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Conjunctivitis

Conjunctivitis is inflammation or infection of the transparent surface layer that covers the white of the eye (the conjunctiva). It can be due to an allergy or an infectious organism (such as a bacteria or virus) and it can also be caused if an irritant such as a chemical, or a foreign body such as a piece of grit, gets into your eye.

Types of conjunctivitis 

Infective conjunctivitis

Both viruses and bacteria can infect your eye and cause conjunctivitis. Infective conjunctivitis is most common in children and older people. This could be because children tend to come into contact with more infections at school. And as people get older, they become more prone to infections as the body’s defence system may not be as strong as it was.

Viruses are thought to be a more common cause of conjunctivitis than bacteria. The type of virus that usually causes the condition is called an adenovirus. Bacterial conjunctivitis is commonly caused by bacteria found in your skin or respiratory system, specifically those called Staphylococcus aureus or Streptococcus pneumonia.

You can catch infective conjunctivitis from being in close contact with another person who has it so it's important to wash your hands after coming into contact with someone who is affected by it.

Sometimes babies develop conjunctivitis in the first few weeks after birth. This can happen if an infection is passed from the mother's cervix (neck of her womb) or vagina during delivery. It could also happen if the baby has a reaction to a treatment applied to the eye. If your newborn baby has signs of an eye infection or if you are worried in any way, contact your GP, although your maternal and child health nurse is likely to spot any problems early on.

Allergic conjunctivitis

There are four types of allergic conjunctivitis:

  • Seasonal allergic conjunctivitis – this affects both eyes and people often get it around the same time of year as hay fever.
  • Perennial allergic conjunctivitis – people with this type of allergic conjunctivitis have daily symptoms in both eyes, often on waking each morning. It may be caused by allergy to house dust mites or animal fur.
  • Contact dermatoconjunctivitis – this type of conjunctivitis irritates the eyelids and occurs most often in people who use eye drops.
  • Giant papillary conjunctivitis – this is common in people who use soft contact lenses, although it can also occur in people using hard contact lenses and after eye surgery too.

Conjunctivitis caused by irritants

You can get conjunctivitis if foreign bodies, such as an eyelash or a piece of grit, or chemicals such as chlorine get into your eye. Conjunctivitis caused by a foreign body may only affect one of your eyes.

Symptoms of conjunctivitis 

Conjunctivitis can cause symptoms including:

  • soreness, often described as a gritty or burning feeling
  • redness of the whites of your eye
  • blurred vision
  • watering from your eye.

The symptoms you experience can also depend on the type of conjunctivitis you have.

If you have allergic conjunctivitis, you may also have:

  • swollen eyelids
  • itchy and watery eyes
  • other hay fever symptoms including sneezing, a runny, itchy nose and itchiness at the back of your throat
  • a rash on your eyelids (for example, if your conjunctivitis is caused by an allergic reaction to a medical or cosmetic product).

If you have infective conjunctivitis, you may also have:

  • a pus-like discharge from your eyes, which might make your eyelids stick together especially after waking (if you have a bacterial infection)
  • a watery discharge that can be crusty in the morning but isn't pus-like (if you have a viral infection)
  • cold-like symptoms, such as a fever and sore throat
  • swollen lymph nodes in front of your ears (lymph nodes are glands throughout your body that are part of your immune system).

When to see a doctor

See your GP straight away if your eyes are very red and/or if you have:

  • severe pain in your eyes
  • sensitivity to light
  • difficulty seeing.

If you’ve had symptoms of conjunctivitis for more than a few days, make an appointment with your GP.

Diagnosis of conjunctivitis 

Your GP will ask about your symptoms and examine you. You may be asked about your medical history and to read a chart to check your vision.

Your GP may use a special dye and a blue light to look at the surface of your eye. This is called a fluorescein examination. If your GP thinks that you have infective conjunctivitis, a swab of your eye may be taken to identify the cause. The swab will be sent to a laboratory for testing.

Your GP may refer you to an ophthalmologist (a doctor who specialises in eye health).

Treatment of conjunctivitis 

What you can do

If you normally use contact lenses, don't wear them until the conjunctivitis has cleared up. Even though your eyes may be itchy, try not to rub them because this can make inflammation worse and you can introduce more foreign bodies or contaminants to the eye. A cool compress, usually a clean facecloth soaked in cold water, may help to soothe your eyes. You can also try soaking a tea bag in warm water for a few minutes, squeezing it to get rid of excess liquid, and then using the tea bag as a compress.

If you have allergic conjunctivitis, try to keep away from whatever is causing the allergy. This may be difficult if you're allergic to pollen, for example, but keeping windows and doors closed on days when the pollen count is very high may help to reduce your symptoms.

Infective conjunctivitis usually settles without treatment within one to three weeks but this can vary between individuals. However, during this time you can easily spread the infection as the discharge carries the contagious infectious organism. It may help if you clean the area around your eyes gently and remove any secretions from your eyelids and lashes with cotton wool soaked in warm water. Use a new cotton wool ball or pad for each eye to prevent eye-to-eye recontamination.

It's also important to wash your hands regularly, particularly after touching your eyes. It's best not to share pillows, towels and facecloths. Don't go swimming until your conjunctivitis has cleared up.

Children with infective conjunctivitis should be kept home from childcare and school until all the discharge from the eye has disappeared. Conjunctivitis caused by chemicals or allergies is not infectious.

Medicines

If you have bacterial conjunctivitis, your GP may prescribe antibiotic eye drops or ointment. These are also available without a prescription at pharmacies. Talk to your pharmacist for more information.

If you have allergic conjunctivitis, antihistamine medicines may help. These are available from pharmacies or your doctor may prescribe them. They are available in the form of eye drops or tablets.

Your doctor may also prescribe eye drops called mast cell stabilizers. These are also available without a prescription from pharmacies. These are more effective at controlling your symptoms over a longer period of time, compared with antihistamines that will give rapid relief. It may take several weeks before you feel they’re having an effect, but you can take an antihistamine simultaneously so that your symptoms can be controlled in the meantime.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist or doctor for advice.

Further information 

Australasian Society of Clinical Immunology and Allergy

www.allergy.org.au/

Sources

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SA Health. Conjunctivitis. [online] Government of South Australia. Aug 2009 [accessed 23 Jun 2011] Available from: http://www.dh.sa.gov.au/pehs/ygw/conjunctivitis-pehs-sahealth-2009.pdf (PDF 61kb)

The Royal Children’s Hospital Melbourne. Conjunctivitis. [online] Parkville, VIC: The Royal Children's Hospital, Melbourne [Last updated 19 Nov 2010, accessed 23 Jun 2011] Available from: http://www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=12125

Weissman BA. Giant Papillary Conjunctivitis. [online] New York, NY: WebMD LLC. [last updated 26 May 2011, accessed 23 Jun 2011] Available from: http://emedicine.medscape.com/article/1191641-overview

Last published: 30 July 2011

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