 3 weeks may relieve discomfort.

Ø Allergic conjunctivitis: Doctor may recommend allergy shots, administered over several months, to reduce your sensitivity to the allergen. Antihistamine eye drops, such as over-the-counter antazoline phosphate (Vasocon-A) or prescription olopatadine ophthalmic (Patanol) may reduce swelling or itching. An oral antihistamine can help relieve itching. A cool compress may help relieve symptoms, too.

Ø Bacterial conjunctivitis: Generally Doctor prescribe antibiotic eye drops, such as sodium sulfacetamide or azithromycin, or ointment such as erythomycin ,bacitracin, or neomycin.

Corresponding and Alternative Therapies :^{( 29-31)}

Ø Alternative therapies can help relieve symptoms. But it must make sure that any solution or compress it put on eye is sterile.

Ø Remember, too, that it can spread conjunctivitis from one eye to another. So don't touch other eye while treating the affected eye.

Ø If we have a mild case of conjunctivitis, start with compresses. Use warm compresses for infective conjunctivitis and cold compresses for allergic or irritative conjunctivitis. For a moderate case, use a compress and an eyewash that comes pre-mixed in a sterilized package or from a competent herbal practitioner.

Homeopathy Treatments :^(32-34)

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of conjunctivitis based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Ø Euphrasia -- for conjunctivitis with watery tears that burn the face and may become a thick discharge. Despite the production of watery tears, the individual may complain of a dry, gritty sensation in the eyes.

Ø Argentum nitricum -- for red, swollen eyes with pus-like discharge and splintering pains.

Ø Pulsatilla-- for conjunctivitis with yellow green discharge and itchy eyes that may accompany or immediately follow a cold. The eyelids tend to stick together, and symptoms generally improve with cold compresses. This remedy is most appropriate for individuals who tend to be irritable and have mood swings.

Ø Belladonna -- for the first stages of conjunctivitis, including the sudden onset of burning, bloodshot eyes, swollen eyelids, and hypersensitivity to light. The eyes are generally hot and throbbing to the touch.

Ø Sulphur -- for burning, pain, and redness of the eyes accompanied by a yellow discharge with foul odor. The eyes are often crusted together, and the individual is usually very hot and thirsty.

Ø Apis mellifica -- for red, burning, swollen eyes that feel better with cold applications.

Prevention of infective conjunctivitis :^(35-38)

Ø Bacterial conjunctivitis is uncommon but can be spread by the hands or from upper respiratory tract infections.

Ø Gonnoccal infection is transmitted from the genital tract or urine to the eye by hands. This is a serious breach of normal hygiene.

Ø Ophthalmia neonatorum can be prevented by the use of povidone iodine drops, tetracycline eye ointment or other antiseptics or antibiotics at birth.

Ø Viral conjunctivitis, in particular adenovirus, can sweep through a community or an institution such as a school very quickly. This is highly infectious and needs to be controlled by the enforcement of strict hygiene standards – towels, face cloths, hands and applanation tonometers are some examples of how this can easily be transmitted.

Ø Prevention of allergic conjunctivitis is not possible unless the patient is able to change his or her environment or job or identify the allergen causing the allergy and remove it, e.g., pollen, animal fur. Drugs can cause an allergy that is reversed by stopping the drug. Atropine, neomycin and eye drop preservatives are particularly common causes of such drug reactions.

CONCLUSION:

As is true for many herbal medicines, there is plenty of literature regarding traditional uses of various herbs for conjunctivitis, but very little systematic work has been done on the clinical aspects of the plants. The authors state that it is likely that many traditional herbal eye remedies are safe, and some may be beneficial. However, they stress the need for standardization as well as formulation with purity of herbal ophthalmic preparations to ensure their safety and reduce the possibility of toxic side effects or complications. This comprehensive review can provide the starting point for any researcher interested in studying the use of herbs in conjunctivitis treatment.

Finally conclude with suggestion that the Viral and bacterial conjunctivitis are both very contagious. Family members should use separate towels. Wash your hands often. Keep children home from school and day care. Be sure to follow your doctor’s advice about using any medications, especially if you have been given antibiotics or corticosteroids. If you wear contact lenses, keep them clean to avoid further irritation and future infections. Do not wear them until your eyes have healed. People with allergic conjunctivitis sometimes develop a severe form with a stringy discharge, swollen eyelids, scaly skin, and significant discomfort. This needs aggressive treatment to prevent scarring of the cornea.

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Received on 15.06.2014 Accepted on 26.06.2014

Research J. Topical and Cosmetic Sci. 5(1):Jan.–June 2014 page30-35

Physiology of the Conjunctiva :( 3)

Conjunctivitis (Pink Eye) in Babies & Children :( 4)

Ø Elderberry

Ø Ginger

Physiology of the Conjunctiva :^{( 3)}

Conjunctivitis (Pink Eye) in Babies & Children :^{( 4)}