Palmetto Cataract and Eye Specialists

Conjunctivitis:

Conjunctivitis

Introduction

Conjunctivitis is an inflammation of the thin, film-like, membrane that covers the inner surface of the eyelids as well as the white eye wall (sclera). The conjunctiva contains many small blood vessels which may become larger, making your eye appear red or pink.

Causes

There are numerous causes of conjunctivitis, including,

Viruses

Viral conjunctivitis is typically caused by adenovirus, the same virus that causes the common cold. Other viruses that can cause conjunctivitis include herpes zoster, herpes simplex, HIV, picornavirus, and poxvirus.

Bacteria

Bacteria such as Staphlyococci, streptococci, gonococci, and Chlamydia can infect the conjunctiva.

Allergies

Environmental or seasonal allergy can affect the eyes. Contact lens may also cause an allergic reaction.

Toxic

Exposure to toxic fumes or chemicals can cause eye irritation. A toxic reaction can also be seen with some eye drops used to treat infection or glaucoma. Or, it may be due to preservatives in eye drops.

Symptoms

Usually, viral conjunctivitis is associated with profuse tearing of both eyes. In many cases, the infection spreads from one eye to the other eye within a few days. It may also be associated with photophobia or light sensitivity and blurry vision due to excessive tearing. There is usually minimal itching. Patients with viral conjunctivitis are quite uncomfortable. Sometimes the symptoms are associated with an upper respiratory infection. The eye symptoms can last up to 10-14 days.

Bacterial conjunctivitis typically affects only one eye. Many patients will have a yellow or green thick discharge. There is usually minimal itching. Most cases of bacterial conjunctivitis are self-limiting, meaning they improve without treatment. However, some forms of bacterial conjunctivitis (such as that from gonorrhea) can cause a rapid infection of the eye.

Most patients with allergic conjunctivitis will complain of severe itching in one or both eyes. They may have a small amount of discharge. The eyelid may be swollen. Also, these patients may have other signs of systemic allergies, such as eczema and asthma.

Toxic conjunctivitis can cause redness, tearing, and eyelid swelling. The conjunctiva may look gelatinous from severe swelling. A careful history will usually reveal the offending agent.

At times, it can be difficult to diagnose the cause of conjunctivitis because symptoms can overlap. That is, sometimes, viral conjunctivitis will be associated with itchiness, or allergic conjunctivitis will be associated with tearing. Your eye care professional can distinguish subtle changes (in and around the eyes) to determine the etiology of your pink eye.

Diagnosis

If you believe you are experiencing symptoms of conjunctivitis, you should see an ophthalmologist for a comprehensive eye examination.

A thorough examination can help to distinguish the cause.

Not all red (or pink) eyes are created equal. Sometimes, a red eye is due to a relatively benign condition such as conjunctivitis. Other times, a red eye may herald a severe infection or inflammation of the eye (ie, a corneal ulcer, scleritis, iritis)

The examination involves a thorough history and an examination of the front of the eye and face. Subtle changes can only be detected with a slit-lamp or microscope. The exam will involve the instillation of a numbing eye drop, which does not affect your vision. The doctor will examine underneath the upper and lower eyelids. A culture of the discharge is usually not required.

A dilated eye examination is not required to evaluate conjunctivitis. However, an annual dilated exam is recommended.

Differential Diagnosis

Doctors use the term 'differential diagnosis' to list other possible causes for your symptoms. The differential diagnosis for red eye includes,
  • Angle closure glaucoma: a glaucoma attack, where the eye pressure increases suddenly.
  • Chemical/toxic burn
  • Corneal abrasion: a scratch on the surface of the eye.
  • Corneal ulcer: an infection on the surface of the eye.
  • Herpetic eye infection
  • Iritis: an inflammation inside of the eye.
  • Scleritis: an inflammation of the eye wall that can be associated with autoimmune diseases.
  • Traumatic eye injury.

Treatment

The treatment will depend upon the cause. At this time, there are no effective treatments for viral conjunctivitis. Treatment involves the use of cool compresses and artificial tears for comfort. Antibiotic drops will not improve viral conjunctivitis. If you have viral conjunctivitis, it is especially important to maintain good eye/hand hygiene. The virus is very contagious and can be transmitted on inanimate objects such as towels and door knobs. Patients are contagious and are encouraged to avoid contact with others until their tearing stops.

Antibiotic drops can decrease the duration of bacterial conjunctivitis. Systemic medications may be required with more severe infections.

Some types of conjunctivitis can be very contagious. In these cases, you should avoid using towels to wipe your face/eyes, wash your hands frequently, keep your hands away from your eyes, and not share towels/makeup.

Allergic conjunctivitis can be managed with antihistamine eye drops, antihistamines pills, steroid drops, steroid pills, and artificial tears. In very severe cases, an allergy skin test and allergy shots can help. It is recommended that patients wash their clothes and shower daily to decrease allergen exposure.

Toxic conjunctivitis treatment involves discontinuing the offending agent. It is treated similar to allergic conjunctivitis.

Complications

Most cases of conjunctivitis resolve without complications. However, some patients with viral conjunctivitis can have an inflammatory response to the virus that occurs after the initial infection subsides. Some forms of bacterial conjunctivitis can lead to a severe infection of the cornea, or front covering of the eye. Allergic conjunctivitis may become recurrent.

Our services

Dr. Itharat performs comprehensive eye exams, including the evaluation of red eye.

If you think you are having symptoms of conjunctivitis or red eye, please call 843-259-2002 to schedule a consultation.

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