different types of conjunctivitis

Some patients with COVID-19 have developed conjunctivitis.  Normally at this time of year we get many emergency patients with conjunctivitis due to allergies. Below is a short description of the different types of conjunctivitis.

We are making the following common sense recommendations:

•  Try not touch your eyes. If you do, then please wash your hands for 20 seconds with soap and water.

• If you are using artificial tears or other ocular medications, try not to contaminate the tip by touching the lids or eye.

• Do not share artificial tears.

• Do not touch the bottles of drops or saline solution with unwashed hands.

 Conjunctivitis (or pink eye) is the inflammation of the conjunctiva — the transparent mucous membrane which covers the white part of the eye. Infectious causes of an inflamed eye and conjunctivitis include bacteria, viruses and fungi. Non-infectious causes include allergies, foreign bodies and chemicals. The often present with characteristic symptoms. These are described below.

Bacterial conjunctivitis

Bacterial conjunctivitis is a common and caused by bacteria that infect the eye through various sources of contamination. The bacteria can be spread through contact with an infected individual, exposure to contaminated surfaces or through other means such as sinus or ear infections.  Dirty contact lens cases, use of contact lenses that are not properly sterilized, blepharitis (unclean lids) or use of contact lenses on a full-time basis is a risk factor. It is somewhat contagious.

Bacterial conjunctivitis usually produces a thicker eye discharge or pus and can affect one or both eyes.  Patients will often note that the eyes are “stuck together” in the morning with a tenacious material.  Bacterial infections can also invade the cornea, which can be very serious. If you experience light sensitivity and severe pain, you may have a corneal infection. You should call our emergency line immediately.  Like any bacterial infection, antibiotics may be used, however there are many resistant organisms now in the community. Fortunately, most cases of bacterial conjunctivitis will clear up without treatment after 1-2 weeks. This is not always the case for corneal involvement.

Antibiotic eye drops may be required if:

• The infection is severe
• The patient is immune compromised
• The infection does not clear up on its own within a week

Treatment of bacterial conjunctivitis is typically accomplished with topical antibiotic eye drops and/or eye ointments. The treatment usually takes from one to two weeks, depending on the severity of the infection, but the patient will not be infectious 12-24 hours after starting the eye drops.  Patients should not wear contacts, should irrigate their eyes several times per day with saline solution and should discard cosmetics, their contact lenses and their contact lens case.

Viral conjunctivitis (this would be in the COVID-19 category)

Viral conjunctivitis is another common type of pink eye that is highly contagious as airborne viruses can be spread through sneezing and coughing, as well as by contact with contaminated objects. Viral conjunctivitis can also accompany common viral upper respiratory infections such as measles, the flu, the common cold (usually adenovirus), and of course, COVID-19.

Viral conjunctivitis usually produces a watery discharge although sometimes the eyes can get quite crusty upon waking.  Often there is a scratchy feeling. Usually viral infection starts in one eye and quickly spreads to the other eye.  Viral conjunctivitis is more common than bacterial conjunctivitis. There are no medications that are effective. While it can be severe, especially in the first week, it is self- limited and usually resolves within 7 to 21 days. Symptoms should start to improve after the first week.

Treatment of viral conjunctivitis usually involves supportive therapies, such as saline rinses several times a day, lubricating eye drops, and sometimes remedies hat help reduce the symptoms: for example, vasoconstrictors, decongestants to reduce the surface swelling and antihistamines to reduce occasional itching.  Treatments usually are continued for one to two weeks, depending on the severity of the infection.

Frequent handwashing, not sharing towels or pillows and disinfection of surfaces are recommended. Patients should not wear contacts, should irrigate their eyes several times per day with saline solution and should discard cosmetics, their contact lenses and their contact lens case.

Allergic conjunctivitis (very common in the spring)

This pink eye caused by eye allergies is very common, especially in the spring. Eye allergies, like other types, can be triggered by allergens including pollen, animal dander and dust mites.  Cosmetics, lotions and other household chemicals can also cause allergic conjunctivitis.

The most common symptoms of allergic conjunctivitis are itchy eyes, mild tearing and swelling of the lids and sometimes the white part of the eye.  Symptoms can be reduced with 1) avoidance 2) cool saline rinses 3) OTC anti-allergy drops. We recommend Zatidor or Alaway, taken every 12 hours. Prescription medications are available if your symptoms do not improve.  Itching or rubbing the eyes will only make it worse (although it will feel satisfying for a minute).  Warm compresses may make your symptoms worse. If you sleep with your window open, it is likely that pollen will be on your bed.

If you have allergies, you will not have a fever or other symptoms such as muscle aches and extreme fatigue. 

Gonococcal and chlamydial conjunctivitis 

You can get pink eye from infections from sexually transmitted diseases including gonorrhea and chlamydia. Treatment requires oral antibiotics.

Giant papillary conjunctivitis

This pink eye usually impacts both eyes and usually contact lens wearers. This condition may cause contact lens intolerance, itching, a heavy discharge, tearing and red bumps on the underside of the eyelids. It is caused by contaminants on the surface of a contact lens, which causes an immune reaction. You may need to stop wearing lenses until it resolves. Occasionally prescription medications are used to hasten resolution.

Non-infectious conjunctivitis 

This conjunctivitis from eye irritation that can result from many sources, including smoke, diesel exhaust, perfumes, hairspray, false eyelashes, cosmetics and other chemicals. Some forms of conjunctivitis also result from sensitivity to certain ingested substances, including herbs such as eyebright and turmeric or touching your eyes after cooking with spices. In some cases, reactions to topical ocular medications can cause toxic conjunctivitis.

If you get conjunctivitis, feel free to contact our office and one of the doctors will get in touch with you to discuss your symptoms.