Conjunctivitis

There are three main types of conjunctivitis you are likely to encounter in practice.

Bacterial Conjunctivitis:

Signs/Symptoms

  • Conjunctival redness
  • Yellow or greenish sticky discharge
  • Grittiness/ foreign body sensation
  • Bilateral
  • Possible slight reduction in vision caused by tearing and discharge.

Causes

  • A range of bacteria can be the cause including Staphylococcus species, Streptococcus pneumoniae, Haemophilus species, Moraxella catarrhalis

Picture shows mild pink eye with yellow discharge which is crusting onto the eyelid margins

Treatment

  • Bacterial conjunctivitis is normally self-limiting, worsening in the first 7 days and then gradually improving.
  • Good lid hygiene, regular bathing of lids in warm boiled water.
  • Cooling compresses will help alleviate symptoms.
  • No sharing of bath towels etc
  • Antibiotics are thought to only lead to a mild improvement in the symptoms and shorten the length of the infection by a matter of days. If symptoms persist then a dispensing optician can instigate the sale of chloramphenicol 0.5% drops or 1% ointment for the treatment of bacterial conjunctivitis only- please see ABDO A&G.
  • After the infection has cleared it is not unusual for mild redness and dry eye to continue for some time- the use of dry eye treatments is recommended.
  • Cease contact lens wear and discard previous contact lens and case if used.

Red Flags

  • Drop in vision
  • More severe photophobia
  • Pain
  • Severe headaches particularly with nausea
  • Corneal opacities
  • Increasing limbal redness

When one or more of these red flags is raised, a conversation with another registrant in practice should take place following which appropriate referral or management should be actioned and noted. If there are no other registrants in practice then contact should be made with colleagues elsewhere or contact should be made for advice to the local Hospital Eye Service (HES).

Viral Conjunctivitis:

Signs/Symptoms

  • Pink/red eye
  • Clear discharge
  • Often patients will report recent cold/flu symptoms
  • Dry/itchy eye
  • Mild photophobia
  • Foreign body sensation

Causes

  • Most commonly associated with adenoviral viruses although rubella, measles and herpes simplex viruses are linked. Usual cause is association with another person who has the virus.

Picture shows the classic redness apparent in conjunctivitis and on looking underneath the lid we can see inflammation and signs of a watery discharge.

Treatment

  • There is no treatment for this condition and patients should be advised that antibiotic drops/ointments will not help.
  • Cold compresses will alleviate symptoms
  • Dry eye drops are appropriate
  • Viral conjunctivitis is self-limiting so it is more about managing the symptoms.
  • Cease contact lens wear
  • Highly infectious- infection control procedures must be put in place by the patient such as no towel sharing etc.

Red Flags

  • Epidemic keratoconjunctivitis is where there is corneal involvement in the adenoviral infection. The patient would be photophobic, and vision would be reduced
  • Pain
  • Reduced Vision
  • Increasing red eye
  • Rash on the forehead can be a sign of herpes zoster

When one or more of these red flags is raised, a conversation with another registrant in practice should take place following which appropriate referral or management should be actioned and noted. If there are no other registrants in practice then contact should be made with colleagues elsewhere or contact should be made for advice to the local Hospital Eye Service (HES).

Allergic:

Signs/Symptoms

  • Usually unilateral
  • Puffy eyes
  • Mild pink eyes
  • Can be seasonal irrational or perennial
  • Mild watery discharge may be present
  • Burning sensation
  • Slight dry eyes although patient will probably repost watery eyes
  • Lid and conjunctiva swelling
  • Itchiness
  • In acute onset px may report sudden swelling of eyelids- this is usually in response to direct contact with the allergen e.g. mascara, eyelash glue etc
  • Can be contact lens related or contact lens cleaning solution related
  • Sub conjunctival haemorrhage are often associated with allergic conjunctivitis due to excessive rubbing of itchy eyes.

Causes

  • Seasonal Allergic Conjunctivitis (SAC) is linked commonly to pollens
  • Perennial Allergic Conjunctivitis is more likely to be link to environment, household dust, household cleaning products, pets, make up, eye products etc.
  • Often unknown particularly in acute onset.

Raised papillae under upper lids which causes symptoms of itchiness and a clear discharge in allergic conjunctivitis. The raised areas are inflamed mast cells which produce histamines.

Picture shows mild “pink eye” and visible on the temporal side is a swollen and raised conjunctiva- this is conjunctival chemosis.

Treatment

  • Removal of the allergen where possible
  • Anti-inflammatory eye drops- (sodium cromoglicate, lodoxamide mast cell stabilizers)
  • Cold compresses to alleviate symptoms
  • Lubricating eye drops
  • Sun spectacles for mild photophobia and also may give limited protection from allergen
  • Use of indoor air purifiers

Red Flags

  • Preseptal or orbital cellulitis
  • Pain
  • Contact lens wear
  • Reduced vision
  • Increasing Photophobia
  • Atopic keratoconjunctivitis with corneal involvement

When one or more of these red flags is raised, a conversation with another registrant in practice should take place following which appropriate referral or management should be actioned and noted. If there are no other registrants in practice then contact should be made with colleagues elsewhere or contact should be made for advice to the local Hospital Eye Service (HES).