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YOU ARE IN > Medical > Condition centres > Eye > Infections of the Eye

Conjunctivitis

Last updated: Monday, December 15, 2008 Print

Conjunctivitis is an inflammation of the conjunctiva, a membrane covering the inner eyelid and front of the eye.

Conjunctivitis can be infectious or non-infectious.

Infectious conjunctivitis is contagious.

Infectious conjunctivitis can be caused by bacteria or viruses.

Non-infectious conjunctivitis can be caused by allergy, chemical irritation, underlying inflammatory diseases, or trauma.

What is conjunctivitis?
Conjunctivitis is an inflammation of the conjunctiva, which is a thin, transparent membrane that covers the surface of the inner eyelid and the front of the eye. This membrane reacts to a wide range of bacteria, viruses, allergy-provoking agents, irritants and toxic agents, as well as to underlying diseases within the body. The conjunctiva is usually clear, but if irritation or infection occurs, the lining becomes red and swollen.

The common name for conjunctivitis is "pink eye". Pink eye is very common, usually not serious, and often resolves in a few days without medical treatment.

The three main types of conjunctivitis are infectious, allergic and chemical.

Neonatal conjunctivitis is a separate type of conjunctivitis. This occurs in a newborn child. One of the most common causes are sexually transmitted diseases such as chlamydia which are aquired by the baby as it is born. This needs to be treated with antibiotics and the mother and partner will also need treatment.

The other common type of conjunctivitis which a newborn child can get is caused by a blocked tear duct (nasolacrimal duct). The eye appears sticky, particularly in the mornings. This will usually get better on its own, but sometimes surgery is needed later.

What causes conjunctivitis?

Infectious conjunctivitis is caused by a contagious virus or bacteria.

"Pink eye" refers to any kind of conjunctivitis. However, especially in schools, "pink eye" refers to a particular viral conjunctivitis (caused by the adenovirus) that is very contagious. Occasionally this form of pink eye can be associated with infection of the cornea (the clear portion of the front of the eyeball).

Other viruses, such as those causing herpes simplex, chicken pox, shingles, or measles, can also infect the conjunctiva.

Blepharitis is inflammation and infection of the eyelids usually marked by redness and crusting at the margins along the lash line. This can cause a secondary bacterial conjunctivitis. Other problems with the eyelids that can lead to or exacerbate conjunctival irritation are styes, a lump called a chalazion, or tear deficiency.

A raised, yellowish growth on the wall of the eye called a pingueculum can often become inflamed by exposure to irritating environments, such as a dry, windy climate.

Allergies to pollen, cosmetics, animals or fabrics often bring on allergic conjunctivitis.

Chemical pink eye can result when any irritating substance enters the eyes. Common irritants are household cleaners, sprays, smoke, smog, industrial pollutants and chlorine in swimming pools.

Conjunctivitis may be drug-induced. Reactions can occur to preservatives in eye drops, or after prolonged use of topical antibiotics or antivirals.

Persistent conjunctivitis can be a sign of an uncommon underlying illness. Most often these are rheumatic diseases, such as rheumatoid arthritis. Conjunctivitis is also seen in Kawasaki's disease (a rare disease associated with fever in infants and young children) and certain inflammatory bowel diseases. Symptoms of certain sexually transmitted diseases, such as chlamydia, may include conjunctivitis.

Subconjunctival haemorrhage, or "eye bruise", occurs when a portion of the wall of the eye (white of the eye) suddenly becomes bright red. This occurs when the tiny blood vessels covering the whites of the eyes rupture from trauma or changes in pressure within the head (for example, as a result of forceful laughing, coughing, sneezing or vomiting, diving under water, or even bending upside down). This tends to be asymptomatic and is usually pointed out by another person. It can appear quite alarming, but is in fact a harmless haemorrhage or bruise under the conjunctiva.

Uncommonly, the inside of the eye can become inflamed, a condition called iritis or uveitis, or sometimes the wall of the eye beneath the conjunctiva can become inflamed (episcleritis or scleritis). These conditions often involve only one eye. They are generally not infectious processes, and sometimes are associated with various medical conditions. They are potentially serious and need to be evaluated by an ophthalmologist and usually treated with anti-inflammatory medications.

Conjunctivitis can be a symptom of glaucoma (raised pressure within the eye).

Conjunctivitis is a well-known complication of wearing contact lenses.

Some forms of conjunctivitis are of fungal origin.

Foreign bodies, scrapes, and sores on the cornea can lead to infection of the conjunctiva; so can infection of the eye socket and areas around the eye.

Who gets conjunctivitis and what are the risk factors?
Conjunctivitis is a common condition. It affects people of all ages, and is common in childhood.

Allergic conjunctivitis is frequently seasonal, and goes along with other typical "allergy" symptoms such as sneezing, itchy nose, or scratchy throat.

There are no specific risk factors associated with conjunctivitis.

What are the symptoms and signs of conjunctivitis?
The symptoms of conjunctivitis include swelling of the eyelids, discharge from the eye which can be watery or pussy, and itching, particularly with allergic conjunctivitis.

The eye appears red and inflammed and in viral conjunctivitis the lymph node in front of the ear tends to be swollen and tender.

How is conjunctivitis diagnosed?
Diagnosis is on the basis of the appearance of the eye and any history of contact with someone else with conjunctivitis. A history of itching and eye discomfort regularly at a particular time of the year will point to allergic conjunctivitis.

Any discharge will be taken and cultured – smeared on an agar plate to look for growth of bacteria – to identify bacteria where bacterial conjunctivitis is suspected.

The undersurface of the lid has a particular appearance in viral conjunctivitis and is different again in allergic conjunctivitis.

Can conjunctivitis be prevented?
Viral and bacterial conjunctivitis are contagious and spread very easily. Poor hand washing is the main cause of the spread of conjunctivitis. Sharing an object with a person who has conjunctivitis can spread the infection. Conjunctivitis is spread through contact with eye drainage, which contains the virus or bacteria.

To prevent infectious conjunctivitis:

Do not share eye make-up.

Do not share contact lens equipment, containers or solutions.

Do not share towels, linens, pillows or handkerchiefs.

Wear gloves if you are looking into someone else's eyes for foreign objects.

Wear eye protection when in the wind, heat and cold.

Wear safety glasses when working with chemicals.

To prevent the spread of pink eye:

Keep your hands away from your eyes.

Wash your hands before and after touching the eyes or face, or using medicine in your eyes.

Change linens, towels and washcloths daily, and do not share these items.

Do not share eye make-up, contact lens equipment or eye medication.

If your eye infection was caused by a bacteria or virus, throw away your old make-up and buy new products.

Do not use eye make-up until the infection is fully cured, or you could reinfect yourself with the eye make-up products.

Do not wear contact lenses until the infection is cured. Thoroughly clean your contact lenses before wearing them again.

Do not attend day-care, school, go to work or use public swimming-pools until symptoms of viral conjunctivitis have begun to improve, which should be within three to five days. Since there are no medications to treat viral conjunctivitis, it is important to prevent the spread of the infection. Home treatment of the symptoms only helps you feel more comfortable while the infection clears up.

Do not attend day-care, school, or go to work until bacterial conjunctivitis has been treated for 24 hours with an antibiotic, which usually kills the bacteria.

If eyedrops or ointment is prescribed, be sure the dropper is clean and does not touch the eye, eyelid or any surface. Replace the dropper or bottle if their tips touch the eye or surrounding area.

Seek treatment promptly.

How is conjunctivitis treated?
Home

Home treatment will help reduce the pain of conjunctivitis and keep your eye free of drainage.

If you wear contact lenses, remove them and wear glasses until your symptoms have cleared up.

Cool or warm compresses can be used, whichever feels better. If an allergy is the problem, a cool compress may be more soothing. With infectious pink eye, a warm, moist compress may help reduce redness and swelling. Use a different compress for each eye, and a clean compress for each application of warmth, to prevent spreading the infection.

Clean the eyelid margins and eyelashes gently and repeatedly with a warm, moist cloth or cotton ball. Wipe from the inside, next to the nose, towards the outside of the eye. Use a clean surface for each wipe so drainage being cleaned away is not rubbed back across the eye. Throw used wipes away. After wiping your eye, wash your hands to prevent drainage from spreading.

In the case of acute chemical conjunctivitis, wash the eyes promptly and thoroughly with large amounts of water. Contact your doctor or local poison control centre.

The ideal treatment for allergic and chemical conjunctivitis is to remove the cause of the allergy or irritation. For instance, avoid contact with animals or other environmental factors that cause an allergic reaction. Wear swimming goggles if chlorinated water irritates the eyes. In cases where these measures won’t work, prescription and over-the-counter eye drops are available to help relieve the discomfort.

Wear sunglasses.

Over-the-counter artificial tear eyedrops can provide comfort.

Pink eye may be more serious if:

You have a condition that decreases your body's ability to fight infection (impaired immune system).
You have vision in only one eye.
You wear contact lenses.

A physician should evaluate conjunctivitis in an infant or toddler because additional treatments such as systemic antibiotics may be necessary.

Medication
Infectious conjunctivitis, caused by bacteria, is usually treated with antibiotic eye drops and/or ointment. Bacterial conjunctivitis usually responds within a few days to treatment with antibiotic eye drops or ointment prescribed by a physician. Some kinds of bacterial conjunctivitis need to be treated with oral antibiotics as well as eye drops or ointments. Be careful not to use medication prescribed for someone else, or for an old infection, as these may be inappropriate for the current infection or may have been contaminated by previous infections.

Viruses in general do not respond to antibiotics: the infection tends to run its course and resolve by being fought off by your body’s immune system. Some antibiotics may be prescribed, however, to prevent secondary bacterial infections from developing. It is sometimes difficult to distinguish between bacterial and viral conjunctivitis, and an antibiotic may be prescribed for a bacterial infection that is in fact viral. If the cause is viral, it will not be affected by the medication and will typically last longer than a bacterial infection.

To apply eyedrops or ointment:

For older children and adults, pull the lower eyelid down with two fingers to form a small pouch. Put the drops or ointment there. Close the eye for several minutes to let the medication move around.

Ask younger children to lie down with eyes closed. For eyedrops, put a drop in the inner corner of the eye. When the eye opens, the drop runs in. For ointment, pull the lower eyelid down to form a pouch in which to put the ointment. Ask the child to close his or her eyes and move the eyeball from side to side to move the drops or ointment around the eye.

Eyedrops are washed out by normal tearing, so they need to be replaced at least three times a day.

With allergic conjunctivitis, topical antihistamines, usually in combination with decongestants, may be prescribed. In severe cases short-term topical steroids may be considered.

Some doctors will prescribe an anaesthetic drop to relieve the discomfort in the eye, but others are reluctant to do this. While these drops definitely do relieve pain and discomfort they also cause loss of the protective blink reflex of the eye. This means that the eye could be damaged while it is anaesthetised. If these drops are used, then most people recommend using a protective eye patch as well.

When to see a doctor
If you think you or your child might have bacterial pink eye, you should see your doctor immediately. If the cause is a bacterial infection, an antibiotic will be needed. If there are other symptoms such as runny nose, cough or earache, there is a good chance that these symptoms are caused by the same bacteria and an oral antibiotic may be needed to reach these germs along with the antibiotic drops or ointment for the eyes.

Your doctor will also want to exclude the possibility that the infection has spread to areas where symptoms may not yet be recognisable.

In the case of acute chemical pink eye, your doctor or your local poison control centre should be contacted at once, even if you think the irritant or chemical is "safe", as some of the most common household products can be the most damaging.

Certain forms of conjunctivitis can develop into a serious condition that may harm your vision. Therefore, it is important to have conjunctivitis diagnosed and treated quickly.

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