Conjunctivitis

What is Conjunctivitis?

Conjunctivitis is an inflammatory condition of the ocular conjunctiva. This is a transparent membrane that covers the "white of the eye," starting from the cornea to the inside of the eyelids, with the main role of protecting and moistening the eye.

Signs and Symptoms of Conjunctivitis

The distinctive sign is "red eye," this being the main reason that brings patients to the doctor.

Common symptoms experienced by the patient are burning sensation, stinging, foreign body sensation or "sand in the eyes," associated with eye itching and discharge. Depending on the cause, discharge can be watery, mucous (viscous), or purulent (whitish-yellow, yellowish-green).

In conjunctivitis, visual acuity is not affected. If the inflammation is severe, conjunctivitis can be complicated by corneal involvement (keratitis), which is accompanied by decreased vision.

Sometimes manifestations also appear at the eyelid level. These can be swollen (palpebral edema) in allergic conjunctivitis or there may be specific lesions (vesicles) in viral blepharo-conjunctivitis (with herpes virus or varicella-zoster).

Allergic Conjunctivitis

Allergic conjunctivitis is inflammation of the conjunctiva caused by the presence of an allergen or irritant (dust, pollen, mites, dander, mold, etc.).

Sometimes it can appear as a reaction to certain medications or substances that we put in the eyes (solutions used for contact lens care or eye drops). Allergic conjunctivitis is much more common among people with known allergic predisposition (asthma or various skin allergies), among children and young people, but also among people who live in areas with large amounts of allergens.

The symptoms are a consequence of the immune system's defense action against allergens, being represented primarily by red, inflamed eye, abundant tearing, burning sensation in the eyes and intense itching sensation, sometimes accompanied by sneezing and watery nasal discharge (allergic rhinitis).

The most common forms of allergic conjunctivitis are seasonal conjunctivitis. It appears especially in the March-May period, as a reaction to pollen or mold.

Perennial conjunctivitis occurs throughout the year, as a reaction to animal hair, dust, or feathers. There are also severe forms of allergic conjunctivitis, namely vernal conjunctivitis, atopic keratoconjunctivitis, or giant papillary conjunctivitis, which can lead to complications if they do not receive adequate treatment.

Treatment of Allergic Conjunctivitis

Allergic conjunctivitis can benefit from several classes of medications (antihistamines, vasoconstrictors, steroidal/non-steroidal anti-inflammatory drugs) especially in topical or oral form, in severe cases. In addition to prescribed treatment, there are a number of measures that can be implemented to control symptoms. Allergens should be avoided, cold compresses should be used on the eyes, frequent showers, use of artificial tears. In cases where conjunctivitis is not well controlled, an allergologist should be consulted.

Viral Conjunctivitis

Viral conjunctivitis is inflammation of the conjunctiva caused by the presence of viruses, most commonly adenovirus being involved. This type of conjunctivitis is extremely common, especially during the warm season, and is very contagious (it is transmitted by air through contaminated respiratory particles, direct hand-to-eye contact, or from insufficiently chlorinated swimming pool water), and the symptoms are not always specific. The evolution is generally favorable, self-limited in 7-10 days.

There are also conjunctivitis caused by herpes simplex virus, varicella-zoster virus; these can have a more severe evolution and can be accompanied by eyelid and corneal involvement.

Viral conjunctivitis frequently manifests as red eye, accompanied by watery/mucous discharge. Excessive tearing appears and sometimes intense itching, but without vision impairment. The symptoms are initially unilateral (in one eye only), but with rapid bilateralization (to both eyes).

Complications of Viral Conjunctivitis

Viral conjunctivitis is a self-limited process with good evolution, however there are situations where it can be associated with general manifestations (adeno-pharyngoconjunctivitis) or ocular complications with corneal involvement (keratitis).

Treatment of Viral Conjunctivitis

It is a treatment primarily aimed at alleviating symptoms, with drops that reduce redness, stinging, itching, and tearing. Sometimes the association of antibiotic drops is useful to prevent bacterial superinfection.

In particular cases of herpetic or zoster conjunctivitis, specific local antiviral treatment is important to remove the risk of complications. Special attention must be paid to limiting the spread in communities, since viral conjunctivitis has a high degree of contagiousness.

Bacterial Conjunctivitis

Bacterial conjunctivitis is inflammation of the conjunctiva caused by bacteria.

Microbial agents can be varied, either from the saprophytic flora of the conjunctiva and eyelids, or external (through direct hand-to-eye contact), or from a clinically inapparent infection. The most commonly encountered microbial agents are Staphylococcus, Streptococcus, Chlamydia, or Haemophilus influenzae.

The symptoms of bacterial conjunctivitis have acute onset, unilateral (in one eye only), frequently the other eye also being affected. It manifests as red eye, mucous or purulent conjunctival discharge, whitish-yellow, with eyelid sticking in the morning upon waking, foreign body sensation, stinging sensation, tearing, but without vision impairment.

Bacterial conjunctivitis is common, very contagious; it does not hurt, but if untreated or improperly treated it can become chronic or complicated with corneal infections, lacrimal pathway involvement, or eyelid scars.

Treatment of Bacterial Conjunctivitis

Treatment is recommended by the ophthalmologist, depending on the severity of the disease form. It consists of applying antibiotic drops or ointments, sometimes also local anti-inflammatory.

In bacterial conjunctivitis, first of all, very rigorous eye hygiene must be maintained because it can spread to people around. Hands should be washed as often as possible, medication should be handled so that it does not come into contact with eye secretions. Local hygiene will be maintained by eye washing with physiological saline or special wipes for the eye area, as well as proper hygiene of personal items.

It should be mentioned that eye patching is contraindicated.

Bacterial Conjunctivitis of the Newborn

It is a severe form of conjunctivitis, caused by chlamydia or gonococcus, in some children born naturally. If untreated, it can lead to important eye complications. Therefore, all children after birth are prophylactically administered antibiotic ointment or silver nitrate in the conjunctival sac. The newborn must be carefully monitored, as they can have persistent eye discharge also due to lacrimal canal obstruction. In this situation, the ophthalmologist recommends rigorous hygiene, massage, and drops with local antiseptics or antibiotics.

Fungal Conjunctivitis

Fungal or mycotic conjunctivitis is inflammation of the conjunctiva caused by fungal infections or fungi. The most commonly encountered form is with Candida Albicans. It is a rare form of conjunctivitis, associated with other signs of immunosuppression. If not properly treated, it can lead to serious eye complications.

Treatment of Fungal Conjunctivitis

Treatment is done with local antifungals in the form of drops.

Chemical Conjunctivitis

Chemical conjunctivitis is inflammation of the conjunctiva caused by chemical substances, irritants, or pollutants. It can also be caused by exposure to UV radiation.

Treatment of Chemical Conjunctivitis

The first measure is removing or neutralizing the causative agent and cleaning the eye surface as well as possible. After this, depending on the degree of inflammation, anti-inflammatory and local antibiotics are administered in the form of drops. These improve symptoms and prevent complications.

Swimming Pool Conjunctivitis

This form of conjunctivitis can have an infectious or irritative cause. When infectious agents are involved, they can be viruses (adenovirus) or bacteria (chlamydia). The irritative form of conjunctivitis is caused by too high chlorine concentration in the pool.

We can prevent the appearance of swimming pool conjunctivitis by wearing swimming goggles, rinsing the eyes well with clean water when leaving the pool. It is recommended to use our own towels (not used by other people). Treatment of swimming pool conjunctivitis addresses treating the causal agent.

Diagnosis of Conjunctivitis

The diagnosis of conjunctivitis will be made by the ophthalmologist during the specialist consultation, based on clinical examination and symptoms. Additional tests (such as an examination of lacrimal secretion) may be necessary to detect the type of bacteria that caused the infection.

Following correct diagnosis, the appropriate treatment will be established for each form of conjunctivitis. It is essential to correctly establish the type of conjunctivitis, because treatment is different. Moreover, applying the wrong treatment not only does not lead to healing but can complicate conjunctivitis.

Hygiene and Prevention of Conjunctivitis

Viral and bacterial conjunctivitis are the most contagious. They can be prevented through good hand hygiene and by avoiding touching the eyes, especially in the warm season, with unwashed hands. Also, during treatment, strict hygiene must be maintained. The affected eye should not be touched. Drop administration must be done with great care, without touching the eye with the bottle tip. In case of touching, it becomes contaminated and must be replaced. All objects that can come into contact with the eye - towels, pajamas, pillowcases, etc. - should be changed and sanitized frequently.

A category at risk are contact lens wearers. Contamination is frequently done through handling lenses with dirty hands. At the first signs of infection, lenses must be removed and discarded along with the case in which they are kept and the related solutions. If conjunctivitis is suspected, lens wearing must be stopped (only glasses will be used) and the ophthalmologist should be consulted.