“Pink eye” or conjunctivitis is a common eye condition that ranges from mild to severe, acute to chronic and has a wide variety of causes. It can affect all age groups and is often misdiagnosed and mistreated. Fortunately, most conjunctivitis gets better on its own. Treatment can be helpful to reduce symptoms and sometimes prevent more serious consequences.

To confuse things, there are other diseases, such as anterior uveitis, episcleritis  and corneal disease, that can make the eye look red but are completely different. It is very important to consider  these conditions in any “pink eye”.

The conjunctiva is the transparent tissue covering the “whites”of the eye and the underside of the eyelids. When this tissue becomes inflamed for any reason, the little blood vessels in the conjunctiva enlarge and the eye looks more pink or red. Often patients correctly or incorrectly equate pink eye with an eye infection.

Important: With any red eye, if you experience significant pain, blurred vision or significant eyelid swelling, call your eye care practitioner right away.

There are  four main causes of conjunctivitis: infection, allergy, toxic/irritant and dry eyes.

Infectious conjunctivitis:

Viral is the most common type of infectious conjunctivitis. Many different viruses can affect the eye. Often cold or flu like symptoms are associated with the conjunctivitis and both eyes are usually effected, one more than the other. One particular viral infection, epidemic keratoconjunctivitis, is quite prolonged and very contagious. The eyes are red, weepy, scratchy and  a bit sensitive to light.

Antibiotic drops such as polysporin, allergy drops or “red eye” drops like Visine are ineffective. Supportive measures such as cold compresses, lubricating drops, avoidance of eye rubbing and rest are most helpful.  Good hygiene measures such as frequent hand washing, not sharing towels or pillows, and keeping the hands away from the eyes are most helpful to reduce the spread to others. Eye cosmetics should be discarded and new makeup avoided until the condition clears. Contact lenses should not be worn. Viral conjunctivitis can last up to 3 weeks.

More serious eye infections caused by the herpes simplex virus or the herpes zoster virus can involve the cornea and can lead to permanent scarring and loss of vision. Accurate diagnosis and aggressive treatment is important.

Chlamydial conjunctivitis is sexually transmitted disease and acts a bit like a viral conjunctivitis that doesn’t get better on its own. Accurate diagnosis and appropriate treatment is important.

Bacterial conjunctivitis is less common and can involve one or both eyes. Usually there is more thick and sticky discharge. Often this will clear on its own but antibiotic drops can clear it up faster. Warm compresses and lubricating drops can help with comfort. Again, contact lenses should not be worn and eye makeup discarded. If abnormal pain or blurred vision is present, or it involves a young child who is quite ill, examination by your optometrist is vital to rule out a more serious, vision threatening corneal ulcer, orbital disease or other problem.

Allergic conjunctivitis

Allergic conjunctivitis is a common cause of “pink eye”. Often this is seasonal with symptoms of itchy, stingy, weepy eyes. Both eyes are effected equally. Pollens, animal dander and molds are common triggers of allergic conjunctivitis. Avoidance of the cause, if possible, air filters, good house cleaning and frequent laundering of bed sheets can be helpful. Cold compresses, eye lubricating drops and avoiding eye rubbing are simple solutions. For more persistent allergies, your optometrist may prescribe allergy drops and/or anti-inflammatory drops which can be very effective.

Toxic/Irritant conjunctivitis

Toxic/Irritant conjunctivitis can occur for a variety of reasons. The conjunctiva can be inflamed because of exposure to chemicals such as chlorine in pools, volatile fumes from paints and thinners, soaps and facial cosmetics, nail polish and compounds released from chopping onions. A misdirected eyelash, poor quality eyeliner and masquera, dust exposure, UV exposure, poor eyelid closure and excessive eye rubbing can inflame the conjunctiva. Contact lens wear, contact lens solutions and eye drops sometimes irritate and inflame the eye.

Dry eye related conjunctivitis

Dry eye related conjunctivitis is quite common, especially as we age. It tends to be chronic with symptoms that wax and wane. I discussed the problem of dry eyes  more fully in a previous blog post, “These Cry’n Eyes”.

“Pink eye” is not as simple as it appears. Having a correct diagnosis of the underlying cause is important to properly treat the condition. Check with your optometrist for the most appropriate care.