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 an inflammation or infection of the conjunctiva. The conjunctiva is a thin, colorless membrane that lines the eyelid and a portion of the eyeball. Once irritation occurs, the lining then becomes red and swollen. Pink eye is a common eye disease; however, it may be contagious and easily spread. There are several types and causes of conjunctivitis.
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. Allergic conjunctivitis can also occur due to an allergic reaction to smoke, chlorine in swimming pools, or other products that come in contact with the eyes. When the conjunctiva is exposed to the irritant, a chain of events leads to the swelling, itching, and redness, which are often associated with this form of conjunctivitis. First, the irritant is detected and marked by the body's immune system as foreign, 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. Allergic conjunctivitis is not contagious or infectious.
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. Practicing good hygiene (such as frequent hand washing) can also help prevent the spread of pink eye.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. It is espically common among children.
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 infection or 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 with 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, poor hygiene, 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 and re-using towels or other items that come into contact with the hands or eyes.
- Properly clean contact lenses.
- Do not use anyone else's eye cosmetics (i.e. mascara) or personal eye-care items.
Persons with viral or bacterial conjunctivitis may stay contagious for 1 to 2 weeks after signs and symptoms first appear.
What are the symptoms?
When the conjunctiva becomes irritated or inflamed, the blood vessels around the eyes dilate (become larger) and become more noticeable, making the eye(s) appear red.
Seasonal Allergic Conjunctivitis
- Red and itchy eyes
- Watery or mild mucous (milky) discharge
- Generally occurs in both eyes
- 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
- 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
Appropriate therapy for conjunctivitis is varied and depends on the diagnosis and severity of the symptoms the person is experiencing. To get suitable treatment, a thorough evaluation from a qualified healthcare provider is recommended. The healthcare provider may assess the condition in a variety of ways including: evaluating the symptoms reported, examining the affected area, or taking bacterial cultures for analysis.
According to the American Optometric Association, the goals of treatment include:
- To increase comfort
- To reduce or lessen the course of infection or inflammation
- To prevent the spread of conjunctivitis
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 allergic trigger(s) may help 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.
Applying cool compressess and artificial tears may aid in reducing discomfort in mild cases.
Bacterial
Although this type of conjunctivitis, if mild, may resolve without treatment, it is best to have a healthcare 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. Like the common cold, the virus has to run its course, which may take up to several weeks. 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 discomfort from the swelling. Artificial tears and cold compresses may be used ease pain and dryness. Alternatively, the 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. These treatments may help relieve symptoms, but will not shorten the course of the infection.
Finally, if the 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.
Drug classes used to treat Conjunctivitis "Pink Eye"
- Ophthalmic Antibiotics
- Ophthalmic Antihistamine and Mast Cell Stabilizer Combinations
- Ophthalmic Antihistamines
- Ophthalmic Mast Cell Stabilizers
- Ophthalmic Steroids
- Ophthalmic non-steroidal anti-inflammatory drugs
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. However, be aware that these medications may cause side effects such as drowsiness, dryness, and irritability.
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, AzaSite, which contains the macrolide antibiotic azithromycin. This product's advantage is that it stays on the eye surface longer so it can be dosed less frewuently. 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.