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What is Conjunctivitis?

The conjunctiva is the skin covering the white part of the eye. It is usually transparent, but when it becomes inflamed or irritated, the eye can appear red and feel irritated. So, it is referred to in some parts of the world as ‘pink eye.’ It can be caused by infection, allergy, inflammation and other causes, and treatment depends on its cause. 

Infectious conjunctivitis is common and is frequently due to viruses, and may be highly transmissible for up to  2 weeks. Strict hygiene is recommended to limit its spread.

Symptoms of Conjunctivitis
  • Red eye
  • Watering and or Ocular Discharge
  • Itch, irritation or discomfort (rarely ‘pain’)
  • Blurred vision – uncommon
  • Periocular oedema or swelling arou
Treatment of Conjunctivitis

Treatment depends on the cause of the conjunctivitis which is usually evident on history taking and examination by an eye doctor or Ophthalmologist. Causes include infection, non-infectious inflammatory conditions, and others. Sometimes, a cause cannot be identified, but these often settle with relatively little treatment.

Viral Conjunctivitis

  • Adenovirus – the most common cause of acute conjunctivitis is by adenovirus which is usually associated and preceeded by cold and flu like symptoms. It commonly affects one eye then the other a few days later. It is highly infectious for two weeks. Lymph glands in the face and neck may be present. Treatment includes lubricating eye drops, strict hygiene to prevent its spread and a cool compress to the eye. Uncommonly, anti-inflammatory medications may be required if there is significant inflammation as a consequence.
  • Herpes simplex virus – aka the cold sore virus, this may be treated with antiviral agents. A detailed eye exam is required to exclude other complications or ocular involvement. It can be recurrent in nature. It usually only affects one eye.
  • Herpes zoster virus (aka shingles) – typically preceded by a rash over the brow and scalp on the same side as the eye, conjunctivitis (amongst other ocular complications) can result following shingles of the face and scalp. Treatment may include lubricants, oral antiviral therapy or anti-inflammatory therapy. Typically, a detailed eye exam is required to exclude any other complications or ocular involvement.

Bacterial Conjunctivitis

  • There are many bacterial infections which can cause conjunctivitis. Typically the onset occurs over 1-2 days and discharge is prominent. Treatment includes topical antibiotics and a sample may be sent to patholoty to confirm the causative agent.
  • Chlamydia trachomatis may cause chronic conjunctivitis and may be tested for at pathology if suspected on history or examination or if the condition is slow to persistent for several weeks. Treatment is with oral antibiotics, which is unique for conjunctivitis, hence it is important to identify and treat this cause as early as possible.

Allergic Conjunctivitis

  • Often affecting both eyes in a seasonal nature with prominent symptoms of itch and discharge, allergic conjunctivitis may have a clear precipitant. This can be treated with anti-allergy drops (ie antihistamines) or tablets, anti-inflammatory drops (ie topical corticosteroids) or other therapies. There is often a history of other problems such as eczema and/or asthma.
Important Notes
  • The conjunctiva is the skin overlying the white part of the eye (sclera)
  • Symptoms can be similar to blepharitis, but include red eye, discharge, crusting and swelling around the eyes
  • Viruses are the most common cause, and may be contagious for up to 2 weeks. Strict hygiene is recommended – such as disposing of tissues, frequent hand sanitization and avoiding sharing towels and personal hygiene products
  • Other causes include bacterial infections requiring antibiotics and allergic causes requiring anti-inflammatory medications
  • Sometimes swabs are sent to pathology to test for causes, particularly if it has been persistent for several weeks