Conjunctivitis

Conjuctivitis is an inflammation or redness of the lining of the white part of the eye and the underside of the eyelid (conjunctiva) that can be caused by infection, allergic reaction, or physical agents like infrared or ultra-violet light.

Description

Conjunctivitis is the inflammation of the conjunctiva, a thin, delicate membrane that covers the eyeball and lines the eyelid. Conjunctivitis is an extremely common eye problem because the conjunctiva is continually exposed to microorganisms and environmental agents that can cause infections or allergic reactions. Conjunctivitis can be acute or chronic depending upon how long the condition lasts, the severity of symptoms, and the type of organism or agent involved. It can also affect one or both eyes and, if caused by infection, can be very easily transmitted to others during close physical contact, particularly among children in a daycare center. Other names for conjunctivitis include pink eye and red eye.

Causes and symptoms

Conjunctivitis may be caused by a viral infection, such as a cold, acute respiratory infection, or disease such as measles, herpes simplex, or herpes zoster. Symptoms include mild to severe discomfort in one or both eyes, redness, swelling of the eyelids, and watery, yellow, or green discharge. Symptoms may last anywhere from several days to two weeks. Infection with an adenovirus, however, may also cause a significant amount of pus-like discharge and a scratchy, foreign body-type of sensation in the eye. This may also be accompanied by swelling and tenderness of the lymph nodes near the ear.

Bacterial conjunctivitis can occur in adults and children and is caused by organisms such as Staphylococcus, Streptococcus, and Hemophilus. Symptoms of bacterial conjunctivitis include a pus-like discharge and crusty eyelids after awakening. Redness of the conjunctiva can be mild to severe and may be accompanied by swelling. Persons with symptoms of conjunctivitis who are sexually active may possibly be infected with the bacteria that cause either gonorrhea or chlamydia. There may be large amounts of pus-like discharge, and symptoms may include intolerance to light (photophobia), watery mucous discharge, and tenderness in the lymph nodes near the ear that may persist for up to three months.

Conjunctivitis may also be caused by environmental hazards, such as wind, smoke, dust, and allergic reactions caused by pollen, dust, or grass. Symptoms range from itching and redness to a mucous discharge. Persons who wear contact lenses may develop allergic conjunctivitis caused by the various eye solutions and foreign proteins contained in them.

Other less common causes of conjunctivitis include exposure to sun lamps or the electrical arcs used during welding, and problems with inadequate drainage of the tear ducts.

Diagnosis

An accurate diagnosis of conjunctivitis centers on taking a patient history to learn when symptoms began, how long the condition has been going on, the symptoms

This person has severe conjunctivitis, most likely caused by an allergic reaction. (Custom Medical Stock Photo. Reproduced by permission.)

experienced, and other predisposing factors, such as upper respiratory complaints, allergies, sexually transmitted diseases, herpes simplex infections, and exposure to persons with pink eye. It may be helpful to learn whether an aspect of an individual's occupation may be the cause, for example, welding. Diagnostic tests are usually not indicated unless initial treatment fails or an infection with gonorrhea or chlamydia is suspected. In such cases, the discharge may be cultured and Gram stained to determine the organism responsible for causing the condition. Cultures and smears are relatively painless.

Treatment

The treatment of conjunctivitis depends on what caused the condition. In all cases, warm compresses applied to the affected eye several times a day may help to reduce discomfort.

Conjunctivitis due to a viral infection, particularly those due to adenoviruses, are usually treated by applying warm compresses to the eye(s) and applying topical antibiotic ointments to prevent secondary bacterial infections.

Viral conjunctivitis caused by herpes simplex should be referred to an ophthalmologist. Topical steroids are commonly prescribed in combination with antiviral therapy.

In cases of bacterial conjunctivitis, a physician may prescribe an antibiotic eye ointment or eye drops containing sodium sulfacetamide (Sulamyd) to be applied daily for seven to 14 days. If, after 72 hours, the condition does not improve, a physician or primary care provider should be notified because the bacteria involved may be resistant to the antibiotic used or the cause may not be bacterial.

For cases of conjunctivitis caused by a gonococcal organism, a physician may prescribe an intramuscular injection of ceftriaxone (Rocephin) and a topical antibiotic

Conjunctivitis is the inflammation of the conjunctiva, a thin, delicate membrane that covers the eyeball and lines the eyelid. It may be caused by a viral infection, such as a cold or acute respiratory infection, or by such diseases as measles, herpes simplex, or herpes zoster. (Illustration by Electronic Illustrators Group.)

ointment containing erythromycin or bactracin to be applied four times daily for two to three weeks. Sexual partners should also be treated.

With accompanying chlamydia infection, a topical antibiotic ointment containing erythromycin (Ilotycin) may be prescribed to be applied 1-2 times daily. In addition, oral erythromycin or tetracycline therapy may be indicated for three to four weeks. Here again, sexual partners should also be treated.

Allergic conjunctivitis can be treated by removing the allergic substance from a person's environment, if possible; by applying cool compresses to the eye; and by administering eye drops four to six times daily for four days. Also, the antihistamine diphenhydramine hydrochloride (Benadryl) may help to relieve itchy eyes.

Alternative treatment

Conjunctivitis caused by gonococcal and chlamydial infection usually requires conventional medical treatment. With bacterial, viral, and allergic conjunctivitis, however, alternative options can be helpful. Internal immune enhancement with supplementation can aid in the resolution of bacterial and viral conjunctivitis. Removal of the allergic agent is an essential step in treating allergic conjunctivitis. As with any of the recommended treatments, however, if no improvement is seen within 48–72 hours, a physician should be consulted.

Homeopathically, there are a number of acute remedies designed to treat conjunctivitis. These include Pulsatilla (windflower, Pulsatilla nigricans), Belladonna, and eyebright (Euphrasia officinalis). Eye drops, prepared with homeopathic remedies and/or herbs, can be a good substitute for pharmaceutical eye drops. Eye washes can also be made. Herbal eyewashes made with eyebright (1 tsp. dried herb steeped in 1 pint of boiling water) or chamomile (Matricaria recutita; 2–3 tsp in 1 pt of boiling water) may be helpful. Eyewashes should be strained and cooled before use, and close attention should be paid to make sure that any solution put into the eye is sterile.

Other simple home remedies may help relieve the discomfort associated with conjunctivitis. A boric acid eyewash can be used to clean and soothe the eyes. A warm compress applied to the eyes for five to 10 minutes three times a day can help relieve the discomfort of bacterial and viral conjunctivitis. A cool compress or cool, damp tea bags placed on the eyes can ease the discomfort of allergic conjunctivitis.

Prognosis

If treated properly, the prognosis for conjunctivitis is good. Conjunctivitis caused by an allergic reaction should clear up once the allergen is removed. However, allergic conjunctivitis will likely recur if the individual again comes into contact with the particular allergen. Conjunctivitis caused by bacteria or a virus, if treated properly, is usually resolved in 10–14 days. If there is no relief of symptoms in 48–72 hours, or there is moderate to severe eye pain, changes in vision, or the conjunctivitis is suspected to be caused by herpes simplex, a physician should be notified immediately. If untreated or if treatment fails and is not corrected, conjunctivitis may cause visual impairment by spreading to other parts of the eye, such as the cornea.

Prevention

Conjunctivitis can, in many cases, be prevented, or at least the course of the disease can be shortened by following some simple practices.

• Frequently wash hands using antiseptic soap, and use single-use towels during the disease to prevent spreading the infection.
• Avoid chemical irritants and known allergens.
• If in an area where welding occurs, use the proper protective eye wear and screens to prevent damaging the eyes.
• Use a clean tissue to remove discharge from eyes, and wash hands to prevent the spread of infection.
• If medication is prescribed, finish the course of antibiotics, as directed, to make sure that the infection is cleared up and does not recur.
• Avoid contact, such as vigorous physical activities, with other persons until symptoms resolve.