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Conjunctivitis
A large number of irritations, inflammations, and infections of the eye are lumped together under
the broad label of "pink eye." Diagnosing and separating each of these different types is critical to
treating each condition effectively. There are three main categories of conjunctivitis: Allergic, bacterial,
and viral.
Allergic Conjunctivitis
Allergic conjunctivitis is a reaction to exposure to allergens such as pollen from grasses and trees,
smoke, dust or chemicals. It is characterized by redness, itching, swelling of the clear tissue covering the
white of the eye (conjunctiva) and watery discharge. Allergic conjunctivitis is then subdivided into atopic,
giant papillary, vernal, and toxic. Each type requires different treatment and management.
The treatment of allergic conjunctivitis is variable, depending on the severity and type. It may
include removing the allergen if possible, cool compresses for the swelling, lubricant eye drops, OTC antiallergy eye drops, and/or allergy pills. More severe presentations may warrant prescription anti-allergy
medications, NSAIDS, steroids, and/or consultation with an allergist and possible desensitization
treatment.
Bacterial Conjunctivitis
Bacterial conjunctivitis is one of the most common ocular infections. It occurs when the natural
defenses against infection of the eye are lost. Traumas, aging, tear film abnormalities, chronic viral
infection or other irritation, alcohol abuse or immunosuppressive treatment may allow bacterial
conjunctivitis to occur.
Bacterial conjunctivitis is categorized into three forms: acute, hyperacute, and chronic. Acute
forms are caused by a proliferation of the normal flora of the lids and lashes. Staphylococcus or
Streptococcus are the most common organisms. Hyperacute forms tend to be caused by Gonococcus,
Chlamydia, Streptococcus, Haemophilus, and Staphylococcus. Chronic conjunctivitis is characterized by a
chronically red eye with little or no discharge or tearing. It is frequently associated with a history of a
chronic irritating cause or toxic substance. Examples include cosmetics, blepharitis, wind, contact lenses
and others.
The severity of the conjunctivitis may vary greatly but the hallmark symptom is lids stuck together
in the morning from a pus-like discharge. Most people also experience redness of the white part of the eye
and swelling of the lids.
Acute forms tend to present in all ages. One eye tends to be involved first, but it may spread to
the other eye. There is no frank pain, but patients will report a nonspecific irritation. Patients will report
an increasingly red eye over a two to three day period. Vision is not affected. Especially in children, there
tends to be medical history of a recent upper respiratory infection (cold, flu, or sore throat). The patient's
main concern tends to be the increasing intensity of the redness.
Hyperacute forms tend to be found more frequently in younger age groups or in the parents of
young children. One eye tends to start first, with the opposite eye following closely behind. There will be
gross redness, swelling of the conjunctiva, and copious mucous discharge. Vision will be blurred due to
the discharge. Patients or parents will be anxious over the rapid development of symptoms. Hyperacute
forms need immediate and aggressive treatment.
Treatment of mild cases usually consists of lid hygiene (warm compresses and lid scrubs) and may
include short term use of antibiotic eye drops. In severe cases, laboratory culture may be taken to
determine the best antibiotic eye drops and/or pills to use.
Viral Conjunctivitis
Viral conjunctivitis is an infection of the covering over the white of the eye (conjunctiva) caused by
exposure to a number of different viruses. It is spread through the air by sneezing and coughing or when
an already infected person touches another person's eyes. Patients may have a history of a cold, flu, or
sore throat. They may have experienced a low grade fever and/or there may be a history of exposure to
another person with the infection. Patients may report a purplish-pinkish eye, watery discharge, and
excessive tearing.
The eye may feel dry, irritated, or a burning sensation. There may be a mild foreign-body
sensation and sensitivity to light. The infection usually starts in one eye and then spreads to the other.
There are many different types of viruses. Some that are known to infect the eye are adenovirus,
cytomegalovirus, Epstein-Barr, Herpes simplex, HIV, Varicella (herpes zoster), measles, mumps, rubella,
and rabies. Even the common cold virus can infect the eye.
Unfortunately, no eye drops, pills, or surgeries are available to kill these viruses. The best defense
is to take preventative steps to protect against infection. Hand washing, getting enough sleep, balanced
diet, and exercise all contribute by keeping the body and the body's immune system healthy and capable of
fighting off disease. Most of these viruses exist within the body as dormant obligate parasites and are
aggravated by external and internal factors. Emotions like stress, anxiety, and fear may cause an eruption.
Physical injury, irritation, or contact lenses may also be contributing factors. Even wind, UV light, and air
pollution have been known to aggravate individuals with viral infections.
In general, treatment is directed at comfort, not cure, to reduce the symptoms of the active
infection. Cool compresses, artificial tears or eye whitening eyedrops may be used in mild to moderate
cases. In more severe cases, such as herpes simplex, antibiotics and antiviral medications may be used.
Steroids are sometimes considered necessary, but carry greater risks. Each case is unique and must be
evaluated by your doctor to determine the best mode of treatment.