Conjunctivitis "Pink Eye"

Introduction

Bothered by red, itchy eyes that feel puffy and seem to be draining constantly? It might be a case of conjunctivitis, and you may benefit dramatically by consulting your personal health care provider to evaluate treatment options.

What is it?

Conjunctivitis (often referred to as "pink eye") is a general term to describe irritation of the conjunctiva. The conjunctiva is a thin, colorless membrane that lines the eyelid and a portion of the eyeball. There are several types and causes of conjunctivitis, but most involve first an irritant and then resulting inflammation of the conjunctiva.

What causes it?

Conjunctivitis may result from allergic, bacterial, and viral irritants; however, viral causes tend to be the most common cause of conjunctivitis.

Seasonal allergic conjunctivitis usually stems from an air-born irritant such as ragweed, pollen, or mold. When the conjunctiva is exposed to the irritant, a chain of events leads to the swelling, itching, and redness often associated with this form of conjunctivitis. First, the irritant is detected and marked by the body's immune system as foreign and unlike other cells. Then the target is marked for elimination. Combatant cells, called mast cells, arrive on the scene to remove the foreign attacker and cause the release of various inflammatory substances such as histamines. Histamines cause the uncomfortable symptoms associated with allergic conjunctivitis such as red, watery, itchy eyes.

A similar chain of events occur when the conjunctiva is exposed to bacterial or viral irritants. Bacterial and viral conjunctivitis are usually associated with a cold and both usually produce a discharge from the eye. Bacterial and viral conjunctivitis can be extremely contagious, and treatment should be sought immediately to prevent the spread to others.

Who has it?

Conjunctivitis is a worldwide ailment and affects all ages, races, and both genders. It is commonly self-referred, that is, patients recognize the symptoms and report them to their healthcare provider.

Bacterial conjunctivitis seems to be more prevalent in children and in newborns when the cause may be an incompletely open or blocked tear duct.

What are the risk factors?

The risk factors associated with conjunctivitis are dependent on the cause of the inflammation and, in some cases, age.

The most common seasonal allergic conjunctivitis risk factor is exposure to an environmental irritant. Specific environment irritants change with the seasons.

In the case of bacterial conjunctivitis the risks vary depending on age. For new born infants, bacteria may be transferred from the mother during vaginal delivery. The factor that increases the risk of infection in the infant is less than adequate prenatal care for the mother. For infants and children the bacteria may be spread by exposure to an infected individual or by chronic ear infections. Adults may contract bacterial conjunctivitis from contact, tear deficiency, or trauma.

Risk for viral conjunctivitis may be increased if one is exposed to an infected individual or if there is a history of sinus infections and congestion.

If the form of conjunctivitis is contagious, it is important to take steps to reduce the chance of spreading it by limiting direct contact and practicing good hygiene. This includes:

  • Avoid touching or rubbing the infected eye(s).
  • Wash hands with soap and water frequently.
  • Avoid sharing towels or other items that come into contact with the hands or eyes.

Persons with viral or bacterial conjunctivitis may stay contagious for 1 to 2 weeks after signs and symptoms first appear.

What are the symptoms?

Seasonal Allergic Conjunctivitis

  • Red and itchy eyes
  • Watery or mild mucous (milky) discharge
  • Generally occurs in both eyes
Bacterial
  • Red and itchy eyes
  • Watery or milky discharge or pus-like discharge
  • Can occur in one or both eyes
  • Can exhibit slight or marked swelling around the eye
Viral
  • Red and itchy eyes
  • Watery discharge
  • Can occur in one or both eyes
  • May be present only for a very short time
  • May be associated with a respiratory infection or sore throat

How is it treated?

Appropriate therapy for conjunctivitis is varied and depends on the diagnosis and severity of the symptoms the patient is experiencing. To get suitable treatment, a thorough evaluation from a qualified healthcare provider is recommended. Your healthcare provider may assess your condition in a variety of ways including: evaluating the symptoms you report, examining the affected area, or taking bacterial cultures for analysis.

Below are explanations of some the treatment options grouped according to type of conjunctivitis. The best option for your condition will be determined by your healthcare provider based on diagnosis, severity and symptoms.

Seasonal Allergic Conjunctivitis

Allergic conjunctivitis may disappear completely when the allergy is managed appropriately. Being aware of and removing your allergic trigger(s) may help you to avert the symptoms associated with this type of conjunctivitis.

Multiple eye drops or ointments (ophthalmic products) are available to treat the symptoms of allergic conjunctivitis. Oral antihistamines may be used if allergy symptoms involve more than just the eyes.

Bacterial

Although this type of conjunctivitis, if mild, may resolve without treatment, it is best to have your practitioner evaluate the appropriate management. Severe bacterial conjunctivitis is characterized by thick pus-like discharge, pain, and marked inflammation of the eye. Your doctor will likely prescribe an ophthalmic antibiotic for treatment of this condition.

Viral

There are no specific treatment options to treat this type of conjunctivitis. In this situation your provider will educate you on how to reduce symptoms and prevent spreading the infection to the other eye or to other people.

Your doctor may also suggest ophthalmic steroids to reduce swelling. Artificial tears and cold compresses may be used ease pain and dryness. Alternatively, your physician may choose to thoroughly rinse the eye with a saline solution. This rinsing will help the eye shed the viral particles causing the infection.

Finally if your symptoms do not improve within 3 to 5 days, return to the doctor for follow-up. It may mean that your condition is more severe than first thought or that the initial treatment is not working sufficiently to improve symptoms.

Helping Yourself

The symptoms of conjunctivitis can be very bothersome. Here are some suggestions to help soothe the discomfort.

  • Remove contact lenses if you wear them
  • Place a cold compress on your eyes
  • Wash your face with warm, soapy water
  • Avoid rubbing your eyes
  • Protect your eyes from irritating substances, such as dirt
  • Over-the-counter artificial tears may soothe the itching and burning.

Following these suggestions may help soothe the discomfort of conjunctivitis, but they should replace your doctor's treatment. Remember to talk to your doctor if you suspect that you have conjunctivitis.

What is on the horizon?

Treatment options for allergic seasonal conjunctivitis have expanded in recent years. Most notable are the oral antihistamines, such as loratidine and cetirizine, which are both now available over-the-counter. These oral antihistamines can be helpful in preventing allergic conjunctivitis when used appropriately prior to the presentation of symptoms.

Recently, an ophthalmic drop that is an antihistamine and a mast cell stabilizer was approved for over-the-counter use as a long-term treatment for patients with allergic conjunctivitis. This product, Zaditor, with the active ingredient ketotifen, is the first available over-the-counter product for long-term treatment of allergic conjunctivitis since past over-the-counter products containing other ingredients such as decongestants are not safe for more than short-term use.

Newer antibiotics are being evaluated for their effectiveness in the treatment of bacterial conjunctivitis. These new developments will provide physicians with more options for treatment. It is probable that the newer antibiotics will have less side effects and a shorter duration of treatment time for patients with this condition.

One example is the newer antibiotic ophthalmic drop that contains the macrolide antibiotic azithromycin. This product's advantage is that it can be administered twice daily for the first two days of therapy and then once daily for the remainder of the therapy. Other antibiotic drops require administration between three and four times daily, sometimes more which can decrease compliance.

References

  1. American Academy of Ophthalmology.Conjunctivitis: Preferred Practice Pattern. 2003. Available at: http://www.aao.org/aao/education/library/ppp/upload/Conjunctivitis_.pdf. Accessed May 2006 and February 2008.
  2. Owen CG, ShahA, Henshaw K, et al. Topical treatments for seasonal allergic conjunctivitis: systematic review and meta-analysis of efficacy and effectiveness.Br J Gen Pract.2004 Jun; 54(503): 412-414.
  3. Bielory L, Lien KW, Bigelsen S. Efficacy and tolerability of newer antihistamines in the treatment of allergic conjunctivitis. Drugs. 2005:65(2):215-28.
  4. Leonardi A. Emerging drugs for ocular allergy. Expert Opin Emerg Drugs. 2005;10(3):505-20.
  5. American Optometric Association. American Optometric Association Consensus Panel on the Care of the Patient with Conjunctivitis. Care of the Patient with Conjunctivitis. November 2002. Available at: http://www.aoa.org/documents/CPG-11.pdf Accessed February 2008
  6. Morrow, G and Abbott, R. Conjunctivitis. American Family Physician 1998; 57(4): 735-49. Available at: http://www.aafp.org/afp/980215ap/morrow.html. Accessed March 2007 and February 2008.
  7. New dosage form: AzaSite (azithromycin 1% ophthalmic solution). Pharmacist's Letter/Prescriber's Letter 2007;23(9):230909 Accessed February 2008.
  8. Topical Treatment of Allergic Conjunctivitis, The Role of OTC Ketotifen (Zaditor, Alaway) . Pharmacist's Letter/Prescriber's Letter 2007;23(1):230106 Accessed February 2008.

Conjunctivitis "Pink Eye" Health Condition Last Updated: February 2008

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It is not intended to diagnose a health condition, but it can be used as a guide to help you decide if you should seek professional treatment or to help you learn more about your condition once it has been diagnosed.

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