Introduction
Conjunctivitis, refers to inflammation of the conjunctiva. The conjunctiva is the outermost layer of the eye and lines the inner surface of the eyelids. Conjunctivitis is most commonly due to an infection, usually viral, but sometimes bacterial or even an allergic reaction. It is also commonly called pink eye.
Background
Inflammation of the conjunctiva is one the most common presentations to the ophthalmologist. Conjunctivitis refers to any condition that result in irritation and inflammation of the conjunctiva. However, viral, bacterial, and allergic are the most common. Usually the cause of the conjunctivitis can be determined by the presenting symptoms and the appearance of the conjunctiva under the microscope.
The conjunctiva is a thin membrane that lines the surface of the eye and the eyelids. It is responsible for much of the lubrication and protection of the eye itself.
Conjunctivitis is very common and represents approximately 30% of all patients that visit the Emergency Department with an eye complaint. Usually conjunctivitis is self limited, however depending on the etiology and the patient, the condition can become severe and even threaten vision.
Many conditions can cause red eyes and present similar in appearance to conjunctivitis. It is important to be evaluated by a specialist when questions arise.
Signs & Symptoms
Symptoms of conjunctivitis can be very highly variable and may include: redness, discharge, swelling, burning, itching, photophobia, foreign body sensation, and even blurry vision. Any patient with ocular complaints should undergo an evaluation by a physician to determine the cause and prescribe an appropriate treatment regimen.
Bacterial conjunctivitis usually has a rapid onset and a fair amount of discharge. Dry eyes and blepharitis can predispose a patient to develop bacterial conjunctivitis.
Viral conjunctivitis can be seasonal, can be associated with a recent URI. It usually has an acute to subacute onset, minimal pain and a history of exposure. A clear watery discharge is extremely common. Occasionally patient may experience severe photophobia and foreign body sensation.
Allergic conjunctivitis is characterized by acute or subacute onset, no pain, and no exposure history. Burning and itching are extremely common and a fair amount of discharge is usually present.
Diagnosis
Almost always, conjunctivitis is a self limited disease and no laboratory evaluation is warranted.
In cases that do not resolved or do not respond to treatment a workup by a specialist is warranted. This usually includes taking a swab of conjunctiva and in rare cases a biopsy.
Treatment
Treatment of typical conjunctivitis is almost always supportive. Artificial tears and/or a cool compress can alleviate the symptoms and provide comfort as the disease runs its course. Antibiotics may be warranted depending on the presenting symptoms and topical steroids can also be used to lessen the inflammation but these should be used judiciously under the direct supervision of a physician.
Allergic conjunctivitis has a variety of treatment modalilities available. There are many over the counter medications to choose from and some more efficacious then others. When blepharitis is a component, a hot compress, lid scrubs with baby shampoo and limiting eye makeup may be of benefit. Consult your physician to determine which may be right for you.
Follow-up
It is very important to prevent further transmission of infectious conjunctivitis. Contact precautions such as hand washing, keyboard and/or phone decontamination, as well as not sharing bed linens/pillow cases may also be important. Anyone employed in a position that has frequent contact with the public should limit their contact during the transmissible stage of their infection. Consult your physician for details.
