CONJUNCTIVITIS - a patient's guide
Dr Peter Ring - Eye Surgeon

Overview

Conjunctivitis is an inflammation of the eye

Symptoms include itching, swelling and discharge

Apart from the discharge, conjunctivitis does not impair vision

Most cases of conjunctivitis are due to a virus or bacterial infection

Treatment normally involves eye drops or ointment

The infection should clear within about one week

To prevent conjunctivitis do not share makeup, towels, or other's eye medication

Soft contact lens wearers should practise careful hygiene when handling their lenses

What is it?

Conjunctivitis is an inflammation of the membrane (conjunctiva) that covers the white of the eye and lines the inner surface of the eyelids. It can be caused by a variety of organisms, or allergy.

Symptoms:

Redness, itching, and swelling of the lids are the main symptoms. The consistency of the discharge may vary from watery to pus depending on the specific cause of the conjunctivitis. Apart from the visual disturbance due to the discharge, there should be no significant impairment of the vision. There should not be any undue sensitivity to light (photophobia).

How do you get conjunctivitis?

Most cases of conjunctivitis are due to bacteria or viruses and may be transmitted to the eye by contaminated hands, towels, handkerchiefs and soft contact lenses. Conjunctivitis tends to be contagious so hygiene is important to prevent spread of an infection.

Treatment:

This varies depending upon the course, but usually involves the administration of ointments or drops. Cool compresses applied to the eye may help reduce itching and swelling. If soft contact lenses are worn they should be disposed of and new lenses inserted once the infection has resolved.

Prevention of conjunctivitis:

This is hard to prevent, but there are measures that can be taken to decrease the risk:

Do not share eye makeup or cosmetics with somebody else

Avoid sharing towels

Wash hands frequently and keep them away from the eyes

Do not use eye medication which has been prescribed for somebody else or is out of date

Soft contact lens wearers should be meticulous with their hygiene in handling their contact lenses

Different types of conjunctivitis:

Bacterial conjunctivitis:

This can occur due to any type of bacteria and the principle feature is the thick muco-purulent (pus) discharge on the eyelids. This may prevent the patient from opening their eyes in the morning. Ideally, the infection should be tested by a laboratory before treatment is started, and there should be a good response within five days.

Viral conjunctivitis:

There may be more discomfort associated with this compared to bacterial conjunctivitis and the discharge is watery rather than purulent. Some cases of viral conjunctivitis are proceeded by a fever and sore throat and a tender gland may be felt in front of the ear which confirms the diagnosis. Unlike bacterial conjunctivitis, the virus cannot be killed by antibiotic drops. The infection is self-limiting so treatment is cold compresses, artificial tears and in severe cases an ophthalmologist will prescribe steroid eye drops. The symptoms last 7-10 days and may grumble on for another few weeks.

Conjunctivitis and sexually transmitted diseases

Infants who get conjunctivitis within the first 10 days of life may have an infection due to gonococcus or chlamydia which they will have picked up during passage through the mother's birth canal. Treatment of mother and baby is indicated.

Gonococcal conjunctivitis in the adult is extremely rare but more commonly seen is chlamydial conjunctivitis typically affecting sexually active teens and young adults. The symptoms are of typical conjunctivitis but the history is one of an infection that has persisted for over three weeks despite treatment with topical antibiotics. Diagnosis of this type of conjunctivitis must be made with laboratory tests as specific treatment is available for these organisms.

Allergic conjunctivitis

This is the most mild and chronic form of conjunctivitis and is due to an allergen or foreign substance irritating the eye. The symptoms will have been present for a long time and may even be seasonal, particularly if it is related to vegetation. Itchiness is sometimes a prominent feature and there may also be a history of other allergies such as asthma, eczema or hay fever.

The first line of treatment is to avoid the allergen if that is known. Women using makeup should avoid doing so in the first instance. There are various decongestant eye drops available such as Albalon, Albalon-A, Naphcon, Naphcon-A and Visine. There are some more recent specific anti-allergy drops such as Livostin and Lomide. Non-steroidal anti-inflammatory drops such as Acular and Ocufen may have a place, but need to be prescribed by a specialist.