What is Conjunctivitis?
One of the most common questions I have heard over the years is “Dr. Steve, do I have pink eye?” Ironically, the patient usually has blazing pink/red, swollen eyes so the diagnosis from my perspective is fairly obvious: Of course it’s pink eye – but why is it pink??? That is the key to proper treatment.
First we need to NOT use the term “pink eye” and instead use “conjunctivitis.” The conjunctiva is the clear superficial layer of tissue that covers the surface of the eyes and the insides of the eyelids. Inflammation or infection of this tissue is called conjunctivitis.
Signs and Symptoms of Conjunctivitis
Most common symptom of conjunctivitis is eye redness. Depending on the type of conjunctivitis, there may be different colors of discharge and mattering. Swelling and crusting of the eyelids are often associated. In some cases there may also be a cold, flu, upper respiratory tract infection or runny nose associated with the conjunctivitis. Lymph nodes in front of the ears may also be swollen.
What Causes Conjunctivitis?
- Environmental Irritants: This is the most common type of conjunctivitis and can be caused by anything in your environment that can irritate your eyes. Good examples are noxious chemicals such as paints, stains, automotive chemicals, cleaning chemicals and chlorinated pools. These agents breakdown your natural tear layer and then directly cause irritation to the conjunctiva. Redness, pain, itching, swelling and mild discharge are common symptoms.
- Viruses: When it comes to the ears, nose, throat and eyes – all the plumbing is connected. Viral infection of any mucous membrane can easily lead to viral conjunctivitis. This is by far the most CONTAGEOUS Patients usually present with red, swollen eyes and clear, watery discharge. An upper respiratory tract infection, fever, and swollen lymph nodes may also be present.
- Allergies: Allergic conjunctivitis can be caused by a variety of factors including seasonal pollens, molds, dust, pet dander, and other allergens. Ocular itching and swelling are the most common symptoms.
- Bacteria: Bacterial conjunctivitis is most common with small children but is the least common conjunctivitis in the general population. It has the classic presentation of thick, yellow/green “eye boogers.” Often times the eyes are mattered shut in the morning.
How is Conjunctivitis Diagnosed?
Proper diagnosis of conjunctivitis requires an eye doctor who will do a slit lamp examination to determine the type of conjunctivitis. A slit lamp is a medical instrument which is essentially a lighted microscope.
How is Conjunctivitis Treated?
Unfortunately, the first place most patients visit for possible conjunctivitis(or other eye problems) is their local Urgent Care. Family physicians at these offices are excellent at treating colds, flu, and hypertension but are not eye specialists and will not have a slit lamp in their office. Here are the treatments for the most common types of conjunctivitis:
- Environmental Irritant conjunctivitis: This type of conjunctivitis is usually treated simply by rinsing the eyes with sterile wash or lubrication drops and applying cold compresses. In some cases a steroid/antibacterial combination eye drop can be used to reduce inflammation and prevent infection. Contact lenses sensitivities can also cause this type of conjunctivitis.
- Viral Conjunctivitis: As with all viral infections, antibiotics are not effective. Similar to the common cold, the conjunctivitis will run its course but simple treatments such as cold compresses, ocular lubrication drops, oral decongestants and pain relievers can be helpful. In more severe cases, steroid eye drops can be cautiously used to reduce swelling and irritation but can only be prescribed by an eye doctor. Some cases of viral conjunctivitis may be due to a cold sore virus(Herpes) or Zoster (Shingles) invading the eye. These can be serious situations and need immediate care as vision threatening ulcerations can develop in a short period of time.
- Allergic Conjunctivitis: The severity of allergic conjunctivitis dictates how it is treated. Mild cases can go without treatment completely. For more bothersome cases, lubrication drops, anti-allergy drops and cool compresses are effective. In severe cases, steroid eye drops may be prescribed in addition to allergy drops.
- Bacterial Conjunctivitis: This is the only type of conjunctivitis effectively treated with antibiotics. Similar to viral infections, an upper respiratory tract infection and fever may also be present. Most bacterial conjunctivitis will resolve spontaneously but antibiotic drops will shorten the course of the infection.
As you can see, most cases of conjunctivitis are not the simple “pink eye” requiring the usual antibiotics. Also, overprescribing of antibiotics can cause increased resistance to the antibiotics themselves so should only be used when necessary. Visine is never effective for conjunctivitis.
What Steps Should I Take If I Think I Have Conjunctivitis?
I recommend making an appointment to see our office as quickly as possible to determine the proper diagnosis and course of treatment. I have 22 of years of experience treating patients with conjunctivitis and other related conditions. The sooner I can check your eyes, the better. All doctors agree that waiting and hoping it will get better is not a prescription for success.