• The Eyes Have It: Conjunctivitis

    IMAGE The change from summer to fall and winter brings different problems to each of us. For some, the seasonal changes bring the all-too-familiar allergies, colds, and flu. For others it brings a less familiar ailment called conjunctivitis, an inflammation of the conjunctiva. The conjunctiva is a thin, transparent layer that covers the inner eyelid and the white part of the eye.
    The symptoms of conjunctivitis can run from merely annoying to very painful, and include:
    • Red, watery eyes
    • Inflamed inner eyelids
    • Scratchy feeling in the eyes
    • Itchy eyes
    • Pus-like or watery discharge
    • Sensitivity to light
    • Swelling of the eyelid
    Basically, there are five types of conjunctivitis: allergic, chemical, viral, bacterial, and ophthalmia neonatorum.

    Allergic and Chemical Conjunctivitis

    Allergic conjunctivitis is caused by exposure to allergens (i.e., pollen, pet hair, or dander), while chemical conjunctivitis results from irritants such as hairspray and airborne pollutants. When caused by an allergen, both eyes are usually affected and it is most often accompanied by tearing, itching, and redness of the eye, and sometimes an itchy and runny nose. The best way to treat these two types of conjunctivitis is to remove the allergen or pollutant from your daily environment. In some cases, this is easy, while in others, it is quite impossible.
    As Dr. Mark Kuperwaser, M.D., associate in ophthalmology at Beth Israel Deaconess Medical Center points out: "Sometimes the allergen can be the type of cosmetic or even laundry detergent you use." In those cases, changing the product may solve the problem. However, sometimes removing the allergen is not possible. In this case, lubricating eye drops to wash out the eyes may be tried or the application of cold compresses over the eyes.
    If these approaches are ineffective, antihistamine eye drops or prescription allergen inhibitors are generally used as treatment. In severe cases, topical steroid-based ointments are prescribed, but only as a last resort, because allergic conjunctivitis can last for an extended period (until the irritant is removed), and extended use of steroidal ointment can cause cataracts or glaucoma. If a chemical is the cause, usually flushing the eye with water will relieve the symptoms.

    Ophthalmia Neonatorum

    Ophthalmia neonatorum is a form of conjunctivitis found only in newborns. It is contracted if the infant's tear ducts are not completely opened or if the infant is exposed to bacteria when it passes through the birth canal of a mother infected with gonorrhea or chlamydia. For this reason, it is routine for hospitals to topically apply an antibiotic to all newborns' eyes. The herpes simplex virus can also be passed on to the child during delivery and cause viral conjunctivitis.

    Bacterial and Viral Conjunctivitis

    Bacterial conjunctivitis is caused by exposure of the eye to some sort of bacteria. It is often referred to as pink eye. Bacterial conjunctivitis generally affects both eyes and is accompanied by a heavy mucus discharge. Bacterial conjunctivitis is treated with antibiotics, given as either eyedrops or as an ointment. Some cases of bacterial conjunctivitis are self-limited, meaning they will go away on their own. In most cases, bacterial conjunctivitis will clear up within a few days, once treatment starts.
    Viral conjunctivitis, on the other hand, is an infection caused by a virus (such as the common cold, flu, or some childhood diseases like measles). It can be limited to one eye or involve both eyes. Viral conjunctivitis generally is accompanied by extreme amounts of eye tearing with only a light discharge of purulent material. There is no medication to treat viral conjunctivitis and it usually will go away on its own within a few days.
    Many doctors also suggest that patients, in addition to any other treatment prescribed, apply a hot compress to the affected eye(s) for at least five minutes each day. "First, the compress will make the patient more comfortable," Dr. Kuperwaser explains. "In addition, [in the case of viral conjunctivitis] the compress both improves blood flow to the eye, which helps fight the virus, and applies heat to the eye, which may help kill the virus." It is important to use a clean, fresh towel each time the hot compress is applied. Otherwise, it can prolong the infection.
    Both bacterial and viral conjunctivitis are contagious. If you contract either of these types of conjunctivitis, measures should be taken to avoid spreading the condition to your other eye or to other people. These measures include:
    • Wash your hands thoroughly and often.
    • Avoid rubbing the infected eye or eyes.
    • Do not share towels, pillowcases, or handkerchiefs with others, and use these items only once before washing.
    • Place a clean towel over the pillowcase each night to avoid re-infection.
    • Do not share eye makeup with others, especially eyeliner and mascara. And avoid using any eye makeup at all while you are suffering from any type of conjunctivitis.
    • If your child contracts bacterial or viral conjunctivitis, you should keep them out of school for a few days. Otherwise, it is not uncommon for the condition to spread throughout an entire class.

    When to Seek Treatment

    Conjunctivitis will often go away by itself, but if not, it can be cured relatively easily. However, certain types of conjunctivitis, if left untreated, can cause permanent damage to your cornea and impair your vision permanently. Accordingly, you should immediately seek treatment if:
    • You develop redness or discomfort in your eye that is affecting your vision.
    • The redness and discomfort in your eye starts to become quite painful, or a yellow or green discharge begins to develop.
    • A condition you believed to be allergic conjunctivitis recurs frequently or worsens.
    • You have a newborn child whose eyes are inflamed and are not producing tears. This may be a sign of ophthalmia neonatorum which, if not treated very quickly, can lead to permanent eye damage.
    If you or your child suffers an eye injury or develops any problem with the eyes that does not clear itself very quickly, it is best to have the condition checked by a doctor right away. Medical problems with your eyes can, in almost all cases, be treated. But failure to treat infections can cause permanent harm to your vision, one of your most precious assets.

    RESOURCES

    American Academy of Ophthalmology http://www.aao.org

    National Eye Institute http://www.nei.nih.gov/

    CANADIAN RESOURCES

    Canadian Family Physician http://www.cfpc.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html

    References

    Allergic conjunctivitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated August 5, 2011. Accessed August 8, 2011.

    American Academy of Ophthalmology website. Available at: http://www.aao.org. Accessed August 8, 2011.

    Infectious conjunctivitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated July 13, 2011. Accessed August 8, 2011.

    Ophthalmia neonatorum. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated January 24, 2011. Accessed August 8, 2011.

    Pink eye (conjunctivitis) symptoms. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/pink-eye/DS00258/DSECTION=symptoms. Updated May 22, 2010. Accessed August 8, 2011.

    Raizman MB, Rothman JS, Maroun F, Rand WM. Effect of eye rubbing on signs and symptoms of allergic conjunctivitis in cat-sensitive individuals. Ophthalmology. 2000 Dec;107(12):2158-2161.

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