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Conjunctivitis (Pink Eye)

Conjunctivitis, generally referred to as pink eye, is an inflammation in the membrane that covers parts of the eye and eyelid. This condition is very common and has many potential causes. Clinicians often classify the causes into two categories: infectious and non-infectious. Infectious causes are those that are contagious and can spread to other people through direct contact or by touching contaminated surfaces or objects. Non-infectious causes are those that are not spread by other people or through cross-contamination. Symptoms of pink eye include redness in the white of the eye(s) or on the inner surface of the eyelid(s), mucopurulent discharge from the eye(s), foreign object sensation, dry or watery eye(s), itching or irritation in the eye(s), burning sensation in the eye(s), decreased or blurred vision, light sensitivity, mild eye pain or discomfort, and swollen eyelids.

Infectious Conjunctivitis

Viral conjunctivitis is the most common type of acute (short-term) conjunctivitis and is most often caused by adenoviruses, the viruses that cause upper respiratory infections like colds and influenza. Other viruses that cause pink eye include measles and herpes. Most cases of acute viral conjunctivitis don't require specific treatment and resolve in about 10-14 days. Antiviral medications may be used to treat more serious conjunctival infections such as those caused by herpes simplex or varicella-zoster.

Bacterial conjunctivitis is the second most common type of infectious conjunctivitis and is caused by many types of bacteria including staphylococcus (staph), streptococcus (strep), and sexually transmitted infections (STIs). Bacterial conjunctivitis is very contagious and easily spreads from person to person. Mild bacterial conjunctivitis may resolve in 2-5 days without treatment without causing complications; however, this type of pink eye is usually treated with antibiotics to help shorten the length of infection, reduce complications, and prevent the spread to others. Antibiotics may be necessary for treatment for certain forms of bacterial conjunctivitis, such as infections caused by STIs.

Non-infectious Conjunctivitis

Allergic or irritant conjunctivitis is caused by the body’s reaction to pollens, dust mites, molds, animal dander, cosmetics, contact lenses or contact lens solution, smoke, chemicals in personal hygiene products, and medications being used to treat other illnesses. Allergic conjunctivitis is commonly associated with other allergic diseases such as hay fever, eczema, and asthma. Treatment of allergic conjunctivitis typically includes over the counter (OTC) antihistamines and decongestants. Irritant conjunctivitis treatment involves immediate flushing of the eye(s) with warm water for an extended period of time (5-10 minutes) and seeking medical evaluation for any exposure to potentially strong substances such as drain cleaner or pepper spray. Avoiding further use of the known or suspected source of allergic or irritant conjunctivitis is key in preventing recurrence.

Treatment

Anyone with symptoms of conjunctivitis should seek medical evaluation for proper diagnosis and treatment. It is important to follow the medical provider’s treatment instructions and follow-up recommendations to prevent complications and avoid recurrence of infection. Antibiotics are not always necessary and only treat conjunctivitis caused by bacteria, not infections caused by viruses or allergens.

Non-prescription recommendations include:

  • Wash hands frequently and before and after touching the eye(s).
  • Apply cool compresses to the eye(s) using a clean washcloth to reduce swelling.
  • Avoid rubbing the eye(s).
  • Remove the discharge/crusting from the eye(s) using a clean wet washcloth.
  • Discontinue use of cosmetics on/near the eye(s), including eyelid(s) and eyelashes.

For contact lens wearers, contacts should NOT be worn until symptoms have resolved and any use of eye ointments/drops has been completed.

Prevention

Reducing the risk of developing conjunctivitis can be accomplished through the following recommendations:

  • Wash hands frequently and keep them away from the eyes, especially after handling cleaning solutions or chemicals.
  • Do not share cosmetics of any kind.
  • Do not share towels or washcloths.
  • Do not swim in stagnant lakes or ponds or in non-chlorinated pools.
  • Do not use eye drops/ointments or medications prescribed for someone else.
  • When reading for extended periods, lubricate the eyes with a liquid lens product.
  • For contact lens wearers, follow all manufacturer instructions and recommendations for use.

Proper Application of Eye Ointment and Drops

  • Hold tube in hand for several minutes to warm before use.
  • Wash hands thoroughly.
  • Open medication tube gently; avoid squeezing the tube when opening to limit medication waste.
  • Gently pull the lower eyelid down.
  • For ointment: squeeze a small amount (1/2 to 1/4 inch) inside the lower lid.
  • For drops: lean the head back, hold the medication bottle between the thumb and first two fingers and place the other two fingers on the nose for stability, and apply drop(s) into the corner of the eye nearest to the nose.
  • Do not touch the tip of the ointment tube/cap or eye drop container to the eyes, fingers, or any surface.
  • Close the eye gently and roll the eyeball slowly in all directions.
  • When using more than one kind of ointment and/or drops at the same time, it is necessary to wait 10 minutes between administration.

Learn more about conjunctivitis from American Academy of Ophthalmology and American Optometric Association.