Intermountain Eye Centers

Conjunctivitis, also known as “pink eye,” is an inflammation of the conjunctiva of the eye. The conjunctiva is the membrane that lines the inside of the eye and also a thin membrane that covers the actual eye.

There are many different causes of conjunctivitis. The following are the most common causes: Bacteria, including: Staphylococcus aureus Haemophilus influenza Streptococcus pneumoniae Neisseria gonorrhea Chlamydia trachomatis Viruses, including: adenoviruses herpes virus Chemicals (seen mostly in the newborn period after the use of medicine in the eye to prevent other problems) Allergies What are the different types of conjunctivitis? Conjunctivitis is usually divided into at least two categories: newborn conjunctivitis and childhood conjunctivitis. There are different causes and treatments for each. NEWBORN CONJUNCTIVITIS The following are the most common causes and treatment options of newborn conjunctivitis: Chemical conjunctivitis: This is related to an irritation in the eye from the use of eye drops that are given to the newborn to help prevent a bacterial infection. Sometimes, the newborn reacts to the drops and may develop a chemical conjunctivitis. The eyes are usually mildly red and inflamed, starting a few hours after the drops have been placed in the eye, and lasts for only 24 to 36 hours. This type of conjunctivitis usually requires no treatment. Gonococcal conjunctivitis: This is caused by a bacteria called Neisseria gonorrhea. The newborn obtains this type of conjunctivitis by the passage through the birth canal from an infected mother. This type of conjunctivitis may be prevented with the use of eye drops in newborns at birth. The newborn eyes usually are very red, with thick drainage and swelling of the eyelids. This type usually starts about two to four days after birth. Treatment for gonococcal conjunctivitis usually will include antibiotics through an intravenous (IV) catheter. Inclusion conjunctivitis: This is caused by an infection with chlamydia trachomatis, obtained by passage through the birth canal from an infected mother. The symptoms include moderate thick drainage from the eyes, redness of the eyes, swelling of the conjunctiva, and some swelling of the eyelids. This type of conjunctivitis usually starts 5 to 12 days after birth. Treatment usually will include oral antibiotics. Other bacterial causes: After the first week of life, other bacteria may be the cause of conjunctivitis in the newborn. The eyes may be red and swollen with some drainage. Treatment depends on the type of bacteria that has caused the infection. Treatment usually will include antibiotic drops or ointments to the eye, warm compresses to the eye, and proper hygiene when touching the infected eyes. CHILDHOOD CONJUNCTIVITIS Childhood conjunctivitis is a swelling of the conjunctiva and may also include an infection. It is a very common problem in children. Also, large outbreaks of conjunctivitis are often seen in daycare settings or schools. The following are the most common causes of childhood conjunctivitis: Bacteria Viral Allergies Herpes

The following are the most common symptoms of childhood conjunctivitis. However, each child may experience symptoms differently. Symptoms may include: Itchy, irritated eyes Clear, thin drainage (usually seen with viral or allergic causes) Sneezing and runny nose (usually see with allergic causes) Stringy discharge from the eyes (usually seen with allergic causes) Thick, green drainage (usually seen with bacterial causes) Ear infection (usually seen with bacterial causes) Lesion with a crusty appearance (usually seen with herpes infection) Eyes that are matted together in the morning Swelling of the eyelids Redness of the conjunctiva Discomfort when the child looks at a light Burning in the eyes The symptoms of conjunctivitis may resemble other medical conditions or problems. Always consult your child’s doctor for a diagnosis.

Conjunctivitis is usually diagnosed based on a complete medical history and physical examination of your child’s eye. Cultures of the eye drainage are usually not required, but may be done to help confirm the cause of the infection.

Specific treatment for conjunctivitis will be determined by your physician based on: Your child’s age, overall health, and medical history Extent of the condition Your child’s tolerance for specific medications, procedures, or therapies Expectations for the course of the condition Your opinion or preference Specific treatment depends on the underlying cause of the conjunctivitis. Bacterial causes: Your child’s physician may order antibiotic drops to put in the eyes. Viral causes: Viral conjunctivitis usually does not require treatment. Your child’s physician may order antibiotic drops for the eyes to help decrease the chance of a secondary infection. Allergic causes: Treatment for conjunctivitis caused by allergies usually will involve treating the allergies. Your child’s physician may order oral medications or eye drops to help with the allergies. Herpes: If your child has an infection of the eye caused by a herpes infection, your child’s physician may refer you to an eye care specialist. Your child may be given both oral medications and eye drops. This is a more serious type of infection and may result in scarring of the eye and loss of vision. Infection can be spread from one eye to the other, or to other people, by touching the affected eye or drainage from the eye. Proper hand washing is very important. Drainage from the eye is contagious for 24 to 48 hours after beginning treatment.

Glaucoma is a condition in which the normal fluid pressure inside the eyes (intraocular pressure, or IOP) slowly rises as a result of the fluid aqueous humor – which normally flows in and out of the eye – not being able to drain properly. Instead, the fluid collects and causes pressure damage to the optic nerve (a bundle of more than 1 million nerve fibers that connects the retina with the brain) and loss of vision.

While physicians used to think that high intraocular pressure (also known as ocular hypertension) was the main cause of optic nerve damage in glaucoma, it is now known that even persons with normal IOP can experience vision loss from glaucoma. Thus, the causes are still unknown.

Age-related macular degeneration (AMD) is a disease that affects an individual’s central vision. AMD is the most common cause of visual impairment in patients over the age of 55 in industrialized nations. It produces variable symptoms, ranging from no symptoms at all to profound central visual loss. Because only the center of vision is affected, people rarely go blind from this disease. However, AMD can make it difficult of read, drive, or perform other daily activities that require fine, central vision. AMD occurs when the macula, which is located in the center of the retina and provides us with sight in the center of our field of vision, begins to degenerate. With less of the macula working, central vision – which is necessary for driving, reading, recognizing faces, and performing close-up work – begins to deteriorate.

There are two primary types of AMD: Dry Form: This type of AMD is the most common. The atrophic or dry form of AMD is marked by the presence of drusen, pigmentary, or atrophic changes in the center of the retina, i.e. the macula. At this stage, symptoms are typically mild, although some vision loss may occur. Although the dry form is currently untreatable, certain patients may benefit from prophylaxis with vitamins and antioxidants, although such use must be carefully supervised to prevent unwanted side-effects. Wet Form: This type of AMD is less common, but accounts for almost all severe vision loss caused by either type of AMD. A minority but very important group of AMD patients will develop the wet form, marked by the growth of new blood vessels under the macula (choroidal neovascularization) with associated bleeding and leakage with central vision loss. The wet form of AMD requires urgent attention and expert care, because it is treatable in many cases with the intraocular injection of anti-VEGF (vascular endothelial growth factor) medications such as Lucentis, Avastin, and others in development. Although the injections themselves are easily tolerated and not painful, the decisions regarding initiation of treatment and ongoing maintenance are complex and require care in the evaluation of diagnostic tests such as Fluorescein Angiography and Optical Coherence Tomography (OCT). AMD, while clearly a continuing problem of epidemic proportions, is increasingly a treatable condition as a result of many successful laboratory and clinical investigations.