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Conjunctivitis
Conjunctivitis

 

Condition
Conjunctivitis
Class
Eye
Description
Conjunctivitis is the name given to an inflammation of the conjunctiva, a transparent membrane that covers the eye. The blood vessels in the eye become enlarged, making the eye appear red and swollen.
Causes
There are two main types of conjunctivitis - allergic conjunctivitis and infected conjunctivitis.

Allergic conjunctivitis is caused by irritants to the eye, such as chlorine in swimming pools, smoke or even by eye makeup. If someone suffers from hay fever, pollen in the air may set up an allergic reaction if it enters the eye. The body's immune system tries to protect the eye against these irritants and sets up a reaction that causes the conjunctiva to become red and swollen.

Infected conjunctivitis is caused by a bacteria or a virus. The body's immune system fights the infection but when doing so it causes the conjunctiva to become red and swollen. Eye infections can be very contagious and it is very easy to transfer the infection from one eye to the next simply by rubbing one eye after another.

In allergic and infected conjunctivitis both eyes are usually affected. If only one eye is affected, the conjunctivitis is likely to be caused by a foreign body in the eye such as a particle of dirt or an eyelash. In the elderly, the lower eyelids can grow weak and turn inwards. The eyelashes may then rub against the inside of the lid or the eyeball, causing irritation and inflammation, leading to conjunctivitis.
Symptoms
Common symptoms of conjunctivitis include reddening of the eye, watery eyes, a sticky discharge often occurring in both eyes and worse on waking, and gritty rather than painful eyes. Eyes can occasionally be sensitive to light, a condition called photophobia, but eyesight is generally not affected.

In infected conjunctivitis, the watery discharge from the eye may contain pus which sticks to the eyelashes making it difficult to open the eyes in the morning. If the infection is caused by Chlamydia bacteria or a virus, such as herpes simplex, the symptoms can be severe and last for a long time.
Treatment
Eye drops containing naphazoline, xylometazoline or witch hazel will help constrict the blood vessels to the eye and may be used as a temporary relief of redness and itching caused by allergic conjunctivitis. If hay fever is the cause, eye drops containing an antihistamine, sodium cromoglicate or corticosteroids can be used to reduce the allergic reaction to pollen in the eyes. Alternatively, antihistamine tablets, used for treating the runny nose and sneezing associated with hay fever, will also ease the symptoms of allergic conjunctivitis.

In cases of infectious conjunctivitis caused by bacteria, antibiotic eye drops such as chloramphenicol will usually clear the infection in 2 or 3 days. More powerful antibiotics may be required if chloramphenicol does not work or if the infection is caused by Chlamydia. Antiviral eye drops containing aciclovir may be used to treat conjunctivitis caused by herpes simplex virus.

If the cause of conjunctivitis is a foreign body in the eye, such as a speck of dirt, an eyelash or an insect, it may be possible to remove the foreign body using an eye wash. If this is not successful, medical help may be needed to remove the foreign body before it causes damage.

If the eyelid turns in towards the eye, the condition may require correction by surgery.
When to consult your pharmacist
A number of products that will relieve the symptoms of conjunctivitis can be obtained from your pharmacist without a prescription. Your pharmacist will ask you to describe your symptoms to determine whether you have allergic or infected conjunctivitis, or a foreign body in the eye.

If your conjunctivitis is the result of an irritant your pharmacist may recommend eye drops containing naphazoline, xylometazoline or witch hazel that constrict the blood vessels in the eye to help reduce redness and itching. If you have allergic conjunctivitis, for example hay fever, your pharmacist will be able to provide eye drops containing sodium cromoglicate that help reduce the inflammatory response. Alternatively, your pharmacist may recommend antihistamine tablets.

If your pharmacist considers that your conjunctivitis is the result of a bacterial infection, eye drops containing the antibiotic chloramphenicol, or eye drops and an eye ointment containing the antibacterial agent propamidine or dibromopropamidine may be recommended.

Lubricating eye drops and eye ointments to soothe sore eyes are also available without a prescription.
When to see your doctor
If the irritation is caused by damage to the eye, this always requires immediate expert treatment. Seek medical advice without delay if there is severe pain in the eye rather than itching, burning or grittiness, or if there is any difficulty with vision.

Also, make an appointment with your doctor if there is a thick discharge or if the eye symptoms do not settle within 48 hours despite treatment. Your doctor will be able to tell if there are conditions other than conjunctivitis responsible for your symptoms.

If you have infected conjunctivitis that has not responded to chloramphenicol your doctor may decide to take a swab from your eye to determine which micro-organisms are responsible for the infection. A doctor is able to prescribe a wider range of products than can be purchased from a pharmacy, including drops containing antiviral agents or antibiotics such as ciprofloxacin, fusidic acid, framycetin or gentamicin. Steroid drops may be prescribed for allergic conjunctivitis.
Living with conjunctivitis
The symptoms of conjunctivitis can be eased by gentle bathing of the eyes with cotton wool and warm water or with an eye lotion recommended by the pharmacist.

If you suffer from allergic conjunctivitis try to avoid the irritants that may be causing the problem. Avoid known irritants such as chlorine in water, tobacco smoke or pollen.

Try to rest the eyes and avoid bright lights. Wear sun glasses when outside to reduce glare and to reduce further irritation of the eye. If you wear contact lenses make sure that you clean them thoroughly and do not wear them while you have conjunctivitis or if treating your eyes with any drops.

In the workplace, talk to your employer or health and safety officer about the lighting and ventilation in the area you work. If you use a computer regularly, ask for a filter that helps cut down reflection, and get someone to check that your computer screen is set up in the right position and is not too bright. Periodically, look away from your computer screen and focus on a distant object. Take regular breaks away from your computer.

If you have a cold or an infection, avoid rubbing your eyes. Use your own towel to avoid transferring any infection to other members of the family.

If you need to use eye drops, carry them with you so that you can use them at regular intervals and according to the dosage instructions. Discard any eye drops remaining two weeks after first opening. Do not keep them for future use as it is highly likely that the drops have become contaminated and further use risks causing severe eye infections.
Advice for carers

If you care for someone who needs help putting drops or ointment in the eye, learn to apply the preparations properly. Your pharmacist is always available to provide advice if you need it.

When putting drops in someone else's eye, it is easier if the person lies on her or his back or, if capable, tilts the head back. Pull the lower eye lid down with the index finger of one hand to create a pocket below the eye. With the other hand, bring the eye dropper close to the eye over the eye pocket. Place the other fingers of this hand on the nose, for balance and to avoid touching the eye with the dropper. Squeeze the eye dropper gently allowing a drop to fall into the eye pocket. Count out the required number of drops. Release the lower eye lid and ask the person to close the eye gently. If necessary, gentle pressure can be placed in the corner of the eye near the nose to prevent the drops from running out of the eye. if both eyes are affected, repeat the procedure for the other eye. If you need to administer more than 1 type of eye drop, wait 10 minutes between giving each type.

When putting ointment in someone else's eye, it is usually best to do it at bed time to avoid disturbing the person's vision. Pull the lower eye lid down with the index finger of one hand to create a pocket below the eye. With the other hand, bring the tube of eye ointment close to the eye over the eye pocket. Point the tube towards the corner of the eye near the nose. While gently squeezing the tube move it to allow about a centimetre of ointment to emerge as a thin line along the inside of the lower eye lid. Release the lower eye lid and ask the person to close their eye gently. Repeat the procedure for the other eye, if both eyes are affected. Avoid touching the eyes or eye lids with the tip of the tube.

Useful Tips
  • Avoid any known causes of irritation to the eyes; avoid smoky or dusty atmospheres
  • If hay fever affects your eyes, try to stay indoors with the windows closed when the pollen count is high
  • Bathe the eye with eye wash as soon as symptoms start
  • A sticky discharge from the eye may be caused by infection, use your own flannel and towel to reduce the risk of spreading the infection to other family members.
  • Use lubricating eye drops to help soothe the eyes


Reviewed on 11 October 2010


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