Conjunctivitis/Pink Eye

The leading cause of a red, inflamed eye is virus infection. A number of different viruses can be responsible for the infection. Viral pink eye symptoms are usually associated with more of a watery discharge that is not green or yellow in color. Often, viral "cold-like" symptoms, such as sinus congestion and runny nose, are also present. The eyelids may be swollen. Sometimes looking at bright lights is painful. While viral pink eye may not require an antibiotic, those affected should see a doctor, as occasionally this form of pink eye can be associated with infection of the cornea (the clear portion of the front of the eyeball). This infection must be correctly detected and treated. Viral pink eye is highly contagious. Viral pink eye usually resolves in seven to 10 days after symptoms appear.

Conjunctivitis caused by a sexually transmitted disease should be treated by a medical doctor. With other forms of conjunctivitis, some types of alternative treatments may be helpful. Some practitioners suggest strengthening of the immune system with herbs such as St. John's wort. Some symptoms of conjunctivitis may be relieved by the use of herbs, such as windflower, eyebright, and Belladonna. These herbs can be prepared in the form of eye drops or eye washes. Preparations should be kept sterile. If no improvement is seen, medical advice should be sought.

A simple home remedy for the relief of the symptoms of conjunctivitis is a boric acid eyewash. A warm compress applied to the eyes for five to ten minutes three times a day can also be helpful. Allergic conjunctivitis should be treated with a cool compress.

Diagnosis of conjunctivitis is usually based on a medical history and physical examination. A doctor will ask when the symptoms began, how long the condition has been going on, the symptoms experienced, and if the patient has had any recent infections or diseases. Contact with anyone who has had conjunctivitis is also important information.

Diagnosis is usually relatively simple because symptoms are obvious. In rare cases, smears may be taken. A smear is obtained by collecting discharge from the eye on a cotton swab. The discharge can then be kept in a warm place until any bacteria that are present begin to grow. The bacteria can then be studied under a microscope.

If treated properly, conjunctivitis usually disappears within a week or two. In cases caused by environmental agents, it gets better only when those agents can be removed or avoided. Cases in which symptoms do not disappear after seventy-two hours, in which there is severe eye pain or changes in vision, or in which a herpes infection is suspected, should be treated by a medical doctor. Untreated cases of conjunctivitis can result in more serious eye problems, such as diminished vision or loss of eyesight.

Many cases of conjunctivitis can be prevented by some simple hygienic practices. These include the following:

Frequent hand washing with antiseptic soap, followed by hand drying with paper towels (to prevent spreading the infection).
Avoidance of substances in the environment known to cause conjunctivitis, such as dust and pollen.
Use of protective eye wear and screens in areas where unusual light conditions are used (such as in tanning salons).
Use of a clean tissue to remove discharge from the eyes.
Careful attention to instructions for the use of antibiotics in the treatment of conjunctivitis, making sure that all of the prescribed medication is used up.
Avoiding contact with people who already have the disease.

American Academy of Ophthalmology (National Eyecare Project). PO Box 7424, San Francisco, CA 94120-7424. (800) 222-EYES. http://www.eyenet.org.

American Optometric Association. 243 North Lindbergh Boulevard, St. Louis, MO, 63141. (314) 991-4100. http://www.aoanet.org.

Allergic conjunctivitis shows pale watery swelling or edema of the conjunctiva and sometimes the whole eyelid, often with a ropy, non-purulent mucoid discharge. There is variable redness.

Viral conjunctivitis, commonly known as "pink eye", shows a fine diffuse pinkness of the conjunctiva which is easily mistaken for the 'ciliary infection' of iritis, but there are usually corroborative signs on biomicroscopy, particularly numerous lymphoid follicles on the tarsal conjunctiva, and sometimes a punctate keratitis.

Pyogenic bacterial conjunctivitis shows an opaque purulent discharge, a very red eye, and on biomicroscopy there are numerous white cells and desquamated epithelial cells seen in the 'tear gutter' along the lid margin. The tarsal conjunctiva is a velvety red and not particularly follicular. Non-pyogenic infections can show just mild injection and be difficult to diagnose. Scarring of the tarsal conjunctiva is occasionally seen in chronic infections, especially in trachoma.

Irritant or toxic conjunctivitis show primarily marked redness. If due to splash injury, it is often present only in the lower conjunctival sac. With some chemicals-above all with caustic alkalis such as sodium hydroxide-there may be necrosis of the conjunctiva with a deceptively white eye due to vascular closure, followed by sloughing of the dead epithelium. This is likely to be associated with slit-lamp evidence of anterior uveitis.

Conjunctivitis symptoms and signs are relatively non-specific. Even after biomicroscopy, laboratory tests are often necessary if proof of aetiology is needed.

A purulent discharge strongly suggests bacterial cause, unless there is known exposure to toxins. Infection with Neisseria gonorrhoeae should be suspected if the discharge is particularly thick and copious.

A diffuse, less "injected" conjunctivitis (looking pink rather than red) suggests a viral cause, especially if numerous follicles are present on the lower tarsal conjunctiva on biomicroscopy.

Scarring of the tarsal conjunctiva suggests trachoma, especially if seen in endemic areas, if the scarring is linear (von Arlt's line), or if there is also corneal vascularisation.

Clinical tests for lagophthalmos, dry eye (Schirmer test) and unstable tear film may help distinguish the various types of dry eye.

Other symptoms including pain, blurring of vision and photophobia should not be prominent in conjunctivitis. Fluctuating blurring is common, due to tearing and mucoid discharge. Mild photophobia is common. However, if any of these symptoms are prominent, it is important to exclude other diseases such as glaucoma, uveitis, keratitis and even meningitis or caroticocavernous fistula.

Many people who have conjunctivitis have trouble opening their eyes in the morning because of the dried mucus on their eyelids. There is often excess mucus over the eye after sleeping for a long period of time.

-wikipedia.org

Investigations are done infrequently because most cases of conjunctivitis are treated empirically and (eventually) successfully, but often only after running the gamut of the common possibilities.

Swabs for bacterial culture are necessary if the history & signs suggest bacterial conjunctivitis, but there is no response to topical antibiotics. Research studies indicate that many bacteria implicated in low-grade conjunctivitis are not detected by the usual culture methods of medical microbiology labs, so negative results are common. Viral culture may be appropriate in epidemic case clusters. Conjunctival scrapes for cytology can be useful in detecting chlamydial and fungal infections, allergy and dysplasia, but are rarely done because of the cost and the general lack of laboratory staff experienced in handling ocular specimens. Conjunctival incisional biopsy is occasionally done when granulomatous diseases (e.g., sarcoidosis) or dysplasia are suspected.

Conjunctivitis sometimes requires medical attention. The appropriate treatment depends on the cause of the problem. For the allergic type, cool water constricts capillaries, and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, non-steroidal anti-inflammatory medications and antihistamines may be prescribed. Some patients with persistent allergic conjunctivitis may also require topical steroid drops.

Bacterial conjunctivitis is usually treated with antibiotic eye drops or ointments that cover a broad range of bacteria (chloramphenicol or fusidic acid used in UK). However evidence suggests that this does not affect symptom severity and gains only modest reduction in duration from an average of 4.8 days (untreated controls) to 3.3 days for those given immediate antibiotics. Deferring antibiotics yields almost the same duration as those immediately starting treatment with 3.9 days duration, but with half the two-week clinic reattendance rate.

Although there is no cure for viral conjunctivitis, symptomatic relief may be achieved with warm compresses and artificial tears. For the worst cases, topical corticosteroid drops may be prescribed to reduce the discomfort from inflammation. However prolonged usage of corticosteroid drops increases the risk of side effects. Antibiotic drops may also be used for treatment of complementary infections. Patients are often advised to avoid touching their eyes or sharing towels and washcloths. Viral conjunctivitis usually resolves within 3 weeks. However in worst cases it may take over a month.

Conjunctivitis due to burns, toxic and chemical require careful wash-out with saline, especially beneath the lids, and may require topical steroids. The more acute chemical injuries are medical emergencies, particularly alkali burns, which can lead to severe scarring, and intraocular damage. Fortunately, such injuries are uncommon.