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Allergic, Bacterial & Viral Conjunctivitis Treatment

Conjunctivitis is one of the most common and treatable eye infections in children and adults. Often called "pink eye," it is an inflammation of the conjunctiva, the tissue that lines the inside of the eyelid. This tissue helps keep the eyelid and eyeball moist.

Hyperemia of the conjunctiva from infection, allergy, or chemical reactions characterizes conjunctivitis. Bacterial and viral conjunctivitis are highly contagious but are also self-limiting after two weeks duration. Chronic conjunctivitis may result in degenerative changes to the eyelids. In the Western hemisphere, conjunctivitis is probably the most common eye disorder.

Causes

Conjunctivitis may be triggered by a virus, bacteria, an allergic reaction (to dust, pollen, smoke, fumes or chemicals) or, in the case of giant papillary conjunctivitis, a foreign body on the eye, typically a contact lens. Bacterial and viral systemic infections also may induce conjunctivitis.

Signs and symptoms

• Redness in the white of the eye or inner eyelid
• Crusts that form on the eyelid overnight
• Gritty feeling in the eyes
• Increased tearing
• Blurred vision
• Thick yellow discharge that crusts over the eyelashes, especially after sleep (in conjunctivitis caused by bacteria)

Diagnosis

Physical examination reveals injection of the bulbar conjunctival vessels. In children, possible systemic symptoms include sore throat and fever.

Monocytes are predominant in stained smears of conjunctival scrapings if conjunctivitis is caused by a virus. Polymorphonuclear cells (neutrophils) predominate if conjunctivitis stems from bacteria; eosinophils, if it's allergy related. Culture and sensitivity tests identify the causative bacterial organism and indicate appropriate antibiotic therapy.

Treatment

The cause of conjunctivitis dictates the treatment. Bacterial conjunctivitis requires topical application of the appropriate antibiotic or sulfonamide.

Although viral conjunctivitis resists treatment, broad-spectrum antibiotic eye drops may prevent secondary infection.

Herpes simplex infection generally responds to treatment with trifluridine drops, vidarabine ointment, or oral acyclovir, but the infection may persist for 2 to 3 weeks. Treatment of vernal (allergic) conjunctivitis includes administration of corticosteroid drops followed by lodoxamide tromethamine (Alomide), a histamine -antagonist, cold compresses to relieve itching and, occasionally, oral antihistamines.

Instillation of a one-time dose of erythromycin into the eyes of newborns prevents gonococcal and chlamydial conjunctivitis.

Prevention

• Teach proper hand-washing technique because some forms of conjunctivitis are highly contagious. Stress the risk of spreading infection to family members by sharing washcloths, towels, and pillows. Warn against rubbing the infected eye, which can spread the infection to the other eye and to other persons.
• Don't touch or rub the infected eye(s).
• Apply warm compresses and therapeutic ointment or drops. Don't irrigate the eye; this will only spread infection. Have the patient wash his hands before he uses the medication, and use clean washcloths or towels frequently so he doesn't infect his other eye.
• Wash your hands after applying the eye drops or ointment to your eye or your child's eye.
• Avoid wearing eye makeup.
• Wear glasses instead of contact lenses. Throw away disposable lenses or be sure to clean extended wear lenses and all eyewear cases.
• Do not share towels or handkerchiefs.