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Conjunctivitis

Conjunctivitis is swelling of the thin, clear layer that covers the white of your eye and lines your eyelid (the conjunctiva). It’s sometimes called pink eye.

The two most common types of conjunctivitis are infective (viral and bacterial) and allergic conjunctivitis. Infective conjunctivitis makes up just over a third of all eye problems in the UK each year. Over half of all visits to the GP for eye problems are due to forms of conjunctivitis.

Types of conjunctivitis

Conjunctivitis is categorised into three main types. These are:

  • infective (viral and bacterial) conjunctivitis
  • allergic conjunctivitis
  • irritant (chemical) conjunctivitis
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Image showing front and side views of the different parts of the eye

Details

  • Symptoms Symptoms of conjunctivitis

    Conjunctivitis can affect one or both of your eyes. The symptoms of conjunctivitis include:

    • redness of the white of your eye
    • pain in your eye, such as a burning sensation, throbbing or aching
    • white or yellow discharge in your eyes – this may cause them to stick together in the morning and be difficult to open
    • blurry vision that clears on blinking caused by discharge around your eye
    • a gritty feeling in your eye that may cause an itching or burning sensation
    • watery eyes
    • sensitivity to light, though this is usually mild

    If you have allergic conjunctivitis, you may have hay fever symptoms, such as sneezing, a runny, itchy nose and itchiness at the back of your throat.

    If you have infective conjunctivitis, you may have cold-like symptoms, such as a fever and sore throat.

    Some of these symptoms can be caused by problems other than conjunctivitis. If you have any of these symptoms, see your GP for advice.

  • Diagnosis Diagnosis of conjunctivitis

    Often the infection will clear up on its own and you can use self-help measures to ease any discomfort. However, if your symptoms persist or get worse, see your GP. He or she will ask about your symptoms and examine you, and may also ask you about your medical history. Your GP may take a swab of your eye. This will be sent to a laboratory to be tested and help identify the cause of your conjunctivitis. He or she may refer you to an ophthalmologist (a doctor who specialises in eye health), although this is rarely necessary.

    If you think your baby has neonatal conjunctivitis, see you GP immediately.

  • Treatment Treatment of conjunctivitis

    Treatment of your conjunctivitis will vary depending on what caused it.

    Self-help

    If you use contact lenses, don’t wear them until your conjunctivitis has completely cleared up. If they are disposable lenses, use a fresh set when it has cleared. It’s also important not to rub your eyes and to make sure you regularly wash your hands. Don’t share pillow cases, towels or go swimming until your conjunctivitis has completely cleared up. Don’t share your eye cosmetics and regularly replace products you use on your eyes.

    If you have allergic conjunctivitis, try to steer clear of whatever is causing your allergic reaction. For example wearing sunglasses can reduce exposure to pollen, as can staying indoors when the pollen count is high. A cool compress, such as a facecloth soaked in cold water, may help to soothe your eyes.

    Infective conjunctivitis usually settles without any treatment within about two weeks. You may find it helps to wipe away any discharge from your eyelids and lashes with cotton wool soaked in cooled boiled water or saline. To help ease the discomfort of infective conjunctivitis, you may find a warm compress, such as a facecloth soaked in warm water, soothing on your closed eyes.

    Although infective conjunctivitis is contagious, you don’t necessarily need to take time off work. If your children have conjunctivitis, they can still go to school while it’s being treated. However, if there is an outbreak of infective conjunctivitis, the school may advise otherwise.

    Medicines

    If you have bacterial conjunctivitis, your GP may prescribe you antibiotic eye drops (or ointment for children). You can also buy these medicines over the counter from a pharmacist.

    Antihistamine medicines or eye drops may help if you have allergic conjunctivitis. These will give you rapid relief from your symptoms.

    Your GP may also prescribe a type of medicine called mast cell stabilisers, such as sodium cromoglicate or nedocromil sodium. These come in the form of eye drops. Mast cell stabilisers work by stopping allergy cells from releasing substances that cause swelling and inflammation. These are more effective for long-term relief of allergic conjunctivitis but may take a few days to start working. It’s important that you take them regularly as indicated. You can take antihistamines at the same time as mast cell stabilisers to give you immediate relief while you wait for the mast cell stabilisers to work.

    Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist or GP for advice.

    If your conjunctivitis is caused by a virus, it usually clears up on its own without the need for medicine. This usually takes no longer than two weeks.

    See our FAQs for more information about ways to ease your symptoms.

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  • Causes Causes of conjunctivitis

    Viral conjunctivitis

    Viruses are a common cause of conjunctivitis. The virus most often associated with conjunctivitis also causes the common cold (adenovirus). You may have infective conjunctivitis if you have a cold or have come into contact with somebody who is coughing or sneezing. Viral conjunctivitis typically affects both eyes and may cause a lots of watery discharge too.

    Bacterial conjunctivitis

    You can get bacterial conjunctivitis by:

    • coming into contact with somebody who already has conjunctivitis
    • having recently had an upper respiratory infection, such as a common cold
    • wearing contact lenses which have become infected
    • touching your eyes with unwashed hands
    • using eye make-up and facial lotions that are contaminated

    Neonatal conjunctivitis affects newborn babies (within the first month of life). It’s different to conjunctivitis that babies may develop as they get older. One of the most common causes is by an infection passed on by the baby’s mother if she has chlamydia or gonorrhoea when giving birth. This can happen even if the mother has no symptoms of infection. Neonatal conjunctivitis can cause permanent eye damage if it isn’t treated quickly. See our FAQs for more information.

    Allergic conjunctivitis

    You’re more likely to get allergic conjunctivitis if you already have allergies.
    If you’re allergic to plant pollens that are released at the same time each year, you may get seasonal allergic conjunctivitis. All year round (perennial) allergic conjunctivitis can be caused by house dust mites and animal fur.
    You may get a form of allergic conjunctivitis called giant papillary conjunctivitis. This can occur if you use contact lenses and are allergic to them, or if you have had eye surgery. See our FAQs for more information.

    Using eye drops and eye make-up can cause inflammation of your eyelids. This form of conjunctivitis is called contact dermatoconjunctivitis.

    Irritant (chemical) conjunctivitis

    Chemical conjunctivitis can be caused by a number of things including:

    • irritant chemicals
    • chlorine in a swimming pool
    • air pollution
    • contact lenses and their cleaning solutions
  • Prevention Prevention of conjunctivitis

    There are a number of ways you can prevent the spread of conjunctivitis. Some examples are listed below.

    • Change your pillow cases regularly.
    • Use clean towels and washcloths, and don’t share them.
    • Wash your hands regularly.
    • Avoid contact with people that have conjunctivitis.
    • Clean your contact lenses correctly.
    • Replace your eye make-up products regularly.
    • Try to not touch your eyes with your hands.
  • FAQs FAQs

    Is there anything I can do to help ease my symptoms when I have conjunctivitis?

    Answer

    Yes, there are lots of things you can do to help reduce the symptoms of your conjunctivitis.

    Explanation

    If you wear contact lenses, it’s important that you don’t wear them while you have conjunctivitis. You can begin to wear them again 24 hours after you have finished your treatment as long as your symptoms have cleared up.

    If your conjunctivitis has been caused by a virus, a warm compress may help to soothe your symptoms.

    If your conjunctivitis has been caused by an allergy, the following may stop your symptoms getting worse.

    • Try to stay away from what it is that you’re allergic to.
    • On days when the pollen count is high, try to keep windows in your house and car closed, and wear sunglasses when you’re outside.
    • Place a cool compress over your eyes.

    If you’re allergic to dust mites it may help to:

    • wash your bed linen regularly
    • fit a mattress with a cover that doesn’t let dust mites through it
    • use synthetic pillows

    There are also things you can do to stop your symptoms from spreading or getting worse.

    • Wash your hands regularly.
    • Don’t rub your eyes.
    • Don’t share towels or pillows.
    • Don’t share make-up applicators and discard any that have recently been used.
    • Don’t go swimming at public swimming pools.
    • Clean away any discharge from your eyelids and lashes using cotton wool soaked in water.

    If you have any questions or concerns about conjunctivitis, speak to your optician, pharmacist or GP.

    What's the difference between a sticky eye and conjunctivitis in babies?

    Answer

    A sticky eye in newborn babies is common and often clears up without treatment within a year. Neonatal conjunctivitis is more serious and can be a sign of a severe infection. It’s important that you contact your GP as soon as possible if you think your baby has conjunctivitis.

    Explanation

    One in five newborn babies are born with a blocked tear duct. This is usually because their tear drainage system has not fully developed. Your baby may have more watery eyes than would appear normal. His or her tears may appear thicker than usual and may become crusty when they dry. This is commonly known as sticky eye. The medical term is congenital nasolacrimal duct obstruction. Sticky eye usually clears without treatment within a year as the tear drainage system opens up and fully develops.

    The symptoms of conjunctivitis can include watery eyes, just like with a sticky eye, so it can sometimes be difficult to tell the difference between the two conditions. However, with conjunctivitis, your baby may also have:

    • puffy, red and tender eyelids
    • watery, bloody or thick pus coming from their eyes
    • red eyes

    It's important to speak to your GP to find out if your baby has conjunctivitis or sticky eye.

    Neonatal conjunctivitis can be the result of an infection passed to your child at birth. Although you may have no symptoms when your baby is born, you may still have bacteria in your vagina that can cause neonatal conjunctivitis. The two most serious infections are chlamydia and gonorrhoea, which can develop into a severe eye infection and could eventually lead to loss of sight. Neonatal conjunctivitis is treated with antibacterial eye drops; these will depend on what caused the infection.

    Why are contact lens wearers more prone to getting conjunctivitis?

    Answer

    Contact lenses that are not disposed of daily can become infected with bacteria, particularly if they are not disinfected effectively. The infection can then spread to your eye, and even re-infect the eye once the eye infection has been treated. Your optometrist may suggest that you switch to a type of lens that is replaced more regularly.

    The chemicals and preservatives in contact lenses and their cleaning solutions can also cause your eyes to become irritated and itchy. This can cause a type of conjunctivitis called giant papillary conjunctivitis. A giant papilla is a large red bump under your eyelid.

    Explanation

    An allergic reaction to a contact lens, or the chemicals used in contact lens cleaning solution, can cause irritation of your eyelid. Debris on the contact lens can sometimes scrape the eyelid triggering giant papillary conjunctivitis. If you have giant papillary conjunctivitis, you may have one or more of the following symptoms.

    • Itching and burning in your eyes.
    • Your eyes may produce a lot of mucus.
    • Blurred vision caused by mucus sticking to your contact lens.
    • You may notice your contact lens move when you blink.

    It's important to see your optometrist (a health professional who examines eyes, tests sight and dispenses glasses and contact lenses) or GP if you have any of these symptoms. This is so that he or she can examine your eyes and exclude any other eye conditions. Occasionally, you may need to be referred to an ophthalmologist for further diagnosis and treatment. An ophthalmologist is a doctor who specialises in eye health, including eye surgery.

    Not cleaning your contact lenses thoroughly and wearing them for too long can increase your chances of getting giant papillary conjunctivitis.

    You will need to stop wearing your contact lenses if you have giant papillary conjunctivitis. Also, you may need to change the products you use to care for your lenses. Sometimes you may need to switch to different contact lenses altogether.

    Often you won’t need any treatment as your symptoms will probably start to reduce as soon as you remove your contact lenses. To help soothe your eyes, place a cold compress (a facecloth soaked in cold water) over your affected eye(s). Also make sure you don't rub your eyes no matter how itchy they are. Occasionally, if your symptoms are particularly bad, your GP may prescribe an antihistamine medicine.

    If you have any questions or concerns about giant papillary conjunctivitis, talk to your optometrist or GP.

  • Resources Resources

    Further information

    Sources

    • Infectious conjunctivitis. The Merck Manuals. www.meckmanuals.com, published November 2012
    • Conjunctivitis – infective. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published August 2012
    • Conjunctivitis. American Optometric Association. www.aoa.org, accessed 4 November 2013
    • Conjunctivitis. BMJ BestPractice. www.bestpractice.bmj.com, published 13 March 2013
    • Acute conjunctivitis. Medscape. www.emedicine.medscape.com, published 9 April 2013
    • Allergic conjunctivitis. Medscape. www.emedicine.medscape.com, published 17 September 2012
    • Conjunctivitis – allergic. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published August 2012
    • Viral conjunctivitis. Medscape. www.emedicine.medscape.com, published 21 March 2013
    • Bacterial conjunctivitis. Medscape. www.emedicine.medscape.com, published 6 March 2013
    • Opthalmia neonatorum. The College of Optometrists. www.college-optometrists.org, published 22 July 2013
    • Nasolacrimal dust obstruction. American Association for Pediatric Ophthalmology and Strabismus. www.aapos.org, published March 2012
    • Guidance on infection control in schools and other childcare settings. Health Protection Agency. www.hpa.org.uk, published April 2010
    • Acute conjunctivitis. BMJ Best Practice. www.bestpractice.bmj.com, published 30 September 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed 6 January 2013 (online version)
    • Contact lens problems. PatientPlus. www.patient.co.uk/patientplus.asp, published 21 January 2011
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    Reviewed by Natalie Heaton, Bupa Health Information Team, January 2014.

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