What Is Infective Conjunctivitis? What Is Conjunctivitis? What Is Pink Eye?

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Main Category: Eye Health / Blindness
Also Included In: Infectious Diseases / Bacteria / Viruses
Article Date: 16 Jul 2009 - 0:00 PDT

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There is a thin layer of cells (membrane) between the inner surface of the eyelids and the whites of the eyes, called the conjunctiva. Conjunctivitis is when the conjunctiva becomes inflamed. Another name for conjunctivitis is pink eye. Inflammation causes tiny blood vessels (capillaries) in the conjunctiva to become more prominent, giving the eye a red or pink look.

According to Medilexicon's medical dictionary, conjunctivitis is the "Inflammation of the conjunctiva."

There are three types of conjunctivitis:

• Irritant conjunctivitis - something has irritated the area. It could be an eyelash that got stuck, or chlorine after a swimming in a pool. The eye(s) can become sore. People instinctively rub sore eyes, which unfortunately tends to irritate them more.


• Allergic conjunctivitis - this happens when an allergen comes into contact with the eye, such as dust mites, pollen or animal fur. An allergen makes the body's immune system overreact, causing irritation and inflammation. Click here for more information on Allergic conjunctivitis.


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• Infective conjunctivitis - this is caused by a bacteria or virus. Sexually transmitted infections, such as Chlamydia or gonorrhea can cause conjunctivitis, but rarely so. A viral or bacterial infection typically makes the eyes red/pink and watery. There will be sticky coating on the eyelashes. Infective conjunctivitis accounts for 35% of all eye-related problems recorded in GP surgeries by the National Health Service (NHS), UK. Children and elderly people tend to get it more than others.

The rest of this article focuses on infective conjunctivitis.

What are the symptoms of infective conjunctivitis?

Typically one eye will be affected first, and a few days later the other one will too - though not always. Signs and symptoms may include the following:

• The eye goes red - irritation and widening of the tiny blood vessels in the conjunctiva make the eye go red. If the eye becomes very red and painful you should see a doctor. If your vision is affected, or you develop photophobia (very sensitive to light) you should see a doctor too. Seeing the doctor if you have these symptoms is important because there is a chance that a more serious condition is causing them.


• Watery eye - there are thousands of cells in the conjunctiva that produce mucus, as well as very small glands that produce tears. When the area is irritated the tear glands become overactive, making the eye watery and shiny.


• Sticky coating on the eyelashes - this is most noticeable and annoying when waking up after a long sleep. Sometimes the eyelids are stuck together, as if by glue. The sticky coating is pus which is produced by the infection. Sometimes the coating can harden into a kind of crust. When this happens to a young child for the first time it can be very distressing - the parent or nearby adult needs to reassure the child that nothing bad has happened and that they will soon be able to open their eyes again after a "gentle wash".


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• Sore eyes - some people describe the sensation as gritty, as if there were sand in the eyes.


• Swollen eyelids - the eyelids may swell when the conjunctiva becomes very inflamed, or if the sufferer has been rubbing them a lot.


• Swollen lymph node - the lymph node in front of the ear becomes swollen and slightly tender. The lymph node is part of the body's immune system, which fights infection. The lymph node may feel like a button under the skin.


• Respiratory tract infection - this may include flu-like symptoms, such as fever, headache, aching limbs, and sore throat.

What causes infective conjunctivitis?

The three most common factors that can cause infection to develop in the eye are:

• Bacteria
• Viruses
• An STI (sexually transmitted infection)

A doctor cannot tell what type of infection it is just by examining the patient. However, conjunctivitis that lasts a long time - several months - is most likely to be caused by an STI, such as Chlamydia. Most other types of conjunctivitis will clear up on their own.

Infective conjunctivitis is extremely contagious. Anybody who has such an infection should be very careful to avoid touching other people, and not allowing others to use his/her towels and toiletries. Good hygiene, including regularly washing one's hands with soap and water, help prevent the spread of the infection.

Diagnosis of infective conjunctivitis

By checking the signs and symptoms, and carrying out an examination, a GP (general practitioner, primary care physician) can diagnose infective conjunctivitis.

As the majority of infective conjunctivitis cases resolve themselves within a couple of weeks without treatment, anybody who continues experiencing symptoms after that period should return to see their doctor, who will reassess the diagnosis and subsequent treatment.

The doctor will need to check that you don't have some other condition, such as allergic or irritant conjunctivitis - as their treatments are not the same. The doctor will also check for blepharitis - a common inflammation of the eyelids which makes them go red, irritated, itchy; there will also be dandruff-like scales on the eyelashes. Blepharitis is not contagious. Other conditions which also include symptoms of reddened eyes are:

• Acute glaucoma - a rare form of glaucoma in which pressure builds up in the eye. People with acute glaucoma experience pain, red eyes, and loss of vision. The symptoms can appear very quickly. Acute glaucoma can result in permanent loss of vision if left untreated.


• Keratitis - the cornea becomes inflamed, and possibly ulcerated. Sometimes scarring of the cornea can occur, which may lead to permanent loss of vision. The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior (front) chamber.


• Iritis - the iris becomes inflamed. Untreated iritis can result in the iris sticking to the front surface of the lens, preventing fluid draining from the pupil. This can eventually lead to permanent eye damage. The iris is the colored part of the eye, behind the cornea - it controls the amount of light that enters into the eye. The iris has a hole in its center called the pupil.


• Swab test - if the doctor wants to know what the cause of the infection is, a swab may be taken from the infected eye. This will then be tested in a lab. If the doctor knows what type of bacteria is causing the infection he/she will be able to provide the most appropriate treatment. It is common for the patient to be prescribed an antibiotic until the swab tests results come back - the aim is to keep the symptoms under control. When the results do arrive a more specific treatment may be prescribed.


• Newborn babies, and babies - any infant up to one month old who has symptoms of infective conjunctivitis should be taken to a doctor immediately. Babies may have sticky eye - the tear duct does not drain properly and starts to produce a discharge of pus. Sticky eye sometimes has the same appearance as conjunctivitis - it is not usually a serious condition.
  
  However, redness in the eye may mean the baby has an infection, and the doctor should check for this. Infants (newborns) with infective conjunctivitis need to be checked by an ophthalmologist (eye specialist) promptly so that they may be treated. There is a risk of serious complications if they are not treated immediately.

What is the treatment for infective conjunctivitis?

Most cases of infective conjunctivitis clear up on their own and require no medical treatment. Do not be surprised if you doctor opts for a "watch and wait" strategy. A study carried out by researchers at the University of Oxford, England, found that most children with infective conjunctivitis (pinkeye) do not need treatment with an antibiotic.

Self care

There is a lot you can do yourself at home to easy your symptoms and possibly speed up recovery if you have infective conjunctivitis:

• Do not wear contact lenses - contact lenses should not be worn until the infection has cleared up completely and all symptoms have disappeared. If you are on any antibiotics for an eye condition/disease you should not wear contact lenses until at least 24 hours after that treatment is finished.


• Eye drops - most of these are OTC (over-the-counter, no prescription required), or they may be prescribed for you by your doctor. Eye drops help relieve soreness and stickiness.


• Keep the eyes clean - when you wake up your eyes may be very sticky, or the eyelids may have stuck together completely. Use cotton wool soaked in warm water and gently clean away the sticky substances. Make sure you do not use the same cotton wool for both eyes. Regularly do this during the day - make sure the procedure is gentle and that you do not irritate the eyes.


• Hand hygiene - clean hands will help prevent other people from becoming infected. Regularly wash your hands with warm water and soap.


• Warm compresses - discomfort from infective conjunctivitis can be soothed by applying warm compresses to the affected eye(s). Soak a clean, lint-free cloth in warm water and wring it out - then apply it gently to your closed eye.

Antibiotics

Experts say the difference in recovery speed offered by antibiotics is usually negligible. Most good doctors will wait seven days before deciding on any antibiotics. The risk of complications from infective conjunctivitis is extremely low. About 10% of people given antibiotics for conjunctivitis experience side effects.

However, if symptoms are severe and/or have lasted more than a couple of weeks, antibiotics may be needed.

The most commonly prescribed antibiotics for infective conjunctivitis are:

• Chloramphenicol - the most popular first choice. Usually presented as eye drops. They should be administered straight onto the eye every two hours for two days, and then every four hours for five days during waking hours. This medication is also available as an ointment - ointments are often easier to administer to an infant or young child than eye drops.


• Fusidic acid - doctors may chose this medication if chloramphenicol is not suitable for the patient, such as pregnant women. The eye drops are administered twice daily, for seven days.

It is not unusual for your vision to become blurry shortly after using eye drops. Make sure you can see clearly before driving or operating machinery. If symptoms do not clear up after two weeks you should return to your doctor. The following symptoms may indicate something more serious, and you should see a doctor immediately:

• Pain in the eye
• Sensitivity to light (photophobia)
• Loss of vision
• The redness in the eye is very intense

Complications

The risk of complications from infective conjunctivitis cause by bacteria or a virus is extremely small.

Sexually transmitted diseases (STIs) - Conjunctivitis caused by an STI is much more likely to have complications, because it may last several months.

Newborn babies (neonates) - neonatal conjunctivitis has a higher risk of complications, compared to others. A neonate (newborn) is a baby up to 28 days old. Neonatal infective conjunctivitis can be severe and progress rapidly. In very severe cases the baby's vision may be affected.

Between 10-20% of neonates with infective conjunctivitis caused by Chlamydia develop pneumonia. Pneumonia is a life-threatening infection for newborns. Other types of bacterial conjunctivitis may also cause complications for a newborn, though rarely. Possible complications include:

• Meningitis - a potentially very serious illness, which can be fatal. The meninges - a layer of cells that cover the brain and spinal cord - becomes infected.


• Cellulitis - a bacterial infection of the dermis - the deep layer of skin - as well as the subcutaneous tissues (fat and soft tissue layer) that are under the skin.


• Septicemia (blood poisoning) - bacteria gets into the bloodstream and attacks the tissues in the body.

The vast majority of babies make a full recovery from infective conjunctivitis with no complications at all.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today