Conjunctivitis
In order to understand conjunctivitis, one must first understand a little about the anatomy of the eye as well as a little physiology of the way eyes become lubricated. The conjunctiva is the thin transparent membrane that lines the inside of the eyelids (i.e., palpebral area) and the front of the eyeballs (i.e., bulbar area). The lacrimal glands, which are located in the outer corners of the eyes, secrete tears which lubricate the eyes. These tears then drain into the nose via tear ducts from the inner corners of the eyes. Inflammation of the conjunctival membrane is called conjunctivitis. There are several conditions which cause inflammation of the conjunctiva which are as follows:
Viral infections – Viral infections are the most common cause of conjunctivitis. Several types of viruses can cause infections of the eye. Most viral infections are highly contagious and spread by contact with the infected individual’s eye secretions. The most common viruses that cause “cold-like” symptoms are primarily responsible for the majority of conjunctival infections. It should be noted that eye infections and upper respiratory infections often co-exist.
The symptoms of viral conjunctivitis may include redness (i.e., “pink eye”), watery discharge, feeling of grittiness, and/or a burning sensation in the eye. Occasionally the discharge becomes mucus-like and the eyelids can stick together with dried and crusted secretions primarily in the mornings. The symptoms usually begin in one eye and then may spread to the other eye after approximately 1 to 2 days.
The symptoms usually become progressively worse for 2 to 3 days and then begin to gradually decrease in intensity over the next 4 to 5 days. It may take 1 to 2 weeks for total resolution of the symptoms to occur.
The treatment of viral conjunctivitis may include the application of an eye drop containing an antihistamine and/or decongestant which is typically used 2 to 3 times a day for no more than 3 to 4 days at a time. Oral antihistamines and analgesics may also be helpful if respiratory symptoms are also associated. Warm or cool compresses can help to relieve any accompanying discomfort. Despite any relief these medicines may bring, these measures do not reduce the duration of the illness, as there is no specific curative treatment for the virus which is the causative agent in viral conjunctivitis.
Bacterial infections – Bacterial infections causing conjunctivitis are also highly contagious spreading by contact with conjunctival secretions and transmitted through objects (i.e., fomites). Usually, several members of a family or several children in a school are infected at the same time. Bacterial conjunctivitis is more common in children than in adults.
The most common symptoms of bacterial conjunctivitis include redness and a thick discharge from one eye, although both eyes can become infected. The discharge may be white, yellow, or green, and it usually continues to drain throughout the day. The affected eye often is “closed shut” in the mornings.
The treatment of bacterial conjunctivitis may include the application of an antibiotic eye drop or antibiotic ointment several times a day. It is also important to maintain good hand and eye hygiene so that it will not spread to the other eye or to other individuals. Ointments are preferable in children and should be applied in the space between the lower eyelid and the eyeball.
The ocular symptoms usually improve on their own even without treatment, but topical antibiotics can reduce the duration of the illness in some individuals. Vision may be blurred for up to 30 minutes after the application of the ointment as the ointment is thick. Contact lens wearers should avoid using their lenses for a few days.
Allergic conjunctivitis – Allergic conjunctivitis caused by the contact of aeroallergens in the environment with the eyes. The symptoms may include severe itching, redness, watery eyes, and in severe cases, blurring of vision and swelling of the eyelids. These symptoms are made worse by rubbing the eyes, however, allergic conjunctivitis is not contagious.
Allergic conjunctivitis can be “seasonal” (i.e., caused by tree and grass pollens in the Spring and/or weed pollens in the Fall) or “perennial” (i.e., caused by indoor allergens such as dust mites, mold spores and/or animal allergens). The symptoms may also be acute or chronic. Allergic conjunctivitis may also be associated with other atopic conditions such as hay fever (i.e., allergic rhinitis) and/or eczema (i.e., atopic dermatitis).
The treatment of allergic conjunctivitis may include the application of an eye drop containing an antihistamine and/or vasoconstrictor which is usually instilled 2 to 3 times a day for relief of the itching and redness. It should be noted that these drops should not be used for more than 3 to 4 days at a time. Eye drops that have both antihistaminic as well as mast cell stabilizing properties [e.g., Zaditor (ketotifen) Patanol (olopatadine)] may be used for a longer course of treatment, if needed. Very severe symptoms not responding to these agents may require treatment with a corticosteroid eye drop for a few days.
Oral antihistamines [e.g., Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine), Xyzal (levocetirizine)] can help relieve other associated symptoms such as itching and excessive sneezing. Lubricant eye drops are also useful in moisturizing the eyes while simultaneously reducing discomfort due to dry eyes.
Avoiding exposure to the pollen in the Spring and Fall, as well as employing environmental controls in order to minimize exposure to indoor allergens (e.g., dust mites, molds, animals) will help reduce the severity of both allergic conjunctivitis and allergic rhinitis symptoms. It should be pointed out that most patients will experience long-term benefit with allergen desensitization (i.e., allergy shots, allergy injections, allergy hyposensitization) treatments by building up a tolerance to the common allergens. Allergy shots are effective in 80-85% of the patients that take them. The average length of time that an individual is on allergy injections is 3 to 5 years.
Other causes of conjunctivitis may include adverse reactions to medications and preservatives, as well as a foreign body in the eye.
Preventive measures recommended in order to reduce the spread of conjunctivitis include avoidance of sharing handkerchiefs, tissues, towels, pillows, and sheets with uninfected people, as well as using frequent and proper hand-washing techniques and/or using alcohol-based hand rubs.
The board certified allergists at Black & Kletz Allergy have 3 locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. The McLean office has a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. The allergy doctors of Black & Kletz Allergy diagnose and treat both adult and pediatric patients. For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. The allergy specialists at Black & Kletz Allergy have been helping patients with allergic conjunctivitis, hay fever, asthma, sinus disease, eczema, hives, insect sting allergies, immunological disorders, medication allergies, and food allergies for more than 5 decades. If you suffer from allergies, it is our mission to improve your quality of life by reducing or preventing your undesirable and annoying allergy symptoms.