Conjunctivitis

What is Conjunctivitis?

Conjunctivitis, often causing redness in the eyes, is a frequent reason why people visit emergency rooms or urgent care clinics. It can affect anyone, regardless of their age, background, or income level. Eighty percent of these acute, or short-term, cases are diagnosed by various non-eye specialist doctors, resulting in significant costs for the healthcare system in the United States, around $857 million a year. Although conjunctivitis typically goes away on its own and rarely causes vision loss, it’s still important to check for other potential causes that could seriously affect vision.

The conjunctiva is a clear, slimy tissue that coats the surface of the eye and the inside of the eyelids. This condition, conjunctivitis, is an inflammation of this tissue, often causing swollen blood vessels, eye pain, and a discharge. It is classified as either acute or chronic and can be caused by an infection or not. Acute conjunctivitis usually lasts 1 to 2 weeks, with symptoms being noticeable for 3 to 4 weeks, while chronic conjunctivitis lasts for more than 4 weeks.

While many infections can cause conjunctivitis, it can also be linked to certain systemic illnesses. These may include Stevens-Johnson syndrome, dry eye syndrome (known as keratoconjunctivitis sicca), nutritional deficiencies especially in vitamin A, inborn disorders like porphyria and Richner-Hanhart syndrome, and even immune disorders like Reiter syndrome.

What Causes Conjunctivitis?

Eye redness and discharge are commonly caused by conjunctivitis, which can be infectious or noninfectious. The most common type of infectious conjunctivitis is viral, with adenovirus being the main culprit. Bacterial conjunctivitis is more prevalent in children and is caused by different bacteria depending on the age group. Noninfectious conjunctivitis is typically caused by allergies, toxins, or irritants.

There are various specific types of conjunctivitis, including acute bacterial conjunctivitis, giant fornix syndrome, chlamydial conjunctivitis, trachoma, neonatal conjunctivitis, and viral conjunctivitis. Allergic conjunctivitis encompasses acute allergic conjunctivitis, seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, and atopic keratoconjunctivitis. Other types include non-allergic eosinophilic conjunctivitis, contact allergic blepharoconjunctivitis, giant papillary conjunctivitis, factitious conjunctivitis, ligneous conjunctivitis, Parinaud oculoglandular syndrome, superior limbic keratoconjunctivitis, and conjunctivitis in blistering disorders such as mucous membrane pemphigoid, Stevens-Johnson syndrome, and toxic epidermal necrolysis.

Risk Factors and Frequency for Conjunctivitis

Conjunctivitis, also known as “pink eye,” can happen to anyone, but its occurrence is influenced by a person’s age, gender, and the time of year. The condition often appears in two different age groups. The first group is children under 7, especially those between 0 to 4 years old. The second group includes women aged 22 and men aged 28. Women tend to be diagnosed slightly more often than men.

The number of cases also varies throughout the year. For example, the condition tends to peak in children aged 0 to 4 in March and in other age groups in May. This pattern appears to be consistent across all geographic regions, regardless of climate or weather variations.

Allergic conjunctivitis is the most commonly diagnosed type, affecting up to 40% of the population. It is especially common in the spring and summer seasons. Bacterial conjunctivitis, on the other hand, is most prevalent from December to April.

• Conjunctivitis affects two main age groups: children under 7, especially those between 0 to 4 years old, and adults around the ages of 22 (women) and 28 (men).
• The condition is slightly more common in women than men.
• It often peaks in the spring, with the highest number of cases in children aged 0 to 4 in March and in other age groups in May.
• This seasonal pattern is observed regardless of the area’s climate or weather.
• Allergic conjunctivitis is the most common type, especially in the spring and summer.
• Bacterial conjunctivitis tends to be most common from December to April.

Signs and Symptoms of Conjunctivitis

Conjunctivitis, commonly known as “pink eye,” is an inflammation of the conjunctiva, the white part of the eye. To diagnose the cause of conjunctivitis, doctors conduct a thorough eye examination and history taking. They would ask about the onset timing, preceding symptoms, whether one or both eyes are affected, and any associated symptoms, such as changes in vision or sensitivity to light. Additionally, they would note factors such as eyelid changes, changes around the eyes, type of eye discharge, and any pain or itching.

During the eye examination, the doctor investigates the patient’s visual acuity, eye movements, visual fields, and pupil responses. They look for changes like redness or swelling in the eye, signs of a foreign body, and check the intraocular pressure. If the entire conjunctiva is red, it usually suggests conjunctivitis rather than more severe conditions. However, if redness is only in one area, they consider other diagnoses.

In the diagnostic process, the type of discharge is significant. Bacterial conjunctivitis typically manifests with persistent thick and sticky discharge, while allergic and viral conjunctivitis show watery discharge. With viral conjunctivitis, there could be lymph node swelling near the ear. Though, a patient’s complaints can be misleading. For example, itchy eyes commonly suggest allergic conjunctivitis but can also occur in bacterial conjunctivitis.

Doctors will also check for small bumps (papillae) on the conjunctiva and yellow-white lesions (follicles). These are not specific signs, but they can provide helpful information. The presence of papillae can indicate bacterial, allergic, or contact lens-related conjunctivitis. On the other hand, follicles often suggest chlamydial or adenoviral conjunctivitis.

If a patient has a history of fever blisters around the mouth or suspects viral conjunctivitis, the doctor might perform a fluorescein examination. This can reveal changes in the cornea due to herpes simplex virus, which causes a different type of viral conjunctivitis and requires different management.

Despite similar presentations, careful history taking and physical examination can provide clues to determine the cause of conjunctivitis. The following signs might be observed in the three most common types of conjunctivitis:

• Bacterial: Red eyes, feeling of a foreign body in the eye, crusty eyes in the morning, thick yellow-white discharge, papillae, rarely lymph node swelling near the ear.
• Viral: Itchy eyes, watery discharge, a recent respiratory infection, follicles on the lower eyelid, tender lymph node near the ear.
• Allergic: Itchy and burning eyes, watery discharge, history of allergies, swollen eyelids, papillae, no lymph node swelling near the ear.

Testing for Conjunctivitis

Lab tests and cultures are not usually necessary to diagnose conjunctivitis, unless there are specific circumstances such as recurring infections or infections that are not responding to treatment. Fast antigen tests can confirm if a virus is causing conjunctivitis and can help prevent unnecessary antibiotic use. Imaging techniques like CT scans or MRIs are generally not used unless there is suspicion of a more serious underlying condition. Depending on the cause of the conjunctivitis, certain actions may be needed such as removing inward-growing eyelashes or flushing out a blockage in the tear duct. Different lab procedures, such as Gram stain or Giemsa stain, can provide valuable information about the type of infection. Viral isolation techniques can confirm acute viral conjunctivitis, while superficial scrapings can be used to detect eosinophils in cases of allergic conjunctivitis.

Treatment Options for Conjunctivitis

When treating inflamed eyes due to infection, it’s important to teach the patient how to avoid spreading the infection. Bacterial inflammation can be treated with eye drops or ointments, with ointments lasting longer but potentially blurring vision. Mild cases can be treated with older antibiotics, while more severe cases may require newer fluoroquinolones. Gonococcal eye infection should be treated with ceftriaxone and chlamydial infection with azithromycin. Viral inflammation usually improves with time, and treatment focuses on relieving symptoms. Herpes simplex keratitis requires antiviral therapy, while herpes zoster eye infection requires both antivirals and topical steroids. The use of steroids with antibiotics is debatable. Allergic eye inflammation can be treated with avoidance of allergens, artificial tears, and topical agents. Patients with certain symptoms should be referred to an eye specialist.

What else can Conjunctivitis be?

If you’re feeling worried about redness in your eye, it’s important to know that there are many causes. This condition could be a sign of a serious, sight-threatening issue or something less serious. When checking for conjunctivitis (pink eye), a doctor must also look out for more serious conditions that could result in vision loss. Multiple potential causes need to be considered:

• Glaucoma
• Iritis
• Keratitis
• Episcleritis
• Scleritis
• Pterygium
• Corneal ulcer
• Corneal abrasion
• Foreign objects in the cornea
• Subconjunctival hemorrhage
• Blepharitis
• Hordeolum
• Chalazion
• Wearing contact lenses for too long
• Dry eye

It’s essential to take notice of specific signs and symptoms. A specific area of redness, partial redness, or serious eye problems such as raised eye pressure, vision loss, intense pain, and difficulty opening or keeping the eye open could suggest conditions other than conjunctivitis.

Medical professionals must be familiar with various eye conditions, including angle-closure glaucoma, iritis, keratitis, corneal ulcers, foreign bodies, and scleritis. All of these conditions could potentially lead to vision loss and will require consultation with an eye specialist.

Glaucoma can cause complete redness in certain parts of the eye, but not in others. It may also result in a semi-dilated pupil, cloudy cornea, specific pattern of redness around the cornea, and raised eye pressure. Iritis, another type of condition affecting the colored part of your eye, comes with pain, blurry vision, light sensitivity, a specific pattern of redness around the cornea, and a white or yellowish substance in the front part of the eye.

If you have infective keratitis, you’ll often feel like there’s something in your eye and might struggle to keep your eye open. These symptoms also show up in people experiencing corneal disorders such as corneal ulcers, abrasions, or a foreign body in the eye. Small injuries to the cornea or the impact of something foreign can result in blood gathering in the front part of the eye, leading to sudden and potentially permanent vision loss.

Scleritis usually comes with severe pain spreading to the face that’s more prominent in the morning and at night. There may also be light sensitivity, pain when moving the eye, tenderness, and swelling of the sclera (the white part of the eye).

Anyone suspected to have serious conditions like iritis, keratitis, scleritis, corneal ulcers or foreign bodies, or anyone experiencing blood or a white/yellowish substance in the front part of the eye, should see an eye specialist within 24 hours. Anyone suspected of having glaucoma should seek help immediately.

Less urgent conditions include pterygium and episcleritis, which tend to cause localized redness. Conditions with symptoms similar to allergic conjunctivitis include blepharitis, wearing contacts for too long, and dry eyes. These all typically involve the feeling of a foreign body in the eye, itching, or burning. Contact wear, not blinking enough, and allergies can be key distinguishing factors. Symptoms of blepharitis include crust around the eyelids, severe redness and swelling of the eyelid borders, while a subconjunctival hemorrhage refers to bleeding seen in the eye’s outer covering.

What to expect with Conjunctivitis

Conjunctivitis, or pink eye, is a common eye problem. Generally, it’s harmless and can be treated. How long the symptoms last depends on the cause of the conjunctivitis.

With viral conjunctivitis, it usually gets worse for around 4 or 5 days before getting better over the next 1 to 2 weeks. Altogether, viral conjunctivitis should clear up in about 2 to 3 weeks. Bacterial conjunctivitis, on the other hand, usually lasts between 7 to 10 days. If antibiotics are used within the first 6 days, the recovery time can be shortened.

It is important to detect and treat bacterial conjunctivitis early, as it may lead to serious conditions, like meningitis and sepsis, if left unattended. In particular, an infection with Neisseria gonorrhoeae can be life-threatening.

Possible Complications When Diagnosed with Conjunctivitis

Acute conjunctivitis complications are not common. Despite this, if symptoms don’t improve within 5 to 7 days, you should see an eye doctor for a more detailed check-up. Individuals with conjunctivitis resulting from the herpes simplex virus are more likely to encounter complications. Roughly 38.2% of these patients could experience issues with their cornea and 19.1% may develop uveitis, a type of eye inflammation. These patients should always arrange for an eye doctor to closely monitor them.

Patients with Neisseria gonorrhoeae also run a high risk of their corneas being affected and may even encounter secondary corneal perforation, which requires proper treatment. Newborn babies with Chlamydial conjunctivitis can potentially develop pneumonia and middle ear infections.

Complications:

• Herpes simplex virus can cause corneal problems and uveitis
• Neisseria gonorrhoeae can result in corneal involvement and secondary corneal perforation
• In newborns, Chlamydial conjunctivitis can lead to pneumonia and middle ear infections

Recovery from Conjunctivitis

When it comes to pink eye, or conjunctivitis, most cases can be handled through simple care methods. It’s vital to explain to patients that pink eye can easily spread from person to person, and maintaining good hygiene can help prevent this spread. It’s also important to educate them on following their prescribed medication routine, understanding that some types of pink eye can get better on their own, and the benefits of using a cold compress on the affected eye. Lastly, regular check-ups with their doctor are key to monitor their condition. If left unchecked, some types of pink eye could possibly lead to scarring on the cornea, or even blindness.

Preventing Conjunctivitis

Viral and bacterial conjunctivitis, which can cause irritated, red, and watery eyes, can easily be spread from person to person. Teaching patients how to prevent the spread is very important. This includes emphasizing the importance of clean hands for everyone involved, including the patients, medical staff, family members, and friends. One study found that almost half of the infected patients tested had the infection on their hands.

Patients should be advised to avoid touching their eyes, shaking hands, sharing personal items like makeup or towels, and not to swim while they’re infected. If a patient with conjunctivitis is admitted to a hospital, it’s best to isolate them to prevent the spread. Medical tools used to treat them should also be thoroughly cleaned to kill any bacteria or viruses.