Introduction
- Conjunctivitis, commonly known as “pink eye,” is inflammation or infection of the conjunctiva, the thin, transparent tissue covering the white part of the eye and the inner eyelids.
- It can be caused by infections, allergies, or irritants and is highly contagious in its infectious forms.
- Proper diagnosis and management are crucial to prevent complications and spread, especially in community settings like schools or workplaces.
Types of Conjunctivitis
- Viral Conjunctivitis
- Caused by viruses, often adenoviruses.
- Highly contagious and commonly spreads through respiratory droplets or direct contact.
- Bacterial Conjunctivitis
- Caused by bacteria such as Staphylococcus aureus, Streptococcus pneumoniae, or Haemophilus influenzae.
- May produce thick, yellow or green discharge.
- Allergic Conjunctivitis
- Triggered by allergens such as pollen, dust mites, or pet dander.
- Often seasonal and associated with other allergic conditions like hay fever.
- Irritant Conjunctivitis
- Caused by exposure to chemicals, smoke, or foreign objects in the eye.
- Non-contagious and usually resolves once the irritant is removed.
Causes of Conjunctivitis
- Infectious Causes
- Viruses: Adenovirus, herpes simplex virus (rare).
- Bacteria: Neisseria gonorrhoeae or Chlamydia trachomatis in severe cases.
- Allergens
- Pollen, molds, or animal dander.
- Irritants
- Chlorine in swimming pools, smoke, or strong odors.
- Contact Lens Use
- Poor hygiene or prolonged wear can lead to irritation or infection.
- Autoimmune Conditions
- Conditions like Stevens-Johnson syndrome may cause chronic conjunctivitis.
Symptoms of Conjunctivitis
- General Symptoms
- Redness in one or both eyes.
- Itching, burning, or gritty sensation.
- Watery or thick discharge.
- Viral Conjunctivitis
- Watery discharge, often starting in one eye and spreading to the other.
- Associated with cold or respiratory symptoms.
- Bacterial Conjunctivitis
- Thick, yellow or green discharge, causing the eyelids to stick together, especially after sleep.
- Swelling of the eyelids.
- Allergic Conjunctivitis
- Intense itching and tearing.
- Swollen eyelids and nasal symptoms like sneezing or congestion.
- Irritant Conjunctivitis
- Immediate redness and discomfort after exposure to irritants.
Complications of Conjunctivitis
- Corneal Involvement: Viral or bacterial conjunctivitis can spread to the cornea, causing keratitis.
- Vision Problems: Prolonged untreated infections may result in scarring or vision impairment.
- Chronic Conjunctivitis: Persistent inflammation from allergens or irritants.
- Spread of Infection: Highly contagious forms can cause outbreaks.
Diagnosis of Conjunctivitis
- Clinical History
- Review of symptoms, exposure to infections, or recent allergen exposure.
- Physical Examination
- Inspecting the eyes for redness, swelling, and discharge.
- Laboratory Tests
- Swab for Culture: Identifies bacterial or viral causes in severe cases.
- Allergy Testing: Identifies specific allergens in allergic conjunctivitis.
- Fluorescein Staining
- Used to detect corneal abrasions or keratitis.
Treatment Options for Conjunctivitis
1. Viral Conjunctivitis
- Self-Limiting: Symptoms usually resolve within 7–14 days without specific treatment.
- Supportive Care:
- Cool compresses for comfort.
- Artificial tears to relieve dryness.
- Antiviral Medication: Required for herpes simplex virus (e.g., Acyclovir).
2. Bacterial Conjunctivitis
- Topical Antibiotics:
- Eye Drops: Chloramphenicol, Ciprofloxacin or Tobramycin.
- Ointments: Erythromycin or Bacitracin for nighttime use.
- Improvement typically occurs within 2–3 days of starting treatment.
3. Allergic Conjunctivitis
- Antihistamines:
- Eye drops (e.g., Olopatadine, Ketotifen).
- Oral antihistamines for systemic symptoms (e.g., Loratadine).
- Mast Cell Stabilizers: Cromolyn sodium to prevent allergic reactions.
- Cool Compresses: Reduce swelling and discomfort.
4. Irritant Conjunctivitis
- Immediate Irrigation: Rinse eyes thoroughly with clean water or saline.
- Lubricating Eye Drops: Relieve dryness and irritation.
- Avoidance: Identify and avoid future exposure to irritants.
Monitoring Parameters
- Symptom Resolution: Monitor for improvement in redness, discharge, and irritation.
- Infection Spread: Prevent cross-contamination to other eye or individuals.
- Adherence to Treatment: Ensure correct use of medications.
- Complications: Watch for worsening symptoms, indicating corneal involvement or systemic infection.
Patient Counseling Points
- Wash hands frequently and avoid touching or rubbing the eyes.
- Do not share personal items like towels, makeup, or contact lenses.
- Discontinue contact lens use during treatment for conjunctivitis.
- Use separate eye drops for each eye if one eye is infected.
- Return to school or work only after symptoms have resolved (typically 24–48 hours after starting antibiotics for bacterial conjunctivitis).
Use in Children
- Viral and bacterial conjunctivitis are common; ensure proper hygiene and regular follow-ups.
- Avoid over-the-counter medications not approved for pediatric use.
Use in Elderly
- Rule out underlying systemic conditions, such as dry eye syndrome or autoimmune disorders, that may mimic or exacerbate conjunctivitis.
FAQs About Conjunctivitis
Q1: What causes conjunctivitis?
- Viruses, bacteria, allergens, irritants, or systemic conditions.
Q2: Is conjunctivitis contagious?
- Viral and bacterial forms are highly contagious; allergic and irritant types are not.
Q3: How is conjunctivitis treated?
- Viral: Supportive care.
- Bacterial: Antibiotic eye drops or ointments.
- Allergic: Antihistamines and mast cell stabilizers.
Q4: How long does conjunctivitis last?
- Viral: 7–14 days.
- Bacterial: 3–5 days with treatment.
- Allergic: As long as the allergen is present.
Q5: Can conjunctivitis affect vision?
- Mild blurriness is common but should resolve with treatment; severe cases may cause complications like keratitis.
Q6: When should I see a doctor for conjunctivitis?
- If symptoms worsen, there is severe pain, or vision changes occur.
Q7: Can I wear contact lenses with conjunctivitis?
- No, discontinue use until symptoms fully resolve.
Q8: Are over-the-counter drops effective?
- Artificial tears can help, but antibiotic or antihistamine drops require a prescription.
Q9: Can conjunctivitis come back?
- Yes, especially if caused by allergies or recurrent infections.
Q10: How can I prevent conjunctivitis?
- Practice good hygiene, avoid sharing personal items, and stay away from infected individuals.
Q11: Are children more susceptible to conjunctivitis?
- Yes, due to close contact in schools and daycare.
Q12: Can pets cause conjunctivitis?
- Yes, allergens from pets can trigger allergic conjunctivitis.
Q13: Is conjunctivitis dangerous during pregnancy?
- Most forms are mild, but consult a doctor for safe treatment options.
Q14: How is neonatal conjunctivitis treated?
- Requires immediate medical attention, often with antibiotics, to prevent complications like blindness.
Q15: Can conjunctivitis be prevented with vaccines?
- Some forms, like adenoviral conjunctivitis, are indirectly preventable with vaccines like the flu vaccine.