Causes of    Conjunctivitis Types of Conjunctivitis Symptoms of Conjunctivitis Allergic Conjunctivitis Viral Conjunctivitis Bacterial Conjunctivitis Giant Papillary Conjunctivitis

1. What is conjunctivitis?

Conjunctivitis, or pink eye, is an inflammation of the conjunctiva, the clear mucous membrane that covers the white part of the eyeball and the inside of the eyelid. Cases may vary from a mild redness with watery eyes to serious infections where vision is impaired or even lost

2. What causes conjunctivitis?

Conjunctivitis happens when the conjunctiva becomes infected, usually by a virus or bacteria. It also can be caused by allergic reactions or chemical irritations.

3. What are the types of conjunctivitis?

The four main types of conjunctivitis are infectious, allergic, giant papillary conjunctivitis and chemical. The infectious form, commonly known as "pink eye" is caused by a contagious virus or bacteria. The allergic form is brought on by the body's reactions to pollen, cosmetics, and animal dander. The chemical form is produced by noxious fumes, air pollution, and chlorine in swimming pools.

4. Is conjunctivitis contagious?

Viral infections are highly contagious. Just like the common cold, you can spread the virus causing conjunctivitis by coughing or sneezing. Sharing items that touch the eye, like makeup and towels, is another good way to spread the virus. Frequent hand washing and avoiding rubbing the eyes are good ways to reduce the risk of spreading the virus.

Usually, the condition improves in a few days. In most cases if you wear contact lenses, it is advisable to discontinue their use until the problem is diagnosed and resolved.

5. What are some warning signs or symptoms?

Signs of conjunctivitis are red and irritated eyes. If you have conjunctivitis, you may wake up with your eyelashes stuck together from dried mucus formed during the night. The condition often affects both eyes and causes a gritty feeling. Although vision is usually not affected, your eyes may be very sensitive to light. There is a stickiness of the eyelids. In severe cases the eyelids are swollen. Itching is another common symptom. Conjunctivitis can be confused with a more serious eye disease known as iritis. That's why it is important to have your eye problem diagnosed and treated by a qualified eye care professional.

6. What are the effects of the different types of conjunctivitis?

  • Viral conjunctivitis usually affects only one eye and causes excessive eye watering and a light discharge

  • Bacterial conjunctivitis affects both eyes and causes a heavy discharge, sometimes greenish

  • Allergic conjunctivitis affects both eyes and causes itching and redness in the eyes and sometimes the nose, as well as excessive tearing

  • Giant papillary conjunctivitis (GPC) usually affects both eyes and causes contact lens intolerance, itching, a heavy discharge, and tearing and red bumps on the underside of the eyelids

7. What are the problems of conjunctivitis in babies?

When conjunctivitis occurs in babies younger than 4 weeks old, it is called neonatal conjunctivitis or ophthalmia neonatorum. This can be caused by a blocked tear duct, which can be treated by gentle massage between the eye and nasal area. Irritation from the antibiotic eye drops regularly given to babies immediately after birth can cause a mild chemical conjunctivitis, which clears up on its own within a couple of days.

Newborns are also susceptible to infectious conjunctivitis, which can be serious. The sexually transmitted bacteria Chlamydia trachomatis and Neisseria gonorrhoeae can pass from an infected mother's birth canal into her baby's eyes during delivery. These bacteria can cause symptoms of conjunctivitis in babies within the first 2 weeks of life, and both can lead to serious eye damage. Less commonly, the viruses that cause genital and oral herpes can similarly be passed to an infant at the time of delivery and may also damage the eyes.

8. What are the most common causes of conjunctivitis in childhood?

Conjunctivitis is an inflammation of the conjunctiva, which is usually caused by infection or allergy. It is frequently referred to as "pink eye" and is the most common acute eye disorder seen by primary care pediatricians and family physicians.

9. How to avoid spreading infections with conjunctivitis?

To avoid spreading infection, take these simple steps:

  • Disinfect surfaces such as doorknobs and counters with diluted bleach solution
  • Don't swim (some bacteria can be spread in the water)
  • Avoid touching the face
  • Wash hands frequently
  • Don't share towels or washcloths
  • Do not reuse handkerchiefs (using a tissue is best)
  • Avoid shaking hands

10. How can I prevent conjunctivitis?

To keep from getting conjunctivitis from someone who has it, or to keep from spreading it to others, follow these guidelines:

  • Wash your hands frequently. Do not touch or rub your eyes.
  • Never share eye makeup or cosmetics with anyone. Also, if lab results show that you have conjunctivitis, throw out eye makeup you have been using.
  • Never use eye medicine that has been prescribed for someone else.
  • Do not share towels, washcloths, or sheets with anyone. If one of your eyes is affected but not the other, use a separate towel for each eye.
  • Avoid swimming in swimming pools if you have conjunctivitis.

Avoid close contact with people until you have used the antibiotics for 24 hours and if your eye does not have a lot of pus. Children can return to school or day care after they have had 24 hours of antibiotic treatment.

Allergic Conjunctivitis

11. What is allergic conjunctivitis?

Allergic conjunctivitis is inflammation of the conjunctiva caused by the body's immune response to allergens such as molds and pollen.

12. What are the symptoms of allergic conjunctivitis?

  • Usually affects both eyes
  • Itching
  • Tearing
  • Swollen eyelids
  • Blurred vision
  • Sensation of fullness in the eyes or eyelid
  • Sensation of foreign body in the eye
  • An urge to rub the eyes

Vision is rarely affected. Infectious conjunctivitis can be distinguished from the allergic type with a thorough examination.

Allergic Conjunctivitis

13. What are the common allergens that cause allergic conjunctivitis?

Common allergens that cause allergic conjunctivitis include:
  • Plant pollens
  • Animal dander
  • Dust mites
  • Mold spores
  • Grass and ragweed
  • Cosmetics and perfumes
  • Skin medicines
  • Air pollution
  • Contact lenses and contact lens solutions

14. What are the types of allergic conjunctivitis?

There are two types of allergic conjunctivitis, seasonal and perennial. The seasonal one is the more common of the two occurring in the majority of people who suffer from this condition. It is associated with seasonal allergies, which commonly occur during the spring and summer months and is usually caused by exposure to airborne allergens, such as grass and plant pollens. Perennial allergic conjunctivitis persists throughout the year and is generally triggered by indoor allergens such as animal dander, dust mites and mold spores.

15. What is the treatment for allergic conjunctivitis?

Treatment is aimed at controlling the symptoms, which are often chronic. Depending on the severity of the symptoms, over-the-counter vasoconstrictor and antihistamine eye-drop combinations may provide relief.

If the symptoms are severe and the treatment is ineffective, mild steroid eye drops may be temporarily prescribed to reduce the allergic response.

Eventually, mast-cell stabilizer eye drops may be substituted for the steroid drops. Mast-cell stabilizers prevent the release of histamines and other mediators of inflammation, which ultimately cause the itching. Patients whose symptoms can only be controlled with ongoing steroid use must be monitored for increased eye pressure and cataracts.

Viral Conjunctivitis

16. What is viral conjunctivitis?

Viral conjunctivitis is the inflammation of the conjunctiva of the eye that results from infection with a virus. Viral conjunctivitis is common with several viral infections - most often with infections caused by adenoviruses or enteroviruses - and can occur during a common cold or the flu.

17. What are the symptoms of viral conjunctivitis?

  • Eyes are red or pink.
  • Eyelids stick together especially in the morning.
  • Eyes Itch.
  • Excess tearing.
  • White- yellow or cream color thick sticky discharge (usually in bacterial infections).
  • Watery discharge (allergic or viral).
  • Pain may be present.
  • Bacterial symptoms often in one eye.
  • Virus infections and allergies often affect both eyes.
  • Bleeding or hemorrhage can be seen as tiny blood vessels rupture (Viral or chemical).
  • Viruses such as Herpes can cause tiny ulcers (shallow open sores).
  • Swelling of conjunctiva can occur.
  • Sensitivity to light
18. What are the viruses that cause viral conjunctivitis?

  1. Adenoviruses
  2. Herpes Simplex
  3. Coxsackie's virus
  4. Measles virus

Viral Conjunctivitis

19. How long will the effects last?

Viral conjunctivitis usually gets worse 5 to 7 days after the first symptoms. It can improve in 10 days to 1 month. If only one eye is affected at first, it may take up to 2 weeks for the other eye to be affected. Usually, if both eyes are affected, the first eye has worse conjunctivitis than the second

20. What is the treatment for viral conjunctivitis?

Doctors don't normally prescribe medication for viral conjunctivitis because it usually clears up on its own within a few days. Like the common cold, there is no cure for viral conjunctivitis. However, the symptoms can be relieved with cool compresses and artificial tears (found in most pharmacies). For the worst cases, topical steroid drops may be prescribed to reduce the discomfort from inflammation. Viral conjunctivitis usually resolves within 3 weeks.

21. Why is there a need to distinguish viral from bacterial conjunctivitis?

Viral and other non-purulent types of conjunctivitis do not require antimicrobial treatment. Often these children are treated mistakenly for prolonged periods of time with both topical and systemic antibiotics with persistence of the red eye. In some situations the topical antibiotic itself may cause an allergic reaction resulting in a persistent red eye.

Bacterial Conjunctivitis

22. What is bacterial conjunctivitis?

Bacterial conjunctivitis is a microbial infection involving the mucous membrane of the surface of the eye. This condition, which is usually a benign self-limited illness, sometimes can signify a severe underlying systemic disease. Occasionally, significant ocular and systemic morbidity may result.

Bacterial Conjunctivitis

23. What organisms are commonly involved in bacterial conjunctivitis?

Bacteria that commonly influence bacterial conjunctivitis are:
  • Staphylococcus aureus
  • Streptococcus pneumoniae
  • H. Influenza
  • Neisseria and others
  • Trachoma -- Chlamydia
  • Tuberculosis
  • Syphilis
  • Parasites or Fungi
24. What are the symptoms of bacterial conjunctivitis?

  • Eyes are red or pink.
  • Eyelids stick together especially in the morning.
  • Eyes Itch.
  • Excess tearing.
  • White-yellow or cream color thick sticky discharge (usually in bacterial infections).
  • Watery discharge (Allergic or Viral).
  • Pain may be present.
  • Bacterial symptoms often in one eye.
  • Virus infections and allergies often affect both eyes.
  • Bleeding or hemorrhage can be seen as rupture of tiny blood vessels.
  • Viruses such as Herpes can cause tiny ulcers (shallow open sores).
  • Swelling of conjunctiva can occur.
  • Sensitivity to light

25. How long will the effects of bacterial conjunctivitis last?

Bacterial conjunctivitis should improve within 2 days after you begin using antibiotics. If your eyes are not better after 3 days of antibiotics, call your health care provider.

26. What are the related conditions for bacterial conjunctivitis?

  • Reiter's Syndrome
  • Sinusitis
  • Stevens-Johnson Syndrome
  • Syphilis
  • Trachoma

27. What is the treatment for bacterial conjunctivitis?

In most cases of adult or childhood conjunctivitis, treatment with topical antibiotics is initiated without cultures. If the ophthalmologist elects for cultures, antibiotic therapy is usually initiated and treatment changed later, as necessary, depending on culture results. Gonococcal conjunctivitis requires intravenous or intramuscular antibiotics in addition to topical therapy.

28. What is Giant Papillary Conjunctivitis?

Giant Papillary Conjunctivitis (GPC) is a condition most commonly associated with contact lens use. The occurrence of GPC is up to four times greater in soft contact lens wearers versus hard contact lens wearers. GPC may affect as many as 20 percent of soft contact lens wearers. Although the mechanism by which GPC occurs is not clearly understood, it seems to be related to the contact lens materials and the preparations used to care for the lens (cleaning and sterilization solutions).

GPC is characterized by giant bumps (papillae), larger than 1 mm on the upper eyelid. Among the earliest signs of GPC is the redness of the upper eyelid. This is an important characteristic if an early diagnosis is to be made. Abnormal thickening of the conjunctiva (the outermost membrane which lines the eyelids) may progress to opacification as inflammatory cells enter the tissue.

29. What are the causes of GPC?

The causes of GPC include contact allergy and perhaps immune system reactions. Typically, GPC results from: exposure to chemicals and preservatives in contact lens solutions, the plastic material itself, pollens and other airborne allergens, or can occur secondarily to a bacterial infection. Hay fever is considered to be a primary precipitatory factor, as are chemical preservatives in lens care products and eye drops. Additionally, over wear and mis-use of contact lenses, especially worn, damaged or soiled lenses can cause GPC.

Giant Papillary Conjunctivitis

30. What are the symptoms of GPC?

Most often, the symptoms of GPC occur while the contact lenses are in place; however, they may persist after removal of the lens from the eye.

  • Redness
  • Itching
  • Burning
  • Mucus discharge
  • Blurred vision
  • Photophobia

The symptoms described above may not necessarily mean that you have giant papillary conjunctivitis. However, if you experience one or more of these symptoms, contact your eye doctor for a complete exam.

31. What are the treatments for GPC?

A first step in treating GPC is to reduce of the amount of time spent wearing contact lenses. Lens care is usually modified to ensure more frequent enzymatic cleaning on an as needed basis. Preserved solutions are discontinued, and patients are advised to rinse and store lenses in unpreserved salt solutions. Lenses may be sterilized by cold or hot, disinfection or treatment with hydrogen peroxide. Hydrogen peroxide is most preferred. If these measures are unsuccessful, new lenses will be prescribed.

As mentioned earlier, GPC appears to be related to the lens materials as well as the design. The physician will work with a patient to find the "right" lenses. Lenses may be switched every few months depending on the patient's history. If the condition does not improve, the physician may have the patient stop wearing lenses -- this reverses the symptoms of GPC.

Follow-up care is important. GPC is difficult to control. If the condition is not treated properly and steps taken to prevent a recurrence, it can become a chronic condition. It may even prevent further use of contact lenses.

32. How to prevent Giant Papillary Conjunctivitis?

  • Do not wear damaged or dirty contact lenses. Replace them as necessary to maintain the highest level of lens hygiene.
  • Always thoroughly clean and disinfect lenses between use. Do not wear irritating lenses. Do not wear them if you think you may be developing an infection. If you sleep in contact lenses, remove them for cleaning and disinfection before discomfort occurs. Consider not leaving your extended wear lenses in overnight. For soft lens wearers, use unpreserved solutions when possible. Always rinse lenses in unpreserved saline before inserting. Of course you should always wash and dry your hands before handling contact lenses and avoid soaps with antiperspirant chemicals, perfumes and other additives.

  • If you have hay fever, consider medication before symptoms become severe.

  • If you have dandruff, especially in your eyebrows, treat the condition and avoid getting the debris in your eye.

  • If you have dry eyes, use unpreserved drops to keep them moist and well lubricated and seek medical attention for on-going treatment.

  • Avoid contact with airborne chemical vapors and sprays. Wear safety glasses or goggles if in situations where such contaminants could get in your eyes.