Conjunctivitis

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

  1. Viral Conjunctivitis
    • Caused by viruses, often adenoviruses.
    • Highly contagious and commonly spreads through respiratory droplets or direct contact.
  2. Bacterial Conjunctivitis
    • Caused by bacteria such as Staphylococcus aureus, Streptococcus pneumoniae, or Haemophilus influenzae.
    • May produce thick, yellow or green discharge.
  3. Allergic Conjunctivitis
    • Triggered by allergens such as pollen, dust mites, or pet dander.
    • Often seasonal and associated with other allergic conditions like hay fever.
  4. 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

  1. Infectious Causes
    • Viruses: Adenovirus, herpes simplex virus (rare).
    • Bacteria: Neisseria gonorrhoeae or Chlamydia trachomatis in severe cases.
  2. Allergens
    • Pollen, molds, or animal dander.
  3. Irritants
    • Chlorine in swimming pools, smoke, or strong odors.
  4. Contact Lens Use
    • Poor hygiene or prolonged wear can lead to irritation or infection.
  5. Autoimmune Conditions
    • Conditions like Stevens-Johnson syndrome may cause chronic conjunctivitis.

Symptoms of Conjunctivitis

  1. General Symptoms
    • Redness in one or both eyes.
    • Itching, burning, or gritty sensation.
    • Watery or thick discharge.
  2. Viral Conjunctivitis
    • Watery discharge, often starting in one eye and spreading to the other.
    • Associated with cold or respiratory symptoms.
  3. Bacterial Conjunctivitis
    • Thick, yellow or green discharge, causing the eyelids to stick together, especially after sleep.
    • Swelling of the eyelids.
  4. Allergic Conjunctivitis
    • Intense itching and tearing.
    • Swollen eyelids and nasal symptoms like sneezing or congestion.
  5. 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

  1. Clinical History
    • Review of symptoms, exposure to infections, or recent allergen exposure.
  2. Physical Examination
    • Inspecting the eyes for redness, swelling, and discharge.
  3. Laboratory Tests
    • Swab for Culture: Identifies bacterial or viral causes in severe cases.
    • Allergy Testing: Identifies specific allergens in allergic conjunctivitis.
  4. 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.