Conjunctivitis

Definition

Conjuctivitis is an inflammation (redness) of the lining of the white part of the eye and the underside of the eyelid (conjunctiva). It can be caused by infection, allergic reaction, or physical agents like infrared or ultraviolet light.

Description

Conjunctivitis is a common eye problem because the conjunctivae are continually exposed to microorganisms and environmental agents that can cause infections or allergic reactions. Conjunctivitis can be acute or chronic depending upon how long the condition lasts, the severity of symptoms, and the type of organism or agent involved. It can affect one or both eyes. If it is caused by infection, it can be easily transmitted to others during close physical contact, particularly among children in a daycare center. Other names for conjunctivitis include pinkeye and redeye.

Causes & symptoms

Conjunctivitis may be caused by a viral infection, such as a cold, acute respiratory infection, or disease such as measles, herpes simplex, or herpes zoster. Symptoms may include mild to severe discomfort in one or both eyes; redness; swelling of the eyelids; and a watery, yellow, or greenish discharge. The symptoms may last anywhere from several days to weeks. Infection with an adenovirus, however, may also cause a significant amount of pus-like discharge and a scratchy sensation in the eye. These symptoms may also be accompanied by swelling and tenderness of the lymph nodes near the ear.

Bacterial conjunctivitis may occur in adults or children. It is caused by such organisms as Staphylococcus, Streptococcus pneumoniae, and Haemophilus. Symptoms of bacterial conjunctivitis include a pus-like discharge and crusty eyelids after awakening. Redness of the conjunctivae can be mild to severe and may be accompanied by swelling. Persons with symptoms of conjunctivitis who are sexually active may possibly be infected with chlamydia or with the bacteria that cause gonorrhea . There may be large amounts of pus-like discharge. Symptoms may include hypersensitivity to light (photophobia), a watery mucous discharge, and tenderness in the lymph nodes near the ear that may persist for up to three months.

Conjunctivitis may also be caused by such environmental hazards as wind, smoke, dust, and allergic reactions caused by pollen, dust, or grass. Symptoms range from itching and redness to a mucous discharge. Persons who wear contact lenses may develop allergic conjunctivitis caused by the various eye solutions and foreign proteins contained in them.

Other less common causes of conjunctivitis include looking at the sun, sun lamps, plant lamps, or the electrical arcs used during welding, as well as defective tear ducts.

Diagnosis

Accurate diagnosis of conjunctivitis centers on taking the patient's history to learn when symptoms began, how long the condition has been going on, the symptoms experienced, and other predisposing factors. Diagnostic tests may include an eye examination, culture, or laboratory test. The discharge may be cultured and Gramstained to determine the organism responsible for causing the condition. Cultures and smears are relatively painless.

Treatment

Conjunctivitis caused by gonococcal or chlamydial infection usually requires prescription antibiotics. Internal immune enhancement with dietary supplements can aid in the resolution of allergic and viral conjunctivitis. Removal of the allergic agent is an essential step in treating allergic conjunctivitis. As with any of the recommended treatments, however, if no improvement is seen within 48–72 hours, a physician should be consulted.

Nutritional therapy

The following dietary changes may be helpful in managing conjunctivitis:

• Taking 25,000 IU (international units) of beta-carotene twice daily for 7 days.
• Taking 500–1000 mg of vitamin C three times daily for 7 days.
• Taking 25 mg of zinc with meals three times daily for 7 days.

Homeopathy

There are a number of homeopathic remedies designed to treat acute conjunctivitis. These include Argentum nitricum (silver nitrate), pulsatilla (windflower), belladonna , Arsenicum album (arsenic trioxide), sulphur (elemental sulphur) and eyebright (Euphrasia officinalis ). Eye drops prepared with homeopathic remedies can be a good substitute for pharmaceutical eye drops.

Herbal therapy

Herbal eyewashes made with eyebright (1 tsp dried herb steeped in 1 cup of boiling water for 10 minutes, then strained and used at once) or chamomile (Matricaria recutita ; 2–3 tsp in 1 pint of boiling water) may be helpful. Eyewashes should be strained and cooled before use. They should be discarded promptly after use, as old infusions may become unsterile.

Other simple home remedies may help relieve the discomfort associated with conjunctivitis. A boric acid eyewash (1 tsp boric acid in 1 cup of water) can be used to clean and soothe the eyes. A warm compress applied to the eyes for 5–10 minutes three times a day can help relieve the discomfort of bacterial and viral conjunctivitis. A clean washcloth soaked in warm water can be used as a warm compress. The patient should close both eyes and apply the compress to the affected eye. A cool compress or cool, damp tea bags (of black tea or chamomile tea) placed on the eyes can ease the discomfort of conjunctivitis.

Allopathic treatment

The treatment of conjunctivitis depends on what caused the condition. In all cases, warm compresses applied to the affected eye several times a day may help to reduce discomfort.

Conjunctivitis due to a viral infection, particularly those due to adenoviruses, are usually treated by applying warm compresses to the eye(s) and applying topical antimicrobial ointments to prevent secondary bacterial infections.

Viral conjunctivitis may cause blindness and should be referred to an ophthalmologist. Topical steroids are commonly prescribed in combination with antiviral therapy.

In cases of bacterial conjunctivitis, a physician may prescribe an antibiotic eye ointment or eye drops containing sodium sulfacetamide (Sulamyd) to be applied daily for 7–14 days. Patients should contact their doctors if the eyes fail to improve after 72 hours. Antibiotic eye drops are instilled (put in drop by drop) into the eye by having the patient tilt the head back and pulling down the lower eye lid. The patient is asked to look upward while the medication is instilled into the conjunctival sac. It is important to avoid touching the dropper to the skin, in order to prevent the eye discharge from contaminating the antibiotic solution. After the drops have been instilled, the patient should gently close the eyes for 1 minute in order not to squeeze out any of the medication.

For cases of conjunctivitis caused by a gonococcus (the bacteria that causes gonorrhea), a physician may prescribe an injection of ceftriaxone (Rocephin) and a topical antibiotic ointment containing erythromycin or bactracin to be applied four times daily for 2–3 weeks. For chlamy-dial infections, a topical antibiotic ointment containing erythromycin (Ilotycin) may be prescribed to be applied 1–2 times daily. To apply an antibiotic ointment, the eye should be gently wiped with a sterile cotton ball moistened with sterile water to remove any discharge. Then, the lower eyelid can be pulled down and a thin ribbon of ointment applied in the lower conjunctival sac. If possible, single-dose dispensers of ointment should be used as a protection against contamination of the medication. The eyelids can be closed and massaged gently to distribute the ointment. Patients may find that their vision is blurry for a few minutes after the ointment is applied, but this is a normal side effect. In addition to topical antibiotics, oral erythromycin or tetracycline therapy may be indicated for 3–4 weeks. Sexual partners should also be treated.

Children with conjunctivitis should typically receive topical antibiotics, according to clinical evidence published in 2002. But the evidence re-emphasized that adults who have non-gonococcal conjunctivitis usually do not need antibiotic treatment, because antibiotic resistance is a growing problem.

Allergic conjunctivitis can be treated by removing the allergic substance from a person's environment, if possible; by applying cool compresses to the eye; and by administering eye drops 4–6 times daily for four days. Also, the antihistamine diphenhydramine hydrochloride (Benadryl) may help to relieve itchy eyes. In 2002, a new study showed that loteprednol and azelastine are two potential treatments for allergic conjunctivitis. Some doctors have prescribed ophthalimic steroids, but they can cause complications in patients. These potential new treatments offer alternatives to steroids for patients with allergic conjunctivitis.

Expected results

If conjunctivitis is treated properly, its prognosis is good. Conjunctivitis caused by an allergic reaction should clear up once the allergen is removed. Allergic conjunctivitis, however, will likely recur if the individual again comes into contact with the particular allergen. Conjunctivitis caused by bacteria or a virus, if treated properly, usually resolves in 10–14 days. If there is no relief of symptoms in 48–72 hours; or if there is moderate to severe eye pain or changes in vision; or if the conjunctivitis is suspected to be caused by herpes simplex, a physician should be notified immediately. If untreated or if treatment fails and is not corrected, conjunctivitis may cause visual impairment by spreading to such other parts of the eye as the cornea.

Prevention

Conjunctivitis can be prevented in many cases; in others, the course of the disease can be shortened by following some simple practices:

• Washing hands frequently using antiseptic soap; using single-use towels during the disease to prevent spreading the infection.
• Avoiding chemical irritants and known allergens.
• In areas where welding occurs, using the proper protective eye wear and screens to prevent damaging the eyes.
• Using a clean tissue to remove discharge from eyes, and washing hands to prevent the spread of infection.
• If medication is prescribed, finishing the course of antibiotics as directed to make sure that the infection is cleared up and does not recur.
• Avoiding wearing eye makeup or contact lenses during the infection. Never share eye makeup with others.

Resources

BOOKS

Jonas, Wayne B. and Jennifer Jacobs. Healing with Homeopathy: The Doctor's Guide. New York: Warner Books, 1996.

Newell, Frank, ed. Ophthalmology: Principles and Concepts. 8th ed. St. Louis: Mosby-Year Books Inc., 1996.

Schwab, Ivan R., and Chandler R. Dawson. "Conjunctiva." In General Ophthalmology, 14th ed. Daniel G. Vaughan, Taylor Asbury, and Paul Riordan-Eva, eds. Norwalk, CT: Appleton and Lange, 1995.

Uphold, Constance R. and Mary Virginia Graham. "Problems of the Eyes." In Clinical Guidelines in Adult Health. Gainesville, FL: Barmarrae Books, 1994.

Zand, Janet, Allan N. Spreen, and James B. LaValle. Smart Medicine for Healthy Living. Garden City Park, NY: Avery Publishing Group, 1999.

PERIODICALS

Guttman, Cheryl. "Lotepredol, Azelastine Provide Potent Arsenal for Acute, Chronic Allergic Conjunctivitis: Longer–term use Proving Safe, Effective for Patients with both Seasonal and Perennial Allergies."Ophthalmology Times (April 15, 2002): 30.

Kane, Kevin Y., et al. "When Should Acute Nonveneral Conjunctivitis be Treated with Topical Antibiotics? (Clinical Inquiries: from the Family Practice Inquiries Network)." Journal of Family Practice (April 2002).

Mai Tran

Teresa G. Odle

Conjunctivitis

Definition

Conjuctivitis is an inflammation or redness of the lining of the white part of the eye and the underside of the eyelid (conjunctiva) that can be caused by infection, allergic reaction, or physical agents like infrared or ultraviolet light.

Description

Conjunctivitis is the inflammation of the conjunctiva, a thin, delicate membrane that covers the eyeball and lines the eyelid. Conjunctivitis is an extremely common eye problem because the conjunctiva is continually exposed to microorganisms and environmental agents that can cause infections or allergic reactions. Conjunctivitis can be acute or chronic depending upon how long the condition lasts, the severity of symptoms, and the type of organism or agent involved. It can also affect one or both eyes and, if caused by infection, can be very easily transmitted to others during close physical contact, particularly among children in a daycare center. Other names for conjunctivitis include pink eye and red eye.

Causes and symptoms

Conjunctivitis may be caused by a viral infection, such as a cold, acute respiratory infection, or disease such as measles, herpes simplex, or herpes zoster. Symptoms include mild to severe discomfort in one or both eyes, redness, swelling of the eyelids, and watery, yellow, or green discharge. Symptoms may last anywhere from several days to two weeks. Infection with an adenovirus, however, may also cause a significant amount of pus-like discharge and a scratchy, foreign body-type of sensation in the eye. This may also be accompanied by swelling and tenderness of the lymph nodes near the ear.

Bacterial conjunctivitis can occur in adults and children and is caused by organisms such as Staphylococcus, Streptococcus, and Hemophilus. Symptoms of bacterial conjunctivitis include a pus-like discharge and crusty eyelids after awakening. Redness of the conjunctiva can be mild to severe and may be accompanied by swelling. Persons with symptoms of conjunctivitis who are sexually active may possibly be infected with the bacteria that cause either gonorrhea or chlamydia. There may be large amounts of pus-like discharge, and symptoms may include intolerance to light (photophobia), watery mucous discharge, and tenderness in the lymph nodes near the ear that may persist for up to three months.

Conjunctivitis may also be caused by environmental hazards, such as wind, smoke, dust, and allergic reactions caused by pollen, dust, or grass. Symptoms range from itching and redness to a mucous discharge. Persons who wear contact lenses may develop allergic conjunctivitis caused by the various eye solutions and foreign proteins contained in them.

Other less common causes of conjunctivitis include exposure to sun lamps or the electrical arcs used during welding, and problems with inadequate drainage of the tear ducts.

Diagnosis

An accurate diagnosis of conjunctivitis centers on taking a patient history to learn when symptoms began, how long the condition has been going on, the symptoms experienced, and other predisposing factors, such as upper respiratory complaints, allergies, sexually transmitted diseases, herpes simplex infections, and exposure to persons with pink eye. It may be helpful to learn whether an aspect of an individual's occupation may be the cause, for example, welding. Diagnostic tests are usually not indicated unless initial treatment fails or an infection with gonorrhea or chlamydia is suspected. In such cases, the discharge may be cultured and Gram stained to determine the organism responsible for causing the condition. Cultures and smears are relatively painless.

Treatment

The treatment of conjunctivitis depends on what caused the condition. In all cases, warm compresses applied to the affected eye several times a day may help to reduce discomfort. Some treatment choices will be based on patient preference, convenience of use, and cost to the patient.

Conjunctivitis due to a viral infection, particularly those due to adenoviruses, are usually treated by applying warm compresses to the eye(s) and applying topical antibiotic ointments to prevent secondary bacterial infections.

Viral conjunctivitis caused by herpes simplex should be referred to an ophthalmologist. Topical steroids are commonly prescribed in combination with antiviral therapy.

In cases of bacterial conjunctivitis, a physician may prescribe an antibiotic eye ointment or eye drops containing sodium sulfacetamide (Sulamyd) to be applied daily for seven to 14 days. If, after 72 hours, the condition does not improve, a physician or primary care provider should be notified because the bacteria involved may be resistant to the antibiotic used or the cause may not be bacterial.

For cases of conjunctivitis caused by a gonococcal organism, a physician may prescribe an intramuscular injection of ceftriaxone (Rocephin) and a topical antibiotic ointment containing erythromycin or bactracin to be applied four times daily for two to three weeks. Sexual partners should also be treated.

With accompanying chlamydia infection, a topical antibiotic ointment containing erythromycin (Ilotycin) may be prescribed to be applied one to two times daily. In addition, oral erythromycin or tetracycline therapy may be indicated for three to four weeks. Again, sexual partners should also be treated.

Allergic conjunctivitis can be treated by removing the allergic substance from a person's environment, if possible; by applying cool compresses to the eye; and by administering eye drops four to six times daily for four days. Also, oral antihistamines may help to relieve itchy eyes. However, many of these drugs also dry the eyes. Therefore, many physicians suggest a combination of antihistamines and lubricating drops or the use of nasal corticosteroid sprays to help relieve allergic conjunctivitis, particularly when it is combined with nasal symptoms.

Alternative treatment

Conjunctivitis caused by gonococcal and chlamydial infection usually requires conventional medical treatment. With bacterial, viral, and allergic conjunctivitis, however, alternative options can be helpful. Internal immune enhancement with supplementation can aid in the resolution of bacterial and viral conjunctivitis. Removal of the allergic agent is an essential step in treating allergic conjunctivitis. As with any of the recommended treatments, however, if no improvement is seen within 48-72 hours, a physician should be consulted.

Homeopathically, there are a number of acute remedies designed to treat conjunctivitis. These include Pulsatilla (windflower, Pulsatilla nigricans), Belladonna, and eyebright (Euphrasia officinalis ). Eye drops, prepared with homeopathic remedies and/or herbs, can be a good substitute for pharmaceutical eye drops. Eye washes can also be made. Herbal eyewashes made with eyebright (1 tsp. dried herb steeped in 1 pint of boiling water) or chamomile (Matricaria recutita ; 2-3 tsp. in 1 pint of boiling water) may be helpful. Eyewashes should be strained and cooled before use, and close attention should be paid to make sure that any solution put into the eye is sterile.

Other simple home remedies may help relieve the discomfort associated with conjunctivitis. A boric acid eyewash can be used to clean and soothe the eyes. A warm compress applied to the eyes for five to 10 minutes three times a day can help relieve the discomfort of bacterial and viral conjunctivitis. A cool compress or cool, damp tea bags placed on the eyes can ease the discomfort of allergic conjunctivitis.

Prognosis

If treated properly, the prognosis for conjunctivitis is good. Conjunctivitis caused by an allergic reaction should clear up once the allergen is removed. However, allergic conjunctivitis will likely recur if the individual again comes into contact with the particular allergen. Conjunctivitis caused by bacteria or a virus, if treated properly, is usually resolved in 10-14 days. If there is no relief of symptoms in 48-72 hours, or there is moderate to severe eye pain, changes in vision, or the conjunctivitis is suspected to be caused by herpes simplex, a physician should be notified immediately. If untreated or if treatment fails and is not corrected, conjunctivitis may cause visual impairment by spreading to other parts of the eye, such as the cornea.

Prevention

Conjunctivitis can, in many cases, be prevented, or at least the course of the disease can be shortened by following some simple practices.

• Frequently washing hands using antiseptic soap, and using single-use towels during the disease to prevent spreading the infection.
• Avoiding chemical irritants and known allergens.
• If in an area where welding occurs, using the proper protective eye wear and screens to prevent damaging the eyes.
• Using a clean tissue to remove discharge from eyes, and wash hands to prevent the spread of infection.
• If medication is prescribed, finishing the course of antibiotics, as directed, to make sure that the infection is cleared up and does not recur.
• Avoiding contact, such as vigorous physical activities, with other persons until symptoms resolve.

Resources

PERIODICALS

Prewitt, Dawn. "Keep an Eye Toward the Nose: These Treatments Can Help Stop the Charge of Rhinoconjunctivitis." Review of Optometry June 15, 2004: 125-127.

"Topical Drugs for Treating Conjunctivitis." GP June 14, 2004: 12.

OTHER

Griffith, H. Winter. "Conjunctivitis (Pink Eye)." ThriveOnline. 〈http://thriveonline.oxygen.com〉.

KEY TERMS

Adenovirus— A virus that affects the upper respiratory tract.

Chlamydia— The most common bacterial sexually transmitted disease in the United States that often accompanies gonorrhea and is known for its lack of evident symptoms in the majority of women.

Gonococcal— The bacteria Neisseria gonorrheae that causes gonorrhea, a sexually transmitted infection of the genitals and urinary tract. The gonococcal organism may occasionally affect the eye, causing blindness if not treated.

Herpes simplex virus— A virus that can cause fever and blistering on the skin, mucous membranes, or genitalia.

Herpes zoster virus— Acute inflammatory virus that attacks the nerve cells on the root of each spinal nerve with skin eruptions along a sensory nerve ending.

Staphylococcus — A bacterial organism, looking much like a cluster of grapes, that can infect various body systems.

Streptococcus — An organism that causes infections of either the upper respiratory or gastrointestinal tract.

Conjunctivitis

Definition

Conjuctivitis is an inflammation resulting in redness of the lining of the white part of the eye and the underside of the eyelid (conjunctiva) that can be caused by infection, allergic reaction, or physical agents like infrared or ultraviolet light.

Description

Conjunctivitis is the inflammation of the conjunctiva, a thin, delicate membrane that covers the eyeball and lines the eyelid. Conjunctivitis is an extremely common eye disease because the conjunctiva is continually exposed to microorganisms and environmental agents that can cause infections or allergic reactions. Conjunctivitis can be acute or chronic depending on how long the condition lasts, the severity of symptoms, and the type of organism or agent involved. It can affect one or both eyes and, if caused by infection, can be very easily transmitted to others during close physical contact, particularly among children in a school or daycare setting. Other names for conjunctivitis include pink eye and red eye.

Demographics

Conjunctivitis is the most common eye infection of childhood. It occurs so frequently that records are not kept, so exact demographic information has not been amassed.

Causes and symptoms

Conjunctivitis may be caused by a viral infection, such as a cold; acute respiratory infection; or other disease such as measles, herpes simplex , or herpes zoster. Symptoms include mild to severe discomfort in one or both eyes; redness; swelling of the eyelids; and watery, yellow, or green discharge. Symptoms may last anywhere from several days to two weeks. Infection with an adenovirus, however, may also cause a significant amount of pus-like discharge and a scratchy, foreign-body-sensation in the eye. These symptoms may be accompanied by swelling and tenderness of the lymph nodes near the ear.

Bacterial conjunctivitis can occur in adults and children and is caused by organisms such as Staphylococcus, Streptococcus, and Hemophilus. Symptoms of bacterial conjunctivitis include a pus-like discharge and crusty eyelids after awakening. Redness of the conjunctiva can be mild to severe and may be accompanied by swelling. Persons with symptoms of conjunctivitis who are sexually active may possibly be infected with the bacteria that cause either gonorrhea or chlamydia. There may be large amounts of pus-like discharge, and symptoms may include intolerance to light (photophobia), watery mucus discharge, and tenderness in the lymph nodes near the ear that may persist for up to three months.

Conjunctivitis may also be caused by environmental hazards, such as wind, smoke, dust, and allergic reactions caused by pollen, dust, or grass. Symptoms range from itching and redness to a mucus discharge. Persons who wear contact lenses may develop allergic conjunctivitis caused by various eye solutions used and the foreign proteins contained in them.

Other less common causes of conjunctivitis include exposureto sun lamps or the electrical arcs used during welding and problems with inadequate drainage of the tear ducts.

Diagnosis

An accurate diagnosis of conjunctivitis centers on taking a patient's history to learn what symptoms are being experienced, when symptoms began, and other predisposing factors, such as upper respiratory complaints, allergies, sexually transmitted diseases , herpes simplex infections, and exposure to persons with pink eye. It may be helpful to learn whether an aspect of an individual's occupation may be the cause, for example, welding. Diagnostic tests are usually not indicated unless initial treatment fails or an infection with gonorrhea or chlamydia is suspected. In such cases, the discharge may be cultured and tested to determine the organism responsible for causing the condition.

Treatment

The treatment of conjunctivitis depends on what caused the condition. In all cases, warm compresses applied to the affected eye several times a day may help to reduce discomfort.

Conjunctivitis due to a viral infection, particularly those due to adenoviruses, are usually treated by applying warm compresses to the affected area and using topical antibiotic ointments to prevent secondary bacterial infections.

Viral conjunctivitis caused by herpes simplex should be referred to an ophthalmologist. Topical steroids are commonly prescribed in combination with antiviral therapy.

In cases of bacterial conjunctivitis, a physician may prescribe an antibiotic eye ointment or eye drops containing sodium sulfacetamide (Sulamyd) to be applied daily for seven to 14 days. If, after 72 hours, the condition does not improve, a physician or primary care provider should be notified, because the bacteria involved may be resistant to the antibiotic used or the cause may not be bacterial.

For cases of conjunctivitis caused by a gonococcal organism, a physician may prescribe an intramuscular injection of ceftriaxone (Rocephin) and a topical antibiotic ointment containing erythromycin or bactracin to be applied four times daily for two to three weeks. Sexual partners should also be treated.

With accompanying chlamydia infection, a topical antibiotic ointment containing erythromycin (Ilotycin) may be prescribed to be applied one to two times daily. In addition, oral erythromycin or tetracycline therapy may be indicated for three to four weeks. Again, sexual partners should also be treated.

Allergic conjunctivitis can be treated by removing the allergic substance from a person's environment, if possible; by applying cool compresses to the eye; and by administering eye drops four to six times daily for four days. Also, the antihistamine diphenhydramine hydrochloride (Benadryl) may help to relieve itchy eyes.

Prognosis

If treated properly, the prognosis for conjunctivitis is good. Conjunctivitis caused by an allergic reaction should clear up once the allergen is removed. However, allergic conjunctivitis will likely recur if the individual again comes into contact with the particular allergen. Conjunctivitis caused by bacteria or a virus, if treated properly, is usually resolved in ten to 14 days. If there is no relief of symptoms in 48 to 72 hours, or there is moderate to severe eye pain , changes in vision, or the conjunctivitis is suspected to be caused by herpes simplex, a physician should be notified immediately. If untreated or if treatment fails and is not corrected, conjunctivitis may cause visual impairment by spreading to other parts of the eye, such as the cornea.

Prevention

Conjunctivitis can, in many cases, be prevented, or at least the course of the disease can be shortened by following these simple practices:

• frequently washing hands with antiseptic soap and using single-use towels while the disease continues
• avoiding chemical irritants and known allergens
• in an area where welding occurs, using the proper protective eye wear and screens to prevent damaging the eyes
• using a clean tissue to remove discharge from eyes and washing hands to prevent the spread of infection
• if medication is prescribed, finishing the course of antibiotics , as directed, to make sure that the infection is cleared up and does not recur
• avoiding close contact, such as vigorous physical activities, with other persons until symptoms resolve

KEY TERMS

Adenovirus —A type of virus that can cause upper respiratory tract infections.

Chlamydia —The most common bacterial sexually transmitted disease in the United States. It often accompanies gonorrhea and is known for its lack of evident symptoms in the majority of women.

Gonococcal —Refers to the bacterium Neisseria gonorrheae. This bacterium causes gonorrhea, a sexually transmitted infection of the genitals and urinary tract. The gonococcal organism may occasionally affect the eye, causing blindness if not treated.

Herpes simplex virus —A virus that can cause fever and blistering on the skin and mucous membranes. Herpes simplex 1 infections usually occur on the face (cold sores) and herpes simplex 2 infections usually occur in the genital region.

Herpes zoster virus —Acute inflammatory virus that attacks the nerve cells on the root of each spinal nerve with skin eruptions along a sensory nerve ending. It causes chickenpox and shingles. Also called varicella zoster virus.

Staphylococcus —Any of several species of spherical bacteria that occur in groups of four or in irregular clusters. They can infect various parts of the body, especially the skin and mucous membranes.

Streptococcus —Plural, streptococci. Any of several species of spherical bacteria that form pairs or chains. They cause a wide variety of infections including scarlet fever, tonsillitis, and pneumonia.

Resources

BOOKS

"Disorder of the Conjunctiva." In Nelson Textbook of Pediatrics. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2004.

Weiss, Avery H. "Conjunctivitis Beyond the Neonatal Period." In Principles and Practice of Pediatric Infectious Diseases, 2nd ed. Edited by Sarah S. Long et al. St. Louis, MO: Elsevier, 2003.

WEB SITES

Silverman, Michael A., et al. "Conjunctivitis." eMedicine, October 12, 2004. Available online at <www.emedicine.com/emerg/topic110.htm> (accessed December 25, 2004).

Lisa Papp, RN Rosalyn Carson-DeWitt, MD

CONJUNCTIVITIS

DEFINITION

Conjunctivitis (pronounced kuhn-junk-tuh-VIE-tis) is an inflammation (redness) of the conjunctiva. The conjunctiva is the membrane that lines the white part of the eye and the underside of the eyelid. Conjunctivitis can be caused by infection, an allergic reaction, or a physical agent, such as infrared or ultraviolet light. Conjunctivitis is often referred to as pink eye because the infection causes the eye to become very bloodshot.

Conjunctivitis: Words to Know

Herpes virus:

A group of viruses that cause many different infections in the human body, including cold sores and infections of the genital area.

DESCRIPTION

Conjunctivitis is an inflammation of the conjunctiva. The condition is very common since the conjunctiva is exposed to many substances that can cause infection or an allergic reaction. Conjunctivitis can be either acute or chronic. An acute condition is one that flares up suddenly and lasts a fairly short time. A chronic condition is one that lasts for a long time, usually many years.

Conjunctivitis can affect one or both eyes. If caused by an infection, it can usually be transmitted to other people quite easily. The disease is very common among children in day care or schools. In such settings, children come into close contact with each other and conjunctivitis spreads quickly throughout the group. The disease is also known by the name of pink eye or red eye. These names come from the physical appearance of the eye as a result of conjunctivitis.

CAUSES

Conjunctivitis can be caused by a bacterial or viral infection; by certain environmental factors, such as smoke, dust, or pollen; or by other factors. Viruses cause many kinds of infections, such as the common cold (see common cold entry), acute respiratory infections, or diseases such as measles (see measles entry). These infections can spread easily to the eye. If they infect the conjunctiva, conjunctivitis results.

SYMPTOMS

Symptoms of conjunctivitis can range from mild to serious. They can affect one eye or both. Some common symptoms include redness of the eye, swelling of the eyelid, and a discharge from the eye. The discharge is watery and either yellow or green in color. Some kinds of viruses cause more serious reactions. They may cause the eye to feel scratchy and have a pus-like discharge. These infections also can cause swelling and tenderness of the lymph nodes behind the ear.

Bacterial infections of the conjunctiva also cause redness of the eye and swelling of the eyelids. They may produce a pus-like discharge that turns crusty during the night. Some forms of bacteria that cause sexually transmitted diseases (see sexually transmitted diseases entry), such as gonorrhea, can also cause conjunctivitis. Infections of this kind may result in intolerance to light and tenderness in the lymph nodes behind the ear. These symptoms may last up to three months.

Some environmental conditions that cause conjunctivitis include wind, smoke, dust, pollen, and grass. As with infections, these factors can cause redness in the eye, swelling of the eyelid, and discharge from one or both eyes. Chemicals in contact lens solutions can sometimes produce similar reactions. Less common causes of conjunctivitis include exposure to sun lamps and problems with the tear ducts, the structures that produce tears for the eyes.

DIAGNOSIS

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.

TREATMENT

The treatment of conjunctivitis depends on the cause of the condition. In all cases, symptoms are usually relieved by the use of a warm compress placed directly on the eye. A compress is a moist pad. The treatment is repeated several times a day.

There are relatively few direct treatments for viral infections. If a herpes infection is suspected, medical advice should be sought. A herpes infection is one caused by a herpes virus (see herpes infections entry). The herpes virus causes a variety of infections, including cold sores and infections of the genital area. Sometimes antibiotics are used to prevent secondary infections. A warm compress is advised to relieve discomfort. The viral infection usually clears up after a few days.

Bacterial conjunctivitis can be treated with antibiotics. Ointments (lotions) or eye drops containing the antibiotic can be placed directly into the eye. The treatment is usually used once a day for one or two weeks. Improvement is usually seen in the first three days. If there is no change, a different drug may be needed, or another cause for the infection should be considered.

Cases of conjunctivitis related to sexually transmitted diseases require special types of care. In some cases, injections of antibiotics may be necessary. Sexual partners should also be notified and treated.

Cases of conjunctivitis caused by environmental factors are treated by removing the agent responsible for the problem. For example, a person who is allergic to dust or pollen should try not to be exposed to these substances. Symptoms can be treated with a cool compress applied directly to the eye. Drugs such as diphenhydramine hydrochloride (pronounced DIE-fen-HI-druh-meen HI-dro-KLOR-ide, trade name Benadryl) can also provide relief when administered as eye drops.

Alternative Treatment

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.

PROGNOSIS

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.

PREVENTION

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.

FOR MORE INFORMATION

Books

Salmans, Sandra. Your Eyes: Questions You Have … Answers You Need. Allentown: People's Medical Society, 1996.

Organizations

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.

Conjunctivitis

What Is Conjunctivitis?

How Does Conjunctivitis Spread and Who Gets It?

What Are the Signs and Symptoms of Conjunctivitis?

How Is Conjunctivitis Diagnosed?

How Do Doctors Treat Conjunctivitis?

Are There Complications?

Can Conjunctivitis Be Prevented?

Resource

Conjunctivitis (kon-jung-tih-VY-tis), often called pinkeye, is an inflammation of the conjunctiva (kon-jung-TIE-vuh), the thin membrane that lines the inside of the eyelids and covers the surface of the eyeball. Conjunctivitis can be caused by viruses, bacteria, allergies, or chemical irritation.

KEYWORDS

for searching the Internet and other reference sources

Chlamydia

Eye infections

Gonorrhea

Herpesvirus

Pinkeye

What Is Conjunctivitis?

Conjunctivitis, is an inflammation of the thin membrane that lines the inside of the eyelids and covers the white surface of the eye. The inflammation can produce redness, burning, or itching of the eyes and sometimes a discharge. Bacterial or viral infections most often cause conjunctivitis. Many different bacteria can be the culprit, most commonly Streptococcus pneumoniae (strep-tuh-KAH-kus nu-MO-nye), Haemophilus influenzae (he-MOH-fih-lus in-floo-EN-zuh), and Staphylococcus aureus (stah-fih-lo-KAH-kus ARE-ree-us). Infections with adenoviruses* and influenza viruses are common causes of conjunctivitis. About 80 percent of all cases of conjunctivitis result from viral or bacterial infection.

*adenoviruses

(ah-deh-no-VY-ruh-sez) can produce a variety of symptoms, including upper respiratory disease, when they infect humans.

Rarely, parasites* and fungal infections can cause conjunctivitis. The condition also can stem from various allergies, irritants, chemicals, and pollutants. Reactions to smoke, dust, makeup, contact lenses, and pollen all can produce symptoms in some people. The sexually transmitted diseases chlamydia* and gonorrhea*, which can be passed from infected mothers to their babies during birth, are the most common causes of conjunctivitis in newborns. These two diseases can lead to conjunctivitis in adults as well. Conjunctivitis usually does not cause problems with vision.

*parasites

(PAIR-uh-sites) are organisms such as protozoa (one-celled animals), worms, or insects that must live on or inside a human or other organism to survive. An animal or plant harboring a parasite is called its host. Parasites live at the expense of the host and may cause illness.

*chlamydia

(kla-MIH-dee-uh) are microorganisms that can infect the urinary tract, genitals, eye, and respiratory tract, including the lungs.

*gonorrhea

(gah-nuh-REE-uh) is a sexually transmitted disease (STD) spread through all forms of sexual intercourse. The bacteria can also be passed from an infected mother to her baby during childbirth. Gonorrhea can affect the genitals, urethra, rectum, eyes, throat, joints, and other tissues of the body.

How Does Conjunctivitis Spread and Who Gets It?

Conjunctivitis, especially of viral origin, typically is seen in children and adults who are caregivers of children, such as parents or day-care workers. Bacterial conjunctivitis is less common in healthy older children and adults. Both the bacterial and viral forms of the condition are contagious. The germs that cause conjunctivitis may be present in nasal secretions and in the discharge from the eyes. People can become infected simply by touching the face of someone with the disease and then rubbing their own eyes without first washing their hands. Sharing contaminated towels or eye makeup also can spread the infection. Infectious conjunctivitis can spread quickly through child-care and school settings and among members of the same family. Bacterial conjunctivitis can remain contagious until treatment with antibiotics is started. The viral form is usually contagious before the symptoms appear and for as long as symptoms, including any discharge from the eye, last.

What Are the Signs and Symptoms of Conjunctivitis?

The first symptoms typically appear within a few days or up to a week after infection. A person may feel discomfort, a gritty sensation under the eyelids, or a feeling that there is something in the eye. Redness develops in the eye, and the eyelids may swell. Bacterial infections usually produce a thick yellowish or greenish discharge. When the person wakes up in the morning, the eyelids might stick together as the result of dried discharge. In viral conjunctivitis, the discharge is often thin, watery, and clear. Viral infections are more likely to affect both eyes and can be accompanied by other symptoms of viral infection, such as cold or flu symptoms.

How Is Conjunctivitis Diagnosed?

Eye discharge and inflammation (redness) of the conjunctiva are the hallmarks of conjunctivitis. The doctor also will ask whether the person has had any recent contact with someone with conjunctivitis and will examine the eyes, making sure the person’s vision is normal. Sometimes the doctor will swab the inside of the eyelids to obtain fluid for laboratory testing, to determine the type of infection. This is more likely to be done in newborn babies or someone at risk of a sexually transmitted disease, such as chlamydial infection or gonorrhea.

Antibiotic eyedrops or ointments are applied to the eye to treat bacterial conjunctivitis. Custom Medical Stock Photo, Inc.

How Do Doctors Treat Conjunctivitis?

Treatment depends on the cause of conjunctivitis. If bacterial conjunctivitis has been diagnosed, antibiotic eyedrops usually are prescribed for about a week. An antibiotic ointment is used for babies. Viral conjunctivitis disappears by itself and does not typically require treatment. (One exception is conjunctivitis caused by herpesvirus* infection, which is treated with antiviral eyedrops.) Over-the-counter pain relievers, such as acetaminophen (uh-see-teh-MIH-noh-fen), and warm compresses placed over the eyelids several times a day may ease the discomfort. Conjunctivitis usually clears up within a week. Cases of viral conjunctivitis can take longer to resolve than bacterial conjunctivitis.

*herpesvirus

(her-peez-VY-rus) is a member of a family of viruses that can store themselves permanently in the body. The family includes varicella virus, Epstein-Barr virus, and herpes simplex virus.

Are There Complications?

Complications of conjunctivitis are rare. In newborns, untreated gonorrheal infection of the conjunctiva can cause a spreading infection of the eye that can lead to blindness. A few viruses cause conjunctivitis that affects deeper parts of the eye, resulting in keratitis (kare-uh-TY-tis), an inflammation of the cornea* that causes changes in vision and sometimes permanent scarring of the cornea. Trachoma (truh-KO-mah), a type of chlamydial conjunctivitis seen in developing countries, also can lead to blindness.

*cornea

(KOR-nee-uh) is the transparent circular layer of cells over the central colored part of the eyeball (the iris) through which light enters the eye.

Can Conjunctivitis Be Prevented?

The best way to prevent infectious conjunctivitis is to wash hands frequently, especially after touching the face of someone who has the infection. It is a good idea for people with infectious conjunctivitis to wash their hands often to avoid spreading the infection. It is also wise not to share makeup; disposable items, such as paper towels and cotton balls; or towels. Washing towels and clothing in hot water can disinfect them.

See also

Chlamydial Infections

Congenital Infections

Gonorrhea

Influenza

Resource

Website

KidsHealth.org. KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of children’s health. It contains articles on a variety of health topics, including conjunctivitis.

http://www.KidsHealth.org