Remember your school days? Most of you certainly had this experience. You avoided school for a few days when you had a pink eye! Your teacher gladly sent you off as other students could catch it and your parents were okay with it.
Pink eye or conjunctivitis is a common eye infection among children that most likely occurs due to bacterial or viral causes. However, as we grow up chronic conditions like high blood pressure, diabetes, and high cholesterol tend to afflict many of us. These chronic conditions carry their corresponding effects on the eye causing damage to vision on the long run.
When it comes to diabetes and eyes, many diabetic eye problems crop up in people whose diabetes is not controlled. When high blood sugar level persists for a long time, it can lead to conditions like proliferative diabetic retinopathy, diabetic macular edema, diabetic cataract, and many others.
In this section, we are going to know about the diseases of the conjunctiva and how to prevent them.
Diseases of the Conjunctiva:
The conjunctiva is a thin membrane that covers the sclera and the inner eyelids. It helps by protecting the eye from microorganisms and small foreign objects. It also maintains the film of tears. The conjunctiva has three layers with the palpebral, bulbar, and the fornix conjunctiva. The conjunctiva is commonly prone to infections, injuries, inflammation, degeneration, scarring, distortion, vascular complications, tumors, fat deposition, pigment abnormalities, and many others. Here are a few conditions of the conjunctiva:
Conjunctivitis is an inflammatory condition that is usually caused due to bacterial or viral infections. However, conjunctivitis can be of various types including allergic conjunctivitis, which is the result of an allergic reaction to foreign objects or chemicals in the eye. It can even be caused due to overexposure to sunlight.
Conjunctivitis can be chronic or short lived depending upon the underlying cause. It usually manifests with symptoms of foreign object feeling in the eye, irritation, burning sensation, tears, mucus or other discharge, and red eye.
Bacterial conjunctivitis is generally treated with topical antibiotics, conjunctival irrigation with eye wash, and if needed anti-inflammatory and anti-analgesic medications. Complications include corneal ulcers and iritis.
Viral conjunctivitis is treated with cold compresses, artificial tears, topical steroids, and if necessary, antibiotics to prevent bacterial super infection.
Other forms of conjunctivitis include keratoconjunctivitis, keratitis, herpes simplex conjunctivitis, trachoma, and vernal keratoconjunctivitis. Of note, trachoma is one of the most leading causes of blindness in India. Recent reports suggest that trachoma is eliminated from India, but till date it had caused blindness among children due to its infectious nature. This disease manifests itself with symptoms affecting both the conjunctiva and the cornea.
Scarring of the conjunctiva occurs due to exposure to chemicals, radiation, and heat. It can even be caused due to mechanical stress, infections, autoimmune conditions, and allergies. Scarring of the conjunctiva is managed pharmacologically with the help of ocular lubricants and palliatives in case of postsurgical and non-traumatic scarring. In case of severe scarring, other treatments such as autoimmune therapies and lid surgeries are prescribed.
Apart from infections, the conjunctiva is prone to degeneration. This can be due to primary or secondary causes. This means that the degeneration of the conjunctiva can occur due to primary reasons (pathological conditions) of the eye like vernal keratoconjunctivitis, bacterial infections of the eyelids, and trauma.
Conjunctival and corneal degeneration can occur due to secondary causes when there is calcium deposits in the eye. This can be caused due to hyperparathyroidism, sarcoidosis, hypercalcemia, and vitamin D intoxication.
Though conjunctival degeneration might not affect vision, it is usually present in both eyes and increases with age. These can be triggered due to environmental toxins.
Degeneration of the conjunctiva can occur in the form of concretions. These appear in the form of white or yellow lesions mostly in the fornix and palpebral conjunctiva. Though these lesions are benign, they might enlarge over time.
Patients might feel foreign body sensation, redness, and decreased vision. Treatment for this condition includes topical steroids, artificial tears, warm compresses, and surgical excision, if needed.
Pinguecula and Diabetes:
A common form of conjunctival degeneration is Pinguecula. This is a formation that occurs due to the thickening of the bulbar conjunctiva. Pingueculae are elevated areas which are either white or yellow in color and are fatty in appearance. It is known that pingueculae form due to overexposure to ultraviolet rays and are mostly seen in people above 60 years of age.
People with diabetes both type 1 and type 2 are prone to pingueculae and the risk increases with the age and tenure of diabetes. Though they are seen as conjunctival degenerations, pingueculae are rarely associated with any symptoms. Treatment is provided only when it develops into pingueculitis.
Vascular Disorders of the Conjunctiva:
The conjunctiva is prone to numerous vascular diseases and disorders that generally cause dilation of the conjunctival vessels. The blood vessels of the conjunctiva turn abnormal, bloated, twisted, damaged, and forms sacs. There might be sludging of blood with microaneurysms. In some cases, it can lead to subconjunctival hemorrhage.
Possible causes of vascular abnormalities of the conjunctiva include diabetic eye problems, hypertension, sickle cell anemia, venous obstruction, infection, allergy, aberrant eyelashes, and usage of topical vasodilators. To treat vascular abnormalities of the conjunctiva, the underlying systemic disease is treated along prescription of artificial tears.
These are generally malignant cancers that occur in the form of squamous cell carcinoma, lymphoma, and malignant melanomas. They have to be surgically removed and followed by cryotherapy and in some cases chemotherapy.
Diabetes and Complications of Conjunctiva:
Diabetes is one condition that is known to affect the entire body if it is not controlled properly. Organs like the eyes and kidneys are prone to diabetes complications leading to end-stage organ disease. When it comes to diabetic eye problems, the effect of diabetes on the conjunctivae is pronounced.
People with diabetes are more prone to conjunctivitis. High blood sugar levels cause the immunity of people with diabetes to reduce. This makes them susceptible to infections. Moreover, the incidence of bacterial conjunctivitis is higher in both people with type 1 and type 2 diabetes. A major reason for this is due to the presence of excess glucose in the mucus membranes, skin, and tears. This is known to promote the growth of bacteria.
Diabetes causes a dysfunction of the lacrimal glands that produce tears. Complications of diabetes and eyes with respect to the conjunctivae also include twisting of the blood vessels known as tortuosity, macrovessel dilation, and loss of capillaries.
Conjunctival angiopathy is one of the diabetic eye problems that is related to diabetic retinopathy. This condition is common in people with type 2 diabetes and causes the width of the blood vessels to increase. The changes in the conjunctiva in fact act as diabetic retinopathy symptoms.
Prevention of Conjunctival Diseases:
• Wash hands frequently with alcohol-based sanitizer.
• Never share eye makeup with others.
• Use swimming goggles while swimming.
• Never rub your eyes.
• Wear proper sunglasses.
• Never share towels.
• Control your blood sugar levels.
• Control your HbA1c levels.
• Get periodical eye exams.