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CONJUNCTIVITIS

OVERVIEW

Conjunctivitis or pink eye is inflammation or infection of the conjunctiva. Conjunctiva is the transparent membrane which covers the white portion of the eye and also lines your eyelid. The white portion of your eye looks pinkish red and small blood vessels become apparent. Usually both eyes are affected. Sometimes the infection starts in one eye and spreads to the other.

Conjunctivitis can occur as a result of infection (bacterial or viral), irritation, allergic reaction or due to inadequately opened tear duct (in babies). Pink eye rarely affects your vision. The symptoms can be controlled by adequate treatment.

Timely diagnosis and treatment of pink eye limits its spread as it is highly contagious. Conjunctivitis epidemics are not uncommon.

Causes

  • Infection: Bacterial or viral
  • Chemical entering and irritating the eye
  • Allergies
  • Foreign object in the eye
  • Blocked tear duct (in new born)

Risk factors for conjunctivitis

Conjunctivitis occurs as a result of exposure to

  • An allergen or substance you are allergic to
  • To someone infected with conjunctivitis
  • Infection of contact lenses
  • Chemical

Types of conjunctivitis

  • Bacterial or viral conjunctivitis : This is caused by bacteria such as streptococci, staphylococci, or haemophilus and may affect one or both eyes. The bacteria may come from your own skin or you may get them from another person suffering from bacterial conjunctivitis. The discharge is thick and yellow-green in color. Highly contagious and spread through secretions from the eyes passed to another person through hand contact, sharing of handkerchief, bed, clothes, towel etc. It can also spread through air. The eye symptoms can be present along with signs and symptoms of upper respiratory tract infections such as running nose, sneezing, sore throat etc. Infection of contact lenses can also cause this. Bacterial conjunctivitis is more common in children. Crusting of eyes is common morning symptom.
  • Viral conjunctivitis : It may affect one or both eyes with watery discharge as the common presenting symptom. The eyes and eye lids are more swollen than in bacterial conjunctivitis. Highly contagious and spread through secretions from the eyes passed to another person through hand contact, sharing of handkerchief, bed, clothes, towel etc. It can also spread through air. The eye symptoms can be present along with signs and symptoms of upper respiratory tract infections such as running nose, sneezing, sore throat etc.
  • Allergic conjunctivitis : It usually affects both eyes as it is an allergic reaction to a substance (allergen) such as pollen or animal dander. The body produces an antibody against this antigen which causes release of inflammatory substances (such as histamines) which cause pink eyes. Symptoms include intense itching and watering of the eyes. Usually you may have other allergic reactions such as sneezing and running nose. The symptoms are usually controlled by anti-allergic eye drops.
  • Conjunctivitis from chemical irritation : This can happen in one or both eyes due to a chemical (acid or alkali) or foreign body accidently entering the eye. The eyes become red, water a lot, and may have a mucous discharge. This conjunctivitis usually clears up in a day or two. If you experience an accidental fall of something into your eyes, you must immediately splash your eyes with clean water and immediately call your doctor.

Symptoms

  • Redness in the white of eyes along with redness on the inner eyelids
  • Itchiness
  • A gritty feeling like sand in the eyes
  • Burning sensation
  • A thick discharge, yellow or green in color. It can dry up and form crusts which make it difficult to open your eyes in the morning.
  • Excess tear formation, watering from the eyes
  • Increased sensitivity to light
  • Blurred vision due to discharge

You must contact your doctor as soon as you develop any of these symptoms along with redness in the eyes. Since conjunctivitis can remain contagious for one –two weeks after the start of the symptoms, early diagnosis and treatment is important to curtail its spread.

Diagnosis

Your doctor can diagnose pink eyes by your symptoms alone and by a clinical examination of your eye. In severe cases or if your cornea is affected or if you are having repeated conjunctivitis or you are not responding to treatment, your doctor may send a sample of your eye secretions for laboratory analysis.

Complication

Usually, conjunctivitis is self limiting and responds well to treatment. Sometimes conjunctivitis may affect the cornea and affect the vision. So, if your vision is affected please call your doctor immediately. Conjunctivitis caused by chlamydia, gonorrhea, and certain adeno virus strains can be serious and affect several body organs.

If you or your child has conjunctivitis:

  • Do not touch your infected eye(s).
  • Do not rub the eye(s)
  • Often wash your hands with soap and warm water.
  • Several times during the day, remove the discharge from eye(s) using a cotton ball or a paper towel. Use separate cotton ball/paper towel for each eye. Discard them in a closed lid dust-bin. Wash your hands well with soap and water, both before and after removing the discharge.
  • Change your towels, pillowcase, and bed linens daily and wash them with detergent in hot water.
  • Do not wear eye makeup or share it with any one.
  • Stop wearing contact lenses. You can wear glasses/spectacles instead.
  • Do not share towels, handkerchief etc.
  • Wash your hands before and after applying eye drops or ointment.
  • If only one eye is infected, do not use the same eye drop for both eyes. If your doctor asks you to use eye drops for the non infected eye, use another bottle of eye drop.
  • Do not use artificial tears or other eye drops without asking your doctor
  • Avoid going to your workplace or sending your child to school or day care

Treatment

  • Treatment for bacterial conjunctivitis : For bacterial conjunctivitis your doctor may prescribe antibiotic eye-drops or ointment. The infection usually takes a few days to go away. Paracetamol or Ibuprofen may be prescribed for pain relief. For complete treatment or to prevent remission, you must use the drops or ointment as prescribed and follow all the instructions given by your doctor.
  • Treatment for viral conjunctivitis : Usually this needs no treatment and heals by 2-3 weeks. If your doctor feels that the viral conjunctivitis is caused by Herpes simplex virus, you may be prescribed a course of antiviral medications. Paracetamol or Ibuprofen may be prescribed for pain relief. For complete treatment or to prevent remission, you must take the medication as prescribed and follow all the instructions given by your doctor.
  • Treatment for allergic conjunctivitis : For allergic conjunctivitis your doctor may prescribe anti-allergic eye drops. In addition your doctor may prescribe antihistamines, steroid, decongestants and anti-inflammatory drops or tablets. To prevent recurrence and for complete cure, you need to take the medication as prescribed and follow all the instructions given by your doctor. Also, it is important to identify the allergen and avoid it as much as possible. An allergy specialist can help you identify the allergen.
  • Treatment for irritant conjunctivitis : As a first aid measure you must splash your eyes with clean water to remove the chemical or foreign body. You must then immediately call your doctor. Your doctor may further clean your eyes with solutions such as normal saline or Ringer lactate or may prescribe some treatment to control the inflammation. Chemical conjunctivitis can cause scarring of eyes and damage the cornea. Please do not rub your eyes and seek immediate help.
  • Other Care : Apply a cool or warm compress to your eyes. Usually cool compress is more soothing, but some may feel that warm compress is better. You can soak a clean cotton cloth in cool or warm water and wring out the extra water and apply on one eye. For each eye use a different cloth and a different water bowl to soak. This will prevent the spread of infection from one eye to another. After each use, wash the cloth well in hot water and detergent.
  • If you wear contact lenses, you should stop wearing them until the symptoms subside completely. Then, wash them well before re-using. If your conjunctivitis is caused by infection of the contact lenses, you will have to change them.
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