CONJUNCTIVITIS - Full extract 

Tom and Marcus are four and two years old, respectively. They are a lively pair, especially when in my consulting room together. 

One morning they both woke up with sticky eyes. Tom's eyes were so crusted up he could not open them until they had been bathed with warm water. Aside from just getting over a cold, they both looked very well. 

Examination of their ears, throat and chest proved normal. However, their eyes were inflamed and pus could be seen inside the lower lids. 

I explained to the children, as best I could, what the problem was and how they would need some special drops and ointment to make them better. I also showed their mother, Sue, how to clean their eyelids and how to get the drops and ointment in. 

Sue rang a few days later to let me know the conjunctivitis had cleared completely.

The conjunctiva is a transparent membrane than lines the inside of the eyelids and the front of the eye. Conjunctivitis occurs when this becomes inflamed for any reason. It can be due to a variety of infections and allergies.

Aided by normal blinking eye movements, tears flow across the front of the eye and drain into a tiny opening at the inner end of the lower eyelid. They then pass down the tear duct to the back of the nose and throat. Anything that blocks the passage of tears can lead to infection. In newborn babies the duct is often not fully open, hence their tendency to recurrent sticky eyes in the first few months. When conjunctivitis occurs, it usually affects both eyes.

If just one eye is affected, it is important to check that there is no foreign body present, or any sign of eye injury. Likewise, contact lenses can occasionally cause contamination and conjunctivitis. If the eyes become sore, contact lenses should always be removed until the eyes are completely comfortable.

Viral conjunctivitis is very common. It is associated with several viral infections and can be quite infectious. The eyes can feel gritty and look quite red. There may also be a slight discharge. Sometimes there are other signs of a viral infection, such as a sore throat. Viral conjunctivitis can take two or three weeks to settle and no specific treatment is usually required. If the eyes are very sore, lubricant drops may give some relief.

Viral infections, like measles and rubella, often have an associated conjunctivitis. Herpes simplex virus, the virus that causes cold sores can also cause conjunctivitis. The infection is of greater concern if the transparent layer in front of the eye called the cornea, is affected. Special antiviral drops and referral to an eye specialist are usually recommended. Herpes eye infections can be recurrent.

Bacterial conjunctivitis causes the typical yellow sticky pus in the eyes. It is quite common, highly infectious and may affect several children at creche or kindergarten at the same time. It usually settles promptly with antibiotic drops and ointment. The drops wash out quickly, hence they need to be used every few hours during the day. The ointment works well at night, forming a film over the eye that helps prevent the eyes sticking in the mornings. If the eyelids do become crusty, they should be wiped with some cotton wool soaked in warm water.

Other hygiene measures, such as not sharing towels, are also important. Uncommon causes of conjunctivitis, such as gonorrhoea, also need to be kept in mind. This condition can cause a purulent infection and permanent eye damage. It is of particular concern in the newborn. Other infections, like chlamydia, also need to be considered when a newborn child is found to have definite conjunctivitis. The vast majority of sticky eyes in babies, turn out to be blocked tear ducts.

Allergies are another common cause of conjunctivitis. It might be a local allergy to a cosmetic, hair shampoo or something the person works with, which has been rubbed into the eyes. Contact lens cleaning solutions and even eye drops, may also be responsible. Allergic conjunctivitis can also be due to hayfever.

A careful medical history can usually distinguish between the various types of allergic conjunctivitis. the symptoms can be relieved with soothing eyedrops. In some cases anti-allergy tablets may also be advised. Persistent cases may require allergy testing and specialist referral.

Health Tip:
* Conjunctivitis usually causes a gritty sensation in both eyes. When one eye is red and painful there could be a more serious cause. An urgent check with your doctor or eye specialist is essential.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001