Conjunctivitis

The symptoms of conjunctivitis usually come on suddenly and include:

• Crust on the eyelids and eyelashes
• Whites of the eyes appear red
• Swelling of the eyelid
• Itching
• Burning
• Eyes sensitive to light
• Foreign object type feeling
• Excessive tears
• Discharge (yellow, green, or white)
• Blurred vision
• Eye pain
• Headache
• Nausea

These include bacteria, viruses, irritants, and allergens. In rare cases, conjunctivitis can be caused by a fungus or parasite. Even less common are cases that may be caused by a sexually transmitted disease such as gonorrhea or chlamydia.

If you have symptoms of pink eye or think you may have been exposed, see your doctor right away for an evaluation. The earlier that treatment is started, the less chance there is for complications.

If you have symptoms for more than a few days, you need to see your doctor. Also, if you were exposed to someone who is being treated for conjunctivitis and are developing symptoms, you should see your doctor.

The doctor will take a thorough history. You will be asked how long the symptoms have lasted and if you have been exposed to environmental irritants or anyone with conjunctivitis. The following exams may be performed:

• Visual acuity test to check your vision
• Inspection of the eye and conjunctiva
• Culture of eye discharge

Treatment for conjunctivitis depends on the type. The doctor will decide which type you have and go from there. If your case is severe, the doctor may decide to start you on antibiotics while you await culture results. Here are the treatments for the main types of conjunctivitis:

Viral conjunctivitis. Viral conjunctivitis will go away on its own in one to two weeks. Antibiotics will not help viral conjunctivitis. The doctor may recommend using some plain saline eye drops (artificial tears). Ice packs can help with swelling and inflammation. If you have a very severe case, the doctor may put you on a short course of antiviral medication.

Bacterial conjunctivitis. Bacterial conjunctivitis is treated with antibiotics. These are given with either an antibiotic ointment or an eye drop that is placed directly in the eye. Once you start treatment, the infection should take around seven to ten days to clear. Your doctor may also recommend ice packs and saline eye drops to help relieve symptoms and swelling. If you have a mild case, the doctor may opt to watch and see if the infection gets better on its own without antibiotics.

Allergic conjunctivitis. Allergic conjunctivitis is an allergic reaction to pollen or animal dander. Treatment consists of removing the offending source and keeping the eyes rinsed to reduce irritation. The doctor may recommend saline eye drops for clearing the irritant, and topical allergy relief drops. You may also need to take an oral antihistamine.

Chemical/irritants. If your conjunctivitis was caused by exposure to chemicals or other irritants, the doctor will most likely flush your eye to remove the offending agent. You may then be prescribed steroid eye drops to reduce inflammation. Understand that if you have redness in your eye after exposure, this is an emergency and you need to see a doctor right away. Especially if you suspect a chemical burn to the eye.

Sexually transmitted infections. Sexually transmitted diseases in the eye such as chlamydia or gonorrhea are treated most often with oral antibiotics because eye drops are usually not enough to clear the infection. The doctor will also recommend treatment for any sexual partners.

Fungal conjunctivitis. While rare, fungal conjunctivitis can be serious and usually requires aggressive treatment. More severe cases will need injections of antifungal medications directly into the eye. The doctor may also prescribe antifungal eye drops and possibly hospitalization for antifungal medications to be given intravenously.

There are a few things you can do to reduce symptoms and increase your comfort. These include:

Use saline eye drops. With your doctor’s okay, try some sterile saline eye drops. You can get these over the counter. Avoid using eye drops that reduce redness as this may cause irritation and burning.

Do not wear contact lenses. If you have conjunctivitis, do not use your contact lenses. If you have disposable lenses, throw any used lenses away and start with a fresh pair after being treated to avoid reinfection. If you have long-term lenses, ask your eye doctor what to do about either cleaning them or replacing them.

Use warm or cold compresses. You can wet a clean cloth in warm or cold water and hold it over your eyes. Warm water will help to loosen any crusting in the eyes, but cold water can help soothe and relieve inflammation. If you only have one infected eye, take care not to touch the uninfected eye with the cloth.

Keep hands away from eyes. Wash your hands often and avoid touching your face near your eyes. This can spread the infection to your other eye or to other people. This infection is highly contagious.

Throw out eye makeup and do not share. If you have conjunctivitis, throw out any makeup you have used.

Alternative and herbal medicine may be helpful for conjunctivitis. Just remember, if the infection does not clear within a few days, you need to see a physician. Some herbal remedies include:

• Chamomile
• Grated uncooked potato astringent
• Herbal eyewashes (goldenseal)
• Ginkgo biloba extract with hyaluronic acid
• Marigold
• Fennel seed
• Eyebright

Conjunctivitis is avoidable if you practice the following:

Good hygiene. Wash your hands or use a good hand sanitizer. Especially if you have been out in public. If you wear contacts, keep them clean. Use the cleaning instructions for your contact lenses and replace them according to your doctor’s and manufacturer’s schedule. Old lenses lose their ability to protect you from infections or eye injuries.

Clean well if someone is infected. If you have someone in your home infected with conjunctivitis, clean all bed linens and areas where they touch. Do not touch the eyedropper to the eye when giving them eye drops. Wash your own hands after treating or cleaning up after them.

Avoid touching your face or eyes. Keep your hands and fingers away from your hands and face unless you are washing your face or putting on makeup. During the day, touch your face as little as possible. Even if you are not at risk for pinkeye, touching your face increases your risk from outside sources.

Reduce exposure. If you will be around irritants, dust, or allergens. Take steps to protect your eyes. Wear utility goggles when there is a risk of splashes or foreign objects. Ask your doctor about using allergy eye drops during peak allergy seasons.

If conjunctivitis is left untreated, complications can develop. The inflammation due to the infection can cause the cornea to be damaged leading to loss of eyesight. If conjunctivitis lasts more than a few days, medical evaluation and treatment are strongly recommended.

American Optometric Association. (2014). Conjunctivitis. Retrieved from American Optometric Association: https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/conjunctivitis?sso=y

Centers for Disease Control. (2014, January 9). Conjunctivitis. Retrieved from Centers for Disease Control: https://www.cdc.gov/conjunctivitis/about/index.html

Josephson, L. (2002). Homeopathic handbook of natural remedies. In L. Josephson, Homeopathic Handbook of Natural Remedies (pp. 207-10). New York, NY: Random House.

Klotz, S. A., Penn C. C.& Negvesky, S. I. B. (2000, October). Fungal and parasitic infections of the eye. Retrieved from National Library of Medicine: https://pubmed.ncbi.nlm.nih.gov/11023963/

Mayo Clinic. (2015, April 2). Complications of conjunctivitis. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/pink-eye/basics/complications/con-20022732

National Library of Medicine. (2012, November 7). PubMed Health. Retrieved from National Library of Medicine: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072497/