Conjunctivitis – the causes, symptoms and treatments.

Conjunctivitis – or pink eye – is an eye condition that can cause significant discomfort to the eyes. Not only that, it also makes the eyes look their very worst due to redness. Conjunctivitis is a very vague term, as it means inflammation but does not describe the cause of the inflammation and irritation. This can be fraught with danger as misdiagnosis is just all too common. All of us will at some stage experience the condition, whether it be as a child, perhaps picked up in the school yard, or as an adult through allergies or perhaps a virus. Either way, it is not a pleasant experience.

The Wrong Diagnosis

At The Eye Practice, we see patients who have been misdiagnosed as having a bacterial infection, when in fact they have something else causing the inflammation. These patients, are not only misdiagnosed, they are then given the wrong treatment. Instead of having the eyes settle in around 7 days, these patients can have the condition lingering for weeks or months even until they are treated appropriately. Unfortunately this happens all too often. Stickiness, mucous, redness and irritation for any length of time is very uncomfortable and embarrassing. Misinformation about conjunctivitis treatment is all too common. Even websites with great authority can accidentally misinform about conjunctivitis. Do not get caught in the Chlorsig trap. You can be different.

What Do I Do If I Have Pink Eye?

If you are experiencing any of the symptoms of conjunctivitis, be sure you understand the importance of accurate diagnosis and treatment and seek the appropriate advice. A day does not go by that we do not see a few cases of red eyes. Many of these have wandered in after a month or two of non resolving conjunctivitis, which is no more than a toxic reaction to all sorts of preservatives. It is so simple. The key is a correct diagnosis. Without a correct diagnosis all that happens is a “best guess”, which invariably is wrong. Is this what you want for your eyes? Read on and you will see how to sort this mess out.

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QUICK GUIDE FOR TREATMENT OF RED EYES

What is Conjunctivitis?

This eye condition is the inflammation and/or infection of the thin, transparent layer that covers the white of the eye and underneath the eyelids. It is usually characterised by redness, irritation and watering of the eye and a watery or mucous discharge. The condition can be very contagious and it is important to get a correct diagnosis and treatment. It is also important to understand that conjunctivitis DOES NOT necessarily mean eye infection.

Red Eyes

Symptoms can vary but usually include:

• Excessive tearing
• Mucus discharge
• Redness and irritation
• Itching and burning
• Crusty eyelashes
• Swelling of the eyelids
• Photophobia – bright light is intolerable

Symptoms typically develop within 24 hours of becoming infected and depending on treatment, may last anywhere from a couple of days to three weeks.

Causes

Conjunctivitis is most commonly caused by an allergic reaction, dry eyes, bacterial or viral infection, irritants, contaminated fingers or a foreign body in the eye. It can also be contracted through a sexually-transmitted disease.

Viral and Bacterial Conjunctivitis

Bacterial and viral conjunctivitis are extremely contagious and are easily spread through poor hand washing or sharing things like face towels or make up. It can also be spread by coughing and sneezing, particularly with children in their early school years.

Conjunctivitis in Babies

Babies can develop this eye condition either as newborns or, typically after 3 months of age. Conjunctivitis contracted from an STD can occur during birth, from an infected mother, and cause newborn babies to contract this disease. This is referred to as neonatal conjunctivitis, and is very serious as it can lead to scarring of the baby’s eyes and even vision loss. Symptoms include red, puffy eyes and thick discharge or pus. Symptoms usually appear within 5-10 days of birth (Chlamydia) or within 2-4 days of birth (Gonorrhoea) and both are serious bacterial infections that require immediate treatment. Sometimes the conjunctivitis is caused by a reaction to the antibiotic eye drops used in babies’ eyes to protect against such infections. This chemical conjunctivitis typically only lasts a day or two and causes redness and swelling but not pus. Babies can also be infected with other, less serious bacterial and viral infections during birth. All eye infections in newborns should be seen by a paediatrician. Once babies start to touch things with their hands – typically from about 3 months of age – they can introduce bacteria into their eyes and cause bacterial conjunctivitis. This requires treatment with an antibiotic eye drop. Chlorsig is often the eye drop of choice as it is effective against a broad spectrum of pathogens. Severe adverse reactions to Chlorsig eye drops are extremely rare but include aplastic anaemia and bone marrow suppression.

Grey Baby Syndrome

Chloramphenicol is an antibiotic used for a range of bacterial infections. But be aware that intravenous use has a very small risk of causing Grey Baby Syndrome – a rare but serious complication caused by accumulation of Chloramphenicol in infants, especially premature babies, whose tiny organs cannot metabolise a build up of the drug in their system. This condition can occur when mothers are injected with the drug during labour, for example if they have bacterial meningitis or other serious infections. The drug can be passed onto their baby. Chlorsig eye drops for the treatment of neonatal eye infections are not associated with Grey Baby Syndrome.

Allergic Conjunctivitis

Allergy happens when the immune system overreacts to something that it has become highly sensitive to. Allergic conjunctivitis is caused by an allergic reaction to substances like pollen and mould. This is typical during the spring season, along with hay fever, particularly on very windy days when the pollen count is usually high. This can also occur when coming into contact with some animals. This is usually caused by an allergy to the animal’s fur, skin flakes (dander), saliva, or urine.

Giant Papillary Conjunctivitis

Another type of allergic conjunctivitis is directly related to contact lens wear. Giant papillary conjunctivitis occurs when the undersides of the eyelids become inflamed due to a reaction with contact lenses – usually soft lenses that are not disposed of daily.

Dry Eyes Conjunctivitis

Dry eyes is one of the most common underlying causes of this eye disease. The symptom that drives most people to seek treatment for dry eyes is redness. Managing the dry eye disease means less inflammation and redness.

Irritants / Chemical Conjunctivitis

This eye condition can be caused by contact to the eye by irritants, such as, chlorine from swimming pools, smoke, and ingredients in cosmetics. Contact on the eye from contact lenses (or their solutions) can also cause conjunctivitis as does a chemical splash in the eye. Medicamentosa is the term used to describe a type of eye inflammation caused by prolonged exposure to eyedrops. Visine and other decongestant drops can also cause conjunctivitis through a rebound effect; as soon as you stop using the drop, the inflammation returns even worse than it was to start. Toxicity to eye drops such as Chlorsig is another common cause of this eye disease. The preservatives contained in the eye drops are usually the culprit. It is ironic that many patients, GPs and pharmacists reach for the Chlorsig as soon as they see conjunctivitis and yet it can make the problem worse.

Gonococcal Conjunctivitis and Chlamydia Trachomatis

Sexually transmitted diseases (STD’S) such as chlamydia, gonorrhoea and the herpes virus can cause a conjunctivitis infection. These are bacterial infections and therefore cause a bacterial conjunctivitis that needs to be treated very quickly. In some cases, and admittedly it is rare, gonorrhoea can cause one of the most serious bacterial infections to the eye (trachoma), that could lead to blindness if not treated promptly. The bacteria can penetrate the cornea, causing corneal ulcers.

Conjunctivitis Treatment

It is imperative to diagnose what is the cause of this eye disease before any treatment is started. Many eye problems have similar symptoms and it is important that your eye problem is diagnosed correctly in order for it to be treated effectively and quickly.

• Conjunctivitis is often treated by GP’s and Pharmacists using an antibiotic called Chlorsig. Please note that rarely is this the correct option. It often makes the condition worse due to the preservatives.
• Most viral conjunctivitis are best left to run their course with no specific treatment required. This can usually take up to 1 week to clear up.
• Bacterial conjunctivitis needs to be treated. This is usually treated with a course of antibiotic eye drops or antibiotic ointment. Sometimes a course of oral antibiotic medication may be prescribed.
• Chemical conjunctivitis needs immediate treatment by washing the affected area (eyes) for about 5 minutes, and calling your optometrist for appointment. After the eye has been rinsed clean from the substance, drops or ointments may be prescribed.
• Chronic or severe inflammation of your eyes may need a short course of steroid eye drops (also called cortico-steroids) to kick-start the healing process.
• For inflammation related to dry eyes, allergy or irritants, the conjunctivitis will not be resolved until the underlying condition is managed. Changing contact lenses and treating underlying dry eye and allergy can all help to eliminate conjunctivitis.
• For viral conjunctivitis, often the best treatment is no eye drops at all. Regular cold compresses can provide symptomatic relief and the condition will resolve on its own much like a common cold.
• Please note the use of 5% ophthalmic iodine combined with a moderate steroid anecdotally seems to stop viral conjunctivitis in its tracks.  More on this in future blogs.

Prevention

Conjunctivitis is contagious. It is easily spread. But if you do have it, you can limit its spread by following these steps:

• Avoid touching or rubbing your eyes. If you have the condition in one eye you are likely to spread it to the other eye.
• Wash hands regularly with soap and water
• Wash hands before and after applying drops to the eyes.
• Wash hands before and after cleaning the eyelids.
• Do not use the same eye drop bottle for infected and non-infected eye.
• Do not wear contact lenses until your optometrists advises you to do so.
• If you wear glasses, clean the lenses regularly with a disposable cloth.
• Do not share towels, pillows, makeup, eye drops, glasses, or any other personal items.
• Avoid swimming pools.

Complications

Most of us have either had conjunctivitis, or know someone who has had it. It’s very common but that doesn’t mean you should not take this condition seriously. In most cases, the condition will be gone within two weeks but in cases where the condition is a bacterial infection or an infection from an STD, the complications can be very serious. Possible complications can include the following:

• Meningitis
• Cellulitis
• Septicaemia
• Otitis Media
• Pneumonia (Neonatal)

Things to remember

• Conjunctivitis needs to be diagnosed by your optometrist or ophthalmologist promptly
• It can be VERY contagious
• Symptoms last between two days and three weeks
• Viral conjunctivitis can linger with significant eye irritation, redness and even blurry vision for months, if not treated properly.
• Children with the condition should not attend school, preschool or any other activities or events around other children
• Wash hands and do not share any personal items

Many eye problems have similar symptoms and it is important that your eye problem is diagnosed correctly in order for it to be treated effectively and quickly.