One of the most common questions I have heard over the years is “Dr. Steve, do I have pink eye?” Ironically, the patient usually has blazing pinkish-red, swollen eyes so the diagnosis from my perspective is fairly obvious: Of course it’s pink eye , but why is it pink? That’s the key to proper treatment.
First, the term “pink eye” should not be used, “conjunctivitis” should be used instead. The conjunctiva is the clear superficial layer of tissue that covers the surface of the eyes and the insides of the eyelids. Inflammation of this tissue is called conjunctivitis.
In my clinical experience, these are the most common causes of conjunctivitis:
1. Environmental irritants
This is the most common type of conjunctivitis and can be caused by anything in your environment that can irritate your eyes. Good examples are noxious chemicals such as paints, stains, automotive chemicals, cleaning chemicals and chlorinated pools. These agents breakdown your natural tear layer and then directly cause irritation to the conjunctiva. Redness, pain, itching, swelling and mild discharge are common symptoms.
This type of conjunctivitis is usually treated simply by rinsing the eyes with sterile wash or lubrication drops and applying cold compresses. In some cases a steroid/antibacterial combination eye drop can be used to reduce inflammation and prevent infection. Contact lenses sensitivities can also cause this type of conjunctivitis.
When it comes to the ears, nose, throat and eyes - all the plumbing is connected. Viral infection of any mucous membrane can easily lead to viral conjunctivitis. This is by far the most contagious conjunctivitis. Patients usually present with red, swollen eyes and clear, watery discharge. An upper respiratory tract infection, fever, and swollen lymph nodes may also be present.
As with all viral infections, antibiotics are not effective. Similar to the common cold, the conjunctivitis will run its course but simple treatments such as cold compresses, ocular lubrication drops, oral decongestants and pain relievers can be helpful. In more severe cases, steroid eye drops can be cautiously used to reduce swelling and irritation but can only be prescribed by an eye doctor.
Some cases of viral conjunctivitis may be due to a cold sore virus or zoster (a.k.a shingles) invading the eye. These can be serious situations and need immediate care as vision threatening ulcerations can form on the eyes in a short period of time.
Allergic conjunctivitis can be caused by a variety of factors including seasonal pollens, molds, dust, pet dander and other allergens. This condition is commonly misdiagnosed as bacterial conjunctivitis and treated with antibiotic eye drops which will be ineffective and can make the problem worse. Ocular itching and swelling are the most common symptoms.
The severity of allergic conjunctivitis dictates how it is treated. Mild cases can go without treatment completely. For more bothersome cases, lubrication drops, anti-allergy drops and cool compresses are effective. In severe cases, steroidal type eye drops may be prescribed in addition to allergy drops.
Bacterial conjunctivitis is most common with small children and has the classic presentation of thick, yellow/green “eye boogers.” Often times the eyes are mattered shut in the morning.
This is the only type of conjunctivitis effectively treated with antibiotics. Similar to viral infections, an upper respiratory tract infection and fever may also be present. Most bacterial conjunctivitis will resolve spontaneously but antibiotic drops will shorten the course of infection.
As you can see, most cases of conjunctivitis are not the simple pink eye requiring the usual antibiotics. Also, overprescribing of antibiotics can cause increased resistance to the antibiotics themselves so should only be used when necessary. Visine or other over-the-counter eye drops are typically never effective for conjunctivitis. Visiting an eye care professional for any eye problem is the first step in proper diagnosis and treatment.
About this Angie's List Expert: Dr. Steve Reinders of Complete Family Eyecare earned his bachelor of science from University of Minnesota and graduate from Pacific University in Oregon with a doctorate of optometry. Currently providing eye care in Minneapolis, Reinders has more than 17 years of experience as an optometrist and is a member of the Minnesota Optometric Association, the American Optometric Association and Vision Source.
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