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Conjunctivitis

The conjunctiva is the clear membrane that encircles and protects the eyeball. When you look at the white of the eye you are really looking through the conjunctiva at the sclera, the tough, leathery outer coat of the eye. The conjunctiva has many small blood vessels running through it. The purpose of the conjunctiva is to lubricate and protect the eye and allow it to move in its socket. Conjunctivitis is an inflammation of this lining of the eye. Conjunctivitis can be caused by a number of different agents: bacteria (as in “pink eye”), viruses, chemicals, allergies, and more. It is sometimes difficult to tell exactly which is the real cause.


BACTERIAL CONJUNCTIVITIS

Bacterial Conjunctivitis is characterized by swelling of the lid, a yellowish discharge, sometimes a scratchy feeling in the eye, and itching and mattering of the lids, especially in the mornings upon awakening. The conjunctiva is red and sometimes thickened. Often both eyes are involved.

The bacteria most commonly at fault are the Staphylococcus, the Streptococcus, and H. Influenza. This disease is very contagious, and sometimes entire families are infected. Laboratory cultures are not typically used to make the diagnosis since this is expensive and time consuming. Most infections are over by the time the results of the lab tests come back.

Treatment is curative. Usually antibiotic drops and compresses ease the discomfort and clear up the infection in just a few days. Occasionally, the infection does not respond well to drops. In those rare cases a second visit to the office should be made and other measures taken. In severe infection, oral antibiotics are necessary. Covering the eye is not a good idea because that incubates the germs. If left untreated, conjunctivitis can create serious complications, such as infections in the cornea, lids, and tear ducts.

Prevention is important for avoiding the disease and stopping its spread. Careful washing of the hands, the use of clean handkerchiefs, and the avoidance of contagious individuals are all helpful. Young children frequently get conjunctivitis because of their lack of understanding about hygiene and contact with germs.

VIRAL CONJUNCTIVITIS

Probably the most common infection seen in the eye doctor’s office is a viral infection of the conjunctiva. The conjunctiva is the clear lining that covers the surface of the white part of the eye. Sometimes this infection is described as a “cold” in the eye.

Dozens of viruses can cause this type of infection. Sometimes only the eye is infected; at other times the eye condition is part of a more generalized problem, such as the “flu” or a cold. Both eyes are usually involved, although one eye may become infected several days prior to the other. Usually symptoms are mild and not serious. Infrequently, however, the eye complaints are incapacitating and extremely bothersome.

Symptoms of Viral Conjunctivitis include a wide spectrum of complaints. Tearing, redness, swelling of the conjunctiva, and a clear discharge are characteristic. Light sensitivity can also be a prominent symptom. Sometimes a lymph node on the cheek in front of the ear swells in response to the virus, (an important clue that the patient has viral, not bacterial conjunctivitis).

If there is involvement of the cornea (the clear front window of the eye) blurred vision may result. Fortunately, this blurriness usually resolves over a few days to weeks and rarely leaves permanent scars. Occasionally, the lids become swollen and the patient experiences serious ocular pain, and very rarely there is bleeding into the lids.

Treatment is aimed at making the patient comfortable during the first few days. Cool compresses soothe the eyes and lids, pain relievers help with discomfort, and occasionally artificial tears will help; but the real treatment is time and rest. Antibiotic drops do not help to treat viral conjunctivitis. Symptoms may last up to two to three weeks. If the blurred vision is significant, driving and work activities should be done only with great caution and care.

Cortisone eye drops are sometimes of great assistance in controlling the symptoms of this infection. Since this disease is very contagious, prevention of spread is very important. The incubation period for viral conjunctivitis is only one or two days, making rapid spread very easy.

Hand washing is critical to avoid spreading the germ. Direct contact with the infected eye should be avoided. Indirect contact through hand towels, wash cloths, and clothing should be carefully eliminated. Complete resolution is expected in almost all patients. Only rarely do symptoms persist causing scarring and blurred vision.