Conjunctivitis (inflammation of the eye)

Reviewed by Dr Caroline McEwan, consultant ophthalmologist, Dr Whye Onn Ho, specialist registrar and Dr Una O' Colmain, specialist

registrar
What is conjunctivitis?

Inflammation is seen as reddish change

in the periphery of the eye often
accompanied by a pus-like discharge.
Conjunctivitis is an inflammation of the conjunctiva, which is the mucous membrane covering the white of the eyes and the inner side of the
eyelids.
It usually affects both eyes at the same time – although it may start in one eye and spread to the other after a day or two. It may be
asymmetrical, affecting one eye more than the other.
There are many causes and the treatment will depend upon the cause.
Conjunctivitis is a common eye condition. It's not serious, but it can be uncomfortable and irritating.
What causes conjunctivitis?
There are five different kinds of conjunctivitis, each with its own cause.
Bacterial conjunctivitis
Bacterial conjunctivitis is an infection caused by bacteria, such as staphylococci, streptococci or haemophilus. These organisms may come
from the patient's own skin or upper respiratory tract or they may be caught from another person with conjunctivitis.
Viral conjunctivitis
Viral conjunctivitis is often associated with the common cold. This may be caused by a virus called 'adenovirus'. This type of conjunctivitis
can spread rapidly between people and may cause an epidemic of conjunctivitis.
Chlamydial conjunctivitis
This type of conjunctivitis is caused by an organism called Chlamydia trachomatis. This organism may also affect other parts of the body and
can cause the sexually transmitted infection chlamydia.
Allergic conjunctivitis
Allergic conjunctivitis is common in people who have other signs of allergic disease, such as hay fever, asthma and eczema. The
conjunctivitis is often caused by antigens like pollen, dust mites or cosmetics.
Reactive conjunctivitis – chemical or irritant conjunctivitis
Some people are susceptible to chemicals in swimming pools or to smoke or fumes, and this can cause an irritation of the conjunctiva with
discomfort, redness and watering. In such cases these irritants should be avoided.
What are the symptoms of conjunctivitis?
Bacterial conjunctivitis
This is a condition that affects both eyes. The eyes will usually feel gritty and irritated with a sticky discharge. The eyelids may be stuck
together particularly in the mornings, and there may be discharge or crusting on the eyelashes.
Viral conjunctivitis
The eyes are red and there may be a watery discharge.
Often the eyelids are very swollen and even the conjunctiva on the white of the eye may be swollen, creating a glassy appearance.
The eyes are uncomfortable, and there may also be the generalised symptoms of a cold. Sometimes there are tender lymph nodes (swollen
glands) around the ear or the neck.
This type of conjunctivitis may also spread to affect the cornea (keratitis), and it may persist for several weeks and cause hazy vision.
Chlamydial conjunctivitis
One or both eyes will be red with a sticky discharge and, sometimes, swollen eyelids. The cornea may also be involved in this condition.
Allergic conjunctivitis
Allergic conjunctivitis is usually associated with intense itching of the eyes.
There may be a stringy discharge and the eyes are usually intermittently red. This may occur at particular times of the year, for instance
during spring and summer when there is a lot of pollen in the air.
Conjunctivitis in young children
Small children may be susceptible to infective conjunctivitis, and they may develop severe forms of the condition because of poor immune
defences.
This is particularly the case in babies, and conjunctivitis in an infant aged less than one month old is a notifiable disease in the UK.
This type of conjunctivitis (ophthalmia neonatorum) may be due to an infection that has been contracted during the passage through the
mother’s birth canal and may include the sexually transmitted infections, such as gonococcal or chlamydialinfection.
Small babies may develop conjunctivitis from other types of infection, but swabs should always be taken in order that appropriate treatment
can be given.
Small babies often have poorly developed tear drainage passages (a condition known as nasolacrimal duct obstruction).
These children are susceptible to watering eyes and they may intermittently become sticky, but this is usually not serious and most of the
time this settles down with no treatment.
How is conjunctivitis treated?
Bacterial conjunctivitis
This is usually treated with broad spectrum antibiotic drops or ointment, (egchloramphenicol or fusidic acid).
The eyes should also be cleaned with cotton wool soaked in cooled boiled water to remove any crusts or stickiness.
For bacterial conjunctivitis, research evidence shows that while 64 per cent of cases will clear on their own within five days, antibiotic eye
medication does lead to increased cure rates and earlier remission.
Viral conjunctivitis
There is no effective treatment for viral conjunctivitis. But the eyes may be made more comfortable by using a lubricant ointment such
as Lacri-Lube.
Cold compresses on the eyes and tablets, such as paracetamol andibuprofen, can help the symptoms.
As this is a highly contagious condition, it's important to ensure that a strict code of hygiene is adhered to, such as hand and face washing
and no sharing of face towels.
Close contact with other people, eg at school, is not recommended for the first one to two weeks to help prevent spread of the infection.
This condition may go on for a prolonged time and in some instances corticosteroid drops have been advocated although these should only
be given under the strict supervision of a doctor specialising in eye disease (ophthalmologist).
Chlamydia conjunctivitis
Treatment is with chlorotetracycline ointment to both eyes and tetracycline tablets in order to ensure that infection elsewhere is controlled.
Children cannot be treated with tetracycline tablets, and erythromycin is usually used for them.
Because of the possible infection of other mucous membranes any associated sexually transmitted infection should be identified and both
the patient and their partners must be treated.
Conjunctivitis in infants
This needs to be taken very seriously.
Specimens are taken from the sticky discharge and such children must be seen by an ophthalmologist.
Treatment is given depending on the underlying cause of the conjunctivitis, based on results of the swabs from the laboratory.
Allergic conjunctivitis
This can be treated using topical antihistamine drops.
Drops, such as sodium cromoglicate (eg Opticrom eye drops), can be used to prevent the allergic response and they need to be used for
many weeks in order to give any result.
Corticosteroid drops are occasionally used, but should only be used under the supervision of an ophthalmologist.
The main treatment should be identifying what is triggering off the allergic response and removing this source of allergen.
What is Trachoma?
Trachoma is a form of conjunctivitis that is common in the developing world, particularly in parts of Africa and Asia.
It's exacerbated by a lack of clean water because it's spread by contact with other infected people and by flies.
Trachoma is one of the world’s greatest causes of blindness because long-standing infection develops and causes scarring of the eyelids
and eyes.
The most effective treatment is to provide a clean supply of water that allows good hygiene.
Antibiotics are also effective in treating the infection in the short term, but recurrent re-infection from within communities causes more
damage.
How does the doctor make the diagnosis?
Conjunctivitis can usually be diagnosed and treated by your GP.
The doctor will usually diagnose the condition based on examination of your eyes and the history that you give.
Sometimes, a swab has to be taken from the eye – especially if there is no improvement on standard treatment.
In some cases that are severe or do not respond to treatment, you may need to see an eye specialist (ophthalmologist).
What should I pay particular attention to?
If there is any worsening of the symptoms despite treatment or if the vision deteriorates, a further consultation with your doctor should be
requested even if treatment is being carried out.
If you wear contact lenses and develop symptoms of conjunctivitis, it's important to see your doctor. People who wear contact lenses can
develop a serious infection of the cornea which requires specialist treatment.
What can be done to avoid conjunctivitis?
Good hygiene of hands and face is important. There should be no sharing of face towels, especially if someone has conjunctivitis.
Conjunctivitis can spread from one eye to the other, especially when you rub your eyes. Pus and crust should be removed by bathing the eye
with lukewarm salt water, which can also lessen the symptoms.
Use disposable tissues when you dry the eyes and throw them away after use. This will limit the contamination. Dispose of any antibiotic eye
drops after the treatment is over.
People who suffer from conjunctivitis should have a special towel that only they use.
It is sensible to never share eye make up or eye drops with another person.
How does conjunctivitis usually progress?
Even if left untreated, most forms of conjunctivitis will gradually get better on their own in a few weeks. Allergic conjunctivitis usually
continues while there's exposure to the aggravating agent.
With appropriate treatment, the eyes are usually more comfortable within a few days, although cases of adenoviral infection may cause
problems for some weeks.
Other people also read:
Allergy: get advice on what other things provoke attacks.
Cataracts: how does the doctor make a diagnosis?
Chlamydia infections: what complications can it cause?
Hay fever and allergic perennial rhinitis: what medicine can you take?
References
Sheikh A, Hurwitz B, Cave J. Antibiotics for acute bacterial conjunctivitis. Cochrane Library. Issue 3, 1999.
Based on a text by Per Lykke Gregersen, consultant
Last updated 03.02.2011