Pinkeye (Conjunctivitis)

The symptoms of bacterial vs. viral conjunctivitis may be similar.

Pinkeye, or conjunctivitis, is inflammation of the membranes (conjunctiva) covering the white parts of the eyes and the membranes on the inner part of the eyelids. These membranes react to a wide range of bacteria, viruses, allergy-provoking agents, irritants, and toxic agents, as well as to underlying diseases within the body.

• Viral and bacterial forms of conjunctivitis are common in childhood, but they also occur in adults. Pinkeye can occur in people of any age.
• Overall, however, there are many causes of pinkeye. These can be classified as either infectious or noninfectious.
• Pinkeye does not cause any vision changes.

Several types of pinkeye include the following:

• Viral pinkeye
• Bacterial pinkeye
• Chlamydia pinkeye
• Allergic pinkeye
• Chemical pinkeye

The causes of pinkeye (conjunctivitis) depend on the type.

Viral pinkeye

The leading cause of a red, inflamed eye is a viral infection. Adenoviruses are the type of virus that is most commonly responsible for the infection.

Other viruses that can cause pinkeye include:

• herpes simplex virus (HSV)
• varicella-zoster virus (VZV)
• poxvirus (molluscum contagiosum, vaccinia)
• picornavirus (enterovirus 70, Coxsackie A24)
• human immunodeficiency virus (HIV)

Bacterial pinkeye

Staphylococci and Streptococci are types of bacteria that commonly cause pinkeye. Sexually transmitted bacteria such as gonococci (Neisseria gonorrhea) and Chlamydia trachomatis may also cause bacterial pinkeye.

Chlamydia pinkeye

Pinkeye due to infection with chlamydia is an uncommon form of bacterial pinkeye in the U.S., but it is very common in Africa and Middle Eastern countries. Chlamydia can cause pinkeye in adults and babies. It is a cause of pinkeye in adolescents and adults that can be sexually transmitted.

Allergic pinkeye

Frequent causes of allergic pinkeye include pollens, animal dander, and dust. It is typically seasonal and accompanied by other typical allergy symptoms such as:

• Sneezing
• Itchy
• Nose
• Scratchy throat

Chemical pinkeye

Chemical pinkeye can result when any irritating substance enters the eyes. Common offending irritants include:

• Household cleaners
• Sprays of any kind
• Smoke
• A foreign body in the eye
• Smog
• Industrial pollutants

Subconjunctival hemorrhage

Bright redness of the whites of the eyes can also occur when the tiny blood vessels covering the whites of the eyes rupture from trauma or changes in pressure within the head (for example, after forceful laughing or vomiting, when diving underwater, or even bending upside down). While it is similar, this condition is called a subconjunctival hemorrhage. While it can appear frightening, it is generally harmless.

• This condition is different from the inflammation of the conjunctiva seen with pinkeye.
• It causes a local area of the white portion of the eye (the sclera) to become brilliantly reddened. It does not typically involve the colored portion of the eye (the iris) and does not affect vision.

The answer to the question about pinkeye contagiousness depends upon the source or cause of the conjunctival irritation. For example, bacterial and viral causes of pinkeye are almost always contagious and are spread from person to person. However, pinkeye caused by allergens and chemical irritants is not contagious by person-to-person contact.

Contagious pinkeye has an incubation period (the time from infection to the start of symptoms) as long as 14 days. However, most doctors do not think that pinkeye becomes contagious to other people until symptoms start to develop. Some bacterial and viral strains are capable of being transferred from humans to pets (for example, dogs and cats) and also from infected pets to humans.

How do you catch pinkeye?

Contagious causes of pinkeye, such as bacterial and viral infections, spread easily from person to person by touching an individual infected with pinkeye and then touching your own eyes or eyelids.

• Individuals who share items like makeup or eye shadow can transfer pinkeye from these surfaces to other individuals.
• Pinkeye in newborns can also be caused by sexually transmitted infections and can be very serious for newborns.
• Contagious pinkeye often spreads to both eyes in the infected individual.
• Adenoviruses can be easily transmitted in pools that are poorly chlorinated.

Similar to the causes of pinkeye, the signs and symptoms of the disease depend on the type.

Viral pinkeye

Viral pinkeye symptoms are usually associated with more of a watery discharge from the eye that is not green or yellow. The discharge may resemble an increase in tears or watery eyes. Viral pinkeye is most common in late fall and early spring.

Often, viral "cold-like" symptoms include:

• Sinus congestion and runny nose, are also present
• Flu-like symptoms
• The eyelids may be swollen or puffy and the inner eyelids reddened
• Itching in the eye and blurred vision
• Sometimes looking at bright lights is painful so the individual experiences sensitivity to light

Bacterial pinkeye

Symptoms of pinkeye caused by bacteria occur rapidly and can include:

• Eye pain or burning
• Swelling
• Itching
• Redness
• A moderate to a large amount of oozing or eye discharge, usually thick and yellow or greenish
• Swelling of the lymph nodes in front of the ears

The discharge commonly accumulates after sleeping. Affected children may awaken with crusty eyelashes most unhappy that their "eyes are stuck shut," requiring a warm washcloth applied to the eyes to remove the discharge.

Chlamydia pinkeye

Chlamydia pinkeye symptoms are similar to bacterial pinkeye symptoms.

Allergic pinkeye

Allergic conjunctivitis symptoms and signs are usually accompanied by intense itching, tearing, and swelling of the eye membranes. Eye pain is minimal or absent with allergic conjunctivitis.

Newborns with signs of conjunctivitis should be immediately taken to a doctor.

In other cases, you should visit a healthcare provider if you have a pink eye along with any of the following:

• Pain in the eye(s)
• Discomfort or sensitivity to light
• Blurred vision that does not improve when discharge is wiped from the eye(s)
• Intense redness in the eye(s)
• Symptoms that get worse or do not improve
• Weak immunity, e.g., HIV infection, diabetes mellitus, cancer treatment, or other medical conditions or treatments

Pinkeye is often treated by primary care physicians, including pediatricians and family practitioners. An eye doctor (ophthalmologist) may also treat pinkeye. Sometimes people may seek care for pinkeye at an urgent care center and may be treated by a specialist in emergency medicine.

Diagnosis by a physician is usually done by physical examination and patient history; seldom are tests run because the only effective treatment is the removal of noninfectious irritants and relatively short-term antibiotic therapy if bacterial pinkeye is suspected. In rare severe infections, physicians may utilize conjunctival scrapings and cultures to identify the infecting organism.

If you are unsure if you or others have contagious pinkeye, act as if it is contagious until you know the cause.

Treatment for pinkeye depends on the type.

Viral pinkeye

While viral pinkeye may not require an antibiotic, those affected should see a doctor, as occasionally this form of pinkeye can be associated with infection of the cornea (the clear portion of the front of the eyeball).

This infection must be correctly detected and treated. Viral pinkeye is highly contagious and typically remains contagious for 10 to 12 days after the onset of symptoms. The symptoms of viral pinkeye can last one to two weeks. Symptoms are pronounced for the first three to five days after symptoms appear, with slow resolution over the following one to two weeks.

Bacterial pinkeye

Bacterial conjunctivitis is treated by applying warm moist compresses to the eyes (try applying to a child's eye one eye at a time during a favorite video) and requires antibiotic eye drops or ointment prescribed by the doctor. Use paper towels and switch to a new one each time. If using washcloths, wash them separately from other laundry in hot soapy water; dry in a hot dryer if possible.

Be careful not to use medication prescribed for someone else, or from an old infection, as these may be inappropriate for the current infection or may have been contaminated from other infections by accidentally touching the medicine bottle to infected areas. A safe, effective, and potentially less frightening method of putting drops into the eyes of children involves asking the child to lie down flat, with instructions to merely "close your eyes," and placing the recommended number of drops in the inner corner of the eye, next to the bridge of the nose, and letting them make a little "lake" there. When the child relaxes and opens the eyes, the medicine will flow gently into the infected mucous membranes without the need to "force open" the eyes.

When someone thinks he (or she) has bacterial conjunctivitis (bacterial pinkeye), it is very important to see a doctor immediately for several reasons.

• First, if the cause is a bacterial infection, an antibiotic will be needed to help the infection-fighting immune system kill this infection.
  • Types of topical ophthalmic (eye drops) antibiotics often used for pinkeye include sulfacetamide, polymixin B-trimethoprim, azithromycin, besifloxacin (Besivance), gatifloxacin (Zymaxid), levofloxacin (Levaquin, Quixin, Iquix), moxifloxacin (Moxeza, Vigamox), tobramycin (Tobrex), ciprofloxacin (Ciloxan), erythromycin (Ilotycin), and others.
  • Oral antibiotics are also required for some types of bacterial pinkeye.
• Finally, a doctor will want to exclude the possibility that the infection has spread to areas where the symptoms may not yet be recognizable.

Chlamydia pinkeye

Chlamydia pinkeye is typically treated with oral azythromycin or oral doxycycline or tetracycline (Sumycin), except in children less than 8 years of age, because of possible discoloration of the teeth.

Allergic pinkeye

Moist, cold compresses applied to the eyes, and over-the-counter (OTC) decongestant eye drops can provide relief. Avoiding exposure to the allergen (such as pollen or cat dander) that leads to an allergic reaction is most helpful. A doctor can prescribe stronger medications if these home remedies are not adequate.

Chemical pinkeye

Prompt, thorough washing of the eyes with very large amounts of water is very important if an irritating substance enters the eye. A doctor or local poison control center should be contacted at once in the case of any chemical, even if it is thought to be safe, as some of the most common household products like bleach and furniture polish can be very damaging.

Home treatment for pinkeye should not be a substitute for seeking the advice of a healthcare professional, and it is important to take all medications as prescribed and to follow a healthcare professional's instructions for managing the condition. However, some remedies can help relieve the symptoms of pinkeye, such as the following:

• Moist warm compresses applied to the eyes can help relieve symptoms.
• OTC treatments like artificial tears (eye drops) can also bring relief.
• Do not wear contact lenses until the pinkeye has resolved. A healthcare professional can offer guidance about when it is safe to resume the use of contact lenses.
• Eye makeup and cosmetic creams should also be avoided in the eye area until the symptoms and signs have resolved.

Pinkeye often improves in two to five days. In some cases, however, it can take up to two weeks to go away completely.

Most uncomplicated cases of pinkeye heal completely without long-term complications. Pinkeye that is related to underlying diseases may recur over time. Some serious infections of the eye may lead to vision loss when not treated properly, so it is important to seek care for severe or persistent pinkeye, or pinkeye that is associated with decreased vision.

Persistent pinkeye (conjunctivitis) can be a sign of an underlying illness in the body. Most often these are rheumatic diseases, such as rheumatoid arthritis, reactive arthritis, and systemic lupus erythematosus.

Conjunctivitis is also seen in Kawasaki's disease (a rare disease associated with fever in infants and young children) and certain inflammatory bowel diseases such as ulcerative colitis and Crohn's disease.

Infectious forms of pinkeye are highly contagious and are spread by direct contact with infected people.

If someone has infectious pinkeye, consider the following tips:

• Avoid touching the eye area and wash your hands frequently, particularly after applying medications to the eye area.
• Wash hands after caring for someone with pinkeye.
• Never share towels or handkerchiefs, and throw away tissues after each use.
• Wash any used towels in hot soapy water separate them from other laundry and dry in a hot dryer if possible.
• Disinfecting surfaces like countertops, sinks, and doorknobs can also help prevent the spread of infectious pinkeye. Use cleaners or disinfectants labeled for killing viruses and bacteria.